Division of Pathology

Laboratory Handbook

Version 1.1
July 2007
 Contents
Introduction - Page 3
Pathology Page No. 4 - 8

Central Sort 9

Biochemistry/ Immunology 10 - 12
Departmental
Information Cellular Pathology 13 - 17

Haematology/ Blood Transfusion 18 - 22

Microbiology 23 - 25

Appendix 26 - 46

2
Introduction
This handbook is a guide to the Division of Pathology at South
Tees Hospitals NHS Trust. It outlines relevant information
related to the Division, and gives a detailed guide to the
services offered.

Laboratory services are provided at both the James Cook and

Friarage sites, with all departments operating as a single
service across both sites.

We aim to provide a high quality, cost effective service that is

focussed on the needs of the patient, and is responsive to the
rapidly changing environment in which we operate.

The Division is comprised of four Directorates, all of which

provide different aspects of pathological analysis and patient
services.

3
General Pathology
5. Important Sample Information
6. Important Sample Information
7. Hours of Work
─ Biochemistry, Haematology, Blood transfusion
─ Blood Transfusion Information
─ Immunology

8. Hours of Work continued

─ Microbiology
─ Cellular Pathology

9. Central Sort
─ General Information
─ Results

4
Important Sample Information
We aim to issue Pathology reports to the right place and on time. For this to be achieved we
must have full, accurate and legible information on the request form and specimen.

Please note the following important points:

1. Surname, Forename, Address and Date of Birth.

2. If a Hospital number is available it must be used at all times.
3. If using pre-printed addressograph labels please ensure that the details are correct for that
particular episode, e.g. the patient's surname, address, consultant or hospital may have
changed. PLEASE NOTE: Addressograph labels must not be used on transfusion samples.
4. Please state the destination for the report, i.e. hospital/ward/dept./secretary/ surgery and
address, If extra copies to a different location are required this must clearly be indicated,
including the address, on the request form. This is particularly important for clinicians outside
the area.
5. Name of the Consultant/GP. If no specific Consultant/GP is indicated the report will be sent
to the directorate/practice head.
6. Indicate if the patient is Private, Category II or Section 58.
7. Please indicate the nature and source of the sample plus the date and time taken (essential
for certain assays).
8. Clinical History - include any antimicrobials and drug therapy and the time of the last dose.
Relevant clinical details are essential to assist in preparing a meaningful report.
9. Test required. Please give the full name of the test (s) required, a recognised abbreviation or
tick the relevant check box.

5
Important Sample Information
Specimens and forms that are not adequately labelled will be rejected or returned for labelling.
This is an important safety measure. The laboratory staff have been instructed that in no
circumstances are they permitted to amend, add to or update patient identification data written
on request forms or specimen bottles.

Please note, correct identification of specimens is of particular importance when blood

transfusion or tissue typing is involved. Laboratory staff have been instructed to reject
specimens unless 3 points of identification on the specimen and form have been made, i.e. Full
name, Date of Birth and Address/Hospital number.

In the case of unconscious, or unidentified patients admitted through the Accident & Emergency
Department, both specimen and form must be identified with the Hospital Number if available.
All reports and blood or blood products issued for the transfusion will bear this number.

If you are taking the blood, please stick the addressograph label onto the Vacutainer parallel
with the length of the tube with patient's name at the top end, but not over the cap.

Please do not obscure the bar code label on blood culture bottles with the addressograph label.

Your co-operation is very much appreciated.

NB: High risk samples should be labelled as such in accordance with Trust policy. The
laboratory should be contacted prior to the sending of category A specimens so that transport
arrangement can be made that meet the Carriage of Dangerous Goods and Use of
Transportable Pressure Equipment Regulations 2004 (for further information please see the
Health & Safety Executive website at http://www.hse.gov.uk/cdg/regs.htm).
6
General Pathology
Hours of Work
Biochemistry, Haematology, Blood transfusion
The Core hours of these departments are: 9.00 am to 5.30pm Monday to Friday at JCUH
site and 8.30 am to 5.00 pm Monday to Friday at FHN site.

Outside of the core hours the department offers both routine and emergency
investigations however priority will be given to urgent work.

Where possible users should avoid sending samples to the laboratory between 4.00am
and 6.00am since this time is dedicated to essential maintenance, calibration and quality
control of instruments prior to the delivery of ITU samples at 6am.

Blood Transfusion Information

Routine samples (including pre operative samples) must reach the department by 1600
for same day processing. Samples received after this time will be processed on the next
routine working day, with blood available in the afternoon.
Routine requests for platelets must reach the laboratory by 11am for same day delivery
from Newcastle.
Consultant advice is available 24 hours a day – please contact via the hospital
switchboard.

Immunology
The laboratory is situated at the James Cook site and is open from 9.00am to 5.30pm
Monday to Friday

7
General Pathology
Hours of Work continued
Microbiology
James Cook University Hospital
A routine service is provided between 9pm and 5pm weekdays and 9.30am till
11.30am Saturdays. Between 5.00pm and 10.00pm on weekdays and between
11.30am and 10.00pm on Saturdays and between 9.30am and 10.00pm on Sundays
Microbiology operates a limited service for urgent and semi-urgent work such as
antibiotic levels.

There is an on-call phone for urgent specimens between 10.00pm and 9.00am, which
can be contacted by asking the switchboard for the Biomedical Scientist on call for
Microbiology. The only specimens that will be processed on call at JCUH are deep pus
and CSF's. An on call Consultant Microbiologist can be contacted via the switchboard to
authorise the processing of any specimens that are considered urgent.

Friarage Hospital
A routine service operates Monday to Friday 9.00am to 5.00pm and Saturday 9.00am
to 12.00pm. A Biomedical Scientist will be handling blood cultures on Sunday mornings
and is available through the switchboard for urgent samples. An on call service
operates out of hours with a Biomedical Scientist available via the switchboard for
urgent samples.

Cellular Pathology
Department working hours are:
Monday-Friday 9:00am to 5:30pm at the James Cook site
Monday-Friday 8:30am to 5:00pm at the Friarage site.
Semen specimens are accepted: 9:00am to 4:30pm at the James Cook site
8:30am to 4:00pm at the Friarage site
Mortuary 8:30am to 4:30pm at both the JCUH and FHN site

8
General Pathology
Central Sort
General Information
The Central Sort department handles the receipt of all specimens received by the Division of
Pathology.

Specimens are firstly validated for analysis by ensuring that patient demographics and
sample types all match the received requesting details.

