Laboratory Medicine Edition 9 Effective March 2011

Transcription

St Vincent’s University Hospital
Laboratory Medicine
Test Requirements Manual
Edition 9
Effective March 2011
Valid Until Feb 2013
SVUH PD NS REV 06/11 0455
SVUH PD NS REV 06/11 0455
Introduction
This manual contains an alphabetic listing of the tests available from the
Laboratory Medicine Department. Each test is described under the headings:
specimen required, type of tube/container and volume of specimen required,
reference range, turn around time and special handling needs for each test.
Minor updates may be made to the version during the year and these will be
available on the hospital website and hospital intranet.
Further information on collection, labelling and transport of specimens to the
laboratory can be obtained in the Department of Pathology and Laboratory
Medicine, User Reference Manual, which is available on the Hospital Intranet
and on the Internet.
Specimen Containers
The correct specimen container must be used when collecting specimens.
Below is a quick guide to the container type that should be used. A more
comprehensive list of the tests, container types required are given under the
individual test names.
Blood Tubes are available with different anticoagulants; the anticoagulant in
the blood tube is written on the label and the cap colour is indicative of the
anticoagulant present. Below is a quick guide for the container required for a
particular test.
Arterial Blood Gas Syringes
Pre heparinised syringes are available for blood gas analysis. A specimen cap
is provided with each syringe and should be placed on specimen prior to
bringing to the laboratory. Specimens must not be sent with needles
attached. Samples for Blood Gas analysis should not be sent on the
pneumatic tube.
Blood Gas specimen for lactate analysis should be placed on ice and brought
to the laboratory immediately.
If more than one blood specimen is taken specimen must be taken in a
particular order. The guide below places the tubes in the correct draw order.
Ed 9
Effective Date: 01/03/2011
Page 1 of 55
Author: Mairead O’Leary
Approved By: Donal Murphy
Blood Containers: Tube Guide placed in Order of Draw
Color Code
Light Blue
Red
Gold
Tube Type
Determinations
Blood Culture
Anaerobic followed by aerobic – if insufficient blood for both culture
bottles, use aerobic bottle only. Blood Culture bottles should be
available on all wards. A supply is available from Microbiology
Reception (Mon – Fri) during opening hours.
Sodium
Citrate
Light blue capped vacutainer with sodium citrate anticoagulant.
Determinations: Coagulation Testing, PT, INR, APTT, D-Dimer,
Thrombophilia Screens, Factor Assays.
Serum
Serum NON GEL - Red capped vacutainer with clot activator.
Determinations: LDH, Ionised Calcium, Phenytoin, Theophylline,
Methotrexate, Lithium Valproate, Carbamazepine Paracetamol,
Salicylates, Vitamin D, Parathyroid Hormone, Osmolality, Bone
Markers, Endocrine Testing (excluding Thyroid)
Serum/Gel
Serum GEL - Gold capped plastic vacutainer with clot activator and gel
for serum separation.
Determinations: TSH, FT4, T3, Cortisol, Digoxin, Growth Hormone,
ADNA, Gastrin, Vitamin B12, Folate, Ferritin, PSA, Free PSA, CEA,
AFP,HCG,CA125, CA19.9,CA153, Electrophoresis, Immunoglobins
(IgG, IgM,IgA,IgE), B2 Microglobin, Ceruloplasmin,Infectious
Mono,Thyroid Ab, Liver Ab, Rheumatology, Coeliac Ab.
Plasma GEL specimen - Light green capped plastic vacutainer
containing lithium heparin anticoagulant and gel for plasma separation.
Determinations: UE, LFT, Cardiac Enzymes, Ca, Mg, Phosphate, Uric
Acid, Total Protein, Amylase, Lipids, Bone Profile, Troponin T hs , Iron
Studies, ACE, CRP
Plasma/
Gel
Light Green
Lavender
Pink
Grey
EDTA
(Potassium)
EDTA
Lavender capped vacutainer with potassium EDTA anticoagulant for
whole blood.
Determinations: Full Blood Count(FBC),ESR, C3/C4, HaemoglobinA1c,
Homocysteine, ACTH, Tacrolimus, Cyclosporin
Pink capped tube with potassium EDTA as anticoagulant
Determination: Group; Crossmatch
Fluoride
Oxalate
Determination: Glucose and Ethanol
Grey capped vacutainer with Fluoride oxalate anticoagulant
Trace
Elements
Determination: Trace Elements.
Plasma non-gel - Royal blue capped vacutainer
Royal Blue
Ed 9
Page 2 of 55
Histology Specimen Containers
Histology Biopsy Formalin Pots
Available from Pharmacy
Adequate volume of formalin is essential for proper
fixation. The volume of formalin recommended should be
ten times the volume of the tissue to be fixed.
Fresh specimens for frozen sections.
All unfixed tissue should be transported to the laboratory
immediately.
Use for Muscle, Kidney, Direct Immunofluorescence, Skins
for Direct Immunofluorescence transported from GP’s
Theatre buckets containing formalin
Dry Containers 20 mls/ 300 mls
Saline Moistened Gauze
Sterile container 70 mls (yellow lid) available in
theatre and Microbiology
Tissue for culture Do not add formaldehyde
Urine Specimen Containers
Sterile plastic container (30 mls) White Cap
Sterile plastic universal container (30mls)
This specimen container can be used for urine, fluid
samples including CSF, ascetic, peritoneal, synovial,
joint sputum, tissue for culture (do not add
formaldehyde).
24 hr urine (plain)
24 hr urine (acid)
24 hr urine container with no preservative.
24 hr urine (acid washed)
24 hr urine container washed with 10 mls of hydrochloric
acid. Container will be marked with hazard warning signs.
Bone Markers Urine
250 mls plastic bottles available from Metabolism lab
24 hr urine container with 10mls of concentrated
hydrochloric acid added. Containers supplied by
Biochemistry Laboratory. The container will be marked with
corrosive warning signs.
Other Specimen Containers
Sterile plastic container (30 mls) White Cap
Specimen container with no preservative, which should be
used for: urines, fluid samples including CSF, ascitic,
peritoneal, synovial, joint sputum tissue for culture.
Do not add formaldehyde
Sterile transport Swabs
Use for all swabs including screening. A supply of sterile
transport swabs are available on all wards and from CSSD.
All samples for virus culture should be sent in virus
transport swabs or in virus culture medium (supplied by
the microbiology reception). Please check with
microbiology laboratory before taking samples as there
may be special requirements for particular investigations.
Faeces samples.
Virus Transport Medium
Sterile plastic Universal Containers
30 mls (blue cap) with spoon
Sterile container 70 mls (yellow lid) available
in theatre and Microbiology
hema screen slides
Heparin and RPMI medium in sterile plastic
containers 30 mls
Ed 9
Page 3 of 55
Tissue for culture. Do not add formaldehyde
Use for Faecal Occult Blood analysis. Slides available from
Biochemistry. Only hema-screen slides accepted.
Available from Haematology for Bone Marrow samples for
Immunophenotyping, Cytogenetic Studies and Molecular
Markers.
Analyte / Investigation
5HIAA
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Urine
24hr urine
collection in an
10 days
acid containing 24
hr urine container
2.5 - 50 mol/24hrs
Lab
Comment
Further information is available from the laboratory or online
http://labtestsonline.org
Biochemistry
Referred to Outside Laboratory (St James's Hospital). Special
container with instructions available from Biochemistry.
Instructions will be explained to patient at the time of collection of
container. Specimen container must be kept upright at all times.
Warning label 'This bottle contains strong acid preservative'
must be attached to bottle.
Acetaminophen
(Paracetamol)
Blood
Serum Red Cap 6
Daily
mls
See Comments
Biochemistry
For interpretation in overdose refer to paracetamol treatment
nomogram. Toxicity is related to post-dose interval, typically
>200mg/L at 4 hours, >100 mg/L at 8 hours, >50 mg/L at 12 hours
post overdose. Lower Paracetamol levels are used if patient is
higher risk. The time of ingestion should be stated on the
request form (if known), together with the date and time of
specimen collection. Specimens taken less than 4 hrs post
ingestion are not considered useful for prediction of toxicity.
Amitryptiline and Imipramine may show significant negative
interference in paracetamol assay.
ACTH
Blood
EDTA Lavender
Cap 5 ml
10 days
0-46 ng/L
Nuclear Medicine
Samples should be placed on ice and delivered to the laboratory
immediately. For urgent requests contact nuclear medicine lab.
ADAMTS 13
See Von Willibrand
Claeving Protease
Blood
Sodium Citrate
Light Blue cap 3
mls x 2
15 days
See Report
Haematology
Samples must be sent immediately to the Coagulation lab for
separation. Specimens Referred to Haematosis Research Unit,
University of London.
Adenosine Deaminase in
Tuberculosis (ADA)
Pleural or
ascitic fluid
Freeze at -70 or send
immediately
Biochemistry
Referred to Dr Lynette Fairbanks, Purine Research Laboratory, 4th Floor,
North Wing, St Thomas' Hospital, Lambeth Palace Road, London SE1
7EH Tel: 0207 188 1266
Adenovirus Abs
Blood
N/A
Microbiology
Dispatch
Referred to National Virus Reference Laboratory University College
Dublin. Use Grey Serology/ Assay Request Form.
AFP
Blood
0-5.8 kU/L
Nuclear Medicine Most useful in germ cell tumours and hepatocellular cancer.
Serum Gold Cap
10 days
5mls
Serum Gold Cap 6
2 days
ml
Alanine
Blood
Aminotransferase (ALT)
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
4 - 50 U/L
Biochemistry
Albumin (Alb)
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
35 - 50 g/L
Biochemistry
Blood
Ed 9 Effective Date 01/03/2011
Page 4 of 55
Avoid Venostasis. See note on calcium or other albumin bound
parameters.
Author Mairead O'Leary. Approved By: Donal Murphy
Albumin excretion rate
(AER)
Albumin/Creatinine
Ratio (ACR)
Container Type/
Volume
Urine
Overnight timed or
30 days
24 hour urine
Normoalbuminuiria < 20
ug/min, Microalbuminuria
20-200 ug/min,
Metabolism
Macroalbuminuria > 200
ug/min
Protocol available from Lab. The date and time of the start and
finish of the collection must be clearly indicated.
Universal Container 30 days
Normoalbuminuiria < 2.5
mg/mmol,
Microalbuminuria 2.5-25
mg/mmol,
Macroalbuminuria >25
mg/mmol
Metabolism
Minimum volume 5 mls.
Biochemistry
Results are not for medico-legal purpose.100 mg% ethanol is
equivalent to 21.7 mmol/L. Urine specimens are sent to the
Toxicology Department, Beaumount Hospital. Note: GLUCOSE
TUBE REQUIRED.
Urine
Turn Around
Reference Range
Time
Blood - Fluoride
Oxalate - Grey
Daily
Alcohol Levels (Ethanol) Blood / Urine
Cap. Urine - Spot
Urine
Serum Red Top
Aldosterone
Blood
15 days
6 ml
Aldosterone:
Blood
See Comment
15 days
PRA Ratio
Alkaline Phosphatase
(Alk Phos, ALP)
Blood
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
N/A
Lab
Upright 140 - 1400 pmol/L Endocrinology
Indicate posture.
28 - 924
Endocrinology
This is a calculated test. See PRA and Aldosterone for specimen
requirements.
Adults 35 - 129 U/L *
Biochemistry
* Alkaline Phosphatase levels in children and adolescents are highly
variable and may be up to 4 times the upper limit of the adult range.
Positive tests for specific allergens indicate exposure to allergen but
do not necessarily correlate with symptoms of allergy. A negative
result means that IgE mediated allergy to this allergen is unlikely. All
results should be interpreted in the light of the clinical history.For
specific IgE to food allergens, please specify the individual allergen
specific IgE required.
Allergen Specific
IgE
Allergen: Aspergillus
Fumigatus
Comment
Specimen
Type
Blood
Serum Gold Cap
5mls
14 days
0.0 - 0.35 kU/L
Page 5 of 55
Immunology
Comment
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Lab
Allergen: Cat dander
Blood
Serum Gold Cap
5mls
14 days
0.0 - 0.35 kU/L
Immunology
14 days
Negative
Immunology
14 days
0.0 - 0.35 kU/L
Immunology
14 days
0.0 - 0.35kU/L
Immunology
14 days
Negative
Immunology
Fish Mix Contains: Shrimp, Blue Mussel, Tuna, and Salmon.
14 days
Negative
Immunology
Fruit Mix Contains: Orange, Apple, Banana, and Peach.
14 days
Negative
Immunology
14 days
0.0 - 0.35 kU/L
Immunology
10 days
0.0 - 0.35 kU/L
Immunology
14 days
Negative
Immunology
14 days
0.0 - 0.35 kU/L
Immunology
14 days
Negative
Immunology
10 days
Negative
Immunology
14 days
0.0 - 0.35 kU/L
Immunology
14 days
0.0 - 0.35 kU/L
Immunology
Allergen: Common Food
Blood
Mix
Allergen: Dog dander
Blood
Allergen: Egg white
Blood
Allergen: Fish Mix
Blood
Allergen: Fruit Mix
Blood
Allergen: Grass Mix
Blood
Allergen: House Dust
Mite
Blood
Allergen: Latex
Blood
Allergen: Meat Mix
Blood
Allergen: Milk
Blood
Allergen: Mould Mix
Blood
Allergen: Nut Mix
Blood
Allergen: Peanut
Blood
Allergen: Soya bean
Blood
Serum
5mls
Serum
5mls
Serum
5mls
Serum
5mls
Serum
5mls
Serum
5mls
Serum
5mls
Serum
5mls
Serum
5mls
Serum
5mls
Serum
5mls
Gold Cap
Gold Cap
Gold Cap
Gold Cap
Gold Cap
Gold Cap
Gold Cap
Gold Cap
Gold Cap
Gold Cap
Gold Cap
Serum Gold Cap
5mls
Serum Gold Cap
5mls
Serum Gold Cap
5mls
Page 6 of 55
Common Food Mix Contains: Tomato, Yeast, Garlic, Onion, and
Celery.
Specific IgE <0.35 does not exclude latex allergy.
Meat Mix Contains: Pork, Beef, Chicken, and Turkey.
Nut Mix Contains: Peanut, Hazelnut, Brazil nut, Almond, and
Coconut.
Specific IgE < 0.35 does not exclude nut allergy.
Specimen
Type
Allergen: Tree Mix
Blood
Allergen: Vegetable Mix Blood
Allergen: Weed Pollen
Mix
Blood
Container Type/
Volume
Serum
5mls
Serum
5mls
Serum
5mls
Serum
5mls
Gold Cap
Gold Cap
Gold Cap
Gold Cap
Turn Around
Reference Range
Time
Lab
14 days
Negative
Immunology
14 days
Negative
Immunology
14 days
Negative
Immunology
14 days
0.0 - 0.35 kU/L
Immunology
Comment
Tree Mix Contains: Box Elder, Silver Birch, Hazel, Oak, and
Sycamore.
Vegetable Mix Contains: Pea, White Bean, Carrots, and Potato.
Allergen: Wheat
Blood
Alpha-1-Antitrypsin
Blood
Serum Gold Cap
5mls
3 days
0.9 - 2.0 g/L
Immunology
Alpha 1 Antitrypsin is an acute phase protein with a lower dynamic
range than CRP or SAA. Reduced levels are associated with
emphysema and cirrhosis.
Alpha-1-Antitrypsin
Phenotype
Blood
Serum Gold Cap
5mls
10 days
See Report
Immunology
Specimens Referred to RCSI, Smurfit Building, Beaumont Hospital
Ammonia
Blood
Plasma Light
Green Cap - 5ml - 1 day
sent on ice
See Report
Biochemistry
Specimens must be sent to the laboratory on ice and frozen within
30 minutes. A control specimen, taken from a healthy individual in
the vicinity of the patient must be sent with the sample. The control
blood specimen must be taken into Lithium Heparin (light green
cap) container. Specimens referred to Temple Stree hospital for
analysis.
Amikacin
Blood
Serum
Gold Cap 5mls
*Daily
See Comments for
Therapeutic Range
Microbiology
*Samples must be received before 2pm (Mon-Fri) and before
11am (Sat-Sun). Patients on once daily regimens should have
specimens taken 12-24 after the dose is given. Single Daily Dose
Regimen: Pre-Dose Level:<5.0 mgs/L.
