HAEMATOLOGY USERS' HANDBOOK

HAEMATOLOGY AND BLOOD TRANSFUSION

USER HANDBOOK

HAEM-PD-UserHbook V9 Haematology and Blood Transfusion User Handbook Page 2 of 40 Authors: Karen Orfinada (Senior Biomedical Scientist) Sally McDonald (Senior Biomedical Scientist), Yurdum Mohammad (BMS) Authorised by: Debbie Mann Review Date: 10

th October 2016

Table of Contents

Table of Contents ..................................................................................................................................................................................................... 2

General Information .................................................................................................................................................................................................. 3

Location ....................................................................................................................................................................................................................................... 3

Contact Numbers and Working Hours ......................................................................................................................................................................................... 3

Near Patient Testing facilities (Point of Care Laboratories) ......................................................................................................................................................... 4

Phlebotomy Services ................................................................................................................................................................................................................... 5

Urgent Requests ......................................................................................................................................................................................................................... 5

Out-of-Hours Service (after hours Monday - Saturday, Sunday and Public Holidays). ................................................................................................................. 5

Making a complaint to the Laboratory .......................................................................................................................................................................................... 5

Medical Staff ............................................................................................................................................................................................................................... 6

Completion of the request form ................................................................................................................................................................................................... 7

Sample Collection (phlebotomy) .................................................................................................................................................................................................. 7

Vacutainer™ Guide ..................................................................................................................................................................................................................... 8

Sample Labelling ......................................................................................................................................................................................................................... 9

Sample Transport to the Laboratory ............................................................................................................................................................................................ 9

Special Handling Requirements .................................................................................................................................................................................................. 9

Routine Haematology (page 1 of 3) ........................................................................................................................................................................ 10

Blood Transfusion (page 1 of 5) ............................................................................................................................................................................. 13

Routine Coagulation (page 1 of 2) .......................................................................................................................................................................... 19

Haemostasis (page 1 of 6) ...................................................................................................................................................................................... 21

Special Haematology (page 1 of 3) ........................................................................................................................................................................ 27

Haemoglobinopathy Genetics (page 1 of 1) .......................................................................................................................................................... 30

Flow Cytometry (HIV and Immunophenotyping) (page 1 of 5) ................................................................................................................................ 31

Specialist Integrated Haematological Malignancy Diagnostic (SIHMDS) (page 1 of 5) .......................................................................................... 36


th October 2016

General Information

Location The Haematology and Blood Transfusion laboratories are located at 60 Whitfield St London W1T 4EU. Samples are sent from the main hospital to Specimen Reception via the ‘Pod’ system and sample deliveries made by courier or from other sites are made via a rear building entrance in Howland Mews. Near Patient Testing facilities for Haematology/Oncology patients are located on the Lower Ground Floor of the MacMillan Cancer Centre on Huntley Street. Haemoglobinopathy Genetics laboratories are located at Ground Floor, 307 Euston Road, London. NW1

Contact Numbers and Working Hours

General Manager 0203 447 2968 or x72968 9.00 – 17.15 Monday - Friday

Debbie Mann

Training and Development Manager 0203 447 9887 or x79887 9.00 – 17.15 Monday - Friday

Stefan Kunka

Quality Compliance Coordinator 0203 447 9887 or x79887 9.00 – 17.15 Monday - Friday

Susan Crouch

Health & Safety Officer 0203 447 8533 or x78533 9.00 – 17.15 Monday - Friday

Norma McQueen

Routine Haematology & Coagulation 9.00 – 19.15 Monday – Friday 9.00 – 13.30 Saturday 9.00 – 13.00 Sunday

Departmental Lead: Billy Janda 0203 447 8961 or 78961 9.00 – 17.15 Monday - Friday

Routine Haematology & General Enquiries 0203 447 8525 or x78525 Routine Coagulation 0203 447 8547 or x78547

Out-of-hours Bleep 7060

Haemostasis Laboratory (Specialised Coagulation) 0203 447 8549/8529 or x78549/78529 9.00 – 17.15 Monday – Friday

Departmental Lead: Pamela Carr 0203 447 8545 or x78545

Flow Cytometry (HIV and Immunophenotyping) 0203 447 9603 or 79603 9.00 – 17.15 Monday – Friday

Departmental Lead: Naina Chavda 0203 447 8541 or x 78541

A limited Leukaemia Immunophenotyping service is available out-of-hours (subject to authorisation by a Haematology Consultant).


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Blood Transfusion Laboratory 0203 447 8522/8523 or x78522/78523 9.00 – 19.15 Monday – Friday

Out-of-hours Bleep 7060 9.00 – 13.30 Saturday 9.00 – 13.00 Sunday

Service Manager: Jenny Berryman 0203 447 8522/8523 or x78522/78523 9.00 – 17.15 Monday - Friday Acting Laboratory Manager: Ian Longair 0203 447 8521 or ext 78521 9.00 – 17.15 Monday – Friday Blood Transfusion Quality Manager: Lubna Awas 0203 447 8521 or ext 78521 9.00 – 17.15 Monday – Friday

MAJOR HAEMORRHAGE

For a Major Haemorrhage at any time: dial telephone extension 2222 (or extension 32222 from the Heart Hospital) and state "Major Haemorrhage" to the switchboard operator to activate the UCLH Trust’s Major Haemorrhage Protocol. In the event of a telephone network failure: dial the Analogue Direct

Telephone Line to Blood Transfusion *020 7 631 0267, or Emergency Mobile *0771 851 2912.

Note, these telephone numbers are for emergency use only: any use of these lines for routine communication will be reported as a clinical incident.

Special Haematology (Haemoglobinopathies) 0203 447 8533 or x78533 9.00 – 17.15 Monday – Friday

Departmental Lead: Norma McQueen

Haemoglobinopathy Genetics 0203 447 9458 or x79458 or 0204 447 5565 or 75565 9.00 – 17.00 Monday – Friday

Scientific and Clinical Departmental Lead: Dr Mary Petrou

Operational Lead: Kristian Rennie

See separate User Handbook for Haemoglobinopathy test information - Haemoglobinopathy Genetics User Handbook (HAEM-PD-HGUserHbook) ;

SIHMDS Specimen Reception (for all Haematological Malignancy samples) 0203 447 8518 or 78518 9.00 – 17.15 Monday – Friday

Samples are forwarded from the SIHMDS specimen reception to Flow Cytometry, Histology and external reference laboratories.

Near Patient Testing facilities (Point of Care Laboratories)

Haematology Point of Care Laboratories provide Full Blood Count results exclusively for Haematology/Oncology outpatients receiving chemotherapy or attending clinic appointments and for the Accident and Emergency Department. MacMillan Cancer Centre (Huntley Street), Lower Ground Floor 0203 447 6855 or extension 76855 08.00 – 17.00 Monday-Friday Accident and Emergency Laboratory – contact main laboratory 0203 447 8961 or extension 78961 08.00 – 20.00 Monday – Friday.


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Phlebotomy Services

For phlebotomy opening times please refer to INSIGHT phlebotomy page via the following link: http://insight/departments/MedicineBoard/Pathology/HaematologyPathology/Phlebotomy/Pages/default.aspx

Urgent Requests

Please contact the relevant laboratory during routine working hours, or Bleep 7060 outside routine working hours to alert laboratory staff of samples en route for urgent processing.

Out-of-Hours Service (after hours Monday - Saturday, Sunday and Public Holidays).

The Haematology Laboratory provides a 7 day / 24 hour restricted service outside of routine hours: a Biomedical Scientist can be contacted via the relevant

Routine Haematology, Routine Coagulation or Blood Transfusion laboratory telephone extension number until 19.15 (see above), or via Bleep 7060 at any time.