The samples undergo preparation for analysis using methods such as centrifugation and are
then passed to the relevant departments. Other duties carried out by the staff in Central
Sort include:
 collection of samples from external locations
 entering of patient test requests into the Pathology laboratory computer
system
 directing paper copies of reports to the correct locations.

Results
At the JCUH site results can be obtained by clinicians (01642 854385) between 1pm and
4pm.

At the Friarage Hospital results can be obtained by clinicians between 9am and 5pm (01609
763039).

9
Biochemistry
11. Biochemistry
─ General Information
─ Internal Organisation
─ Test Information

12. Immunology
─ General Information
─ Test repertoire
─ Requesting of Tests
─ Interpretation of Results

10
 Biochemistry
General Information
A 24-hour shift system operates for the Biochemistry department, offering all analyses that are likely
to be needed in an emergency situation. Outside of the core hours the department offers both
routine and emergency investigations from a more limited repertoire.

Where possible, users should avoid sending samples to the laboratory between 4.00am and 6.00am
since this time is dedicated to essential maintenance, calibration and quality control of instruments
prior to the delivery of ITU samples at 6am.

The Biochemistry department offers a broad spectrum of tests used in the diagnosis and monitoring
of disease. This involves the measurement of specific chemical components of body fluids using a
variety of analytical techniques.

Internal Organisation
The department is divided into three sections, automation, endocrinology and special chemistry.
Automation
This section performs the high volume of routine and urgent tests required from Biochemistry
in a large NHS Trust. It is staffed 24 hours a day, with minimal staffing levels outside core
hours.
Endocrinology
This section offers a comprehensive range of endocrine tests including tumour markers,
hormone assays and markers of cardiac damage.
Special Chemistry
This section performs a range of assays, which require the use of specialist analytical
techniques such as mass spectrometry and HPLC.

Test Information
See Appendix 1

11
 Immunology
General Information
This department specialises in investigating and aiding the management of patients with disorders of
the immune system. This includes autoimmune disease, systemic vasculitis, neurological diseases,
allergy, suspected immunodeficiencies (primary and secondary) and malignant diseases. It provides a
comprehensive range of investigations to assist the clinicians caring for patients with these diseases
and interacts with and underpins clinical activity within a wide range of disciplines including
rheumatology, nephrology, dermatology, infectious diseases, haematology, neurology and
paediatrics.

Test repertoire
We provide a comprehensive range of tests for the immunological investigation of patients. We aim to
provide the highest quality of service with prompt delivery of accurate results, backed up by specialist
medical and scientific expertise. Where specific tests are not available locally, we will refer samples
on to colleagues in other centres. The quality of all our work is regularly and frequently monitored in
National Quality Control Schemes (UKNEQAS).

Requesting of Tests
Common pathology request forms are in use. A list of immunology tests most frequently requested
(both in-house and referred) are given on the test information page but if you require unlisted tests,
please contact the laboratory in advance to ensure that the test is available and the correct sample
type is taken.

Interpretation of Results
The department is happy to assist in the interpretation of patient's test results. Interpretative
comments are added to test reports where appropriate. A full list of tests offered is described in the
following pages. There is a brief summary of the clinical application of each test that is intended to be
helpful but is not intended to replace discussion of individual patients.

Test Information
Please see appendix 1 and 5 12
Cellular Pathology
14. General Information

15. Histology

16. Cytology

17. Cytology continued + Mortuary Information

13
 Cellular Pathology
General Information
Three points of patient identification are required on both the specimen container and the appropriate
request form.
Two point of identification are required on cases sent to the laboratory as slides.
Location and Consultant must be on the request form.
Specimen type and clinical details must be on the request form.
Cervical sample requests must include:-
 Previous test date
 Relevant cervical history/ treatment
 Cervix visualised and 360° sweep boxes ticked
 Sample taker code
 LMP date plus hormone status

Failure to do this may result in delays in diagnosis while the specimen is returned to source.

Request forms for Histology and Non-gynaecological cytology can be requested by telephoning the
department. Please note that the HMR101 forms for Gynaecological samples are included in the Liquid
Based Cytology (LBC) kits. Contact the laboratory if more details are required.

A consultant pathologist or senior scientist is available for urgent reporting or urgent queries during
normal working hours.

Suitable plastic gripper specimen bags with side pocket for request forms are available from the
department or from pathology reception. These bags will accommodate specimen pots up to 250ml in
size.
14
 Cellular Pathology
Histology
Biomedical scientists and Medical laboratory assistants work with Pathologists to provide South Tees
Hospitals NHS Trust and local GPs with a speedy accurate tissue diagnostic service. There are
laboratories at both the James Cook and Friarage hospital sites.

Specimens received range from small biopsies to whole organs. Tissue specimens sent to the
laboratory are treated in such a way that they may be examined microscopically. After fixation in
formaldehyde they are dissected then processed through alcohol and clearing agents to allow paraffin
wax embedding. The tissue is then sectioned using a microtome to produce 4µ sections on glass
slides that are stained and examined microscopically by a Pathologist.

Specimens are prioritised for preparation and reporting depending on:-

a. Clinical information
b. Referral under cancer targets
We aim to report the majority of specimens in-house but do also use the private sector to report
some specimens during periods of consultant leave.

Usually the pathologist is able to write a report after looking at the initial slides stained by
haematoxylin and eosin. Sometimes, however, special stains or immunocytochemistry may be
required before a complete diagnosis can be made.

Turnaround times
We aim to provide urgent reports within 48-72 hours of receipt of the specimen. Within the Trust
reports are available electronically. Currently primary care reports are issued daily as paper copies.
Routine pathology for primary care specimens is usually available within 6 weeks of receipt of a
specimen. If a result is required more urgently, please indicate this clearly on the request form.

Test Information
See appendix 2
15
Cellular Pathology
Cytology
We offer a routine cytology service to the NHS Cervical Screening Programme at JCUH and a
non-gynae clinical service on both the James Cook and Friarage sites.

 At James Cook this includes the screening of Liquid Based Cytology samples
(gynaecological) and the analysis of non-gynaecological specimens
prepared using a range of techniques, including Thinprep processing.
 At the Friarage site only non-gynaecological samples are prepared and
screened.

This department specializes in the microscopic evaluation of samples and analysis of the
cellular material present. Screening staff, Biomedical Scientists, Advanced Practitioners and
Pathologists are involved in the screening and diagnosis of:
 Benign changes/tumours
 Pre-cancerous changes
 Malignant tumours

We partake in the External Quality Assessment (EQA) scheme for cervical cytology.