Amoebic Abs
Blood
Serum Gold Cap
5mls
10 days
N/A
Microbiology
Dispatch
Referred to Hospital for Tropical Diseases London.Use Grey
Serology/ Assay Request Form.
Amylase
Blood
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
28 - 100 U/L
Biochemistry
Amylase
(Urinary)
Urine
Sterile Universal
Container - Timed
Collection
Androstenedione
Blood
Serum Red Cap 6
15 days
ml
Same day if
received
1 - 17 U/Hour
before 11am.
Biochemistry
Please state duration of urine collection.
Female: 3.3 - 9.9 nmol/L,
Endocrinology
Male: 2.1 - 7.7 nmol/L
Page 7 of 55
Specimen
Type
Angiotensin Converting
Blood
Enzyme (ACE)
Anti-Acetycholine
Receptor (AChR)
Antibody
Anti-Adrenal Antibody
Anti-Aquaporin-4
antibodies
(also known as NMO
antibodies)
Serum Gold Cap
5mls
Blood
Serum Gold Cap
5mls
Blood
Blood
Anti-Cyclic Citrinullated
Blood
Protein (CCP) antibody
Turn Around
Reference Range
Time
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
Blood
Anti Beta 2 Glycoprotein
Blood
1
Anti Cardiolipin
Blood
Antibodies [ACA]
Anti-Centromere
Antibodies (ACM)
Container Type/
Volume
20 days
20 days
Adults: 15 - 70 U/L *
Negative
Lab
Comment
Biochemistry
* Higher plasma ACE levels may be found in healthy children and
adolescents. Treatment with ACE Inhibitors may reduce ACE
activity measurements in plasma.
Immunology
Negative
Immunology
Specimens Referred to Oxford Radcliffe Hospitals (UK).
Anti-acetylcholine receptor antibodies are strongly associated with
myasthenia gravis but the test may be negative in approximately 1015% of patients with this disorder.
Specimens Referred to University College London Hospitals.
Anti-adrenal antibodies are found in patients with Addison's disease
and also in patients with autoimmune polyglandular syndrome
Specimens Referred to University College London Hospitals.
NMO-IgG was first described by Lennon et al in 2004 in around
65% of patients with neuromyelitis optica (NMO, also called Devic's
disease). Aquaporin 4 was subsequently defined as the major NMOIgG antigen by the same group.
Serum Gold Cap
5mls
20 days
Negative
Immunology
Serum Gold Cap
5 days
See Report
Haematology
Referred to St. James’s Hospital.
Serum Gold Cap
4 weeks
See Report
Haematology
Assay includes IgG and IgM antibodies.
Serum Gold Cap 5
7 days
mls
Negative
Immunology
Anti-centromere is an ANA pattern which is detected by ANA
screening. It does not need to be requested as a separate test
along with ANA requests. Anti-centromere antibody is typically
associated with CREST syndrome (Calcinosis, Raynaud’s
phenomenon, Oesophageal dysmotility,Scherodactyly and
Telangiectasia). It is also seen in patients with scleroderma and in
13% of patients with primary biliary cirrhosis.
Serum Gold Cap
5mls
See Report
Immunology
This antibody appears to be more specific (approximately 90%) for
rheumatoid arthritis than rheumatoid factor.
14 days
Page 8 of 55
Specimen
Type
Anti-double stranded
Blood
DNA (dsDNA) antibodies
Container Type/
Volume
Turn Around
Reference Range
Time
Lab
Comment
Serum Gold Cap
5mls
10 days
Negative
Immunology
Performed when ANA is positive with a titre of 1:800 or greater.
Strongly positive anti-dsDNA is suggestive of SLE.
Anti DNA
Blood
Serum Gold Cap 6
3 - 4 weeks
ml
0 - 5.3 IU/ml
Nuclear Medicine For urgent requests contact Lab.
Anti-Endomysial
Antibodies (EMA)
Blood
Serum Gold Cap5ml
Negative
Immunology
Assay only performed if anti-tTG is positive. Anti-EMA antibodies
are highly specific for coeliac disease
When ANA is positive 1:800 or greater an anti-ENA screen is
performed. When positive, sample is further tested for antibodies to
the individual antigens. In general, repeat testing is unhelpful.
Anti-RNP antibodies are found in mixed connective tissue disease
and approximately 30% of patients with SLE. Anti-Sm antibodies
are found in 15-20% of patients with SLE and are specific for this
condition. Anti-Ro antibodies are found in approximately 70% of
patients with Sjogrens syndrome, and approximately 30% of
patients with SLE, but may also be found in other connective tissue
diseases. Anti-La antibodies are usually only found in association
with anti-Ro antibodies. They are found in 25-50% of patients with
Sjogren's syndrome and 10-15% of SLE patients. Anti-Jo-1
antibodies are associated with the anti-synthetase syndrome
(polymyositis and interstitial lung disease). Anti-Scl 70 antibodies
are found in 20-40% of patients with systemic sclerosis.
14 days
Anti-ENA (Extractable
Nuclear Antigen)
antibodies. Test
includes anti-RNP, anti- Blood
Sm, Anti-SSA (Ro) AntiSSB (La), anti-Scl-70 and
anti-Jo-1
Serum Gold Cap or
Heparin Gel Light 30 days
Green Cap 5 mls
Negative
Immunology
Anti-Glutamic acid
Decarboxylase (antiGAD)
Blood
Serum Gold Cap
5mls
20 days
<100 U/ml
Immunology
Blood
Serum Gold Cap
5mls
Daily as
requested for
urgent
Negative
samples
same day
Anti-Glomerular
Basement Membrane
(GBM) antibodies
Immunology
Page 9 of 55
These antibodies are found in approximately 80% of newly
diagnosed type 1 diabetes and in stiff man syndrome
This test is available on an urgent basis by arrangement with the
laboratory. A positive anti GBM is associated with Goodpasture’s
Syndrome (anti GBM disease).
Container Type/
Volume
Turn Around
Reference Range
Time
Lab
Anti-GM1 antibodies
Blood
(Ganglioside antibodies)
Serum Gold Cap
5mls
20 days
Immunology
Anti-GQ1b antibodies
Blood
(Ganglioside antibodies)
Serum Gold Cap
5mls
Specimen
Type
20 days
Negative
Negative
Immunology
Anti Granulocyte
Antibodies
Comment
Anti-ganglioside (GM1) antibodies are associated with Guillan-Barré
syndrome.
Anti-ganglioside (GQ1) antibodies are associated with Miller Fisher
syndrome.
Haematology
See Anti Neutrophil Antibodies.
Specimens Referred to The Doctors Lab (UK).
Anti-insulin antibodies are found in approximately 30% of patients
with type 1 diabetes
Anti-Insulin Antibodies
Blood
Serum Gold Cap
5mls
20 days
<1 U/ml
Microbiology
Dispatch
Anti-Intrinsic Factor
Antibodies
Blood
Serum Gold Cap
5mls
20 days
Negative
Immunology
Anti-Islet Cell Antibodies Blood
Serum Gold Cap
5mls
20 days
Negative
Immunology
Anti-LKM (Liver Kidney
Blood
Microsomal) antibodies
Serum Gold Cap
5mls
10 Days
Negative
Immunology
Anti-LKM antibodies are associated with type II autoimmune
hepatitis but may also be seen in hepatitis C.
Anti-MAG (Myelin
Blood
associated glycoprotein)
Serum Gold Cap
4.5mls
28 days
Negative
Immunology
Specimens Referred to Oxford Radcliffe Hospitals (UK).These
antibodies are associated with chronic sensory neuropathies.
Anti-Mitochondrial
Antibodies (AMA)
Blood
Serum Gold Cap
5mls
2 days
Negative
Immunology
Anti-mitochondrial antibodies (M2 pattern) are usually associated
with (primary biliary cirrhosis (PBC). Confirmatory test for anti-M2
antibodies performed on positive samples.
Anti-M2 antibodies (Anti
Mitochondrial antibodies Blood
subtype M2)
Serum Gold Cap
5mls
21 days
Negative
Immunology
Follow-on test performed only on AMA (mitochondrial antibody)
positive samples. Anti M2 antibodies are highly specific for primary
biliary cirrhosis.
Page 10 of 55
Specimens Referred to Dept of Haematology, St. James's Hospital.
The presence of these antibodies is associated with pernicious
anaemia.
Specimens Referred to University College London Hospitals (UK).
These antibodies are found in approximately 70% of patients
presenting with type 1 diabetes.
Container Type/
Volume
Blood
Serum Gold Cap
5mls
28 days
Negative
Immunology
Anti-Neuronal antibodies
(includes anti-Hu, antiBlood
Yo and anti-Ri
antibodies)
Serum Gold Cap
5mls
28 days
Negative
Immunology
Associated with paraneoplastic syndromes affecting the nervous
system.
Anti-MuSK (Muscle
specific kinase)
antibodies
Turn Around
Reference Range
Time
Comment
Specimen
Type
Lab
These antibodies are found in approximately 40% of patients with
myasthenia gravis with negative anti-acetylcholine receptor
antibody.
Anti-Neutrophil
Cytoplasmic Antibodies
Blood
(ANCA) includes CANCA and P-ANCA
Serum Gold Cap 5
14 days
mls
Negative
Immunology
Samples are screened by indirect immunofluorescence for ANCA.
If positive anti-PR3 and anti-MPO tests follow.This test is available
on an urgent basis by arrangement with the laboratory. Negative
ANCA makes vasculitic diseases less likely.C-ANCA is positive in
over 90% of patients with generalised Wegener’s granulomatosis
and in 30% of patients with microscopic polyarteritis.P-ANCA with
MPO specificity occurs in 50-80% of patients with microscopic
polyangitis and up to 25% of patients with Wegener's
granulomatosis.
Anti Neutrophil
Antibodies
Serum Gold Cap
and EDTA
Lavender Cap
See Report
Haematology
EDTA required for WCC and Neutrophil count. Referred to H+I
Filton, NHS Blood and Transplant, Bristol. Samples must be
received into lab before 12:00 for same day dispatch.
Anti-Nuclear Antibody
(ANA)
Blood
Blood
Serum Gold Cap
5 mls
21 days
7 days
Negative.
Immunology
Page 11 of 55
Samples are screened at 1/80 dilution. Staining pattern and titre are
reported on positive samples. Negative ANA makes connective
disease unlikely.Weak positive is unlikely to be clinically
significant.Strongly positive ANA are more likely to be associated
with connective tissue disease. The occurrence of ANA may
increase with age, infection, malignancy, therapy with certain drugs
and a range of inflammatory disorders.
Specimen
Type
Anti-Gastric Parietal Cell
Blood
Antibodies (PCA)
Container Type/
Volume
Serum Gold Cap
5mls
Turn Around
Reference Range
Time
10 days
Negative
Lab
Immunology
Comment
Anti-gastric parietal cell antibodies are found in approximately 90%
of patients with atrophic gastritis and pernicious anaemia. They may
also be found in patients with other autoimmune endocrine
disorders and in the healthy relatives of patients.
Anti Phospholipid
Antibodies - see Lupus
Screen
Specimens Referred to Immunology Dept, St. James's Hospital.
Antibodies against basment membrane zone antigen are found in
bullous pemphigoid and its variants. Antibodies against the
epidermal adhesion molecules are associated with pemphigus
vulgaris and its variants
Anti-Skin antibodies
(associated with
blistering skin disorders Blood
pemphigus and
pemphigoid)
Serum Gold Cap
5mls
Anti-Smooth Muscle
Antibodies (SMA)
Blood
Serum Gold Cap
5mls
10 days
Negative
Immunology
AntiStreptolysin O titre
(ASO)
Blood
Serum Gold Cap
5mls
5 days
See Report
Microbiology
Dispatch
Referred to Claymon Biomnis Labs. Use Grey Serology/ Assay
Request Form.
Anti-Striated muscle
antibody
Blood
Serum Gold Cap
5mls
10 days
Negative
Immunology
These antibodies are present in patients with myasthenia gravis
(MG). 80-90% patients with MG and thymoma are positive for these
antibodies.
Blood
Serum Gold Cap
5mls
0-1.9UmL
Microbiology
Dispatch
<50 IU/ml = negative
50-75 IU/ml = borderline
>75 IU/ml = positive
Immunology
Anti-tTG (Tissue
Transglutaminase)
Antibodies
Anti-Thyroid Antibodies:
Anti- Thyroid Peroxidase Blood
Antibodies (TPO)
20 days
14 days
Serum Gold Cap/
Lithium Heparin or 10 days
EDTA 5mls
Negative
Immunology
Page 12 of 55
Elevated levels of anti-smooth muscle antibodies may be
found in a variety of infectious disorders and in
autoimmune hepatitis. Higher levels are more often
associated with autoimmune hepatitis.
Referred to Immunology Dept, St. James's Hospital.
Anti-tTG antibodies are strongly associated with coeliac disease. An
anti-EMA test will follow all positive tests.
High levels of Anti-TPO antibodies indicate current or future risk of
autoimmune thyroid disease. Thyroid function tests should be
checked. In general repeat testing is unhelpful
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Lab
Comment
Anti Thrombin
Blood
Sodium Citrate
Light Blue Cap 3
mls
4 - 6 weeks
80 - 120 iu/dl
Haematology
Tests done in batches unless requested urgently. See
Thrombophilia Screen.
Anti-TSH (Thyroid
stimulating hormone)
Receptor Antibodies
Blood
10 days
0.0 - 1.5 IU/L
Immunology
Specimens Referred to Endocrinology Dept, St. James's Hospital.
Associated with Grave's disease.
Anti-VGCC (Voltage
gated calcium channel)
antibodies
Blood
Serum Gold Cap
5mls
20 days
Negative
Immunology
These antibodies are associated with the Lambert-Eaton
myasthenic syndrome
Anti-VGKC (Voltage
gated potassium
channel) antibodies
Blood
Serum Gold Cap
5mls
20 days
Negative
Immunology
Voltage Gated potassium channel antibodies have been reported in
neuromyotonia, Morvan's syndrome and limbic encephalitis
Anti Xa Assay [heparin
assay]
Blood
Sodium Citrate
Light Blue Cap 3
mls
6 hours
See Report
Haematology
Used to monitor certain patients on low molecular weight heparin.
Contact Coagulation laboratory (ext.4395) to pre-arrange assay.
Samples should be taken 4 hrs after last injection of Heparin.
Antral Washout (AWO)
AWO
Sterile Universal
72hrs
N/A
Microbiology
Mycology culture also routinely performed on all AWO specimens.
APML Testing (T15:17)
Bone
Marrow
Aspirate or
Blood
Bone Marrow in **
RPMI or EDTA
9mls
2-3 weeks
Not Applicable
Haematology
Useful for Promyelocytic leukaemia. ** Containers available from
Haematology. Referred to Molecular Diagnostic Laboratory, St.
James Hospital.
APTT
Blood
3 hours
23 - 35 seconds
Haematology
One sample sufficient for PT, INR, APTT, D-Dimers and Fibrinogen.
APTT Ratio
Blood
Haematology
Used for heparin monitoring.
Sodium Citrate
Light Blue Cap 3
mls
Sodium Citrate
Light Blue Cap 3
mls
3 hours
Page 13 of 55
Arterial Blood Gases
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
pH = 7.35 - 7.45,
pCO2 (male) 4.67 - 6.4 kPa,
pCO2 (female) 4.27 - 6.0 kPa, pO2
<60 yrs 11.0 - 14.4 kPa, pO2 >60
yrs10.0 - 11.3 kPa
Actual Bicarbonate 22 - 26
mmol/L
Base Excess - 2 to + 2,
Oxygen Saturation 95 - 99%
Lab
Comment
Biochemistry
After taking sample, ensure no air bubbles are present. Bring to
the lab immediately. ABG specimen should not be sent via the
POD system.The pO2 reference range refers to patients on room
air. For patients on oxygen therapy, a pO2 of 8 kPa is generally
taken as a minimum target.
Cytology
Large volume of fluid received in drain bags not suitable.
Arterial
Blood
Pre-heparinised
blood gas syringe - 20 mins
2ml
20ml fresh
sample
Universal / 20 mls
3 days
Heparin Gel 4.5ml
4 hrs
8 - 40 U/L
Biochemistry
10 days
N/A
Microbiology
Dispatch
Ascitic Fluid for
Microbiology See Fluids
Section
Ascites Fluid for tumour
Aspartate
Blood
Aminotransferase (AST)
Aspergillus Ab
Aspergillus Antigen
(Galactomannam)
Atypical Pnuemonia
Screen (Chylamdia,
Mycoplasma and
Coxiella)
Blood
Blood
Blood
Serum Gold Cap
5mls
Serum
Gold Cap 5mls
3 serum gold cap
required
7 days
Microbiology
See
individual
tests.