The following services are available out of routine working hours:

Full Blood Count (FBC), Erythrocyte Sedimentation Rate (ESR), Blood Film Examination.

Clotting Screen / Fibrinogen Assay / D-Dimers

Group and Antibody Screen for Pre-op/Crossmatch

Crossmatch

Pre-op sickle testing

Bleep 7060 to discuss any urgent requests for any services that are not usually available out of routine working hours.

Making a complaint to the Laboratory

If you would like to make a complaint relating to a specific test please contact the relevant section lead, Blood Transfusion Quality Manager or Haematology Compliance Coordinator.

Alternatively, please complete the online Datix incident reporting procedure available on the intranet and we will investigate your complaint.

http://insight/departments/MedicineBoard/Pathology/HaematologyPathology/Phlebotomy/Pages/default.aspx


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Medical Staff

Consultants (Speciality)

Dr Marie Scully- Lead Clinician (TTP, Haematology & Transfusion) 020 7025 7970 or 020 3447 9884 Email: [email protected] Dr Kirit Ardeshna (Lymphoma) 020 3447 9443 or ext 79443 Fax: 020 3447 9911 Email: [email protected] Dr Hannah Cohen- via secretary (Haemostasis) 020 3447 8563 or ext 78563 Email: [email protected] Dr Bernard Davis (Joint red cell unit) 020 3447 9638 or ext 78538 Email: [email protected] Dr Shirley D’Sa (Myeloma &Waldenstroms macroglobulinaemia) 020 3447 8028 or ext 78028 Fax: 020 3447 9911 Email: [email protected] Dr Victoria Grandage (Children & young peoples cancer services) 020 3447 5239 or ext 75239 Fax: 020 3447 5827 Dr Rajeev Gupta 020 3447 8483 or ext 78483 Email: [email protected] Dr Jonathan Lambert (Lymphoma) 020 3447 9443 or ext 79443 Email: [email protected] Dr Emma Morris (BMT & HSCT) 020 3447 9712 or ext 79712 Fax: 020 3447 9571 Email: [email protected] Dr Ri Liesner 020 3447 9884 or ext 79884 Email: [email protected] Dr Karl Peggs (BMT & HSCT) 020 3447 9712 or ext 79712 Fax: 020 3447 9571 Email: [email protected] Dr Mary Petrou (Womens health, Haemoglobinopathy Genetics) 0203 447 9458 or ext 79458 Fax: 020 3447 9864 Email: [email protected] Dr Martin Pule 020 3447 8483 or ext 78483 Email: [email protected] Dr Neil Rabin (Myeloma) 020 3447 8028 or ext 78028 Email: [email protected] Dr Farrukh Shah (Joint red cell unit) 020 3447 9638 or ext 79638 Email: [email protected] Dr Kirsty Thomson (BMT & HSCT) 020 3447 9712 or ext 79712 Fax: 020 3447 9571 Email: suzie.knapton’uclh.nhs.uk Dr Sara Trompeter (Children & young peoples cancer services) 020 3447 9638 or ext 79638 Fax: 020 3447 9911 Email: [email protected] Dr Andres Virchis (Leukaemia) 020 3447 9712 or ext 79712 Email: [email protected] Professor Anthony Glodstone (Pathology, Haematological malignancies) 020 3447 1528 or ext 71528 Email: [email protected] Professor Asim Khwaia (Leukaemia) 020 7679 6554 or ext 79456 Fax: 020 3447 9911 Email: [email protected] Professor David C Linch (Lymphoma) 020 3447 8483 or ext 78483 Fax: 020 3447 9911 Email: [email protected] Professor Stephen Mackinnon (Bone marrow & Stem cell programme) 020 3447 9712 or ext 79884 Email: [email protected] Professor John B Porter (Red cell unit & haemaglobinopathies) 020 3447 9638 or ext 79638 Email: [email protected] Prof Kwee L Yong (Myeloma & cancer services) 020 3447 8028 or ext 78028 Fax: 020 3447 9911 Email: [email protected] Dr. John Paul Westwood (Haemostasis) 0203 447 6854 or 020 3447 9884 or ext 79884 Email: [email protected]

mailto:[email protected]











th October 2016

Specialist Registrars (9.00 – 17.00 Monday – Friday)

Haematology Laboratory SpR Bleep 7000 Blood Transfusion Laboratory SpR Bleep 7050 Haemostasis Laboratory SpR Bleep 7044 On-call Haematology Registrar/SpR (out-of-hours) Contact via Switchboard

Clinical advice During routine working hours (Monday – Friday 9.00 – 17.00), please contact the relevant laboratory Specialist Registrar via the bleep system. A Haematology Registrar/SpR is on call outside routine working hours: contact via the switchboard.

Completion of the request form

Please use the appropriate request form for the tests required and ballpoint (indelible) ink pen to complete the form.

Please provide the patient’s full name, hospital number and date of birth.

Please provide the date and time of sample collection and relevant clinical information to facilitate sample processing and the interpretation of results. The patient should be aware of the information collected and the purpose for which it is collected.

Please use a separate Blood Transfusion request form for Blood Transfusion requests; Group & Save, Crossmatch, Kleihauer, DAT.

Please ensure that the destination of the report, the name of the requesting/responsible clinician and a contact bleep/telephone number for the responsible clinician is provided to enable laboratory staff to notify the clinician regarding unsuitable (urgent) samples and to relay and/or discuss urgent or grossly abnormal results.

Please tick the box next to the test(s) requested; if a required test is not listed, write it clearly into the “Additional Tests” section.

Please tick the appropriate box when the patient is anticoagulated (on warfarin or heparin).

If possible please provide clinical details.

Please ensure that adequate samples are taken for the tests requested and that each sample is labelled correctly. Contact the relevant laboratory for clarification of sample requirements if required.

Sample Collection (phlebotomy)

The sample collection policy for staff trained in phlebotomy [Haem-PD-BloodSampColl] and guidelines for sample labelling are available on the UCLH Intranet and can be sent electronically to GP practices.


th October 2016

Vacutainer™ Guide

Becton Dickinson

Vacutainer ™

Ordering

Information

Tests / Screens

EDTA 4.5 ml 10mls for DNA

FBC, ESR, Reticulocyte count, IPF, Blood film (note: ESRs cannot be performed on 7ml EDTA tubes), Sickle screen.

Glandular Fever testing (note, Glandular Fever testing can be performed on an SST sample), Lymphocyte subsets (including CD4, CD8 counts), Chronic and Acute Leukaemia Screens, Hereditary Spherocytosis Dye binding assay, Plasma Viscosity, PCR in Haemostasis, Haemoglobinopathy Genetics (DNA), Genetic Haemocromatosis mutations

Flow Cytometry

BM in EDTA for Acute Leukaemia and lymphoma screens. Kleihauer, DAT

EDTA - Blood Transfusion ONLY

Blood Transfusion

*Group & Save (including antibody screen), *Crossmatch, Kleihauer, DAT

*Sample identification for Group & Screen or Crossmatch MUST be hand written with 4 correct points of ID

Note : underfilled samples are unsuitable for testing.

Sodium citrate (citrated tube) 4.5 ml or 2.7ml

Clotting screen / Fibrinogen / D-Dimers. These tubes must be filled exactly to the 4.5ml mark on the side of the tube: underfilled & overfilled samples are unsuitable for testing. For Paediatric Clotting Screens, see below. Citrated Platelet Count (alert Coagulation laboratory staff that the sample is en route: it must not be centrifuged).

Specialised Haemostasis tests must be authorised by a Haematology/Haemostasis SpR/Consultant See the Haemostasis section below for the samples required for specialised Haemostasis tests.