16
 Cellular Pathology
Cytology continued
Gynaecological samples:
The James Cook Cytology department is fully converted to Liquid Based Cytology (LBC), and acts as a
'spoke' site; with gynaecological sample preparation taking place at the University Hopsital of North
Durham ('hub' site). The department has an annual workload of approximately 20 000 cervical
smears The samples are screened for pre-cancerous cellular changes originating from lesions on the
cervix. The optimum time to take a cervical sample is mid-cycle. If the sample is taken from another
site e.g. vagina or vault sample, please note this on the request form. Features associated with
infection from a number of micro-organisms may also be identified and will be indicated in the final
report. Please note: infections should be confirmed via microbiological assessment and treated
accordingly.
Non-Gynaecological samples:
The Cytology departments at both James Cook and the Friarage analyse Non-Gynaecological
specimens for malignant cells. These samples may originate from a range of body sites such as; body
cavities, the breast, respiratory/gastrointestinal/urinary tracts (see specimen types in test
information). Samples maybe submitted as fresh fluids, washings, brush samples, or Fine Needle
Aspirations (FNA's) - please see test information for advice on sample collection.
We aim to report all samples within 6 weeks with the majority reported within 4 weeks.
Test Information
See appendix 3
Mortuary Information
The mortuary at James Cook University Hospital is the community mortuary for the South Tees area.
The mortuary at the Friarage Hospital is the community mortuary for North Yorkshire and
Richmondshire.
Coroners and consented hospital post mortems are performed as well as providing a service for
forensic post mortems.
17
Haematology/ Blood Transfusion
19. Blood Transfusion
─ General Information
─ Test Information

20. Blood Transfusion

─ Sample Timing

21. Blood Transfusion

─ Cross matching
─ Key factors known to affect test performance or interpretation

22. Haematology
─ General Information

18
 Blood Transfusion
General Information
Routine samples (pre operative samples including crossmatch) must reach the department by 1600 for
same day processing. Samples received after this time will be processed on the next routine working
day, with blood available in the afternoon.

Routine requests for platelets must reach the laboratory by 11am for same day delivery from Newcastle.
Consultant advice is available 24 hours a day – please contact via the hospital switchboard
Test Information
Sample Requirements
Addressograph labels must not be used on blood transfusion samples.
The transfusion specimen required for Group and Save, Crossmatch, DAT, and Kleihauer is a fully filled
4.5ml EDTA (7.5ml bottle at FHN). This must be labelled with 3 points of identification:
 Full name
 Date of Birth
 Hospital Number
If a hospital number has not been assigned to the patient then their address will be accepted.
Individuals taking samples for transfusion should be aware of the competencies for taking venous
samples for transfusion outlined in the NPSA Safer Practice notice 14 'Right Patient, Right Blood'. It is
the responsibility of the PCT or hospital to ensure that staff taking samples for transfusion purposes are
appropriately trained. If further advice or assistance with training is required please contact the
transfusion practitioners.
NB:
If a hospital number exists for a patient and this is not used, the sample will be rejected.
The sample and form must be signed by the person taking the blood and their name and the name of
the requesting clinician must be printed on the request form.
Specimens sent in the wrong bottle or insufficiently and/or incorrectly labelled will be discarded.
Specimens are retained for cross matching purposes for 5 days for patients not transfused in last 3-
month period.
19
Blood Transfusion
Sample Timing
When patients have received a previous blood transfusion the timing of the repeat
crossmatch sample is critical. The table below is the current BCSH recommendation:

Patient transfused within Sample to be taken no more than

3-14 days 24 hours before transfusion
15-28 days 72 hours before transfusion
29 days to 3 months 1 week before transfusion

At JCUH only the first 2 apply since samples are retained for a maximum of 5 days.
At FHN samples are retained for 3 weeks so all 3 apply.

Additional tests may only be requested on samples in accordance with these guidelines. If in
doubt, please contact the laboratory.

Pregnant women who require blood must have samples screened every 7 days maximum.

In situations where patients are being repeatedly transfused and have not shown any
demonstrable antibody production, samples may be screened every 72 hours. It is
important that new patients do not fall into this category as it will not be known if they are
likely to form antibodies early on. If in doubt check with a senior member of staff.

Private Blood Groups

Private blood groups can be supplied for travel or personal requirements. The current cost
for these can be obtained from laboratory.

20
 Blood Transfusion
Cross matching
For routine cross-matching, specimens need to reach the laboratory BEFORE 4pm on a weekday
for blood required next morning or 11am on a Sunday for blood required Monday morning.
Routine crossmatch requests on patients with a current Group and Save specimen already in the
laboratory will be accepted up to 4pm on a weekday for blood required next morning.
Emergency crossmatched blood can usually be supplied within 45 minutes.
All requests for blood required in less than 4 hours must be telephoned to the laboratory.
When making a telephone request for blood, the patient's full name, date of birth or hospital
number must be given. The requesting clinician and the person telephoning the request will be
recorded.
Following implementation of the Blood Safety & Quality Regulations (2005) blood products can
only be supplied to outlying hospitals if a technical agreement is in place between the PCT or
independent hospital and transfusion laboratory.

Key factors known to affect test performance or interpretation

Samples will be rejected if received more than 48 hours post phlebotomy.
It is not possible to provide accurate blood grouping on clotted samples or haemolysed samples,
including those stored at inappropriate temperatures.
Small samples must be processed manually and these will only be accepted for young children.
All patients requiring a group & save are tested for red cell antigens and antibodies in the plasma.
In some patients antibodies may not be detectable - this includes neonates, very elderly patients
and those with immunodeficiency - in these patients the red cell antigens are checked twice as a
confirmatory test. Blood groups may also be affected by recent medical interventions, particularly
bone marrow transplantation, and it is important to inform the laboratory about this.

21
 Haematology
General Information
Haematology specialises in the diagnosis and treatment of disorders of the blood. The department
runs the laboratory service for haematology within the pathology division at both The James Cook
University Hospital and The Friarage Hospital. We offer a full and comprehensive range of modern
diagnostic and therapeutic services treating all diseases of the blood including acute leukaemias,
myeloma, lymphomas, myeloproliferative disorders, haemoglobinopathies, anaemias, bleeding and
clotting disorders. The laboratories work to nationally agreed standards as set out by the Clinical
Pathology Association (CPA) and Medicines and Healthcare Products Regulatory Authority (MHRA)

The Friarage Hospital

The haematology laboratory at the Friarage Hospital is based within the blood sciences department.
It is a new purpose built laboratory opened in 2007. The laboratory offers a basic range of routine
and emergency diagnostic tests including full blood counts, coagulation screens and blood
transfusion. More complex tests are referred to the laboratory at The James Cook University
Hospital or to national reference laboratories.