Microbiology
Dispatch
Autopsies/Post Mortems
Histology
See section 30 of User Reference Manual
Microbiology
Dispatch
Microbiology
Dispatch
Referred to Royal Brompton Hospital, U.K.G154. Use Grey
Referred to R.S.I.L., Central PHL, Colindale, London. Use Grey
Useful in CML. Referred to Molecular Diagnostic Lab, St. James’s
Hospital. Samples must be received into lab before 12:00 for same
day dispatch.
Avian Abs
Blood
Serum/ 5-10ml
10 days
N/A
Bartonella Abs
Blood
Serum/ 5-10ml
10 days
N/A
BCR-ABL [Molecular
Marker]
Bone
Marrow or
Blood
Bone Marrow in
RPMI or Lavender 2 - 3 weeks
EDTA 9mls
See Report
Haematology
Bence Jones Protein
(See Protein
Electrophoresis)
Urine
Sterile Universal
Container
See Report
Biochemistry
5 days
Page 14 of 55
Referred to Mycology Reference Centre Leeds General Hospital.
Use Grey Serology/ Assay Request Form
Use Grey Serology/ Assay Request Form. Please note testing is
performed once weekly on Wednesdays.
Specimens Referred to outside laboratory. See Mycoplasma,
Coxiella/Q Fever and Chlamydia. A large volume of serum is
required for these tests so please ensure a sufficent volume
of blood ( 3 blood tubes) is sent to laboratory.
Urinary electrophoresis carried out. Depending on the results of the
electrophoresis, specimen may be sent for immunofixation.
Specimen
Type
Benzodiazepines,
Barbiturates, Opiates,
Urine
Cocaine, Propoxyphene,
Phenothiazines
Beta 2 Glycoprotein
Beta 2 -Microglobulin
(B2M)
Bicarbonate - see
Carbon Dioxide
Blood
Blood
Container Type/
Volume
Serum- Gold Cap 5
10 days
mls
Serum Gold Cap 7 days
5ml
Comment
N/A
Biochemistry
Referred to Outside Laboratory (Beaumont Hospital). Specimens
must be received into laboratory before 12.00. Urgent specimens sent straight from ED to Beaumont Hospital by taxi.
See Report
Haematology
Referred to St. James Hospital.
0.8 - 2.2 mg/L
Biochemistry
10 mls Cytolyt
container (avialable 2 days
from Cytology)
Cytology
* Cytolyt available from Cytology. Second sample to be sent if
FISH Studies in Mayo Clinic are required.
Cytology
Please specify if Endoscopic or Percutaneous sample.
1.7 - 5.0 mol/L
Biochemistry
Direct (Conjugated) Bilirubin measurement is occasionally required
but is not warranted if Total Bilirubin is < 30 mol/L. Protect
specimens from light.
1.7 - 21 mol/L
Biochemistry
Protect specimens from light.
2 days
Histology
Histology tissues (routine) must be fixed (in 10% formalin)
immediately in containers of adequate size. The container should be
at least ten times the volume of the tissue.
2 days
Histology
Histology tissues must be fixed (in 10% formalin) immediately in
containers of adequate size. The container should be at least ten
times the volume of the tissue. Please phone laboratory prior to
sending urgent biopsy.
Bilary Brushings
In Cytolyt*
Bile Duct Brushings for
tumour
Brushings
In Preservcyt
from
available from
common bile
Cytology
duct
Bilirubin - Direct
(Conjugated)
Blood
Heparin Gel 4.5 ml
4 hrs
Bilirubin (Total)
Blood
Heparin Gel Light
Green Cap 4.5 ml
4 hrs
Biopsy, Routine
Various
10% Formalin
Biopsy, Urgent.
See Liver Biopsy
Various
10% Formalin
Lab
Turn Around
Reference Range
Time
3 days
Page 15 of 55
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Lab
Comment
Blood Culture
Blood
B/C Bottles 8-10
ml Please send
aerobic and
anaerobic bottles
Neg cultures
reported after 6
days. Pos
cultures notified
to team.
N/A
Microbiology
Use Yellow Microbiology Request Form. All positive results are
phoned to the team/ clinician when confirmed.
Blood Films
Blood
4 hours
See Report
Haematology
Blood films are made from FBC sample. Urgents samples may take
up to 2 hrs.
Blood Group
Blood
Bone Alkaline
Phosphatase (BAP)
Blood
Serum Red Cap 6
20 days
ml
Female: 6.1 -11.8 µg/L,
Male: 7.2 - 15.0 µg/L
Metabolism
Bone Biomarker Profile
Ionised Calcium
PTH
25(OH)D
P1NP
OCI
BAP
CTX -1
Blood
Serum Red Cap
3 x 6 ml
20 days
See individual tests
Metabolism
Fasting specimen required. Bone Marker Protocol available from
Metabolic Lab. Send on sample on ice. Results affected by: Fasting,
Circadian Variation.
Bone Biomarker Profile
DPD
NTX-1
Calcium/Creatinine
Ratio
Urine
2 hour timed urine
or 2nd morning
void, Specimen
40 days
container available
in Lab.
See individual tests
Metabolism
Fasting specimen required. Bone Marker Protocol available from
Metabolic Lab. Results affected by: Fasting, Circadian Variation.
Bone Marrow Aspirate
Marrow
Glass Slides,
Approx 10
Heparinised RPMI days
Haematology
Provisional results available within 48 hrs - discussed at weekly
MDT meeting. For cytogenetic analysis and immunophenotyping,
special containers are available in the haematology laboratory.
Bone Marrow Biopsy
Bone
Marrow
Trephine
10% Formalin
3 days
Histology
Turn around time may be longer if decalcification is required
BRAF
Tissue
10 working
days
Histology
To request test phone laboratory on 4797. Referred to Lab 21, UK
via histology dispatch.
Breast Resection
Margins
Fresh
tissue*
20 minutes
Histology
* Bring tissue to laboratory and give to staff member immediately.
EDTA Lavender
Cap. 3 mls
EDTA Pink Cap
6mls
Dry
2 hrs
Blood Bank
Page 16 of 55
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Lab
Breast Sentinel Node
tumour detection
Breast
axillary
nodes
10% Formalin
Labelled
'Radioactive'
3 days
Histology
Bronchial Brushings for Bronchial
tumour
brushings
In Preservcyt
available from
Cytology
3 days
Cytology
Bronchial Washings for
Microbiology C/S, TB,
Mycology (BAL)
Sterile Universal
Container
8 days
(culture and
sensitivity)
Microbiology
Washing
Container/amount
available
3 days
Cytology
Fresh
specimen
Bronchial Washings for
Fresh
tumour /Bronchoalveolar
sample
Fluid
Brucella Antibody
Blood
Serum/ 5-10ml
10 days
C1 Esterase Inhibitor
Blood
Serum Gold Cap
5mls
10 days
CA 125
Blood
CA 15-3
Blood
CA 19-9
Blood
Carbohydrate deficient
Transferrin
N/A
Comment
at least ten times the volume of the tissue. Pots must be labelled as
Radioactive.
All BWs and BALs are processed for TB.
Microbiology
Dispatch
Referred to Brucella Diagnostic Unit, Aintree Hospital, Liverpool.
Use Grey Serology/ Assay Request Form.
Immunology
Specimens Referred to Immunology Dept, St. James' Hospital.
An acute phase protein with a lower dynamic range than CRP or
SAA. Reduced levels are associated with hereditary angioedema
Serum Gold Cap 6
2 days
ml
Serum Gold Cap 6
2 days
ml
Serum Gold Cap 6
2 days
ml
0 - 35 kU/L
Nuclear Medicine Most useful in ovarian cancer.
0 - 40 kU/L
Nuclear Medicine Most useful in breast cancer.
0 - 37 kU/L
Nuclear Medicine Most useful in pancreatic cancer.
Blood
2 Serum Red
Capped
See Report
Biochemistry
Referred to: Dr Joanne Marsden, Kings College Hospital, Demark
Hill, London SE5 9RS. One serum sample to referred, the other
sample is kept frozen.
cAMP
Urine
25 ml aliquot from
10 days
a 24 hrs collection
See Report
Biochemistry
Referred to outside laboratory.
Caeruloplasmin
Blood
Serum Gold Cap 3 days
5ml
0.25 - 0.63 g/L
Biochemistry
4 - 6 weeks
Page 17 of 55
Calcium
(Urinary)
Calcium - Ionised
Specimen
Type
Container Type/
Volume
24 hrs urine bottle
Urine - 24hr (plastic) - no
collection
preservatives
required
Serum Red Cap 6
Blood
ml
Calcium (Total)
Blood
Calcium/Creatinine
Ratio (Urinary)
Urine
Calcitonin
Blood
Cannabis,
Amphetamines,
Methadone, L.S.D,
Alcohol
Blood
Carbamazapine
(Tegretol)
Blood
Carbon Dioxide
(Bicarbonate, TCO2)
Blood
Carboxyhaemoglobin
Blood
See also Methemoglobin
Turn Around
Reference Range
Time
Lab
Comment
Same day if
received
2.5 - 7.5 mmol/24hr
before 11am.
Biochemistry
Urine collection bottle and request form must be clearly labelled with
patient name and hospital number. The date and time of the start
and finish of the collection must be clearly indicated.
Daily
1.19 - 1.35 mmol/L
Metabolism
Samples must be received on day of collection.
2.2 - 2.6 mmol/L
Biochemistry
Avoid venostasis as may cause inaccurate total calcium
measurement.
0.07 - 0.41
Metabolism
Part of Bone Biomarker Protocol available from the metabolic
laboratory. *Specimen container available from the metabolic lab.
Test done on
21st of
<10 nmol/L
month.
Biochemistry
Referred to Endocrinology, Mater University Hospital.
10 days
N/A
Biochemistry
must be received into laboratory before 12.00 for same day
dispatch. Urgent specimens - send straight from ED to Beaumont
Hospital by taxi.
Daily
4 - 12 mg/L
(Monotherapy),
4 - 8 mg/L (if
polypharmacy is present).
Biochemistry
In combination therapy,
the suggested therapeutic
range for carbamazepine
is lower: 4 - 8 mg/L.
Metabolism of Carbamazapine may be increased by phenytoin and
phenobarbitone and is decreased in liver dysfuction.
24 - 32 mmol/L
Biochemistry
Avoid small samples.
<2% Non Smokers; <5%
Smokers; <10% Heavy
Smokers.
Biochemistry
Please ensure that there are no air bubbles present. Bring to
laboratory immediately. See note on smoking.
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
2 hour timed urine
or 2nd morning
void.*
Serum - must be
transported to the
laboratory stat on
ice.
Serum Red Cap 6ml
Serum Red Cap 6mls
20 days
Heparin Gel Light
4 hrs
Green - 4.5ml
Pre-heparinised
blood gas syringe - 20 mins
2ml
Page 18 of 55
Specimen
Type
Catecholamines
(including Metanephrine)
Urine
CD20/CD19
Blood
CD34
Blood
Container Type/
Volume
24hr urine
collection - acid
containing bottle
obtainable from
Biochemistry
Laboratory *
EDTA Lavender
Cap 3 ml
EDTA Lavender
Cap 3 ml
Turn Around
Reference Range
Time
Comment
15 days
Noradrenaline: 50 - 900
nmol/24hr, Adrenaline:
Biochemistry
25 - 230 nmol/24hr,
Dopamine: 250 3300nmol/24hr
Referred to Outside Laboratory (St James's Hospital). * Special
Instructions must be given to patients on the collection of
urine into an acid containing bottle. Warning label 'This bottle
contains strong acid preservative' must be attached to bottle.
6 hours
See Report
Haematology
Used to monitor the effects of RItuximab. Prior arrangement with
Immunophenotyping Laboratory (Ext.4792) is essential.
2 hours
See Report
Haematology
Assayed pre peripheral blood stem cell processing.
See Lymphocytes
subsets
CD4/CD8 Ratio
Lab
Microbiology
Dispatch
CEA
Blood
Serum Gold Cap 6
2 days
ml
0 - 3.5 µg/L
Nuclear Medicine Most useful in colorectal cancer
Chloride
Blood
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
95 - 108 mmol/L
Biochemistry
Cholesterol (Total)
Blood
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
Recommended: <5.2
mmol/L, Borderline Risk:
Biochemistry
5.2 - 6.19 mmol/L, High
Risk: 6.2 mmol/L
N.B - Label specimen container and form fasting (F) if patient
is fasting. Target cholesterol value following lifestyle advice or drug
therapy is <5.0 mmol/L.
Chromogranin A
Blood
EDTA Lavender
Cap 3mls
See Report
Biochemistry
Serum must be frozen within 1 hour. Referred to Dr Joy Ardill,
Regulatory Peptide Lab, Mulhouse Building, Royal Victoria
Hospital, Belfast BT12 6BA.
Chromium
Blood
EDTA Trace
Element Tube navy cap with blue 2 weeks
band on tube (K2
EDTA Plus).
See Report
Biochemistry
Specimen referred to Charing Cross Hospital.
Chylamdia Abs
Blood
Serum - Gold Cap 4 days
See Report
Microbiology
Dispatch
Referred to external Lab (Claymon Biomnis).
4 - 6 weeks
Page 19 of 55
Part of Urea and Electrolytes Profile.
Lab
Comment
1.15 - 4.59 mmol/24hr
Metabolism
Part of stone screen.The date and time of start and finish of
collection must be clearly indicated.
3 days
See Report
Microbiology
Dispatch
3 days
See Report
Microbiology
Dispatch
Dublin. Use Grey Serology/ Assay Request Form. If sending other
tests, send a separate EDTA sample for CMV PCR.
3 hours
See Report
Haematology
Correct volume of blood is essential. One sample sufficient for PT,
INR, APTT, D-Dimers, Fibrinogen.
See Report
Biochemistry
Specimens referred to Charing Cross Hospital.
Titre <64
Immunology
It is extremely important that the blood is collected and transported
to the laboratory at 37º C. A portable incubator is available in the
Phlebotomy Dept on the ground floor for this purpose.
3 days
Histology
Bring Tissue to Histology Laboratory and give to staff member
immediately or sent in the dumb waiter. Phone laboratory (Ext
4350) when sending sample in the dumb waiter.
72 hour
Batched
C3: 0.75 - 1.40 g/L
analysis on
C4: 0.16 - 0.39 g/L
Mon, Wed &
Fri
Biochemistry
2 weeks
Biochemistry
Specimen
Type
Container Type/
Volume
Citrate
Urine
24 hour urine bottle
20 days
- no additive
CMV IgG and IgM
antibody
Blood
Serum red/gold
cap 5mls
CMV PCR
Blood and
CSF
Coagulation Screen [PT,
Blood
INR, APTT]
EDTA 3mls
(blood), Universal
container (CSF)
(see relevant CSF
section)
Sodium Citrate
Light Blue Cap 3
mls
Turn Around
Reference Range
Time
Cobalt
Blood
EDTA Trace
Element Tube navy cap with blue 2 weeks
band on tube (K2
EDTA Plus).
Cold Agglutinins
Blood
Serum Gold Cap
10 mls
Colon Resection
Histology
Fresh tissue
Dry
Bleep 602
Complement
(Total C3 & Total C4)
Blood
EDTA Lavender
Cap - 5ml
Copper
Blood
Serum Trace
Element Tube navy cap with red
stripe on tube.
14 days
See Report
Page 20 of 55
Lab
Comment
See Report
Biochemistry
Specimens referred to Charing Cross Hospital. Special container
with instructions available from Biochemistry. Instructions will
be explained to patient at the time of collection of container.
Specimen container must be kept upright at all times. Warning
label 'Acid washed container - container washed with conc.
HCL' must be attached to bottle.
Serum Gold Cap 6
2 days
ml
A.M. 138 - 690 nmol/L
P.M. 70 - 345 nmol/L
Nuclear Medicine
State time of sample collection on request form.
Stress may elevate levels.
Blood
Serum/ 5-10ml
10 days
N/A
Microbiology
Dispatch
Referred to outside laboratory Use Grey Serology/ Assay Request
Form.
Coxsackie/Enterovirus
IgM
Blood
Serum/ 5-10ml
10 days
N/A
Microbiology
Dispatch
Referred to PHL West Parke Hospital, Surrey, UK. Use Grey
Serology/ Assay Request Form. Samples only referred after
consultation with Clinical Microbiologist.