SST 5ml

Cardiolipin antibodies (Antiphospholipid antibodies), Erythropoietin, Soluble transferring receptor.

2GPI antibodies

Lithium Heparin 4.5 ml

Haemoglobinopathy screen, G6PD assay, Pyruvate Kinase assay, Red Cell Osmotic Fragility, Globin Chain Biosynthesis, Oxygen Dissociation curve

Cytogenetic chromosomal analysis and FISH.

Sodium citrate (citrate) 1.0 ml

Paediatric Clotting Screen, Fibrinogen, D-Dimers (1ml tubes). Contact the Haemostasis laboratory for other Haemostasis tests for paediatric patients. These tubes must be filled exactly to the 1ml mark on the side of the tube: underfilled & overfilled samples are unsuitable for testing. These tubes are issued from the Haemostasis Laboratory to the Neonatal Unit, Paediatric A&E and Phlebotomy Outpatient Departments and can be issued to other locations on request: contact x78549 or x78545. Monday – Friday 09.00 – 17.15


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Sample Labelling

Please label samples clearly with hospital number, first and last name and date of birth using a ballpoint (permanent/indelible) ink pen. The NHS number may be used in place of the hospital number for GP and non-UCLH Trust patients.

Samples for a Group and Save (including an antibody screen) and Crossmatching must be hand written with four correct points of ID. Sticky labels are not permitted. Please include the time and date of collection and the signature of the person collecting the sample.

A minimum of three points of identification must be provided for all other samples.

NOTE: Samples received broken/leaking, inadequately labelled, aged, clotted, haemolysed or otherwise unsuitable for testing will not be processed; an appropriate comment will be entered onto the computer system. If the requested tests are urgent, laboratory staff will attempt to notify the ward/clinician.

Sample Transport to the Laboratory

Refer to the Pathology Specimen Transport policy on the UCLH Intranet for hospital transport.

Samples from GP practices must be sent via UCLH Trust transport; via the next available collection during the working day. If a significant delay in sample transportation to the laboratory is anticipated, please discuss with laboratory staff, as sample deterioration may limit the viability of results.

Special Handling Requirements

Please see the ‘Notes’ section in the test tables below, or contact the relevant laboratory for information regarding special handling requirements.


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Routine Haematology (page 1 of 3)

Autolab. 1st Floor, Whitfield St Laboratories, 60 Whitfield St London W1T 4EU 0203 447 8961 or x78961 (Haematology) Bleep 7060 (out-of-hours)

0203 447 8547 or x78547 (Routine Coagulation)

Please contact the laboratory for reference range(s) if not listed below:

Test Specimen

Type

Reference

ranges

Key Factors

affecting tests

Notes Out of

hours

service

Time Limit

for

requesting

additional

tests from

time of

venesection

Turnaround time

from receipt of

sample

Acanthocytes 4.5ml EDTA (can be performed on same sample as FBC)

0-3 % Delay in receiving sample

Sample not kept at room temperature

Send sample ASAP to the laboratory as prolonged storage affects cell morphology

No service provided

Within 24 hours

12 hrs

Blood Film 4.5ml EDTA (can be performed on same sample as FBC)

Not applicable Delay in receiving sample

Sample not kept at room temperature

Send sample ASAP to the laboratory as prolonged storage affects cell morphology. Please give clinical details / reason for request

Service for clinically urgent requests

Within 24 hours

Urgent:

Non-

urgent

4hrs (not out of hours unless the laboratory is contacted)

24 hrs

Citrated Platelet Count (platelet clumping in EDTA)

4.5ml Sodium Citrate

150-400 x109/l Clot in sample Please indicate clearly on

the request form that sample is for a citrated platelet count. Notify the Routine Coagulation Laboratory that the sample is en-route: do not centrifuge the sample.


Within 24 hours

8 hrs

ESR 4.5ml EDTA (can be performed on same sample as FBC)

<40yrs: 1-7 mm/hr (F) 1-5 mm/hr (M) ≥40yrs: 1-20mm/hr

Clot in sample

Insufficient sample

Delay in receiving sample

Can be performed on same sample as FBC if sample >3mls. Cannot be performed on a 7ml EDTA tube.


Within 24 hours

Urgent

Non-

urgent

2 hrs

24 hrs


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Test Specimen Type Reference

ranges

Key Factors

affecting tests

Notes Out of

hours

service

Time Limit

for

requesting

additional

tests from

time of

venesection

Turnaround time

from receipt of

sample

Fluid Count (e.g. Pleural, Ascitic, Knee fluid)

Fluid to be taken into EDTA

or 10 or 20ml sterile container

Delay in receiving sample

Please use “Urine/other” request form-specify type of fluid


Within 24 hours

4 hrs

Full Blood Count (FBC)

4.5ml EDTA

Adult WBC: 3-10 x10

9l

Neutrophils: 2-7.5 x10

9/l

Haemoglobin: 115-155g/l (F) 130-170 g/l (M)

MCV: 80-99 fl Platelets: 150-400 x10

9/l

Clot in sample Insufficient, Lipaemic or Icteric samples Delayed sample receipt

> 1ml blood required Sample must be received within 12 hrs of collection Lipaemic/icteric samples can affect performance of test and may delay results


Sample must be received in the laboratory within 12 hours of collection

Urgent: 1 hr

Non-

urgent: 8 hrs

Glandular Fever Screen

4.5ml EDTA Can be performed on FBC sample

or a 4.5 / 7ml clotted sample

Clot in sample Test can be added on to existing FBC sample (time limit: 7 days)

No service provided

Within 7 days Urgent: 2 hrs

Non-

urgent: 24 hrs

Immature Platelet Fraction

4.5ml EDTA Can be performed on FBC sample

Clot in sample Delayed sample receipt

Test can be added on to existing FBC sample


8 hrs


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Test Specimen Type Reference

ranges

Key Factors

affecting tests

Notes Out of

hours

service

Time Limit

for

requesting

additional

tests from

time of

venesection

Turnaround time

from receipt of

sample

Reticulocytes 4.5ml EDTA Can be performed on FBC sample

20-100 x 109/l

Clot in sample Delayed sample receipt

Test can be added on to existing FBC sample (time limit: 24 hours)

No service provided

Within 24 hours

8 hrs

Sickle Screen 4.5ml EDTA (can be performed on same sample as FBC)

Samples from children < 6 months old can give false negative results Anaemia

Clot in sample

All samples for sickle screens are referred to Special Haematology for confirmation (if not previously confirmed)


Within 7 days Urgent: 1hr

Non-

urgent: 24 hrs

Referral Laboratory (Malaria testing)

Parasitology Laboratory Hospital for Tropical Diseases Building Capper St London WC1E 6JA 0845 155 5000 ext 75418


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Blood Transfusion (page 1 of 5)

1st Floor, 60 Whitfield St London W1T 4EU 0203 447 8522 / 8523 or x78522 / 78523 (Routine hours) Bleep 7060 out-of-hours

MAJOR HAEMORRHAGE (see page 4 of this user manual)

Samples and form MUST carry full and correct patient identification, i.e. handwritten forename, surname, date of birth and hospital number - requests made without these details will not be accepted.

Forms must be signed by both the requesting medical officer and the phlebotomist. The phlebotomist must sign and date the sample. Please provide a bleep number for enquiries.

Please refer to the Trust Blood Component Transfusion Policy and Procedure available on the UCLH Intranet.

Test Specimen

type

Key Factors affecting

tests

Notes Out of

hours

service

Time Limit for

requesting

additional

tests from

time of

venesection

Turnaround time from

receipt of sample

Crossmatch 7ml EDTA (Pink top)

Incorrectly labelled, Insufficient, clotted and haemolysed samples will be rejected.