The James Cook University Hospital

The haematology laboratory is based within the pathology department at The James Cook University
Hospital. It is a purpose built laboratory opened in 2002. We are able to offer a wide range of basic
and complex investigations including: full blood counts and blood films, bone marrow tests including
cytochemistry, coagulation screens and monitoring of patients on warfarin, investigations of
bleeding disorders and clotting disorders (factor assays and thrombophilia screening), vitamin
assays, regional flow cytometry service aiding the diagnosis of leukaemias and lymphomas and
haemoglobinopathy screening.

Test Information
See appendix 1
22
Microbiology
24. Microbiology
─ General Information
25. Microbiology
─ Test Information

23
Microbiology
General Information
The Microbiology department deals with the culturing, isolation and identification of micro-
organisms such as bacteria and fungi and viruses obtained from various parts of the body
using specimens such as swabs from wounds and pus, faeces, urine, respiratory specimens
and other body fluids such as blood and cerebrospinal fluid.

Bacteria that cause infection are identified and tested for sensitivity to various antibiotics. It
may take up to 2-3 days to confirm a diagnosis due to the time required for a culture to
grow. Some cultures require much longer incubations in the order of 4 weeks (e.g. Fungal
culture)

Stool for parasites and urine full examination and direct microscopy are also carried out in
this department.

Important
Please ensure that all container tops are seated correctly on their threads and securely
tightened down – leaking specimens are a hazard and will not be processed unless there are
exceptional circumstances.

24
Microbiology
James Cook Site
A routine service is provided between 9pm and 5pm weekdays and 9.30am till 11.30am
Saturdays. Between 5.00pm and 10.00pm on weekdays and between 11.30am and 10.00pm
on Saturdays and between 9.30am and 10.00pm on Sundays Microbiology operates a limited
service for urgent and semi-urgent work such as antibiotic levels. Results should be at all times
looked up on the ICEweb system. Important positive results such as positive blood cultures will
always be phoned to the ward as soon as they flag positive.

There is an on-call phone for urgent specimens between 10.00pm and 9.00am, which can be
contacted by asking the switchboard for the Biomedical Scientist on call for Microbiology. The
only specimens that will be processed on call at JCUH are deep pus and CSF's. If other
specimens are deemed urgent enough then you will need to contact the on call Consultant
Microbiologist to OK such specimens.

Friarage site
A routine service operates Monday to Friday 9.00am to 5.00pm and Saturday 9.00am to
12.00pm. A Biomedical Scientist will be handling blood cultures on Sunday mornings and is
available through the switchboard for urgent samples. An on call service operates out of hours
with a Biomedical Scientist available via the switchboard for extremely urgent samples.

Test Information
See Appendix 4

25
Appendix
Appendix 1 - At a glance guide to tests and bottle types
Appendix 2 - Histology Tests
Appendix 3 - Cytology Tests
Appendix 4 - Microbiology Tests
Appendix 5 - Immunology Tests
Appendix 6 - Phonebook

26
 Appendix 1 - At a glance guide to
tests and bottle types
Test listed in alphabetical order Aldosterone Biochemistry SST Contact lab in advance
Alkaline phosphatase Biochemistry SST
For Vacutainer tubes Alkaline phosphatase Biochemistry SST
Key Bottle top colour Bottle Type isoenzymes
CIT Light blue Sodium Citrate α 1 anti trypsin Immunology SST
SST Gold Serum separator tube (with gel separator) Amino acids Biochemistry SST
PST Green Lithium heparin plasma separator tube Amino acids (urine) Biochemistry UNI
Aminophylline Biochemistry SST
FO Grey Sodium fluoride potassium oxalate
Ammonia Biochemistry PST Contact laboratory
EDTA Purple Edta tube
first. Must be received
PLAIN Red Plain tube (no additive) on ice within 30 mins
Amphetamine Biochemistry UNI
UNI 25ml Universal Urine container Amylase Biochemistry SST
24H 24 Hour Urine container Amylase (urine) Biochemistry UNI
24HA 24 Hour Urine container with acid Anti-neutrophill Immunology SST
cytoplasmic antibody
Test Department Sample type Other Information (ANCA)
α Feto Protein (AFP) Biochemistry SST Androstenedione Biochemistry SST
Acanthocytes Haem EDTA Part of FBC Anti-cardiolipin Immunology SST
ACE Biochemistry SST Anti glomerular Immunology SST
basement membrane
Anti-acetyicholine Immunology SST
antibody (GBM)
receptor antibody
Anti-nuclear antibody Immunology SST
(ACR) (ANA) or anti-nuclear
Acetylcholinesterase Biochemistry SST factor (ANF)
Acetylcholinesterase Biochemistry EDTA Anti streptolysin titres Microbiology SST
(RBC) (ASOT)
ACTH Biochemistry EDTA Sample must be Anti Thrombin III see Thrombophilia
received in laboratory Screen
within 30 mins of Antibiotic assays Microbiology SST
being taken Ascobic acid (vitamin Biochemistry PST
Activated Protein C Haematology See Thrombophilia C)
Resistance Screen Aspergillus antibody Microbiology SST
Bacterial serology Microbiology SST
Adrenal antibodies Immunology SST
Barbiturates Biochemistry SST
AFB Microbiology 3 x UNI (Phenobarbitone)
Albumin Biochemistry SST Bence-Jones Protein Immunology UNI
Alcohol (Ethanol, Biochemistry FO Bence-Jones Protein Immunology 24H
C2H5OH) (Quantitative)