C-Peptide
Blood
Serum Red Cap - 6
ml. Serum needs
4-6 weeks
to be frozen within
1 hour.
0.2 - 3.2 g/L
Biochemistry
Referred to Outside Laboratory (St James's Hospital). Specimens
dispatch.
Creatine Kinase
(Total CK)
Blood
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
Male: 1 - 185 U/L
Female: 1 - 125 U/L
Biochemistry
Total CK may be elevated following IM injection.
Creatinine
Blood
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
Male: 62 - 106 mol/L
Female: 44 - 80 mol/L
Biochemistry
Creatinine
(Urinary)
24hr Urine bottle
collection
preservatives
required
Creatinine Clearance
24hr Urine bottle no preservatives
Urine - 24hr
required
24 hrs
collection /
Blood:
Blood
Heparin Gel - 4.5
ml
Specimen
Type
Container Type/
Volume
Copper
Urine
24 hr urine
collection in acid
washed bottle.
Cortisol
Blood
Coxiella / Q Fever Abs
Turn Around
Reference Range
Time
2 weeks
Mon - Fri
Same day if
received
before 11am
Biochemistry
< 40yr: Male: 90 - 139
ml/min per 1.73m2,
Female: 80-125 ml/min
Biochemistry
per 1.73m2, Decreases
approximately 6.5 ml/min
per decade.
Page 21 of 55
Blood specimen for creatinine must be taken during or within 24
hours of urine collection. Urine collection bottle and request form
must be clearly labelled with patient name and hospital number.
The date and time of the start and finish of the collection must be
clearly indicated.
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Lab
CRP
Blood
Heparin Gel Light
Green Cap 5mls
4 hrs
Biochemistry
0- 5 mg/l
Biochemistry
The above assay (ie CRP) has a functional sensitivity of 0.6 mg/L
and therefore may suffice for hsCRP but the manufacture does not
advocate the use of the assay for cardiovascular risk stratification.
Negative
Immunology
Cryoglobulins are found in patients with lymphoproliferative
disorders, vasculitis, connective tissue disease and chronic infection
especially hepatitis C.
It is extremely
important that the blood is collected and transported to the
laboratory at 37º C. A portable incubator is available in the
Phlebotomy Dept on the ground floor for this purpose.
Please ensure sample is in the laboratory before 12.00 Mon-Fri.
Only on discussion with Clinical Microbiologist.
hsCRP (High Sensitivity
CRP)
Cryoglobulins
Blood
Serum Yellow
Tube/ 20 mls
Cryptococcal Ag
Blood or
CSF
Serum 5-10mls or
Daily on
CSF (see relevant
request
CSF section)
N/A
Microbiology
Cryptococcal Abs
Blood
Serum/ 5-10ml
10 days
N/A
Microbiology
Dispatch
CSF
As much as
possible into 3
universal
containers. Please
number each
container.
Cell counts:
1hr Culture: WCC: 0-5 per cmm
kept for 48hrs-RCC: 0-9 per cmm
10 days
2-5mls
14 days1month
CSF
Cell Counts & Culture
CSF - CJD
CSF
10 days
Comment
CRP rises rapidly after onset of an acute phase response,
beginning within 6 - 12 hrs and peaking within 24 - 48 hrs. The
CRP response may be less pronounced in liver disease.
Microbiology
Microbiology
Page 22 of 55
Referred to PHL West Parke Hospital, Surrey, UK. Use Grey
Serology/ Assay Request Form
All samples should be brought to microbiology laboratory
immediately and handed to scientific staff. Outside of routine hours
please hand into the haematology scientist on-call. All positive
results are phoned to the team/ clinician when confirmed. Use
Yellow microbiology form. PLEASE STATE TIME OF CSF
COLLECTION ON REQUEST FORM. CSF samples must not be
sent in the pod system.
Please contact Clinical Microbiologist before taking samples.
Sample must be frozen within 30 minutes of collection. Ideally these
samples should be collected during routine hours. PLEASE STATE
TIME OF CSF COLLECTION ON REQUEST FORM. CSF
samples must not be sent in the pod system.
Specimen
Type
Container Type/
Volume
CSF ACE (Angiotensin
Converting Enzyme)
CSF
0.5 ml of CSF in
plain plastic
container
CSF for malignancy
Fresh
sample
> 4ml if
possible
Sterile Universal
Container
CSF Glucose
CSF
Fluoride Oxalate
tube Grey Cap 0.3ml (min)
CSF Lactate
CSF
CSF Protein
CSF
Turn Around
Reference Range
Time
Lab
Biochemistry
Comment
Please supply CSF Total Protein Result. Specimen should be
frozen ASAP. Refrigerated samples accepted if noted on
request form. Referred to Neurometabolic Unit Box 105, National
Hospital for Neurology, Queen St, London WCIN 3BG (Dr
J.M.Land).
Cytology
CSF specimens should be brought to Microbiology
Laboratory. CSF samples must not be sent in the pod system.
CSF Glucose: 2/3 of
plasma Glucose value
Biochemistry
Bring to microbiology laboratory immediately and Micro staff
will forwarded to Biochemisty. It is essential that the time of
collection of CSF specimen is recorded on the request form.
Blood for plasma glucose should be taken at the same time. Please
Note: Fluoride Oxalate specimen is not suitable for CSF Protein
analysis. CSF samples must not be sent in the pod system.
CSF Spec must be
taken into sterlin
5 days
container
See Report
Biochemistry
Immediately after collection bring aliquot of CSF to
Biochemistry for freezing. Specimen must be frozen within 30
minutes. Referred to Claymon Biomnis. CSF samples must not
be sent in the pod system.
Sterile Universal
Container - 0.3ml
(min)
0.15 - 0.45 g/L
Biochemistry
Bring to microbiology laboratory immediately. Microbiology staff
will forward the specimen to Biochemistry. Please state time of
specimen collection on request form. CSF samples must not
be sent in the pod system.
2 days
1 hr
1 hr
CTX-1
C-Terminal cross-linking
Serum
Telopeptide of type 1
Collagen
Serum Red Cap 6
20 days
ml
Age related reference
ranges
Metabolism
Fasting specimen required. Part of Bone Biomarker. Protocol
available from Lab. Results affected by: Fasting, Circadian
Variation.
Cyclosoporine (Neoral,
CYS)
Blood
EDTA / 3mls
Patient should be
individually monitored.
Immunology
Sensitivity of assay 30 ug/L Take trough sample (i.e. pre-dose).
Samples should be stored at 4º C (fridge) overnight.
Cyst Fluid Cytology
Fresh
Sample
Universal/ as much
3 days
as possibe
Cystine (urine
quantitative test)
Urine
24hr Urine /
(no preservative)
5 Day
Cytology
Adults:10 - 22 mol/mmol
Biochemistry
creatinine
Page 23 of 55
Referred to Outside Laboratory (Temple Street Hospital).
Specimens must be received into laboratory before 12.00 for same
day dispatch.
Specimen
Type
Cytochemistry
Cytotoxic Antibodies
Container Type/
Volume
Turn Around
Reference Range
Time
Lab
Bone marrow
Blood or
slides or EDTA
bone marrow
Lavender 3ml
24 hours
See Report
Haematology
Blood
5 days
See Report
Biochemistry
Serum Gold Cap
Bone
Cytogenetics for
Marrow/
Haematology Disorders
Blood
Bone Marrow in
Heparinised RPMI 10 days
or EDTA x 2
See Report
Haematology
D-Dimers
Blood
Sodium Citrate
2 hours
Light Blue Cap 3ml
0 - 0.5 FEU/ml
Haematology
Dengue Fever Abs
Blood
Serum/ 5-10ml
Deoxycortisol
(11-Deoxycortisol)
Blood
Serum Red Cap 6
20 days
ml
As requested N/A
Basal <10 nmol/L,
Post Metyrapone 175 500 nmol/L
Female: 0.9 - 12.0
umol/L,
Male: 2.0 - 15.0 umol/L
Referred to National Virus Ref. Laboratory University College
Dublin. Use Grey Serology/ Assay Request Form
Endocrinology
State whether basal or post Metyrapone.
Serum Red Cap
6 ml
Digoxin
Blood
<1 day (for
Serum Gold Cap 6 urgent
1.02 - 2.58 nmol/L
ml
requests,
(Therapeutic range)
phone Lab).
Nuclear Medicine
Direct Coomb's Test
Blood
EDTA Pink Cap
6mls
3 hrs
Blood Bank
EBUS (Endoscopic
Bronchial Ultrasound)
Air-dried
slides +
checked stat
for adequacy Sent in slide tray
+ needle
rinse in
Cytolyt*
2 days
Cytology
Page 24 of 55
Referred to National Blood Centre, St James Hospital. Samples
must be received into laboratory before 12:00 for same day
dispatch.
Heparinised RPMI medium available from Haematology Dept.
Referred to Sheffield Regional Genetics Lab. Clinical details
essential. Samples must be received into laboratory before 12:00 for
same day dispatch.
Microbiology
Dispatch
DHEAS
Dehydroepiandrosterone Blood
sulphate
17 days
Comment
Endocrinology
Blood should be drawn pre-dose or at least 8 hours post oral dose.
Where a digoxin request cannot wait until the next routine period,
switch can contact a member of Nuclear Medicine Laboratory staff.
Out of hours requests must be sanctioned by a Consultant.
These must be booked with the Cytopathologist. *Cytolyl available
from Cytology.
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Lab
Comment
EBV PCR
Blood and
CSF
EDTA 3mls
(blood), Universal
container (CSF)
(see relevant CSF
section)
3 days
See Report
Microbiology
Dispatch
Dublin. Use Grey Serology/ Assay Request Form. If sending other
tests, send a separate EDTA sample for
EB virus Abs
Blood
Serum/ 5-10ml
2-3 working
days
N/A
Microbiology
Dispatch
Electron Microscopy
Tissue
In Tumos EM
fixative*
21 days
Histology
10 working
days
Histology
EGFR
Tissue
Eosinophil Count
Blood
Epilim
See Valproic Acid
Erythropoietin
EDTA Lavender
Cap. 3 mls
4 hours
0.0 - 0.5 x 10^9/l.
Blood
2 weeks
Blood
4 hours
See Report
Male 0 - 25 mm/hr
Female 0 - 30 mm/hr
Haematology
Laboratory informed beforehand. *EM fixative obtained from
laboratory. Referred to UK
To request test phone laboratory on 4797. Referred to Lab 21, UK
via histology dispatch.
Eosinophil count is included in Full Blood Count with Differential.
Eye Swabs
Serum Gold Cap
EDTA Lavender
Cap. 3 mls
Blood - Fluoride
Oxalate - Grey
Blood / Urine
Cap. Urine - Spot
Urine
Eye Swabs Transport Swab
Factor Assays
Blood
Sodium Citrate
6 hours
Light Blue Cap 3ml
See Report
Haematology
Factor V Leiden
Blood
Lavender EDTA
3mls and 2
4 - 6 weeks
Sodium Citrate for
APCR result.
See Report
Haematology
Only tested if APCR is low. Must supply APCR results or sodium
citrate for APCR Testing.Referred to Coagulation Laboratory
NCHCD, Rialto Gate, St. James Gate, St. James Hospital TEL 01
4162956. Specimens must be received there before 4pm.
Faecal Elastase
Faeces
Universal Container
with spoon (blue
1 week
cap) Freeze
sample
Biochemistry
Referred to external Lab (Claymon Biomnis). Frozen sample.
ESR
Ethanol (Alcohol)
Biochemistry
Haematology
One EDTA tube is adequate for FBC and ESR.
Results are not for medico-legal purpose.100 mg% ethanol is
equivalent to 21.7 mmol/L.Urine specimens are sent to Toxicology
Department, Beaumount Hospital.
Daily
N/A
Biochemistry
48 - 96 hrs
N/A
Microbiology
Page 25 of 55
Used for investigation of conjunctivitis.
Tests done in batches unless requested urgently. Some coagulation
factors are labile, please contact coagulation (Ext.4395) laboratory
before taking samples.
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Lab
Comment
Biochemistry
NB - Faecal specimens must be sent fresh to laboratory to
arrive before 3 pm of the day of collection or apply faeces to
the slide and send slide to the laboratory. Patient Preparation:
Diet: a meat-free, high fibre is recommended, starting the day
before testing and continuing through the test period. Foods which
contain peroxidase-like substances (e.g. turnips, horseradish, etc)
should be avoided during the test period. Patients with active
bleeding from other conditions (e.g. haemorrhoids, menstruation)
should not be tested. Medications: some oral preparations, such
as aspirin, iron, phenenylbutazone or indomethacin can cause GI
irritation and occult bleeding and should not be used during the test
period, if possible. Instructions for taking sample: With
applicator, apply thin smear of stool inside area I on slide. With
same applicator choose a second stool site for area II. Close and
reseal cover. (Slides available from Biochemistry).
Faecal
sample on
Hema
Screen slide
test.
Slides - one on
each of 3 days ….
7 hr
Sterile Universal
Container - 10g
Faeces
Ova & Parasites/ C.diff
Screen / Culture
Faeces
Universal Container if neg*
C.diff Toxin:
with spoon (blue
same day**
cap)
N/A
Microbiology
All positive results are phoned to the team/ clinician when
confirmed. *Positive faeces culture-up to 5days.
**Please send samples for C. difficile to laboratory before 1pm for
same-day result.TAT is 24hrs if received after 1pm.
Farmer’s Lung Abs
Blood
Serum
Gold Cap 5mls
N/A
Microbiology
Dispatch
Use Grey Serology/ Assay Request Form
Referred to Royal Brompton Hospital, U.K.
FDP
Blood
Sodium Citrate
See
Light Blue Cap 3ml Comment
See Comment
Haematology
This test has been replaced by the D-Dimers.
Ferritin
Blood
Serum Gold Cap 6
2 days
ml
Female: 13 - 150 µg/L
Male: 30 - 400 µg/L
Nuclear Medicine Non-specific elevations can occur in several different diseases.
Fibrinogen
Blood
Sodium Citrate
2 hours
Light Blue Cap 3ml
1.5 - 4.0 g/l
Haematology
Fine Needle Aspirate
(FNA)
N.B. See Thyroid FNA
e.g. Breast,
Lymph
node, Lung
In Cytolyt available
3 days
from Cytology
Faecal Occult Blood
Negative / Positive
Culture: 48hrs
O&Ps: 1 week
10 days
Cytology
Page 26 of 55
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Lab
Comment
FISH panel for Myeloma
Bone
Marrow
Bone Marrow
Slides X 6
NA
Haematology
Referred to National Centre for Medical Genetics, Crumlin Hospital.
Contact Crumlin before sending. Clinical details essential.
Flowcytochemistry
Blood or
bone marrow
Haematology
See Immunophenotyping.
Histology
Test is requested by Pathologists. If Her 2 FISH are referred to an
external center turn around time is 20 days.
See Report
Fluorescent in-situ
Breast,
Paraffin processed
Hybridisation (FISH) Her12 days
Lymph node tissue
2 neu test
Fluid Analysis (Total
Protein, LDH, amylase,
glucose, pH, etc as
appropriate)
Pleural /
Peritoneal /
Ascitic /
Synovial /
Wound
Drain /
Pseudocyst /
?Urine, etc
Sterile Universal
Container - 2ml for
7 hr
all tests except
glucose and pH
see comment*
Fluids for Microbiology
(from normally sterile
sites) Cell
counts/Culture/Crystals
(where indicated)
Peritoneal /
Ascitic/
Synovial/
Pleural
Universal Container
and EDTA sample
and Blood Culture
bottles
Folate (Red Cell)
Blood
EDTA Lavender
Cap 6 ml
Folate (Serum)
Blood
Serum Gold Cap 6
2 days
ml
Free Light Chains
Blood
Serum Gold Cap
For pleural fluids, total
protein > 30g/L suggests
an exudate. Refer to
Biochemistry
Clinical Protocol for other
tests.
Positive
Gram-stains
reported
WCC: 0-200/cmm
immediately,
Culture 4896hrs.
10 days
* If fluid glucose analysis is required, then an aliquot of fluid
should be placed in a glucose tube (Fluoride Oxalate) - 1 ml. If
pH analysis is required, an aliquot of fluid should be
transferred immediately to an ABG syringe (1-2mls). Expel any
air. Bring to laboratory immediately. Viscous samples cannot be
analysed. Please state collection time on request form.