Perform a BloodTrack sample enquiry or call the laboratory to check whether there is a valid Group & Save available in laboratory before sending a new sample. > 2ml required for adults >1ml required for neonates (<4 months)


Contact Laboratory

Emergency: Group O blood on demand from local blood fridges.

On Demand: From local HemoSafe or HemoNine blood fridges for eligible patients with current, completed Group & Save sample who are suitable for remote issue.

Urgent/STAT from the

lab: 10 mins plus transport time for group-specific blood (only if valid Group & Save sample available in laboratory).

Otherwise 45mins for full crossmatch or 10 mins uncrossmatched from receipt of sample in laboratory plus transport time.

*If antibodies are present,


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turnaround time to be determined on a case by case basis.

Non-urgent: same day non-emergency crossmatch: 2 hours plus transport time.

*If antibodies are present, turnaround time to be determined on a case by case basis.


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Test Specimen

type


tests

Notes Out of

hours

service

Time Limit for

requesting

additional

tests from

time of

venesection


receipt of sample

Direct Antiglobulin Test (DAT)

4.5 /7ml EDTA

Can be added onto existing Group & Save or Haematology FBC sample


Within 5 days Urgent: 1 hr from receipt of sample in laboratory

Non-urgent: 24hrs

Group & Save 4.5/7ml EDTA

Insufficient, clotted and haemolysed samples will be rejected.

>2ml required for adults >1ml required for neonates (<4 months)


Sample must be received in the laboratory within 12 hours of collection

Urgent: 1 hr from receipt of sample in laboratory

Non-urgent: 24hrs

Kleihauer 4.5ml EDTA

Delay in receiving sample. Sample not kept at room temperature before performing test.

Sample should be ideally collected within 2 hours of delivery or

sensitising event and MUST be

tested within 24 hours (including Saturdays and Sundays)


Within 5 days

24 hrs

Antenatal: Anti D/c quantitation Anti-K titre

7-10ml EDTA + sample for Group & Save

Referred to Red Cell Immunohaematology Department, North London Blood Transfusion Centre (NLBTC) Samples sent on Friday will not be collected by NLBTC until Monday

No service provided

Additional EDTA samples are required for test, contact the laboratory.

3 working days

HLA and disease association (e.g. HLAB27)

7-10ml EDTA

Referred to Histocompatibility and Immunogenetics Department, NLBTC Samples sent on Friday will not be collected by NLBTC until Monday

No service provided


5-7 working days


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Test Specimen

type


tests

Notes Out of

hours

service

Time Limit for

requesting

additional

tests from

time of

venesection


receipt of sample

HLA typing 7-10ml EDTA (if white cell count <2 x10

9/l send

double volume of blood)

Referred to Histocompatibility and Immunogenetics Department, NLBTC Samples sent on Friday will not be collected by NLBTC until Monday

No service provided


5-7 working days

Referral laboratories:

Red Cell Immunohaematology North London Blood Transfusion Centre Charcot Road London NW9 5BG 0208 957 2831

Histocompatibility and Immunogenetics North London Blood Transfusion Centre Charcot Road London NW9 5BG 0208 957 2812

Requests for routine (scheduled) surgery

Requests must be received in the laboratory by 1900hrs on the day before surgery. A positive antibody screen will delay completion of testing and provision of compatible units. Patients with known antibodies must be followed up within an agreed time-frame prior to surgery according to their pre-admission group and screen report.

Samples received after this time will be prioritised by order of the theatre list. Emergency cases will take priority.

Where Remote Issue is not available, requests for routine surgery should comply with the local Maximum Surgical Blood Ordering Schedule (MSBOS). Refer to the Trust Blood Transfusion Manual on the intranet.


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Transport of Routine Blood and Blood Products

Remote issue of red cells has been implemented at UCLH. This allows blood to be issued directly from the Remote Issue blood fridge at the point of care, rather than from the laboratory for most patients. A small percentage of patients will still need blood crossmatched by the laboratory but this can also be stored in the remote issue blood fridge and dispensed when required. FFP for patients will be sent to remote issue fridges by the laboratory and dispensed in the same way. Cross matched blood for patients with special requirements and those not eligible for remote issue and other blood products are dispatched as follows:

Non-urgent blood and blood products are dispatched from the laboratory at various times during the day.

Urgent blood and blood products are dispatched from the laboratory by courier (arranged by the laboratory). PLEASE CONTACT THE LABORATORY

(x78523/78522 during routine work hours or Bleep 7060 out of hours) IF BLOOD IS REQUIRED URGENTLY.

*FFP will be returned to the laboratory 24 hours after it has been thawed.

*Unused platelets/FFP/Cryoprecipitate are withdrawn the day after the original date required.

Cryoprecipitate should be used within 4 hours of thawing and any remaining units returned to the lab.

*If the product is no longer required, contact Blood Transfusion immediately. This can reduce blood component wastage if the units can be re-

issued to a different patient before the expiry time.

Always ring the laboratory before use of EMERGENCY UNCROSSMATCHED BLOOD*


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Guidelines for Clinical Situations

1. Life threatening haemorrhage (acute massive blood loss) Massive obstetric haemorrhage

Refer to the Major Haemorrhage Algorithm

http://insight/departments/MedicineBoard/Pathology/HaematologyPathology/BloodTransfusion/Documents/Major%20haemorrhage%20algorithm.pdf For further Information refer to the Trust Major Haemorrhage Protocol http://insight/guidelines/Clinical%20guidelines/Major%20Haemorrhage%20Protocol%202012.pdf

2. Non-acute bleeding and neonatal surgery

Obtain:

Contact:

Coagulation screen and FBC

Blood Transfusion Registrar

Monday →Friday 09:00-17:00:

UCLH Bleep 7050/7000

All other times:

General Haematology Registrar via UCLH switchboard

Discuss: Appropriate treatment (If a high risk procedure, or the patient has a known coagulation abnormality, contact the Haemostasis Registrar prior to procedure and discuss the patient’s management)

Monday →Friday 09:00 – 17:00

Haemostasis Registrar UCH Bleep 7044/7000

All other times:

General Haematology Registrar via UCH Switchboard

3. Indications for the transfusion of red cells, FFP, cryoprecipitate and platelets

Please refer to the relevant chapter/appendix in the Trust Blood Component Transfusion Procedure Manual http://insight/guidelines/Clinical%20guidelines/Blood%20Transfusion%20Manual%202012.pdf

4. Patients with Special Transfusion Requirements For patients who may require CMV negative blood products, Irradiated blood products, Washed red cells and/or HLA matched platelets:

Please refer to the relevant appendix in the Blood Component Transfusion Procedure Manual. Ensure that the laboratory has received a Blood Transfusion Status Form by emailing BT Status or by faxing to fax number 0203 447 9587 before requesting blood products (this form can be downloaded from the Blood Transfusion site on the UCLH intranet).

http://insight/departments/MedicineBoard/Pathology/HaematologyPathology/BloodTransfusion/Documents/Major%20haemorrhage%20algorithm.pdf

http://insight/guidelines/Clinical%20guidelines/Major%20Haemorrhage%20Protocol%202012.pdf

http://insight/guidelines/Clinical%20guidelines/Major%20Haemorrhage%20Protocol%202012.pdf

http://insight/guidelines/Clinical%20guidelines/Blood%20Transfusion%20Manual%202012.pdf


th October 2016

Routine Coagulation (page 1 of 2)

Autolab 1st Floor, Whitfield St Laboratories, 60 Whitfield St London W1T 4EU Tel: 0203 447 8547 or x 78547

Citrated samples must be adequately filled (a 9:1 blood:citrate sample ratio is required for all citrated samples). Tests cannot be performed on underfilled, overfilled, haemolysed or clotted samples.