27
 Appendix 1 continued
β 2 Microglobulin Immunology SST Combs Test (DAT, Blood Transfusion EDTA
β HCG Biochemistry SST DCT, DAG)
Bile pigments Biochemistry UNI Copper (may go with Biochemistry SST
(Bilirubin, Urobilin, zinc)
Cooper (urine) Biochemistry Special bottle. Please
Urobilinogen)
contact laboratory.
C1 esterase inhibitor Immunology SST
Cortisol Biochemistry SST Sampling times 9am
(C1-INH) level and midnight
C3 & C4 Immunology SST Cortisol (urine) Biochemistry 24H
C2H5OH (Ethanol) Biochemistry FO Coxsackie antibodies Microbiology SST
CA125 Biochemistry SST C peptide Biochemistry SST Sample must be sent
Caeruloplasmin Immunology SST to laboratory on ice
Calcium Biochemistry SST and received within ½
Candida Microbiology SST an hour of being taken
antigen/antibody Creatine kinase (CK) Biochemistry SST
Carbemazepine Biochemistry SST Creatinine Biochemistry SST
(Tegretol) Creatinine (urine) Biochemistry 24H
Creatinine Clearance Biochemistry SST & 24H
Cardiac Enzymes Biochemistry SST
Crossmatch Blood Transfusion EDTA fully labelled
(LDH, CK, AST)
Cryoglobulins Immunology Please contact
Catecholamines Biochemistry SST laboratory for advice
CEA (Carcino Biochemistry SST CSF Bacteriology Microbiology UNI
Embryonic Antigen) CSF Chemistry Biochemistry FO & UNI
Centromere Immunology SST CSF VIrology Microbiology UNI
Antibodies CSF Xanthochromia Biochemistry UNI Container must be
Cholesterol Biochemistry SST protected from light
Cholinesterase Biochemistry SST Cyclosporin A Biochemistry EDTA
CMV Microbiology SST Cystine Biochemistry 24H
(Cytomegalovirus) Cytomegalovirus Microbiology SST
antibodies (CMV)
Coagulation Screen Coagulation CIT Cytomegalovirus Microbiology Virus transport
(urine) medium
Cold Agglutinins Blood Transfusion EDTA
DHEA Biochemistry SST
(Cold antibodies) Differential protein Immunology SST & 24H
Complement Fixation Microbiology SST clearance
Test Digoxin Biochemistry SST
Drugs of Abuse Biochemistry UNI
Electrolytes Biochemistry SST
Epanutin (Phenytoin) Biochemistry SST
EPO (Ertyropoeitin) Haematology SST

28
 Appendix 1 continued
Erythrocyte Haematology EDTA Helicobacter Microbiology SST
Sedimentation Rate 5HIAA Biochemistry 24HA Contact laboratory for
Ethanol (C2H5OH) Biochemistry FO bottle
Ethosuximide Biochemistry PLAIN HIV Microbiology SST
Ethylene Glycol Biochemistry PST HLA B27 Haematology EDTA
Homocystine Biochemistry UNI
Factor Assays Coagulation CIT Test by arrangement.
Immunolglobulins Biochemistry SST
Contact Laboratory for
(IgG, IgM, IgA)
details Immunoglobulin (IgE) Immunology SST
Ferritin Biochemistry SST INR Coagulation CIT
Fibrinogen Coagulation CIT Insulin Biochemistry SST Sample must be
Folate (Folic acid) Biochemistry SST received in laboratory
Free T3 Biochemistry SST with ½ an hour of of
Free T4 Biochemistry SST venepuncture on ice
FSH See Gonadotrophin Intrinsic factor Coagulation SST
Full Blood Count Haematology EDTA antibodies
(FBC) Iron (Overdose only) Biochemistry PLAIN
G6PD Biochemistry EDTA Contact laboratory. Islet Cell Antibodies Immunology SST
Kleinhauer Haematology EDTA
GGT Biochemistry SST
Lactate Biochemistry FO
Glucose Biochemistry FO A SST sample can be
LH See Gonadotrophin
used but must be Light Chains Immunology 24H
under 2 hours old Quantitation
Glucose Tolerance Biochemistry FO Lipids Biochemistry SST
Test (GTT) Lithium Biochemistry SST Sample timing 12
Gonadotrophin (FSH Biochemistry SST hours post dose
LH) Liver Function Tests Biochemistry SST
Growth Hormone Biochemistry SST Fasting sample (LFT)
(GH) required Lupus anicogulant See Thrombophilia
Haemaglobin Haematology EDTA By prior arrangement screen
Electrophoresis with laboratory Magnesium Biochemistry SST
Haptoglobin Immunology SST Malarial Parasites Haematology EDTA Laboratory
notification required
HbA1C Biochemistry EDTA
before sample is sent
Haemachromatosis Haematology EDTA x 2 Mercury (urine) Biochemistry UNI
Gene Metabolic screen Biochemistry UNI
HCG (Beta HCG, β- Biochemistry SST (urine)
HCG) Methanol Biochemistry FO A separate specimen is
Hepatitis A-E Microbiology SST required for ethanol
antibodies Microalbumin Biochemistry UNI

29
 Appendix 1 continued
Myoglobin Biochemistry SST Rheumatoid Factor Immunology SST
Neutrophil Immunology SST (Rose Waller)
cytoplasmic antibodies Rubella antibodies Microbiology SST
(ANCA) Salicylate Biochemistry SST
Oestrodiol Biochemistry SST SCL 70 Immunology SST
Oligoclonal Bands Immunology SST & UNI for CSF (Autoantibodies)
Osmolality Biochemistry SST STS (serological test Microbiology SST
Osmolality (urine) Biochemistry UNI for Syphilis)
Parahormone Biochemistry EDTA Tegretol Biochemistry SST
(Parathyroid, PTH) Testosterone Biochemistry SST
Paul Bunnell Haematology EDTA Theophylline Biochemistry SST
(Monospot, GFST) Thrombophilia Screen Coagulation Patient rests 10 mins,
Phenobarbitone Biochemistry SST 3 x CIT, 1 x SST
Phenytoin (Epanutin) Biochemistry SST Thyroid Function See TSH
Phospholipid Immunology SST Total Iron Binding See Transferrin
antibodies Capacity (TIBC) Saturation
Platelet Aggregation Coagulation CIT x 4 By prior arrangement Transferrin Saturation Biochemsitry SST
with laboratory
Triglyceride Biochemistry SST
Progesterone Biochemistry SST
TSH (Thyroid Biochemistry SST
Prolactin Biochemistry SST
Stimulating Hormone)
Protein Immunology SST
U&E Biochemistry SST
Electrophoresis
U&E (urine) Biochemistry 24H
Prothrombin Time Coagulation CIT
Urea Biochemistry SST
(PT)
Prostate Specific Biochemistry SST Uric acid (Urate) Biochemistry SST
Antigen (PSA) Valproic acid Biochemistry SST
Plasma Viscosity (PV) Haematology EDTA (Valproate/ Epilim)
RAST (specific Immunology SST Detailed history Vancomycin Microbiology SST
antigens) essential VDRL Microbiology SST
Reducing substances Biochemistry Blue top faecal Vitamin A Biochemistry SST x 2 Protect bottles from
(Faecal) container light. Contact
Reducing substances Biochemistry UNI laboratory
(Urine) Vitamin B12 Biochemistry SST
Renin Biochemistry PST Sample must be Vitamin B1 Thiamine Biochemistry PST
received in laboratory Vitamin B2 Biochemistry PST
within 30 mins of Riboflavine
venepuncture. Do not Vitamin B6 Biochemistry PST
send sample on ice. Pyridoxine

30
 Appendix 1 continued
Vitamin C (Ascorbic Biochemistry PST
acid)
Vitamin D Biochemistry SST
Vitamin E Biochemistry SST
VMA Biochemistry 24HA Bottles available from
laboratory
Von Willebrands Coagulation 2 x CIT Required in laboratory
asap.