Microbiology
Examination and identification of bi-refringent crystals available if
indicated. All pleural samples are sent for TB culture.
Nuclear Medicine
Please contact nuclear medicine lab before sending samples.
Sample will be referred to St. James’s Hospital if necessary.
3.5 -16.0 µg/L
Nuclear Medicine
Ideally patient should be fasting. Please state if patient is receiving
folate supplements.
See Report
Haematology
Referred to St. James’s Hospital. Samples must be received into
laboratory before 12:00 for same day dispatch.
Free T4 (thyroxine, free) Blood
Serum Gold Cap 6
2 days
ml
12.0 - 22.0 pmol/L
Nuclear Medicine Usually used as a 2nd line test to TSH.
Free Testosterone Index
Blood
(FTI)
See Comment
1 - 4.7
Endocrinology
15 days
Page 27 of 55
This is a calculated test. See testosterone and SHBG for specimen
requirements.
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Lab
Comment
Frozen Section
Histology
Fresh tissue
to Lab
immediately
DO NOT
USE POD
Dry in 60 mls
container. A
sterlin, 30 mls
container is not
suitable.
20 minutes
Histology
Phone Histology (Ext 4350) before taking specimen. Frozen
sections must not be sent in the POD.
Fructosamine
Blood
Serum or Heparin
Plasma
1 week
Biochemistry
Referred to external Lab - Temple St.
FSH
Follicle Stimulating
Hormone
Blood
Serum Red Cap 6
3 days
ml
Full Blood Count {WBC,
Hb, RBC, HCT, MCV,
MCH, MCHC, Platelet
Blood
count, White Cell
Differential}
EDTA Lavender
Cap. 3 mls
Gamma Glutamyl
Transferase (GGT)
Blood
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
Gastrin
Blood
Serum Gold Cap 6
3 - 4 weeks
ml
Gastrointentinal Biopsy
Mucosal side
up on card 10% Formalin
or plastic
2 days
Genetic Testing*
Blood
10 days
Genital Swabs
Microscopy & Culture
(Samples for Chlymdia
and Gonnorhoea please
refer to comment)
Cervical/
Urethral
Transport Swabs
High Vaginal
Swabs
72hrs
EDTA 2 x 3ml
See Report
Male: 2 - 10 U/L
Female:
Follicular 2 - 12 U/L
Endocrinology
Mid Cycle 12 - 25 U/L
Luteal 2 - 12 U/L
Post Menopause 30 - 150
U/L
4 hours.
Urgent
See report
Samples 1 hr
State LMP.
Haematology
Differential included in Full blood count during routine hours.
Available on request out of hours.
Male: 8 - 61 U/L
Female: 5 - 36 U/L
Biochemistry
Part of LFT profile.
13 - 115 ng/L
Patient must be fasting for at least 12 hours prior to sampling.
Nuclear Medicine Bring blood to Lab immediately for separation. Urgent requests
contact Lab.
Histology
at least ten times the volume of the tissue.
See Report
Biochemistry
* State clearly what genetic testing is required. Referred to
National Centre for Medical Genetics, Crumlin Hospital.
N/A
Microbiology
If Chylamdia or N. gonnorhoeae is suspected please contact the
NVRL or microbiology department (inpatients) for relevant transport
media. These samples are referred to National Virus Reference
Laboratory University College Dublin.
Page 28 of 55
Lab
Comment
Daily
See Comments for
Therapeutic Range
Microbiology
Same Day if samples received before 2pm Mon-Fri or 11am
Sat/SunSingle Daily Dose Regimen Pre-Dose Level: <1.0 mgs/L.
For information on divided daily dose regime please refer to back of
assay request form LF-MIC-REQ2 Use Grey Serology/ Assay
Request Form.
Three - EDTA
Lavender Cap 3
mls. Must be on
ice.
6 -10 weeks
See Report
Biochemistry
Referred to outside laboratory - Regulatory Peptide Lab., Belfast.
Blood
Serum/ 5-10ml
10 days
N/A
Microbiology
Dispatch
Glucose
Blood
Fluoride Oxalate
(Grey topped
vacutainer) - 2ml
4 hrs
3.0 - 6.0 mmol/L (Fasting) Biochemistry
Referred to Hospital for Tropical Diseases London. Use Grey
For further interpretation of fasting and random plasma glucose
values, please see interpretative comments on report form. Please
mark tube fasting if patient is fasting.
Glucose 6 Phosphate
Dehydrogenase or G6PD
Blood
EDTA Lavender
Cap 3 mls
5 days
See Report
7 hr
Diabetes Mellitus:
Fasting 7.0 mmol/L
and/or 2hr post glucose
load 11.1 mmol/L
Impaired Glucose
Tolerance (IGT):
Fasting <7.0 mmol/L
and/or 2hr post glucose
load 7.8 and < 11.1
mmol/L
Impaired Fasting
Glycaemia (IFG):
Fasting 6.1 and < 7.0
mmol/L
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Gentamicin
Blood
Serum Gold Cap
5mls
GI Hormones/ Gastric
Peptides (including
Chromogranin and VIP)
Blood
Giardia Abs
Blood Fasting & 2
Glucose Tolerance Test
Fluoride Oxalate
hour post
(GTT)
Grey Cap - 2ml
75g glucose
load
Haematology
Biochemistry
Please refer to GTT Protocol (available from Biochemistry or
Phlebotomy Dept) For GTT performed on in-patients wards the
glucose material (Polycal) and GTT protocol may be obtained from
Pharamacy. Interpretation: In the absence of symptoms of D.M,
diagnosis requires confirmation with at least one additional
diagnostic blood glucose measurement on another day. Other
causes of a raised blood glucose should be excluded. The values
given under "Reference Range" refers to plasma venous glucose
concentrations. Please give time of collection of fasting and 2hr pp
specimen.
Group and Crossmatch
Blood
EDTA Pink Cap
6mls
3 hrs*
Blood Bank
*excluding patients with RBC antibodies.
Group and Hold
Blood
EDTA Pink Cap
6mls
2 hrs*
Blood Bank
*excluding patients with RBC antibodies.
Page 29 of 55
Specimen
Type
Container Type/
Volume
Growth Hormone
Blood
Serum Gold Cap 6
10 days
ml
Gynae Cervical Samples
Cervical
sample into Preservcyt (in
liquid fixative Gynae OPD)
(Preservcyt)
20 days
Cytology
National Cancer Screening Samples are sent directly to Quest
Laboratories. Sample outside the screening cohort: by arrangment
with the Coombe Hospital.
H1N1 (Swine Flu)
Viral Swabs:
Nose and
Viral swab (pink)
Throat
96hrs
Microbiology
Dispatch
Samples referred to the National Virus Reference Laboratory
Haemochromatosis
Genetic Screen
Blood
Referred to Outside Laboratory. Specimens should be received into
laboratory before 12.00 for same day dispatch. Full clinical details
should be given and iron studies should be done prior to requesting
genetics.
Haemoglobin
Blood/Drain EDTA Lavender
Fluid
Cap 3mls
Haemoglobin A1c
Blood
2 X EDTA
Lavender Cap
Turn Around
Reference Range
Time
Comment
Female: 0 - 24 mIU/L,
Male: 0 - 2.4 mIU/L
Lab
Nuclear Medicine For urgent samples contact Lab.
15 days
N/A
Biochemistry
4 Hrs
See Report
Haematology
EDTA Lavender
Cap 3 ml
3 days
HbA1c
Endocrinology
IFCC 22-40 mmol/mol
DCCT(derived) 4.2 - 5.8%
Haemoglobinopathy
Screen: Thalassaemia
Screen or Haemoglobin Blood
A2 or F or Haemoglobin
electrophoresis
EDTA Lavender
Cap 3mls x 2
7 days
See Report
Haematology
laboratory before 12:00 for same day dispatch. EDTA tubes & FBC
results & 2 unstained slides sent to St. James's Hospital.
Haemolytic Anaemia
Screen inc FBC, Blood
Film, Retic Count and
Haptoglobins
EDTA Lavender
Cap 3 ml
4 hrs
See individual test
Haematology
Also request: Direct Coombs Test, Bilirubin and LDH.
EDTA / 6mls
48hrs
N/A
Microbiology
Dispatch
Referred to Irish Meningococcal Reference Lab. Temple St.
Childrens' Hosp, Dublin. Use Grey Serology/ Assay Request Form.
Blood
Haemophilus influenzae
Blood
PCR
Ham's Test
See PNH
Screen
Haematology
Page 30 of 55
Specimen
Type
Container Type/
Volume
Haptoglobins
Blood
Serum Gold cap or
EDTA Lavender
2 days
Cap. 3 mls
HCG Pregnancy Test
HCG Tumour Marker
Urine or
Serum
10 mls
Blood
HDL Cholesterol
Blood
(fasting for 12-14 hours)
Heinz Bodies
Blood
Heilcobacter pylori
Antigen
Faeces
Heparin Assay
Blood
Heparin Induced
Thrombocytopenia
Screen [HITS]
Hepatitis A, B, C Abs
Turn Around
Reference Range
Time
Comment
Haematology
NB: State if urgent.
Qualitative HCG test. Sensitivity 25 IU/L.
Quantitative HCG levels on serum samples are available from
Nuclear Medicine Laboratory.
0-25 IU/l
Immunology
2 days (for
Serum Gold Cap 6 urgent
ml
requests,
phone Lab).
Female:
Non-pregnant Premenopausal 0 - 5.3 IU/L,
Post Menopausal 0 - 8.3
IU/L,
Male: 0 - 2.6 IU/L.
Nuclear Medicine Quantative test measuring Total HCG.
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
A level of <1.0 mmol/L is a
marker of increased CHD Biochemistry
risk
Fasting specimen required (fasting for 12-14 hours).
See Report
Samples must be less then 1 hour old. One tube sufficient for FBC
and Heinz bodies.
EDTA Lavender
Cap 3mls
Universal Container
with spoon (blue
cap)
Sodium Citrate
Light Blue Cap 3
mls
Daily
0.45 - 2.42 g/l
Lab
24 hours
Haematology
Daily (MonFri)
See Report
Haematology
See Anti Xa Assay.
Blood
2 x Sodium Citrate
Verbal results
3mls Light Blue
available
See Report
Cap, 1 xSerum
within 2 days
Red Cap
Haematology
Specimens referred to Coagulation Lab, NCHCD, Rialto Gate, St.
James's Hospital (Tel 01 4162956) Specimen must be received in
SJH there before 4pm
Blood
Serum Red/Gold
Cap 5 mls
Microbiology
Dispatch
Referred to National Virus Reference. Laboratory University College
6 hours
Microbiology
3 DAYS
See Report
Page 31 of 55
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Lab
Comment
Hepatitis B Viral load
Blood
Serum Red/Gold
Cap 5 mls
3 days
See Report
Microbiology
Dispatch
Send to Microbiology Dispatch within 6 hours of sampling.Referred
to National Virus Reference Laboratory University College Dublin.
Hepatitis C Viral Load
Blood
2xSerum Red/Gold
3 days
Cap 5 mls
See Report
Microbiology
Dispatch
Send to Microbiology Dispatch within 6 hours of sampling.Referred
to National Virus Reference Laboratory University College Dublin.
Hepatitis C Genotype
Blood
Serum Red/Gold
Cap 5 mls
See Report
Microbiology
Dispatch
Her2 Immunos
Breast or
Paraffin processed
10 days
Lymph node tissue
Histology
Requested by Pathologists
Herpes Simplex virus
Isolation
Viral Swab
Pink top viral swab 14 days
See Report
Microbiology
Dublin
Herpes Simplex virus
PCR
Blood and
CSF
Serum/ 5-10ml,
CSF universal
container(see
relevant CSF
section)
2-5 days
N/A
Microbiology
Dispatch
Histoplasma Abs
Blood
Serum/ 5-10ml
10 days
N/A
Microbiology
Dispatch
Referred to PHL Myrtle Road, Bristol, U.K. Use Grey Serology/
Assay Request Form.
HIV Abs
Blood
Serum/ 5-10ml
24hrs
N/A
Microbiology
Dispatch
HIV Viral load
Blood
EDTA Lavender
Cap 3mls x2
5 days
See Report
Microbiology
Dispatch
Dublin.Use Grey Serology/ Assay Request Form.
HLA Antibodies [auto]
Blood
Serum Gold Cap
5 days
See Report
Haematology
Referred to National Blood Centre. Samples must be received into
HLA B27 Typing
Blood
Yellow HLA [ACD]
5 days
or EDTA/10 mls
See Report
Haematology
10 days
HITS Screen - see
Heparin Induced
Thrombocytopenia
Screen
Page 32 of 55
Lab
Comment
See Report
Haematology
Yellow HLA [ACD]
10 days
or EDTA/10mls
See Report
Haematology
Blood
**2 x Sodium
Citrate (20 mls) + 1 2 weeks
x Gold Cap Serum
See Report
Biochemistry
** Collection tube available from Phlebotomy. Referred to
Histocompatibility Dept, Beaumont
HLA Typing for Liver
Transplants (patients
and family members)
Blood
**2 x Sodium
x Gold Cap Serum
See Report
Biochemistry
HLA Typing for Lung
Transplant
Blood
**2 x Sodium
x Gold Cap Serum
See Report
Biochemistry
HLA Typing for Matched
Blood
Platelets
Yellow HLA [ACD]
5 days
or EDTA/10mls
See Report
Haematology
HLA Typing for
Haematology Transplant
Blood
Patients and Family
Members
Yellow HLA [ACD]
5 days
or EDTA/10 mls
See Report
Haematology
Referred to National Blood Centre, St. James Hospital. Samples
must be received into laboratory before 12:00 for same day
dispatch.
EDTA Lavender
Cap - 5ml on ice
5 - 15 mol/L (Adults)
Biochemistry
Please send specimen on ice. Please send full clinical details.
N/A
Microbiology
Dispatch
Specimen
Type
Container Type/
Volume
HLA B51
Blood
Yellow HLA [ACD]
10 days
or EDTA/10mls
HLA DR Screen
Blood
HLA Typing for Kidney
Transplant
Homocysteine
Blood
Turn Around
Reference Range
Time
5 days
Hydatid Disease Abs
Blood
Serum/ 5-10ml
Hydroxy Progesterone
(17-Hydroxy
Progesterone)
Blood
Serum Red Cap 6
15 days
ml
Basal <5 nmol/L
Endocrinology
IGF-1
Insulin-like Growth
Factor 1
Blood
Serum Red Cap 6
15 days
ml
Age and gender based
contact Laboratory for
details.
Endocrinology
10 days
Page 33 of 55
Provide age and gender.
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Blood
Urine
Serum Gold Cap 1 Serum 14
ml
days, Urine
Urine 20 mls
15 days
Bone
Marrow or
Blood
Marrow in RPMI or
EDTA Lavender
2 -3 weeks
Cap 3ml x 2.
Lab
Comment
IM Screen - See
Infectious Mono Screen
Immunofixation
1. Serum
2. Urine
Immunoglobulin Gene
Rearrangement
Immunology
See Report
Haematology
Immunoglobulin Type E
Blood
(Total IgE)
Serum Gold Cap 5ml
72 hour Batched
analysis on
Monday,
Wednesday &
Friday
1 - 165 kU/L (healthy nonBiochemistry
allergic adults)
Immunoglobulins
(IgG, IgM, IgA)
Blood
Serum Gold Cap 5ml
72 hour Batched
analysis on
Monday,
Wednesday &
Friday
IgG: 8 - 15 g/L,
IgM: 0.4 - 2.4 g/L,
IgA: 0.9 - 4.3 g/L
Immunophenotyping
EDTA Lavender
cap 3 mls or
Blood or
marrow, **
bone marrow
Heparinised in
RPMI
Infectious
Mononucleosis screen
(previous test names
Monospot/Paul Burnell)
Blood
INR
Blood
Insulin
Blood
EDTA Lavender
Cap 3mls or
Serum Gold Cap
Tube/3mls
Sodium Citrate
Light Blue Cap 3
mls
Serum Red Cap
6 ml
This procedure confirms and identifies the presence of a
monoclonal protein (follow on test to electrophoresis).
Useful in B Cell Malignancies. Referred to Molecular Diagnostic
Laboratory in St. James’s Hospital. Samples must be received into
lab before 12:00 for same day dispatch.
A normal Total IgE level does not exclude an increased
concentration of a specific IgE antibody.
Biochemistry
48 hours
See Report
Haematology
** Specimen containers available from Haematology. Consult
Haemotology Medical Team for Immunophenotyping Requests.