Paediatric citrated tubes are issued from the Haemostasis Laboratory to the Neonatal Unit, Paediatric A&E and Phlebotomy Outpatient departments and can be issued to other locations on request: contact x78549/78545 during routine hours.

Include clinical details on the request form, e.g. “patient receiving Warfarin/Heparin therapy” or “post op”; to facilitate appropriate testing and interpretation of results.

Send the request form and sample to the laboratory as rapidly as possible; notify the laboratory regarding very urgent requests on ext 78547 (during routine working hours) or Bleep 7060 (out of hours).

Grossly lipaemic samples may require manual testing, potentially delaying results.

Abnormal results that require further laboratory investigation and/or manual testing/confirmation may be delayed.

Test Specimen

type

Key Factors

affecting tests

Note Reference Range Out of hours

service

Time Limit

for

requesting

additional

tests from

time of

venesection

Turnaround time

from receipt of

sample

Coagulation screen PT/INR, APTT, TT, Fibrinogen

2.7ml or 4.5ml Sodium Citrate

Heparin & Warfarin.

Delayed receipt of sample.

May not be possible on grossly lipaemic samples.

Heparin & warfarin

therapy affects results

and determines

appropriate testing please indicate that the patient is on heparin and/or warfarin on the request form.

PT: 10-12 secs APTT: 25-37 secs TT: 15.5-18.5 secs Fib: 1.5 – 4.0 g/L


5 hours Urgent: 1hr

Non-

urgent: 4 hrs


th October 2016

Routine Coagulation (page 2 of 2)

Test Specimen

type

Key Factors

affecting tests

Note Out of hours

service

Time Limit

for

requesting

additional

tests from

time of

venesection

Turnaround time

from receipt of

sample

D-dimers


This test can be added for an existing citrated sample.

Normal cut off: 0 – 0.55 mg/L FEU

DVT/PE cut off: <550 ←μg/L FEU


5 hours Urgent: 1hr

Non-

urgent: 4 hrs

(Unfractionated) Heparin Monitoring: APTT ratio



Please indicate Heparin therapy on the request form (tick box or handwrite).

Therapeutic range: 2.0 – 3.0


5 hours Urgent: 1 hour

Non-

urgent: 4 hours

INR 4.5ml or 2.7ml Sodium Citrate


Please indicate Warfarin therapy on the request form (tick box or handwrite).

Overall range: 1.5 – 4.5

An individual patient’s target range is a clinical decision: contact the Anticoagulation Clinic (ext 75222/x79139, 9-5 Mon-Fri) for target ranges or seek advice from the Haemostasis SpR on bleep 7044 (during routine hours) or via the switchboard (out-of-hours).


5 hours Urgent: 1 hour

Non

urgent: 4 hours


th October 2016

Haemostasis (page 1 of 6)

2nd

Floor, 60 Whitfield St London W1T 4EU Hours: 09.00 – 17.15 Monday - Friday Tel: 0203 447 8545 / 8549, x78545 / 78549

All Haemostasis tests must be requested/authorised by the Haemostasis SpR (Bleep 7044), Haematology SpR (Bleep 7050) or Haematology Consultant, with the exception of the following:

Cardiolipin Antibody testing Plasma Viscosity measurement Thrombophilia Screens from the Hyper Acute Stroke Unit (HASU) and the National Hospital for Neurology and Neurosurgery Antiphospholipid Antibody Screens from Rheumatology Outpatients (Professor Isenberg’s Clinic).

Please discuss requests with Haemostasis laboratory staff if necessary, to ensure adequate samples are collected.

Citrated samples must be adequately filled (a 9:1 blood:citrate sample ratio is required for all citrated samples). Tests cannot be performed on underfilled, overfilled, haemolysed or clotted citrated samples. Paediatric citrated tubes are issued from the Haemostasis Laboratory to the Neonatal Unit, Paediatric A&E and Phlebotomy Outpatient departments and

can be issued to other locations on request: contact x78549/78545 during routine hours.

Include clinical details on the request form to facilitate appropriate testing and interpretation of results.

Send the request form and sample to the laboratory as rapidly as possible; plasma must be processed within 5 hours of venepuncture.

For very urgent requests, notify the laboratory staff on ext 78549 / x78545 (during routine working hours) or Bleep 7060 (out of hours).

Test Specimen type Key Factors

affecting

tests

Notes Reference

Range

Out of hours

service

Time Limit for

requesting

additional

tests from

time of

venesection

Turnaround

time from

receipt of

sample

Anti-Xa assay

For monitoring low molecular weight heparin –(LMWH) therapy.

1 x 4.5ml Sodium Citrate sample

Delayed receipt of sample

Samples should be collected 4 hours post an injection of Low Molecular Weight Heparin.

This test requires authorisation by clinical Haematology staff.

Therapeutic range: 0.5 – 1.0 IU/ml.

Individual patient’s target range is a clinical decision.

By agreement with the Haematology Consultant on call and subject to staff availability.

Contact the Laboratory

Urgent: 12 hrs

Non-urgent: 5 working days


th October 2016



affecting tests

Notes Reference

Range

Out of hours

service

Time Limit for

requesting

additional tests

from time of

venesection

Turnaround time

from receipt of

sample (in

working days

for non urgent

requests)

Antiphospholipid

Antibody Screen

/ Lupus Screen incorporates Lupus Anticoagulant testing and Cardiolipin Antibody testing

2 x 4.5 ml Sodium Citrate samples

and

1 x 5ml SST sample

Warfarin, Heparin and Rivaroxaban therapy.

Delayed receipt of sample (Lupus Anticoagulant test).

Lupus Anticoagulant testing is inappropriate when patients are receiving heparin therapy.

Contact the laboratory regarding Lupus Anticoagulant testing.

Refer to Anti-Cardiolipin Antibody testing.

No out of hours service


3 working days

Cardiolipin

Antibodies

(ACLA)

1 x 5ml SST sample

This test does not require authorisation.

IgG: 12 GPLU/ml

IgM: 12 MPLU/ml


3 working days

2 Glycoprotein

1 Antibodies

(B2GPI)

1 x 5ml SST sample

A single SST sample is sufficient for ACLA & B2GPI Antibody testing.

IgG: < 10 U/ml

IgM: < 6 U/ml



3 working days

Lupus

Anticoagulant

test

Dilute Russell’s Viper Venom Time test

or Taipan Venom Time test (on warfarin).

3 x 4.5ml Sodium Citrated samples

Warfarin, Heparin and Rivaroxaban therapy.


Lupus Anticoagulant test is inappropriate for patients on heparin therapy.

An SST sample is required if Cardiolipin Antibody testing is also requested.


Contact the laboratory

3 working days


th October 2016



affecting tests

Notes Reference

Range

Out of hours

service

Time Limit for

requesting

additional

tests from

time of

venesection

Turnaround

time from

receipt of

sample (in

working

days for non

urgent

requests)

Thrombophilia

screen Antithrombin activity, Protein C activity, Free Protein S, Lupus Anticoagulant, Cardiolipin Antibodies, Factor V Leiden, Prothrombin Gene Mutation, Also Factor VII and X assays when patients are on warfarin.

Antithrombin Antigen, Protein C Antigen and Protein S activity may be performed when abnormal results are obtained in above assays

4 x 4.5ml Sodium Citrated samples + 1 x 5ml SST sample + 1 x 4.5ml EDTA


Plasma must be processed within 5 hours of venesection.