Please Note: Due to changes in either the way a test is carried out or in where a test is referred, the
sample type may be different to that listed at the time of print for more obscure tests. Please
contact the laboratory if more advice is needed.

31
 Appendix 2 - Histology Tests
Test Name Protocols
Crystals in Synovial fluid Place in a dry container and send to laboratory as soon as possible

Faecal fats Place a small amount of faeces in a small dry container

Only the presence or absence of fat is reported, no quantitative
analysis is performed
Fat in urine Place in a universal container and take to laboratory as soon as
possible

Foetus Some foetuses are sent directly to Newcastle

If the clinician indicates the foetus is to be sent to JCUH or Friarage:
If < 14 weeks gestation place in 10% formalin as per routine
Histology
If > 14 weeks gestation send dry to the Mortuary

Frozen sections Phone the laboratory

Specimen must be sent dry
Specimen must be taken to the laboratory immediately
Include phone number that report is to be telephoned to
24 hours notice is required

Haemosiderin in urine Place in a universal container and take to laboratory as soon as possible

32
 Appendix 2 continued
Test Name Protocols

Histology (routine) Place specimen in 10% formalin

Specimen should be covered in 20x volume of formalin. If this is not
possible, take specimen to histology a.s.a.p.
Complete request form
Take to Pathology reception
At Friarage include requests for photographs

Immunofluorescence (oral biopsies) Inform Histology at JCUH before taking specimen

Place specimen on card in a small drop of saline in a dry container
Place pot and form in plastic wallet (provided by laboratory)
At JCUH take specimen to laboratory immediately
At Friarage arrange transport to JCUH laboratory
immediately

Immunofluorescence (skin) Inform Histology at JCUH before taking specimen

Place specimen on card in a small drop of saline in a dry
container
Place pot and form in plastic wallet (provided by laboratory)
At JCUH take specimen to laboratory immediately
At Friarage arrange transport to JCUH laboratory
immediately

Lymph nodes Send specimen to Histology in a dry container immediately if

a diagnosis of lymphoma is suspected

Muscle biopsies Muscle biopsies are not routinely provided phone the Neuropathologist
for advice. 48 hours notice is required
33
Appendix 2 continued
Test Name Protocols

Renal biopsies Inform Histology at JCUH before taking specimen

Place specimen in a drop of saline in a dry container
Place pot and form in a plastic wallet (provided by the
laboratory)
Take specimen to laboratory immediately

Semen (infertility) Dry container

Kept at body temperature
Taken to the laboratory within 2 hours of being taken
Monday - Friday only: 9:00am-4:30pm at JCUH
8:30am - 4:00pm at Friarage

Semen (post vasectomy) Dry container

Kept at body temperature
Taken to the laboratory within 2 hours of being taken
Monday - Friday only: 9:00am-4:30pm at JCUH
8:30am - 4:00pm at Friarage

Testicular biopsies Place in Bouin's fluid

Take to Pathology reception

34
 Appendix 3 - Cytology Tests
Test Name Protocols
Approximately 20ml of fluid in a white top
universal container to be sent to the
Ascitic/Peritoneal fluid laboratory for processing. Please note: in the
case of a significant time delay from sample
collection to sample submission, refrigerate
the sample
Samples collected into appropriate collection
Bladder washings
vessels available from clinic site
Samples collected into appropriate collection
Bronchial aspirates
vessels available from clinic site
Place the brush into a pot of CytoLyt solution.
Bronchial brushes Pots are available from the laboratory upon
request
Please do not take a sample without
appropriate training. Contact your local
cervical sample training co-ordinator for
Cervical Sample information.
The optimum time to take a cervical sample
is mid-cycle.
Further Information
Any clot/tissue present will be
sent to histology for further
processing
Please remember to remove the
plastic sheath from the brush
before placing it into the pot.
Please note: if the sample is
taken from a site other than the
cervix e.g. vagina or vault, note
this on the request form.
If two samples are taken; one
from the ectocervix and one from
the endocervix, place both
brushes into one sample pot.
In the advent of two cervices
being present, take two samples
and place each brush into
separate sample pots clearly
marked right and left.
35
 Appendix 3 continued
Test Name Protocols Further Information
Use plain universal bottle and take to
CSF laboratory immediately

Breast: Take one fixed and one air-dried
slide, labelled 'F' and 'A' respectively, place
these into separate slide transport boxes and
send to the laboratory in a plastic wallet.
Other Body Sites: The clinician may prepare
Fine Needle Aspirates fixed and/ or air-dried slides depending on
(FNA’s) the nature and anatomical location of the site
aspirated. These slides should be labelled 'F'
and 'A' respectively and placed into separate
slide transport boxes and sent to the
laboratory in a plastic wallet.
Please note: Slides should be
fixed with cytological fixative,
both of which are available from
the Cytology department on
request.
If an excessive volume of fluid is
aspirated, place into a white top
universal container or a pot
containing CytoLyt solution.

Place the brush into a pot of CytoLyt solution. Please remember to remove the
Pots are available from the laboratory upon plastic sheath from the brush
Gastric brushes
request before placing it into the pot.