Prior arrangement with lab (4792) is essential. Provisional results
available within 48 hrs - discussed at weekly MDT meeting.
3 days
Negative
Immunology
This antibody is present within 1-12 weeks after onset of symptoms
in 80-90% of cases of infectious mononucleosis. It may persist for
up to one year. Up to 50% of infected children under four years of
age may fail to produce this antibody.
3 hours
See Report
Haematology
Used for warfarin monitoring.
3 days
Fasting 2 - 15 mU/L
Endocrinology
State whether fasting or post prandial.
Page 34 of 55
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Lab
Iron Stain
Bone
Marrow
Slides
5 days
Haematology
Comment
4 hrs
Iron: Male:11 - 34 mol/L,
Female: 9 - 32 mol/L,
Transferrin: 2.0 - 3.4 g/L , TIBC
Calculated: 50 - 85 mol/L %
Transferrin saturation >45%
(fasting) may be consistent with
iron overload
Biochemistry
Fasting specimen is preferred. Tests should not be requested if
patient is taking Iron supplements. Required also if
haemochromatosis genetics is requested.
2 - 3 weeks
See Report
Haematology
Useful in Myeloproliferative Disorders. Referred to St. James’s
Hospital. Samples must be received into laboratory before 12:00
for same day dispatch.
Serum/ 5-10ml or
universal container 5 days
of urine
See Report
Microbiology
Dispatch
Dublin.
Heparin Gel Light
28 days
Green Cap - 4.5ml
See Report
Biochemistry
Specimen referred to Sheffield Diagnostic Genetics Service.
Histology
* TAT under review. To request test phone laboratory on 4797.
Haematology
Referred to National Maternity Hospital. Samples must be received
into laboratory before 12:00 for same day dispatch.
Iron Status including
Iron, Transferrin, TIBC
(calculated),% Iron
Binding Saturation
Blood
Heparin Gel 4.5ml (for all Iron
Status tests)
JAK2 Mutation
Blood
EDTA Lavender
Cap 3mls
JC/BK virus PCR
Blood or
fresh urine
Karyotyping
Blood
KRAS
Tissue
10 days*
Blood
EDTA Lavender
Cap 3ml
Blood/CSF
2 days
See Report
Blood: Pre-heparinised
blood gas syringe - ABG
2ml on ice. CSF: sterile
universal container - 1 ml
(minimum)
20 mins
Blood: arterial 0.36 - 1.25
mmol/L, Venous 0.90 - 1.7
mmol/L,
CSF:
refer to clinical protocol
Biochemistry
NB: Bloods for Lactate analysis must to be placed on ice
immediately and transported without delay to Biochemistry. CSF
specimen for Lactate must be brought to Biochemistry
immediately as the specimen must be frozen within 30
minutes.
Lactate Dehydrogenase
Blood
(LDH)
Serum Red Cap 6ml
4 hrs
240 - 480 U/L
Biochemistry
Must be red cap serum tube.
LDL Cholesterol
(calculated)
Blood
See fasting lipid profile.
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
See Comments
Biochemistry
Fasting specimen required. (Fasting 12 - 14 hours) Target LDL
Cholesterol following lifestyle advice or drug therapy is < 3.0
mmol/L.
Lead
EDTA Lavender
Cap 3 mls
<0.5 mol/L
Biochemistry
Referred to Outside Laboratory (City Labs). Specimens must be
received into laboratory before 12.00 for same day dispatch.
Kleihauer Test
Lactate Blood /CSF
Blood
4 months
Page 35 of 55
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Legionella Urinary
Antigen
Urine
5-10ml
24hrs (MonFri)
N/A
Lab
Comment
Microbiology
Part of screen for community-acquired pneumonia.
Microbiology
Dispatch
Microbiology
Dispatch
Dublin. Use Grey Serology/ Assay Request Form
Leishmania Abs
Blood
Serum/ 5-10ml
10 days
N/A
Leptospira Abs
Blood
Serum/ 5-10ml
10 days
N/A
Serum Red Cap
6 ml
3 days
Male: 2 - 14 U/L, Female:
Follicular 2 - 12 U/L, Mid Cycle
15 - 50 U/L, Luteal 5 - 15 U/L
Post Menopause 30 - 150 U/L
Endocrinology
State LMP.
Serum or Lithium
Heparin
1 week
See Report
Biochemistry
Referred to external lab. (Claymon Biomnis).
LH Luteinising Hormone Blood
Blood
Lipase
Lipids - Fasting
Includes Total
Cholesterol, HDL
Cholesterol, Calculated
Blood
LDL Cholesterol,
Triglycerides, HDL/Total
Cholesterol % (fasting
12 - 14 hours)
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
See under individual tests Biochemistry
Lipids - Non Fasting
Includes Total
Cholesterol and
Triglycerides
Blood
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
Lipoprotein
Blood
Serum
1 week
See Report
Biochemistry
Referred to external lab. (Claymon Biomnis).
Listeria Abs
Blood
Serum/ 5-10ml
10 days
N/A
Microbiology
Dispatch
Referred to Lab. of Healthcare-associated Infection , SRMD, CPHL,
Colindale, London. Use Grey Serology/ Assay Request Form.
Lithium
Blood
Therapeutic Range: 0.4 1.1 mmol/L
Biochemistry
Liver biopsy of graft
liver for frozen section
Serum Gold Cap 4 hrs
5ml
Fresh biopsy (dry)
and bring to lab
30 minutes
immediately
Histology
Page 36 of 55
Fasting specimen required (fasting 12 - 14 hours). Target
Cholesterol values following lifestyle advice or drug therapy are:
T.Cholesterol: <5.0 mmol/L, LDL Cholesterol: <3.0 mmol/L.HDL
cholesterol level: <1.0 mmol/L is a marker for increased CHD risk.
Specimens should be taken 12 hours after dose. Please Note:
Serum specimen only.
Liver Biopsy Urgent Out of Hours should be arranged through
Telephone Switch who will contact the Histopathologist -oncall and a Medical Scientist
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Liver Biopsy for
quantative copper
analysis
Fresh biopsy (dry)
Liver biopsy and bring to lab
immediately
Liver Function Tests
(LFT's) includes
albumin, total bilirubin,
alkaline phosphatase,
GGT, ALT
Blood
Liver Histology Urgent
Post-transplant
Liver biopsy 10% Formalin
Lupus Screen
Blood
Sodium Citrate
Light Blue Cap 3
mls x4 and
Serum Gold Cap
15 days
Lyme Disease Abs
Blood
Serum/ 5-10ml
5 days
Lymph Node (?
Lymphoma)
Lymph Node Dry container
Lab
Histology
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
If AST analysis is also required, please state on request form.
Histology
Contact the laboratory prior to sending sample if required
urgently. Liver Biopsy Urgent Out of Hours should be arranged
through Telephone Switch who will contact the Consultant-oncall and a Medical Scientist.
See Report
Haematology
See comments in thrombophilia screen in User Reference Manual.
N/A
Microbiology
Dispatch
Histology
Delivery to laboratory immediately and hand to a staff member.
6 hours
minimum
3 days
Lymphocyte subsets
(CD4 and CD8 T cells)
Blood
EDTA Lavender
Cap 3mls
10 days
T cells 57-79%,
Helper T CD4 34-51%
Cytotoxic T CD8+ 17-37%
Immunology
T cells 600-2200
Helper T 380-1500
Cytotoxic T 190-800
Macroprolactin
Blood
Serum Red Cap
6mls
10 Days
See prolactin minus
macroprolactin
Endocrinology
Magnesium (Mg)
Blood
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
0.7 - 1.0 mmol/L
Biochemistry
Comment
Contact Histology (Ext 4350) before taking specimen. When
specimen is taken deliver to Histology immediately and hand
to a member of staff. Specimen referred to The Royal
Infirmary, Glasgow.
Page 37 of 55
Specimens Referred to Immunology Dept, St. James' Hospital.
Please state time of collection on request form. Specimen must
be delivered to Microbiology before 12:30 pm (Mon - Fri).
See prolactin minus macroprolactin.
Turn Around
Reference Range
Time
Lab
Comment
Daily Mon Fri same day
3.0 - 4.25 mmol/24hr
if received
before 11am
Biochemistry
Serum Gold Cap
5mls
10 days
Haematology
Referred to London School of Hygiene and Tropical Medicine.
Blood
EDTA Lavender
Cap 3mls
2 - 4 hours
Haematology
Please contact Haematology Laboratory before taking samples with
clinical details, where the patient has been and relevant treatment.
Measles Abs
Blood
Serum/ 5-10ml
3 days
N/A
Microbiology
Dispatch
Meningococcal PCR
Blood or
CSF
EDTA / 6mls or
universal container
of CSF (see
24hrs
relevant CSF
section)
N/A
Microbiology
Dispatch
Referred to Irish Meningococcal Ref. Lab. Temple St. Childrens'
Hosp., Dublin. Samples must be delivered to Microbiology Lab
before 11.30am for same day results. Use Grey Serology/ Assay
Request Form.
Mercury
Blood or
Urine
Blood EDTA,
Urine: 24 hr
28 days
collection in acid
washed container*
Biochemistry
Referred to Public Analyst Lab. *Special container with
instructions available from Biochemistry. Instructions will be
explained to patient at the time of collection of container. Specimen
container must be kept upright at all times. Warning label 'Acid
washed container - container washed with conc. HCL' must be
attached to bottle.
Metabolic Profile
Blood or
Urine
Serum or 5 ml
Urine in universal
container
Biochemistry
Referred to Temple St. - please include clinical details for
interpretation of results.
Methemoglobin
Atrerial or
Venous
Blood
Pre-heparinised
blood gas syringe 20 mins
2ml. Ensure no air
present.
Biochemistry
The nornal fraction of Methemoglobin is <1.5% of the total
haemoglobin. Increased levels of Methemoglobin reduce the oxygen
carrying and oxygen releasing capacity of heamoglobin. Levels
above 10-15% can result in pseudocyanosis. Methemoglobin may
cause headache and dysnoea at levels above 30% and may be
fatal.
Specimen
Type
Magnesium (urinary)
24hr urine bottle
collection
preservatives
required
Malaria Antibodies
Blood
Malaria Screen
Container Type/
Volume
See Report
1 week
See Comment
Page 38 of 55
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
7 hrs
N/A
Biochemistry
48 hrs - 96
hrs
N/A
Microbiology
Investigation of carriage of MRSA. Use Yellow microbiology form.
See Report
Microbiology
Dispatch
Histology
Refered to Beaumont Neuropath Muscle Biopsies for Histochemistry
must be booked early by phoning Histology (Ext: 4350 or 4330), as
these are transported to Beaumont Hospital on the day taken. Bring
to the laboratory immediately. SVPH arrange their own transport.
Direct
Microscopy:
Universal Container 48hrs Fungal N/A
Culture: 2 - 3
wks
Microbiology
Use Yellow
microbiology
form
confirmed.
EDTA Lavender
Cap 3mls
28 days
Immunology
Specimens Referred to Harefield Hospital (UK).
5 days
N/A
Microbiology
Dispatch
48-96 hrs
N/A
Microbiology
Total CK is a more useful indication of Rhabdomyolysis.
Investigation of nasal carriage of St.aureus & MRSA. Use Yellow
microbiology form.
Serum Red Cap 6ml - Protected
specimen from
Light
Blood
MRSA Screen
Culture for MRSA
Nasal Swab
Transport Swabs
Groin Swab
Mumps IgM antibody
Blood or
saliva
Serum red/gold
cap 5mls or
4 days
Universal container
of saliva
Muscle Enzyme
Histochemistry
Skeletal
muscle
biopsy
In Salinemoistened gauze
Mycology Specimens
(Superficial)
Microscopy & Culture
Skin / Hair/
Nails
Mycophenolate
(Cellsept)
Blood
Myoglobin
Nasal Swab
Culture
Blood
Comment
Specimens referred to St James's Hospital. From Mon - Fri, during
opening hours specimens are dispatched from Biochemistry.
Specimen must be received in the laboratory before 12:00 for same
day dispatch. Dosage and time taken to be written on request form.
Contact Biochemistry in advance if 'urgent' high dose sample needs
to be sent out. Out of Hours Samples - (protect from light) are sent
to St. James Hospital by the ward. Notify St. James Hospital
before sending samples. Give contact number so St James'
can phone results.
Methotrexate (MTX)
Mycoplasma Abs
Lab
Serum/ 5-10ml
10 days
See Comment
Nasal Swab Transport Swab
Page 39 of 55
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Lab
Comment
Nerve Biopsy
Sural nerve
biopsy
In Salinemoistened gauze
15 days
Histology
Neuropath Muscle Biopsies for Histochemistry must be booked
early by phoning Histology (Ext: 4350 or 4330), as these are
transported to Beaumont Hospital on the day taken. Bring to the
laboratory immediately. SVPH arrange their own transport.
Neurokinin
Blood
EDTA Lavender
Cap 3mls
4 - 6 weeks
Biochemistry
Plasma must be frozen within one week. Specimens referred to : Dr.
Joy Ardill, Regulatory Peptide Lab, 2nd Floor Kelvin Building, Royal
Victoria Hospital, Belfast BT12 6BA
Neutrophil Alkaline
Phosphatase [NAP]
/Leucocyte Alkaline
Phosphatase [LAP]
Fresh blood
EDTA Lavender
Cap 3mls
20 days
15 - 100
Haematology
NAP may be useful in the diagnosis CML and Polycythemia Rubra
Vera [PRV]. Bring sample to lab immediately.
Nitrogen Excretion
(Urinary)
24hr urine bottle Urine - 24hr (plastic). No
collection
preservatives
required
24 hrs
7 - 10g/24hr (stable noncatabolic state) Up to 20
Biochemistry
- 30g/24hrs following
major surgery or trauma.
NTX-1
N-Terminal cross-linking
Urine
Telopeptide of Type 1
Collagen
2 hour timed urine
or 2nd morning
40 days
void*
25.5 - 72.4 nmol
BCE/mmol Cr
Metabolism
available from Lab. Results affected by:Fasting, Circadan
Variation.*Specimen container available for Metabolic Laboratory.
OCI
Osteocalcin Intact
Blood
Serum Red Cap 6
20 days
ml
Female: 9.7 - 18.1 ug/L
Male: 9.5 - 22.2 ug/L
Metabolism
available from Lab. Bring to Metabolic Laboratory on ice. Results
affected by: Fasting, Circadan variation.
Oestradiol
Blood
Serum Red Cap 6
3 days
ml
Male: 50 - 150 pmol/L,
Female: Follicular 130 -500
pmol/L,
Mid
Cycle 520 - 1470 pmol/L,
Luteal 110 - 620 pmol/L,
Post Menopause < 90 pmol/L
Endocrinology
State LMP.
Oestrogen Receptor
Breast or
Paraffin processed
7 days
Lymph node tissue
Histology
Page 40 of 55
Specimen
Type
Container Type/
Volume
Oligoclonal Banding
CSF (see
relevant
section for
information
on CSF) &
Blood
CSF and Serum
Gold Cap 4.5mls
Osmolality (blood)
Blood
Osmolality (urine)
Turn Around
Reference Range
Time
Lab
Comment
Specimens Referred to Immunology Dept, St. James's Hospital.
CSF must be accompanied by serum sample taken at the same
time.
Oligoclonal bands are found in the CSF of 80-90% of patients with
multiple sclerosis but may also be found in other
infectious/inflammatory disorders of the central nervous system
CSF Albumin 0.14-0.2 g/L CSF
IgG 0.02-0.04 g/L IgG Index 0-0.7
CSF IgG Pattern NORMAL
Immunology
Serum Red Cap or
Green Cap Plasma Daily
6 ml
280 - 295 mmol/kg
Metabolism
Urine
Universal Container Daily
N/A
Metabolism
Osmotic Fragility Test
Blood
Heparin Dark
Green cap (No Gel) 48 hours
x2
0.4 - 0.445%
Haematology
Test useful in patients with query Hereditary Spherocytosis. Please
make arrangements with laboratory (ext.4657) before taking
sample.
Oxalate
Urine
20 days
- no additive
Female: 0.04 - 0.32 mmol/24hr,
Male: 0.08 - 0.49 mmol/24hr
Metabolism
Part of stone screen. The date and time of start and finish of
collection must be clearly indicated.
P1NP procollagen-1Propeptide
Blood
Serum Red Cap 6
20 days
ml
27.2 - 71 ug/L
Metabolism
Part of Bone Biomarker. Protocol available from laboratory. Results
affected by: Fasting, Circadium varaition.