Warfarin and Heparin

Acute illness may affect results of some tests

These tests require authorisation unless the patient is a Haematology, NHNN or HASU patient: for all other patients, please contact the Haemostasis or Haematology SpR (bleep 7044 or 7050) for authorisation before taking samples.

These tests can be requested individually.

Samples for Factor V Leiden, MTHFR and Prothrombin Gene Mutation are sent from Haemostasis, UCLH to TDL Genetics


Antithrombin, Protein C and Protein S only, by agreement with the Haematology Consultant on call and subject to staff availability.


3 working days

AT Ag, PS activity, 10 working days

PC Ag, 20 working days

MTHFR mutation. 1 x 4.5ml EDTA

A single EDTA sample is adequate for FVL, PGM and MTHFR mutations

This test requires authorisation unless requested by a Haematologist.

Referred to TDL.



3 working days


th October 2016



affecting

tests

Notes Reference

Range

Out of hours

service

Time Limit for

requesting

additional

tests from

time of

venesection

Turnaround

time from

receipt of

sample (in

working

days for non

urgent

requests)

Bleeding screen

1) von Willebrand Factor Antigen

2) von Willebrand Factor Activity

3) Factor VIII assay

4) Platelet Aggregation


Recommendation: also send an EDTA sample for a FBC and citrated sample for Coagulation screen.

Heparin affects FVIII result.


FVIII: 0.50 – 2.00 IU/ml

VWFAg: 0.50 – 1.60 IU/ml

VWFAct: 0.50 – 1.87 IU/ml

Factor VIII only, by agreement with the Haematology Consultant on call and subject to staff availability.


3 working days

Platelet Aggregation

studies


Recommendation: also send an EDTA sample for a FBC)

Aspirin affects platelet aggregation: testing is not recommended. Delayed receipt of sample.Samples not kept at room temperature.

Significant thrombocytopaenia: aggregation studies only possible with an adequate platelet count

Samples must be kept at room temperature and received by the lab within 1.5 hours of phlebotomy and before 1200 hrs.



Tests must be performed within 5 hours of venepuncture.

1 working day


th October 2016



affecting

tests

Notes Reference

Range

Out of hours

service

Time Limit for

requesting

additional

tests from

time of

venesection

Turnaround

time from

receipt of

sample

PFA-100

(Platelet function analysis)

1 x 4.5ml Sodium Citrated sample

Recommendation: also send an EDTA sample for a FBC)

Aspirin affects results.


Sample not kept at room temperature.

Significant thrombocytopenia, anaemia, leucopaenia.

The sample must be kept at room temperature & tested within 5 hours.

Platelet Aggregation Studies must be requested separately if required.




1 working day

Factor Assays

FVIII, FIX, FXI, FXII

FII, FV, FVII, FX

FXIII

4.5ml Sodium Citrated samples –

contact the laboratory for the number of samples required (dependent on tests requested).

Heparin and Warfarin.

Acute illness (contact the laboratory).


Required factor assays must be specified on the request form.


Factor VIII + IX only, by agreement with the Haematology Consultant on call and subject to staff availability.


3 working days For FXIII, 5 working days

Fibrinogen Antigen 4.5 ml Sodium Citrate sample

Delayed sample receipt

1.5 – 4.0 g/L No out of hours service

Contact the laboratory.

20 working days

Bethesda Inhibitor

Assay

2 x 4.5 ml Sodium Citrate sample

Delayed sample receipt

Only appropriate where factor levels extremely low.


As for factor assays

Contact the laboratory.

20 working days


th October 2016


Referral Laboratories:


affecting

tests

Notes Referenc

e Range

Out of

hours

service

Time Limit

for

requesting

additional

tests from

time of

venesection

Turnaround

time from

receipt of

sample (in

working

days for

non urgent

requests)

Heparin induced

thrombocytopaenia

(HIT) screen

Heparin:PF4 antibody

assay

1 x 4.5ml Sodium Citrated sample (preferred)

Urgent test: send the sample to the lab. Immediately.

This test MUST be authorised by a

Haematology Consultant (i.e. not a

SpR): contact via the Haematology SpR (bleep 7044/7050) or switchboard out of hours.


By agreement with the Haematology Consultant and subject to staff availability.


Urgent: 1 working day

Non-urgent: 5 working days

Plasma viscosity 1 x 4.5ml EDTA sample

Variations in temperature


Samples must be kept at room temperature.

Samples that have been refrigerated are unsuitable for testing.

Samples should not be warmed, but warming does not make them unsuitable for testing

1.4 - 1.75 mPa

By agreement with the Haematology Consultant on call and subject to staff availability.

7 days 2 working days

For Rivaroxaban assay, ADAMTS 13, PF1.2

and TAT (Thrombin antithrombin complex) Haemostasis Research Unit, Department of Haematology University College London Hospitals 1

st Floor, 51 Chenies Mews

London WC1E 6HX

For VWF Multimers and Nucleotides Haemophilia Centre and Thrombosis Unit, Ground Floor Royal Free Hospital Pond Street London NW3 2QG

For Factor V Leiden, Prothrombin Gene

Mutation and MTHFR Mutation and FXIII The Doctor’s Laboratory, 60, Whitfield St. London W1T 4EU


th October 2016

Special Haematology (page 1 of 3)

2nd

Floor, 60 Whitfield St London W1T 4EU Hours: 09.00 -17.15 Monday – Friday 0203 447 8533 or x78533

Haemoglobinopathy & Haemolytic Anaemia investigations

Reference ranges are provided on the report and on the IT system.


affecting tests

Notes Out of

hours

service

Time Limit for

requesting

additional

tests from

time of

venesection

Turnaround

time from

receipt of

sample (in

working days)

Haemoglobinopathy screen

4.5ml EDTA/Lithium heparin + sample for FBC

Age of sample Can be performed on FBC sample

No service currently

Within 7 days Urgent: 2 hours if no further testing required

Non urgent: 72 hours if no further testing required

%Hb S levels 4.5ml EDTA/Lithium heparin

Can be performed on FBC sample


Within 7 days Urgent: 2 hours

Non urgent: 24 – 48 hours

Hb Electrophoresis (CA, CE or acid gel reflex tests)

4.5ml EDTA/Lithium heparin

Can be performed on FBC sample


Within 7 days 5 days

G6PD levels 4.5ml EDTA or Lithium heparin

Sample not stored at 2-6 °C

Recent blood transfusion can invalidate the result. Please indicate if patient has been transfused recently.


Within 7 days Urgent: 2 – 4 hours

Non urgent: 48 hours

Pyruvate Kinase levels

4.5ml Lithium heparin

Sample not stored at 2-6 °C

Recent blood transfusion can invalidate the result. Please indicate if patient has been transfused recently.


Within 48 hours

Urgent: 24 hours

Non urgent: 72 hours


th October 2016



affecting tests

Notes Out of

hours

service

Time Limit for

requesting

additional tests

from time of

venesection

Turnaround

time from

receipt of

sample (in

working days)

Haemoglobin H stain 4.5ml EDTA or Lithium heparin

Age of sample Samples greater than 48 hours old are unsuitable for this test.

No service provided

24 hours 48 hours

Heinz Body Preparation

4.5ml EDTA or Lithium heparin

Age of sample Samples greater than 48 hours old are unsuitable for this test.

No service provided

48 hours 72 hours

Hereditary Spherocytosis Dye Binding Assay

4.5ml EDTA Age of sample Please arrange with laboratory Samples greater than 24 hours old are unsuitable for this test.