Place the brush into a pot of CytoLyt solution. Please remember to remove the
Oesophageal brushes Pots are available from the laboratory upon plastic sheath from the brush
request before placing it into the pot.
Approximately 20mls of fluid in a white top
universal container to be sent to the
Pericardial fluid
laboratory for processing. Please note: in the
case of a significant time delay from sample

36
 Appendix 3 continued
Test Name Protocols Further Information
Samples collected into appropriate collection
Peritoneal washings
vessels available from clinic site
Approximately 20mls of fluid in a white top
universal container to be sent to the
laboratory for processing. Please note: in the
Pleural fluid
case of a significant time delay from sample
collection to sample submission, refrigerate
the sample
Please note: any sputum samples
To be collected into a sputum pot. submitted to the laboratory will
Sputum be confirmed by telephone that
analysis for malignant cells is
required.
Any material collected should be sent to the
Thyroid fluid laboratory in a plain white topped universal
container
Approximately 20mls of urine in a white top Red topped universal pots
universal container to be sent to the containing boric acid are to be
laboratory for processing. Please note: in the used for microbiological
Urine (cytology)
case of a significant time delay from sample investigations only and must not
collection to sample submission, refrigerate be used for urine cytology.
the sample
Uterine brush Fixed slide

37
 Appendix 4 - Microbiology Tests
Test Name Specimen Turn-around Time Test Name Specimen Turn-around Time
ACANTHAMOEBA PCR Corneal scrape 72 hours CHLAMYDIA Penile swab, Endocervical 72 hours
TRACHOMATIS PCR swab, Urine, Eye swab
ADENOVIRUS Faeces 72 hours
CHLAMYDIA EDTA ,BAL, induced sputum 72 hours
ADENOVIRUS PCR EDTA, Throat swab, Eye 72 hours
PNEUMONIAE PCR *
(Q,T) swab, Vitrous humour, NPA,
Induced sputum, Urine CHLAMYDIA EDTA, BAL, induced sputum 72 hours
PSITTACI PCR *
AFB 3 x EMU 6 weeks
CLOSTRIDIUM Faeces 24 hours
ANTENATAL SST 72 hours DIFFICILE
SEROLOGY
CMV SERUM SEPARATOR TUBE 5 days
ANTI STREPTOLYSIN SERUM SEPARATOR TUBE 5 days (CYTOMEGALOVIRUS)
TITRES (ASOT) ANTIBODIES
ANTIBIOTIC ASSAYS SERUM SEPARATOR TUBE In-house 2 hours CMV PCR (Q) EDTA, BAL, NPA, Induced 2 days
Send-away 24 hours sputum, Urine, Eye swab,
vitrous humour
ASPERGILLUS SERUM SEPARATOR TUBE 2 weeks
ANTIBODY CORONAVIRUS PCR EDTA, Throat swab, NPA, 72 hours
induced sputum, BAL
ASPERGILLUS GENUS EDTA, CSF, induced 72 hours
PCR * sputum, BAL COXIELLA BURNETII Tissue (e.g. heart valve, 5 days
PCR placenta)
ASTROVIRUS Faeces 72 hours
CRYPTOCOCCUS PCR EDTA, CSF 72 hours
BACILLUS Bacterial cultures, Eschar 8 – 12 hours *
ANTHRACIS biopsy, Lesion washings
CSF BACTERIOLOGY Plain sterile (universal) Up to 72 hours
BACTERIAL SERUM SEPARATOR TUBE 2 weeks CSF VIROLOGY Plain sterile (universal) 48 hours – 2 weeks
SEROLOGY depending on test
BLOOD CULTURE Aerobic (JCUH grey/ FHN Up to 5 days before CULTURE (ALL Relevant swab/container Up to 72 hours
blue) discard SPECIMENS) (consult laboratory if advice
Anaerobic bottles (JCUH required)
orange/ FHN purple)
CYTOMEGALOVIRUS SERUM SEPARATOR TUBE Unknown
BLOOD CULTURE Mycology bottle (green) Up to 5 days before (CMV)
(MYCOLOGY) discard CYTOMEGALOVIRUS Virus transport medium Unknown
BLOOD CULTURE Paediatric bottle (JCUH Up to 5 days before (URINE)
(PAEDIATRIC) pink/ FHN yellow) discard DENGUE (A) EDTA 24 – 48 hours
BORRELIA CSF, EDTA 2 weeks EBV PCR (Q) EDTA, CSF, vitreous 72 hours
BURGDORFERI PCR humour, Tissue, Eye swab
BRUCELLA SERUM SEPARATOR TUBE 2 weeks ENTEROVIRUS PCR EDTA, CSF 72 hours
ANTIBODIES (T)
BRUCELLA GENUS EDTA 72 hours EPSTEIN BARR VIRUS SERUM SEPARATOR TUBE 5 days
PCR * (EBV) ANTIBODIES
CANDIDA ALBICANS CSF, Swab 72 hours FRANCISELLA Tissue biopsy, wound swab, 24 –48 hours
PCR * TULARENSIS Bacterial culture

38
 Appendix 4 continued
Test Name Specimen Turnaround Time Test Name Specimen Turnaround Time
FUNGAL SERUM SEPARATOR 2 weeks LEGIONELLA Urine 24 hours
ANTIBODIES TUBE ANTIGEN
GENTAMICIN SERUM SEPARATOR 2 hours LEPTOSPIRA SERUM SEPARATOR 2 weeks
ASSAY TUBE ANTIBODIES TUBE
HAEMOPHILUS EDTA, CSF 72 hours LEPTOSPIRA EDTA, Urine 1 week
INFLUENZA PCR GENUS PCR *
HAEMORRHAGIC EDTA, Urine, Post-mortem 6 –12 hours LIESHMANIA PCR Bone marrow in EDTA tube, 5 days
FEVER VIRUSES tissue splenic aspirate in EDTA
PCR (ACDP4, tube
LASSA, MARBUG,
EBOLA, CCHF) LISTERIA EDTA, CSF 72 hours
MONOCYTOGENES
HBSAG (AUSTRALIA SERUM SEPARATOR 48 hours
PCR
ANTIGEN) TUBE
HEPATITIS A-E SERUM SEPARATOR 2 weeks MEASLES PCR EDTA, CSF 72 hours
ANTIBODIES TUBE MUMPS PCR EDTA, CSF 72 hours
HEPATITIS B VIRUS EDTA 72 hours
PCR (Q,T,R) MYCOBACTERIA CSF 1 – 4 days
PCR
HEPATITIS C PCR EDTA 5 days
MYCOPLASMA SERUM SEPARATOR 5 days
(Q,T)
ANTIBODIES TUBE
HEPATITIS D PCR EDTA 72 hours
MYCOPLASMA EDTA 72 hours
HEPATITIS G PCR EDTA 72 hours GENUS PCR *
HERPES SIMPLEX CSF, Brain tissue, Eye 5 days NEISSERIA EDTA, CSF, isolates 24 – 48 hours
VIRUS TYPE 1 AND swab MENINGITIS PCR (T)
2 PCR (T)
HIV SERUM SEPARATOR 48 hours NOROVIRUS Faeces 72 hours
TUBE
HIV GENOTYPING EDTA 14 days PAPILLOMAVIRUS Tissue 72 hours
PCR (T)
HIV PROVIRAL DNA EDTA 7 – 10 days
PCR PARAINFLUENZA EDTA 72 hours
VIRUSES 1,2,3 PCR
HIV RNA PCR (Q) EDTA 10 – 14 days
PARVOVIRUS B19 EDTA, Amniotic fluid 7 – 14 days
HTLV 1 PCR EDTA 72 hours
PCR
HTLV-1 ANTIBODY SERUM SEPARATOR 5 days
PNEUMOCOCCAL EDTA, CSF 48 hours
TUBE
PCR
HUMAN HERPES EDTA, CSF 72 hours
VIRUS 6 PCR PNEUMOCOCCAL Urine 24 hours
ANTIGEN
HUMAN HERPES EDTA, CSF 72 hours
VIRUS 7 PCR PNEUMOCYSTIS NPA, Induced sputum, BAL 72 hours
CARINII PCR *
HUMAN HERPES EDTA 72 hours
VIRUS 8 PCR POLYOMA BK EDTA, CSF 72 hours
VIRUS PCR (Q)