10 days
Paracetamol
(Acetaminophen)
Blood
Serum Red Cap 6
Daily
mls
See Comments. State
time of ingestion on form if Biochemistry
known.
For interpretation in overdose refer to paracetamol treatment
nomogram. Toxicity is related to post-dose interval, typically
>200mg/L at 4 hours, >100 mg/L at 8 hours, >50 mg/L at 12 hours
post overdose. Lower Paracetamol levels are used if patient is
higher risk. The time of ingestion should be stated on the
request form (if known), together with the date and time of
specimen collection. Specimens taken less than 4 hrs post
ingestion are not considered useful for prediction of toxicity.
Amitryptiline and Imipramine may show significant negative
interference in paracetamol assay.
Parathyroid Hormone
(PTH)
Blood
Serum Red Cap
6mls
12 - 64 ng/L
Specimens should be delivered to the laboratory as soon as
possible post venepuncture. If same day delivery is not possible
serum must be separated and frozen.
5 days
Metabolism
Page 41 of 55
Lab
Comment
Metabolism
* Do not mix up with Cross Match Tube. Send specimen to the
lab on ice. Specimen Referred to Royal Liverpool University
Hospital.
Cytology
See Report
Haematology
Must be delivered to laboratory. Do NOT use POD. Screening Test
only - futher Platelet Aggregation/Function assays are referred to
St.James's Hospital.
N/A
Metabolism
24 hrs urine collection, part of stone screen.
pH 7.35 - 7.45
Biochemistry
See Arterial Blood Gas
N/A
Biochemistry
Analyse within 2hrs of collection.
7 days
10 - 30 mg/L
Biochemistry
dispatch.
4 hrs
Therapeutic Range:10 20 mg/L
Biochemistry
The therapeutic range given is a guide only; individual patient
responses may vary and patients may exhibit toxic symptoms within
reference range.
Biochemistry
Adults 0.8 - 1.4 mmol/L
Biochemistry
Levels in children (2-12 years) are higher.
24 hours
See Report
Haematology
Sample must not be stored in fridge - samples are sent St.
James’s Hospital. Plasma should be seperated and stored at RT if
taken over weekend.
5 days
See Report
Haematology
Specimen
Type
Container Type/
Volume
Parathyroid -related
Peptide Hormone
(PTHrP)
Blood
Plasma PinkCap(Potassium EDTA 28 days
with Aprotinin) 5ml*
Peritoneal Fluid for
tumour
20 ml Fresh
Universal/20 mls
sample
PFA 100 Test
Blood
pH
Urine
pH
Blood
pH
Fluid
Phenobarbitone
Blood
Serum Red Cap 6ml
Phenytoin
Blood
Serum Red Cap 6ml
Phosphate (Urinary)
24hr urine bottle
collection
preservatives
required
Phosphate, Inorganic
(PO4)
Blood
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
Plasma Viscosity
Blood
EDTA Lavender
Cap 3mls X 2
Platelet Allo antibodies
Blood
Serum Gold Cap
Turn Around
Reference Range
Time
See report form
3 days
Sodium Citrate x 2,
4 Hrs
EDTA x1
Daily
or universal
Pre-heparinised
blood gas syringe - Daily
2ml
Collect or transfer
into heparinised
Daily
syringe.
Mon- Fri
same day if
16 - 48 mmol/24hrs
received
before 11am.
Page 42 of 55
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Platelet
Function/Aggregation
Studies
Blood
Sodium Citrate
Light Blue cap x 5
Pleural Fluid for tumour
20 ml Fresh
Universal / 20 mls
sample
PM Sample
(Toxicology)
Urine
Universal Container 4 months
Pneumococcal PCR
Blood or
CSF
EDTA / 6mls or
CSF (see relevant
section)
Pneumococcal Urinary
Antigen
Urine
Lab
Comment
Referred to Coagulation Lab, NCHCD, St.James. Samples must be
received there before 4pm
See Report
Cytology
N/A
Biochemistry
Referred to Outside Laboratory (Beaumont Hospital).
1 Day
N/A
Microbiology
Dispatch
5-10ml
24 hrs MonFri
N/A
Microbiology
Pneumocystis Carnii/
Jiroveci
Fresh
Broncho
Alveolar
Lavage
(BAL)
Large Container/
amount available
Daily
Cytology
Lab must be informed in advance if test required ungently- Ext.
4310/4613. Sputum not suitable.
PNH screen
Blood
EDTA Lavender
Cap 3mls X 2
48 hours
Haematology
Samples must be fresh. This replaces the Ham's test. Please make
arrangements with laboratory (ext.4792) before taking sample.
Provisional results available within 48 hrs.
Porphobilinogen (PBG)
Urine - 24hr
collection
(Spot urine if
emergency
request)
24hr urine bottle
(plastic) - no
preservatives
15 days
required - Protect
from light at all
times
Biochemistry
dispatch. Protect specimen from light at all times.
Porphyrins (blood)
Blood
EDTA x2, Lithium
Heparin x1
Protected from
light at all times
15 days
Biochemistry
* If patient presents with symptoms of an acute attack, please
forward a random urine to SJH and follow ASAP with other
three samples (blood, urine, faeces). Referred to Outside
Laboratory (St James's Hospital). Specimens must be received into
laboratory before 12.00 for same day dispatch.
Porphyrins (faeces)
Faeces
Universal container
- 10g - Protected
6 weeks
from light at all
times
Biochemistry
must be received into laboratory before 12.00. Full clinical history
required.
2 days
<16 mol/24hrs ….
Random Urine: <1.5
mol/mmol creatinine
Page 43 of 55
Referred to Irish Meningococcal Ref. Lab. Temple St. Childrens'
Hosp , Dublin. Use Grey Serology/ Assay Request Form.For same
day results samples must be received in microbiology lab
before 11.30am
Part of screen for Community-acquired pneumonia. Use Yellow
microbiology form.
Specimen
Type
Container Type/
Volume
Porphyrins (urine)
Urine
24hr urine bottle
(plastic) - no
preservatives
15 days
required - Protect
from light at all
times
Potassium (K)
Blood
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
Potassium (Urinary)
PRA
Plasma Renin Activity
Pregnancy Test
24hr urine bottle
collection
preservatives
required
2 x 3 ml EDTA
Blood
Lavender Cap
tubes on ice
Urine or
Serum
10 mls
Turn Around
Reference Range
Time
Mon - Fri
Same day if
30 - 100 mmol/24hrs
received
before 11am
17 days
Daily: 30
mins after
specimen
received.
2 months batched
2 X Serum
analysis;
separated & frozen
dispatched
weekly
Serum Red Cap 6
3 days
ml
Procollagen Type III
Amino Peptide
Blood
Progesterone
Blood
Progesterone Receptor
Breast or
Paraffin Processed
7 days
Lymph node tissue
Prolactin (Total)
Blood
Prolactin minus
Macroprolactin
Blood
3.5 - 5.0 mmol/L
Serum Red Cap 6
3 days
ml
Serum Red Cap 6
10 days
ml
Lab
Comment
Biochemistry
dispatch.
Biochemistry
Bring to laboratory as soon as possible - elevated values can occur
if separation of plasma from blood cells is delayed. Do not
refrigerate whole blood. Do not take blood from a limb with an IV
Potassium Infusion.
Biochemistry
Upright: 0.5 - 6.8 ng/ml/h Endocrinology
Send samples on ice to laboratory immediately. Indicate posture.
State if urgent
Qualitative HCG test. Sensitivity 25 IU/L.
Quantative HCG levels on serum samples are available from
Nuclear Medicine Laboratory.
<25 iu/l
Immunology
1.7 - 4.2 g/L
Biochemistry
Referred to Outside Laboratory (Manchester Royal Infirmary).
day dispatch.
Luteal > 22 nmol/l
Endocrinology
State LMP.
Histology
Female: 105 - 548 mUl/L,
Male: 89 - 365 mU/L
Endocrinology
Female: 83 - 383 mUl/L,
Male: 73 - 247 mU/L.
Endocrinology
Page 44 of 55
Specimen
Type
Protein (Total)
Blood
Protein C
Blood
Protein/Creatinine Ratio
Urine
(UPCR)
Container Type/
Volume
Plasma Light
Green Cap - 5ml
Sodium Citrate
Light Blue Cap 3
mls
24hr urine bottle
Protein Electrophoresis - Urine - 24hr (plastic) - no
(Urine Quantitative)
collection
preservatives
required
Protein Electrophoresis
Blood
(Serum)
Serum Gold Cap5ml
24hr urine bottle
collection
preservatives
required
Prothrombin Mutation or
EDTA Lavender
Blood
PT 3 UTR
Cap 3 mls
Sodium Citrate
Prothrombin Time
Blood
Light Blue Cap 3
mls
Protein Excretion
(Urinary)
PSA (Free)
(FPSA)
Blood
Lab
4 hrs
60 - 85 g/L
Biochemistry
6 hours urgent
75 - 155 iu/dl
Haematology
Tests done in batches as part of the Thrombophilia screen every 4 6 weeks, unless requested urgently.
Biochemistry
UPCR > 45mg/mmol should be considered positive for proteinuria,
although lower levels may be significant in the concomitant
presence of haematuria. Diagnosis of persistent proteinuria requires
2 or more positive tests, one to two weeks apart. UTI should always
be out ruled in a positive sample as this can lead to a false positive
result.
Mon - Fri
Random urine
Same day if
specimen, Early
3 - 14 mg/mmol
received
Morning if possible
before 11am
Protein Electrophoresis - Urine - fresh Sterile universal
spot
container - 10ml
(Urine Qualitative)
Comment
Turn Around
Reference Range
Time
7 days
Qualitative Reporting
Biochemistry
7 days
Quantitative Reporting of
paraprotein level (where
applicable)
Biochemistry
7 days
60 - 85 g/L (Total Protein)
Qualitative reporting for all
other fractions.
Biochemistry
Quantitation of
Paraprotein Level (where
applicable)
N.B: Serum specimen essential. Give full clinical details.
Depending on the results of the electrophoresis, specimens may be
sent for immunofixation.
Mon - Fri
Same day if
0.05 - 0.15 g/24hr
received
before 11am
Biochemistry
4 weeks
See Report
Haematology
3 hours
11.5 - 13.5 seconds
Haematology
One sample sufficient for PT, INR, APTT, D-Dimers, Fibrinogen.
N/A
Nuclear Medicine
The free PSA is expressed as a ratio of the total PSA present in the
specimen. Most useful if total PSA 4 - 10 g/L.
Serum Gold Cap 6
2 days
ml
Page 45 of 55
Lab
Comment
Age Related:
40-49 <2.5 µg/L,
50-59 <3.5 µg/L,
60-69 <4.5 µg/L,
70-99 <6.5 µg/L
Nuclear Medicine
As well as prostate cancer, PSA may be elevated in patients with
BPH, prostatitis or following manipulation of the prostate, e.g. after
needle biopsy. The role of PSA in prostatic cancer screening is
controversial.
Usually in a
8 days
Universal Container
N/A
Microbiology
TAT is 8 days to allow for enrichment
Blood
Serum Red Cap
6mls
12 - 64 ng/L
Metabolism
Parathyroid Hormone
Related Peptide
Blood
Potassium EDTA
3 - 4 weeks
+ Aprotinin x2*
* Specimen Containers
available from
Phlebotomy.
Metabolism
Q Fever / Coxiella Abs
Blood
Serum/ 5-10ml
N/A
Microbiology
Dispatch
Quantiferon
Blood
Special containers
available from
1-5 days
Microbiology Lab
See Report
Microbiology
Dispatch
Red Cell Transketolase
Blood
Heparin Gel Light
Green 4.5 mls
1 month
See Report
Haematology
Do not centrifuge sample. Referred to Claymon Biomnis.
Renal Biopsy, fresh
renal cortex
Needle
Biopsy
Tissue in a small
amount of Saline
10 days
NA
Histology
Contact the Histology Laboratory (Ext 4797 or 4350) before
taking biopsy samples. Bring fresh specimen to histology lab
immediately and give to staff member to check sample
adequacy before leaving the laboratory.
Renal phosphate
threshold (TmP)
Blood
Metabolism
Fasting specimen required, part of Bone Biomarker Profile Protocol
available from Matabolic Lab.
Renal phosphate
threshold (TmP)
Urine
Metabolism
Fasting specimen required, part of Bone Biomarker Profile Protocol
available from Matabolic Lab.
Specimen
Type
Container Type/
Volume
PSA (Total)
(TPSA)
Blood
Serum Gold Cap 6
2 days
ml
Pus
Pus
Parathyroid Hormone
(PTH)
Turn Around
Reference Range
Time
5 days
5 days
Serum Red Cap
20 days
6mls
2 hour timed
morning collection,
20 days
bottle available in
Lab.
0.84 - 1.48 mmol/L
Page 46 of 55
Where possible specimens should be delivered to the laboratory on
the day they are taken. If same day delivery is not possible serum
must be frozen.
* Specimen Containers available from Phlebotomy. Send
specimens to Metabolism on ice. Specimens referred to Dept Clin
Chem, 4th Floor, Duncan Building, Royal Liverpool Hospital,
Prescot St, Liverpool L7 8XP.
Available Monday to Thursday only.Please contact Microbiology Lab
for relevant request form and sample containers. Samples must be
received before 14:30. Samples are referred to the TB Laboratory in
the Mater Hospital
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Renal Profile
(Urea/Electrolytes).
Includes urea,
creatinine, sodium,
potassium, chloride.
Blood
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
Respiratory Viruses (IF
and PCR)
Throat swab,
Nasopharng Swab from site or
eal swab or BAL (universal
aspirate,
container)
BAL
Retic Count
Blood
Rickettsia Abs
Rubella Abs
Lab
On request
See Report
Microbiology
Dispatch
EDTA Lavender
Cap 3ml
4 hours
16-80 x 10^9/l.
Haematology
Blood
Serum/ 5-10ml
10 days
N/A
Blood
Serum/ 5-10ml
5 days
N/A
NB: Do not take blood from a limb with an IV Infusion. Do not place
whole blood specimen for Potassium analysis in fridge.
One EDTA sample is adequate for Full Blood Count and Retic
Count. Test is inappropriate post transfusion.
Specimens referred to Outside Laboratory. Use Grey Serology/
Assay Request Form.
Immunology
RF is positive in 80% of patients with rheumatoid arthritis.
Negative RF makes a diagnosis of RA unlikely, however does not
completely exclude diagnosis.
High levels of RF are frequently associated with rheumatoid arthritis.
Levels of rheumatoid factor may increase with age, infection,
malignancy, therapy with certain drugs, and in a range of
inflammatory disorders.
See Comments
Biochemistry
Severity of salicylate poisoning cannot be assessed from serum
levels alone. Salicylate intoxication is usually associated with levels
of > 350 mg/L. Severe toxicity is associated with salicylate levels of
> 700 mg/L. Conjugated bilirubin levels above 140 mol/L may
cause significant negative interfearance in the salicyclate assay.
10 days
N/A
Microbiology
Dispatch
2 weeks
See Report
Biochemistry
Rheumatoid Factor (RF) Blood
Serum Gold Cap
Salicylate
Blood
Serum Red Cap
6mls
Daily
Schistosoma Abs
Blood
Serum/ 5-10ml
Selenium
Blood
Serum Trace
stripe on tube.
Microbiology
Dispatch
Microbiology
Dispatch
Comment
1 day
0-20 IU/ml
Page 47 of 55
SHBG
Sex Hormone Binding
Globulin
Sickle Cell Screening
Test
Sirolimus (Rapamune)
Skin for DIF
Immunofluorescence
1. ? Bullous
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Blood
Serum Red Cap
6 ml
10 days
EDTA Lavender
Cap 3ml
EDTA Lavender
Blood
Cap 3mls
Fresh skin to
Peri-lesional Histology lab
immediately
Blood
Lab
Female: 25 - 122 nmol/L,
Endocrinology
Male: 11 - 54 nmol/L
Comment
State if patient is on oestrogen or pregnant.
2 hours
Haematology
20 days
Immunology
Specimens Referred to Harefield Hospital (UK).
7 days
Histology
Contact laboratory priory to taking biopsy Ext. 4797/4350. GP DIF
samples use saline-moistened gauze.