No service provided

Within 8 hours 48 hours

Red Cell Osmotic Fragility

4.5ml Lithium heparin Please arrange with laboratory

No service provided


Red Cell Oxygen Dissociation

4.5ml Lithium heparin Please arrange with laboratory

No service provided


Methaemoglobin screen

4.5ml EDTA N/A No service provided

48

Globin Chain Biosynthesis

3 x 4.5ml Lithium heparin (10ml blood required)

Please arrange with laboratory

No service provided

Within 8 hours Urgent 7 working days

Non urgent 14 days

Haemoglobinopathy DNA and Haemochromatosis

2 - 4 x 4.5ml EDTA (10 - 20ml blood required)

Referred to Haemoglobinopathy Genetics, UCLH

No service provided

Additional samples are required for test.

3-20 working days

Erythropoietin 7ml clotted sample (no anticoagulant)

No service provided


14 days


th October 2016



affecting tests

Notes Out of hours

service

Time Limit for

requesting

additional tests

from time of

venesection

Turnaround

time from

receipt of

sample

Soluble Transferrin Receptor assay

7ml clotted sample Via Haematology Consultant. Referred to Kings College Hospital

No service provided


4-8 weeks

Transcobalamin 7 ml clotted sample Referred to Royal Free Hospital. Sample must be separated within 2 hours. Referred to Royal Free Hospital

No service provided


4-6 weeks

Liver Dry Iron Estimation

Biopsy sample in Formalin

Referred to Royal Free Hospital. No service provided


2-6 weeks

Referral Laboratories:

Haemoglobinopathy Genetics Haemoglobinopathy Genetics Centre Molecular Genetics Laboratory 307 Euston Road London NW1 3AD 0203 447 9458

Department of Clinical

Chemistry Kings College Hospital Denmark Hill London SE5 9RF 0207 737 4000 ext 3501

Special Haematology Royal Free Hospital Pond Street London NW3 2QG 0207 794 0500 ext 33413

For Paroxysmal Nocturnal

Haemoglobinuria (PNH): Haematological Malignancy Diagnostic Service Level 3 Bexley Wing St James University Hospital Beckett Street LEEDS LS9 7TF


th October 2016

Haemoglobinopathy Genetics (Page 1 of 1)

Haemoglobinopathy Genetics, Molecular Genetics Laboratory, Hours 09.00-17.00 Tel: 0203 447 9458 307 Euston Road, London NW1 3AD For further information on the molecular testing provided by this laboratory please see separate document: Haemoglobinopathy Genetics User Handbook (HAEM-PD-HGUserHbook) ,


th October 2016

Flow Cytometry (HIV and Immunophenotyping) (page 1 of 5)

2nd

Floor, 60 Whitfield St, London W1T 4EU Hours: 09.00 – 17.15 Monday - Friday Tel: 0203 447 9603 or x 79603

Please see report or telephone laboratory for reference ranges

Test Specimen Type Key

Factors

affecting

tests

Notes Out of hours service Time Limit for

requesting

additional tests

from time of

venesection

Turnaround time

from receipt of

sample (in

working days)

Acute Leukaemia Screen. This includes Myeloperoxidase stain, Esterase stain

Bone Marrow in EDTA (can be performed on peripheral blood if bone marrow is not available) No minimum volume. Analysis can also be carried out on CSF, pleural and ascites fluid.

Heavily clotted sample

Pleural, Ascites and CSF samples not being spun onto slides within 12 hours of being taken.

Please discuss with Haematology SpR (Bleep 7000/7001) before sending.

Please send samples directly to SIHMDS Specimen Reception

Please let Flow Cytometry laboratory know to expect sample.

Transport samples at room temperature.

The service at weekends and Bank Holidays is for new acute leukaemia screens only and must be backed by Consultant Haematologist. Contact Laboratory on-call bleep 7060. Clinical staff must be available for interpretation of results as this will not be provided by laboratory staff.

Within 24 hours Urgent: If lab is pre notified of urgent samples results can be authorised in 8 hours.(reported by SpR and Consultant)

Non-urgent: 48hrs (reported by SpR and Consultant)

Chronic Leukaemia Screen

Peripheral Blood in EDTA

Can be performed on BM, CSF, pleural fluid and Ascites fluid.

No minimum volume.


Pleural, Ascites and CSF samples not being spun onto slides within 12 hours of being taken

Please send samples directly to SIHMDS Specimen Reception

Please let Flow Cytometry laboratory know to expect the samples.


No service provided Within 24 hours Urgent: If lab is pre notified of urgent samples results can be authorised in 8 hours (reported by SpR and Consultant)

Non-urgent: 48hrs (reported by SpR and Consultant)


th October 2016



Factors

affecting

tests

Notes Out of hours

service

Time Limit

for

requesting

additional

tests from

time of

venesection

Turnaround

time from

receipt of

sample (in

working days)

Lymphoma Screen Bone Marrow or Peripheral Blood

(Can be performed on existing FBC sample)

No minimum volume.


Please send samples directly to SIHMDS Specimen Reception.

Please let flow cytometry laboratory know to expect sample.


No service provided Within 24 hours

Urgent: : If lab is pre notified of urgent samples results can be authorised in 8 hours (reported by SpR and Consultant)

Non-urgent: 48hrs.

Bone Marrow Aspirate 8 x bone marrow smears for morphology (all slides MUST be labeled with hospital number, surname and date of sample. (Please note, DOB is not required, date of sample is crucial)

2 EDTA for Immunophenotyping and/or Molecular Testing

1 Heparin for CGN and/or Molecular Testing

Slides not dried thoroughly. Slides not labeled correctly Heavily clotted sample.

BM slides and aspirate must be delivered to Specialist Integrated Haematological Malignancy Diagnostic Service (SIHMDS) via courier. Courier pick up from Cancer Centre and phlebotomy already in place. Transport at room temperature

BM received out of hours which need to be processed out of hours must be communicated to haematology out of hours bleep (7060). They will be stained and ready for reporting by registrar.

Within 24 hours

Urgent ( i.e.

Acute

Leukaemia): Same day for reporting by Haem SpR/consultant

Non-urgent: 48 hours (reported by SpR and Consultant)


th October 2016



Factors

affecting

tests

Notes Out of hours

service

Time Limit

for

requesting

additional

tests from

time of

venesection

Turnaround

time from

receipt of

sample (in

working days)

Lymphocyte subsets for HIV monitoring and for haematology patients.

1 x 4.5ml EDTA (Adult)

1 x 0.5ml (Paediatric)


Clotted sample

Please discuss all HIV negative requests with Haem SpR (Bleep 7000/7001) Samples should be <24hours old. Samples received after 1600hrs will not be processed till the next working day Transport at room temperature


24hrs (reported by registered Laboratory staff)

CD19 (for patients receiving anti-CD20 Rituximab)

4.5ml EDTA


Clotted sample

Transport at room temperature. No service provided Within 24 hours

24hrs (reported by registered Laboratory staff)


th October 2016



Factors

affecting

tests

Notes Out of hours

service

Time Limit

for

requesting

additional

tests from

time of

venesection

Turnaround

time from

receipt of

sample (in

working days)

Cerebrospinal Fluid (CSF)

CSF in 10/20ml sterile container

No minimum volume

Sample not delivered as soon as they have been taken.

Between 9.00am-4.30pm samples need to be delivered by hand to SIHMDS specimen reception. After 4.30pm they need to be hand delivered to main Haematology Lab on 1

st

floor at 60 Whitfield St.

If white cells are seen upon microscopic examination of cytospin slides, they are referred to Haem SpR for verification and may be immunophenotyped if indicated.

Transport at room temperature

All CSF requests received out of hours will be partially processed but not reported. If they need to be looked at out of hours the on-call lab staff need to be contacted (7060)

Within 24 hours

24hrs (reported by registered laboratory staff and Consultant) If sample needs immunophenotyping then TAT will be increased.

Iron stain 8 x Bone Marrow Slides

If there are no granules present on slides.

Slides must be labelled in pencil with hospital number, surname and date of sample. (DOB is not required)


48 hours (reported by SpR and Consultant)


th October 2016



Factors

affecting

tests

Notes Out of hours

service

Time Limit

for

requesting

additional

tests from

time of

venesection

Turnaround

time from

receipt of

sample (in

working days)

Urinary Haemosiderin 10mls urine None Haemosiderin slides are prepared by lab staff and need 24 hours to dry before being stained.


72 hours (reported by SpR)

Pleural or Ascites fluid 1ml fluid in sterile container

Sample not delivered as soon as they have been taken.

Between 9.00am-4.30pm samples need to be delivered by hand to SIHMDS specimen reception. After 4.30pm they need to be hand delivered to main Haematology Lab on 1

st

floor at 60 Whitfield St.

If white cells are seen upon microscopic examination of cytospin slides, they are referred to Haem SpR for verification and may be immunophenotyped if indicated.

Transport at room temperature


24hrs (reported by registered laboratory staff and Consultant) If sample needs immunophenotyping then TAT will be increased.


th October 2016

Specialist Integrated Haematological Malignancy Diagnostic (SIHMDS) (page 1 of 5)

2nd

Floor, 60 Whitfield St London W1T 4EU Hours: 09.00 – 17.00 Monday - Friday Tel: 0203 447 8518 or x 78518 All immunophenotyping, cytogenetics, molecular and histology samples will be received at SIHMDS and referred to destination laboratories.

Test Specimen

type

Key Factors

affecting tests

Notes Out of

hours

service

Time Limit

for

requesting

additional

tests from

time of

venesection

Turnaround

time from

receipt of

sample (in

working

days)

Cytogenetic (chromosomal analysis) -Testing for suspected haematological disease disorders (at presentation, post therapy or bone marrow transplant). Aplastics/ general anaemia Acute Myeloid Leukaemia –M1,M2,M3,M4,M4Eo,M5 A.L.L Burkitt’s Lymphoma CLL CML Diffuse Large B cell Lymphoma ET Follicular Lymphoma Mantle cell lymphoma MDS (CMML/RA/RARS/RAEB) Myelofibrosis Multiple Myeloma MPD (ET/Polycythaemia) NHL Pancytopenia Plasma cell Leukaemia PRV Thrombocytopenia/Neutropenia

Bone Marrow

Peripheral Blood: 5-10ml Samples should be in Lithium Heparin or Cytopots (RPMI 1640 + Heparin medium). Except for CD138+ isolated plasma cells for FISH on multiple myeloma cases.

Poor sample quality (clotted or more than a day old) Sample transported and or stored above or below room temperature Sample Contaminated by bacteria Sample taken into wrong transport medium

Sent to: Great Ormond Street Hospital, Paediatric Malignancy Unit (PMU) Samples must be received before 2pm (Monday-Friday) for samples to get to PMU on the same day.

Analysis will be carried as appropriate or in consultation with the referring Consultant or Registrar. The samples may be left overnight at room temperature and delivered to laboratory immediately the following morning.

No service provided

N/A Urgent

referrals: 10 working days

Routine

requests: 15 working days


th October 2016



affecting tests

Notes Out of

hours

service

Time Limit

for

requesting

additional

tests from

time of

venesection

Turnaround

time from

receipt of

sample (in

working

days)

Cytogenetic FISH (Fluorescent Insitu Hybridisation) Analysis -Testing for suspected haematological disease disorders (at presentation, post therapy or bone marrow transplant). Aplastic anaemia AML-M1,M2,M3,M4,M4Eo,M5 A.L.L Burkitt’s Lymphoma CLL CML Diffuse Large B cell Lymphoma ET Follicular Lymphoma Hypereosinophilic Syndrome Mantle cell lymphoma MDS Multiple Myeloma MPD (ET/Polycythaemia) NHL Plasma cell Leukaemia PRV

As above

Bone Marrow or Peripheral Blood in EDTA for FISH only.

CD138+ isolated plasma cells for FISH on multiple myeloma cases is preferable however bone marrow samples may also be adequate.

Poor sample quality (clotted or more than a day old) Sample transported and or stored above or below room temperature Sample Contaminated by bacteria Sample taken into wrong transport medium

Sent to: Great Ormond Street Hospital, Paediatric Malignancy Unit (PMU) Samples must be received before 2pm (Monday-Friday) for samples to get to PMU on the same day. Analysis will be carried as appropriate or in consultation with the referring Consultant or Registrar. The samples may be left overnight at room temperature and delivered to laboratory immediately the following morning.

No service provided

N/A Rapid FISH: 3 working days

Urgent

referrals: 10 working days

Routine

requests: 15 working days


th October 2016



affecting

tests

Notes Out of

hours

service

Time Limit

for

requesting

additional

tests from

time of

venesection

Turnaround

time from

receipt of

sample (in

working

days)

JAK-2 mutation analysis

Peripheral Blood/Bone Marrow in EDTA

Sent to: Great Ormond Street Hospital, Paediatric Malignancy Unit (PMU) Samples must be received before 2pm (Monday-Friday) for samples to get to PMU on the same day. Analysis will be carried as appropriate or in consultation with the referring Consultant or Registrar. The samples may be left overnight at room temperature and delivered to laboratory immediately the following morning.

No service provided

N/A 10 working days

PCR

BCR/ABL Ph+ve ALL

Peripheral Blood in 10-20ml EDTA

Sent to: Imperial College Molecular Pathology Laboratory Hammersmith Hospital

Samples will be sent the following day if received after 2pm. Samples need to arrive before midday on Fridays and prior to bank holidays which span a weekend

No service provided

N/A

10 working days


th October 2016


Test Specimen type Key

Factors

affecting

tests

Notes Out of

hours

service

Time Limit

for

requesting

additional

tests from

time of

venesection

Turnaround

time from

receipt of

sample (in

working

days)

PDGFR receptor Peripheral Blood/Bone Marrow in EDTA

Sent to Wessex Regional Genetics Laboratory, Salisbury District Hospital


No service provided

N/A 10 working days

Chimerism Studies

T-cell receptor rearrangement


Sent to: Department of Haematology, Royal Free Hospital


No service provided

N/A 10 working days

CLL

MRD

IgVH


Sent to HMDS, St James University Hospital


No service provided

N/A 10 working days

PNH testing PB sample Sample needs to be under 24 hours

All PNH screens are referred to Leeds Royal Infirmary. SIHMDS needs to be phoned the day before the sample arrives to the lab in order

No service provided

N/A 5 working day


th October 2016

old to book a courier to Leeds. The sample needs to be in the lab at 12.00pm at the latest in order to be sent the same night. Samples which are not expected by the lab and/or arrive after 12.00pm will not get to Leeds in time for processing. Samples must not be taken on Friday. Thursday 12.00pm is the very latest for any given week.


Referral laboratories:

Paediatric Malignancy Unit Level 2 Camelia Botnar Laboratories Great Ormond Street Hospital Great Ormond Street London WC1N 3JH

Imperial College Molecular Pathology

Laboratory G-block 2

nd floor, D2.04

Hammersmith Hospital Du Cane Road London W12 0HS

Department of Haematology Royal Free Hospital Pond Street Hampstead London NW32QG

Haematological Malignancy Diagnostic Service

(HMDS) St James Institute of Oncology Level 3 Bexley Wing St James University Hospital Breckett Street Leeds. LS9 7TF

Wessex Regional Genetics Laboratory Salisbury District Hospital Odstock Road Salisbury Wiltshire SP2 8BJ