Skin for DIF
Immunofluorescence
2. ? SLE/DLE
3 biopsies:
lesional, non- Fresh skin to
lesional and Histology lab
non-lesional immediately
exposed
7 days
Histology
Contact laboratory priory to taking biopsy Ext. 4797/4350. When
specimen is taken delivery to Histology immediately and hand to
staff member. GP DIF samples use saline-moistened gauze.
Skin for DIF
Immunofluorescence
3. ? Vasculitis
A fresh
lesion
Fresh skin to
Histology lab
immediately
7 days
Histology
Contact laboratory priory to taking biopsy Ext. 4797/4350. GP DIF
samples use saline-moistened gauze.
Skin Sentinel Node
melanoma detection
10% Formalin
Adjacent
labelled
lymph nodes
Radioactive
3 days
Histology
immediately in containers of adequate size. The container must be
as least ten times the volume of the tissue. Ensure samples and
form are labelled radioactive.
Sodium (Na+)
Blood
Biochemistry
NB: Do not take blood from a limb with an IV Infusion.
Sodium (Urinary)
Sodium Concentration
(Urinary Spot)
Sputum
Culture for respiratory
pathogens
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
24hr urine bottle
collection
preservatives
required
Sterile Universal
Urine - Fresh
Container - 5ml
spot
(min)
Sputum
135 - 145 mmol/L
Mon - Fri
Same day if
80 - 250 mmol/24hr
received
before 11am
Biochemistry
7 hrs
Refer to clinical protocol
Biochemistry
N/A
Microbiology
Universal Container 72 hrs
Page 48 of 55
Sputum from CF patients take up to working days for culture results
due to requirements for Molecular Identification. Use Yellow
microbiology form.
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Sputum for tumour
Fresh
sample
Universal /approx 5
3 days
mls
Lab
Comment
Cytology
Microbiology
Dispatch
Microbiology
Dispatch
Strongylloides Abs
Blood
Serum/ 5-10ml
10 days
N/A
Syphilis Serology
Blood
Serum/ 5-10ml
5 days
N/A
Tacrolimus (also known
Blood
as FK 506 or Prograf)
EDTA / 3mls
4 days
Each patient should be
individually monitored
Immunology
Sensitivity of assay 1.5ug/L. Take trough sample (i.e. pre-dose).
Samples should be stored at 4 degrees Celsius (fridge) overnight.
TB Specimens
AFB Stain & TB Culture
Various
Acid-Fast
Depending on the Stain: 24sample usually
48hrs TB
Universal Container Culture: 26wks
N/A
Microbiology
confirmed. Use Yellow microbiology form.
TCR Gene
Rearrangements
Bone
Marrow or
Blood
Marrow in RPMI or
EDTA Lavender
2 - 3 weeks
Cap 3ml
See Report
Haematology
Useful in T Cell Malignancies. Referred to St. James’s Hospital.
Samples must be received into laboratory before 12:00 for same
day dispatch.
Teicoplanin
Blood
Serum Gold Cap
5mls
Microbiology
Pre dose sample should be taken immediately before the next dose
is given. Pre-Dose Level: 10-40 mgs/L. Use Grey Serology/ Assay
Request Form LF-MIC-REQ2.
Testicular Histology
Testicular
Biopsy
Twice weekly
See Comments for
(Tues and
Therapeutic Range
Thurs)
Bouins Fixative (in
2-3 days
theatre)
Serum Red Cap 6
10 days
ml
Female: 0.3-1.7 nmol/L ,
Male: 7.9-28.9 nmol/L
Endocrinology
Indicate gender.
15 days
Female 0.5 - 4.5
Endocrinology
This is a calculated test. See testosterone and SHBG for specimen
requirements.
4 hrs
Therapeutic Range:10 Biochemistry
20 mg/L See comments.
Testosterone
Blood
Testosterone:SHBG
Ratio
Blood
See Comment
Blood
Serum Red Cap 6ml
Histology
Thalassaemia Screen
See Haemoglobinopathy
Screen
Theophylline
Page 49 of 55
Blood should not be taken from a limb with an IV Aminophylline
Infusion.Therapeutic effects may be achieved at levels above 5
mg/L and undesirable side effects may occur at >15 mg/mL.
Therefore, a lower therapeutic range has also been recommended
to reduce toxicity (5 - 15 mg/L).
Specimen
Type
Thioguanine Nucleotide Blood
Comment
Referred to Dr. Lynette Fairbanks, 3rd Floor Block 7, South Wing,
St. Thomas Hospital, London SE1 7EH.
Container Type/
Volume
Turn Around
Reference Range
Time
Lab
EDTA Lavender
Cap 3mls x 2
20 days
See Report
Biochemistry
48hrs
N/A
Microbiology
For bacterial cause of sore throat. Use Yellow microbiology form.
Testing is inappropriate during acute post thrombotic phase.
Samples must be received in laboratory before 16:00 as samples
require preparation prior to storage. See guidelines for
Thrombophilia Testing in User Reference Manual.
Throat Swab
Throat Swab Transport Swab
Thrombophilia Screen
[includes Protein C,
Protein S, Anti-thrombin,
Activated Protein C
Resistance, Fibrinogen,
Lupus Screen
Blood
Sodium Citrate
Light Blue Cap 3ml
4-6 weeks
x 5 , Serum gold
cap x 1, EDTA x 1
Reports Issued with
interpretative comments
Haematology
Thyroglobulin levels
(TG)
Blood
Serum Red Cap
6mls
1.5 - 35 ng/ml
Endocrinology
Thyroid FNA
At least 6 airdried smears
+ needle
In slide tray
rinse in
Cytolyt*
5 days
Cytology
*Cytolyt available from Cytology
Tissue for C&S
Various
Sterile
8 days
Microbiology
Special 70mls container (yellow-capped) available in theatre. No
formaldehyde should be added.
Tobramycin
Blood
Serum Gold Cap
5mls
Daily, Samples
must be received
before 2pm (MonFri) and before
11am (Sat-Sun)
See Comments for
Therapeutic Range
Microbiology
Single Daily Dose Regimen Patients on once daily regimens should
have specimens taken 12-24 after the dose is given. Pre-Dose
Level: <1.0 mgs/L. Use Grey Microbiology Serology/ Assay
Request Form LF-MIC-REQ2.
Total T3
Blood
Serum Gold Cap 6
2 days
ml
1.3 - 2.6 nmol/L
Nuclear Medicine Usually used as a second line test to TSH.
Blood
Serum Red Cap 6mls, Fluoride
Oxatate (grey
topped) tube
required for
Ethanol.
Toxicology Blood
Screen Please do not
request Toxicology Blood
Screen, but specify drug
tests required e.g
Paracetamol, Salicylates,
Ethanol.
20 days
10 days
N/A
Biochemistry
Page 50 of 55
Requests for other drugs such as Tricyclics, Benzodiazepines, or
Barbiturates will be referred to Beaumont Hospital. Specimens
dispatch. Urgent specimens - send directly from ED to Beaumont
Hospital by taxi. Paracetamol, Salicylates, Ethanol are carried out in
Biochemistry see individual tests for details of specimen types and
TAT.
Comment
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Toxocara Abs
Blood
Serum/ 5-10ml
10 days
N/A
Toxoplasma Abs
Blood
Serum/ 5-10ml
5 days
N/A
TPMT
(Thiopurine
Methyltransferase)
Blood
Potassium EDTA
(purple topped
vacutainer) X 2
8 weeks Batched
analysis;
dispatched
weekly
Normal: 26 - 50
pmol/h/mgHb
Carrier: 10 - 25
Biochemistry
pmol/h/mgHb Deficiency:
<10 pmol/h/mgHb
Referred to Outside Laboratory (Guys Hospital London).
day dispatch.
TRACP5b
Tartrate-Resistant acid
Phosphatase
Blood
Serum Red Cap 6
60 days
ml
Age and gender specific
Metabolism
Part of Bone Biomarkers.Bring specimen to laboratory on ice.
Protocol available from Metabolic Lab.
Transferrin
Blood
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
2.0 - 3.4 g/L
Biochemistry
Trichinella Abs
Blood
Serum/ 5-10ml
N/A
Microbiology
Dispatch
Triglycerides
(Fasting 12-14 hours)
Blood
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
0.15 - 1.8 mmol/L
(Fasting)
Biochemistry
Fasting is the preferred specimen.
10 days
Lab
Microbiology
Dispatch
Microbiology
Dispatch
The universal definition of myocardial infarction requires a rise
and/or fall of cardiac troponin in patients with symptoms of cardiac
ischaemia or ECG changes, with at least one value above the 99th
percentile (upper limit of normal). Therefore it is recommended that
two troponin specimens are taken for measurement, the first at
presentation and the second at a minimum of 6 hours later.
In a clinically ischaemic patient consider AMI if:
a) TNThs changes by 100% in two specimens at least 6 hrs apart
AND
b) at least one result is >14ng/L.
Troponin T High
Sensitivity (TNThs)
Blood
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
3 - 14 ng/L
(99th centile of values in a Biochemistry
healthy population)
Tryptase - for
Anaphylatic Reaction
Blood
Serum Gold Cap 6
20 days
ml*
See Report
Biochemistry
Dispatch
TSH
Blood
Serum Gold Cap 6
2 days
ml
0.27 - 4.2 mIU/L
Nuclear Medicine TSH is performed as a front line thyroid function test.
Page 51 of 55
* Three samples to be taken at 1 hour, 3-6 hours and 24 hours.
Referred to Immunology St. James Hospital.
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Urate (Uric Acid)
Blood
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
Urate (Urinary)
24hr urine bottle
collection
preservatives
required
Urea
Blood
Urea (Urinary)
24hr urine bottle
(plastic) - no
Urine - 24hr
preservatives
collection or
required or Sterile
spot urine
Universal container
(spot)
0.14 - 0.42 mmol/L
Mon- Fri
Same day if
1.48 - 4.46 mmol/24hr
received
before 11am.
Heparin Gel Light
4 hrs
Green Cap - 4.5ml
2.1 - 7.1 mmol/L
Mon- Fri
Same day if
received
before 11am.
Comment
Biochemistry
Specimens for Urate from patients on rasburicase should be
taken into pre-chilled tubes and placed on ice immediately.
Bring to Biochemistry without delay. Inform laboratory staff
that the patient is on rasburicase.
Biochemistry
Biochemistry
Biochemistry
Urea / Electrolytes
See Renal Profile
Urinary Haemosiderin
Lab
Biochemistry
Urine
Urinary Myoglobin
[See CK]
Universal Container
5 days
20 ml
Haematology
See Comment
Total CK is more useful indication of Rhabdomyolysis.
Urine Examination
Cell Count/ Culture
MSU / CSU Universal Container
Microscopy same
day Culture and
Sensitivity: 2472hrs
Urine for tumour
Fresh
sample
Sterile Universal
3 days
Valproate (Valproic
Acid)
Blood
Serum Red Cap 6mls
Same Day
Samples must be fresh.
WCC: 1 - 10/cmm
RCC: <1 /cmm
Colony Count:
>100,000CFU/ml is
indicative of UTI
Microbiology
Colony Count: >100,000CFU/ml indicative of UTI. Use Yellow
microbiology form.
Cytology
40 - 100 mg/L
Page 52 of 55
Biochemistry
Serum concentrations are no better a guide to clinical response
than is the dose. Therefore routine monitering of valporate
concentrations is not recommended. Measurment in psychiatric
patients may be useful when compliance is an issue.
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Lab
Comment
Vancomycin
Blood
Serum Gold Cap
5mls
Daily, Samples
must be received
before 2pm (MonFri) and before
11am (Sat-Sun)
See Comment for
Therapeutic Range
Microbiology
Pre dose samples should be taken immediately before the next
dose is given. Pre-dose levels should be <15mgs/L
Varicella zoster virus
IgG and IgM Abs
Blood
Serum/ 5-10ml
2-3 working
days
N/A
Microbiology
Dispatch
Varicella zoster virus
PCR
CSF
CSF (see relevant
2 days
section on CSFs)
See Report
Microbiology
Dispatch
Dublin
Vitamin A
Blood
7 weeks Serum Non Gel - batched
6ml - Protect from analysis;
light - Frozen
dispatched
weekly
1.6 - 3.7 mol/L
Biochemistry
dispatch. To be frozen. Batched weekly for dispatch.
Vitamin B1 (Thiamin)
Blood
2ml EDTA whole blood
frozen within 4 hours &
protected from light
Biochemistry
Referred to Claymon Biomnis
Vitamin B12
Blood
Vitamin B6
Blood
Vitamin C
Blood
Vitamin D (1,25(OH)2D)
Calcitriol
Blood
Viscosity - See Plasma
Viscosity
Serum Gold Cap 6
2 days
ml
EDTA whole blood
frozen within 4
7 days
hours - Protect
from light
191 - 663 ng/L
Nuclear Medicine Please state if patient is receiving exogenous Vitamin B12.
42 - 115 mmol/L
Biochemistry
Specimens should be stored away from light. Referred to
Outside Laboratory (Claymon Biomnis). Specimens must be
received into laboratory before 12.00 for same day dispatch.
**Plasma Green
Cap - 5ml. Protect 6 days
from light.
See Report
Biochemistry
**Bring specimen to laboratory immediately as specimen must
be frozen within one hour. 3mls of frozen plasma is required
for test. Specimen must be stored away from the light.
Specimen referred to Claymon Biomnis.
Serum Red Cap 6
60 days
ml
22.8 - 153.6 pmol/L
Metabolism
serum must be separated and frozen (ideally within 4 hrs).
Page 53 of 55
Specimen
Type
Container Type/
Volume
Vitamin D (25(OH)D)
Blood
Serum Red Cap 6
20 days
ml
Vitamin E
Blood
Vitamin K
Serum
Vitamin K for Warfarin
Resistance
Serum
VKORC1
Blood
VMA
24hr urine
Urine - 24hr collection in an
collection
acidified 24 hrs
urine container
Von Willebrand's
Disease screen
Blood
VRE Screen
Rectal Swab Transport Swab
Lab
Comment
Recommended
Threshold > 50 nmol/L
Metabolism
serum must be separated and frozen (ideally within 4 hrs).
Turn Around
Reference Range
Time
Serum Non Gel 6ml - Protect from
light
**Red/Gold Cap
2mls Protect from
light.
Red/Gold Cap
6mls Protect from
light
7 weeks
21.3 - 43.8 mol/L
Biochemistry
4 weeks
See report form
Biochemistry
20 days
See Report
Haematology
Referred to St. Thomas Hospital, London.
EDTA Lavender
Cap 3 ml
20 days
See report form
Haematology
Referred to St. Thomas Hospital, London. Genetic test to detect
Warfarin resistance. Warfarin levels should also be measured.
2.5 - 45 mol/L
Biochemistry
Referred to Outside Laboratory (St James's Hospital). Special
Instructions will be explained to patient at the time of collection of
container. Specimen container must be kept upright at all times.
Warning label 'This bottle contains strong acid preservative'
must be attached to bottle.
See Report
Haematology
laboratory before 12:00 for same day dispatch. Samples received
after the daily Claymon collection should be sent to coagulation lab
fro separation and freesing.
4 days
N/A
Microbiology
15 days
Sodium Citrate
Light Blue Cap 3ml 3 weeks
x4
dispatch. Batched weekly for dispatch.
**Protect specimen from light. Serum must be seperated and frozen
within 1 hour. Referred to Claymon Biomnis Laboratory. Batched
weekly for dispatch.
vWF Cleaving Protease
See ADAMTS 13
Warfarin Levels
Blood
Serum Red/Gold
Cap 6mls
10 days
See Report
Haematology
Serum must be seperated. Vitiman K levels must also be
measured. Specimens referred to St.Thomas Hospital, London.
White Cell Differential
Blood
EDTA Lavender
Cap 3 ml
4 hours
See Report
Haematology
Differential included in Full blood count during routine hours.
Page 54 of 55
Lab
Comment
N/A
Microbiology
State site of swab on form. Use Yellow Microbiology Request Form.
Referred to Div. of Enteric Pathogens, CPHL, Colindale, London.
Specimen referred to Charing Cross Hospital.
Specimen
Type
Container Type/
Volume
Turn Around
Reference Range
Time
Wound Swabs
Various
Swab from site or
exudate
48 - 96 hrs
Yersinia Abs
Blood
Serum/ 5-10ml
10 days
N/A
Microbiology
Dispatch
Zinc
Blood
Serum Trace
stripe on tube.
2 weeks
See Report
Biochemistry
Page 55 of 55

Laboratory Medicine Edition 9 Effective March 2011

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