POLYOMA JC VIRUS EDTA, CSF 72 hours

PCR

39
 Appendix 4 continued
Test Name Specimen Turnaround TIme Test Name Specimen Turnaround Time
POXVIRUS Vesicle fluid, Vesical crusts 6 - 8 hours
TOXOPLASMA GONDII EDTA, CSF, vitreous humour 72 hours
PROPIONIBACTERIA Abscess Pus 72 hours PCR
/ACTINOMYCES
PCR * TROPHERYMA CSF 14 days
WHIPPELII PCR
RESPIRATORY NPA 24 hours
ANTIGENS URINE CULTURE Boric acid bottle Up to 48 hours
RETROVIRUS EDTA 72 hours VANCOMYCIN ASSAY SERUM SEPARATOR TUBE 2 hours
GENUS PCR *
RHINOVIRUS PCR EDTA, NPA, Throat swab, 72 hours VARICELLA ZOSTER EDTA, CSF, vesicle fluid, 72 hours
induced sputum, BAL PCR vitrous humour, Eye swab

ROTOVIRUS Faeces 72 hours VIRAL EDTA, urine, Post-Mortem 6 – 12 hours

HAEMORRHAGIC tissue
RSV PCR EDTA, NPA, Throat swab, 72 hours FEVER PCR
induced sputum, BAL
VIRAL SEROLOGY SERUM SEPARATOR TUBE 5 days
RUBELLA SERUM SEPARATOR 5 days
ANTIBODIES TUBE WEST NILE VIRUS EDTA, CSF 72 hours
RUBELLA VIRUS EDTA 72 hours PCR
PCR YELLOW FEVER (A) EDTA 32 – 48 hours
SARS EDTA, NPA, Throat swab, 72 hours
(CORONAVIRUS) induced sputum, BAL
PCR Keys:
ST. LOUIS EDTA 32 – 48 hours
ENCEPHALITIS (A)
Q - viral load quantitation service available.
STAPHYLOCOCCUS EDTA, isolates 72 hours
GENUS PCR *
T - genotyping service available.
STAPHYLOCOCCUS Isolates 72 hours
MEC A GENE PCR *
A - Arbovirus PCR.
STREPTOCOCCUS CSF, EDTA, Throat swab 72 hours
PNEUMONIAE PCR
* - assays with limited diagnostic evaluation suggest liaise with Consultant
STS (SEROLOGICAL SERUM SEPARATOR 5 days Microbiologist prior to requesting.
TESTS FOR TUBE
SYPHILIS)
TICK-BORNE EDTA 32 – 48 hours
ENCEPALITIS (A)
TORCH SCREEN SERUM SEPARATOR 5 days
TUBE
TOXOPLASMA SERUM SEPARATOR 5 days
ANTIBODIES TUBE

40
 Appendix 5 - Immunology Tests
Test Name
Allergen specific IgE (RAST)
Alpha-1 Acid Glycoprotein
(Orosomucoid)
Alpha-1-anti-trypsin (A1AT)
Alpha-1-anti-trypsin Phenotyping Performed in all cases of A1AT deficiency SST tube
(PI typing)
Test Details
Request must specify which allergens
should be tested based on clinical history.
As much clinical information as possible
must be given. In adults, if total IgE is very
low (<4OkU/L), RAST not indicated.
Reported to be a marker of activity in
inflammatory bowel disease, but is less
sensitive than CRP as a 'slow' acute phase
reactant.
This is an enzyme inhibitor whose levels
are increased during inflammation as an
acute phase reactant. Low levels are
suggestive of AlAT deficiency but may be
masked during inflammation.
when the A1AT level gives results below
the age related normal range. Also
performed as part of family screening for
A1AT deficiency once a deficient sibling or
spouse has been identified.
Tube Test Name Test Details Tube
SST tube Anti-ENA antibodies (Ro,La, Sm, Confirmatory test performed only if ANA
RNP, Scl 70 and Jo-1 see POSITIVE. Antibodies to extractable
below) nuclear antigens are of use in classification
and prognosis of subsets of connective
tissue diseases , Major clinical
associations:
SST tube
Anti-Ro - SLE (particularly photosensitivity) -
Cutaneous LE - Sjogrens syndrome -
Recurrent miscarriage - Neonatal lupus
and congenital heart block,
SST tube Anti-La - SLE - Sjogren s syndrome.
Anti-Sm - SLE.
Anti-RN P - SLE - Mixed connective tissue disease.
Anti-Scl 70 found in 20-40% of patients with
progressive systemic sclerosis and 20% of
patients with limited scleroderma.
Anti-Jo-1 Found in 20-40% of patients with
aggressive polymyositis usually in
association with interstitial lung disease
and arthralgia

Anti-acetyicholine receptor
antibody (ACR)
Anti-adrenal antibody
Anti-cardiac muscle antibody
Anti-cardiolipin antibody (ACL)
Anti-centromere antibody
Anti-dsDNA antibody (dsDNA)
This antibody is positive in SO - 90% of SST tube
patients with myasthenia gravis
See anti-endocrine gland antibodies SST tube
Positive in some patients with Dressler’s SST tube
syndrome and post-cardiotomy syndrome
See Anti-phospholipid antibody SST tube
Indicated in the investigation of SST tube
unexplained Raynaud’s; positive in 60 -
70% of patients with the CREST variant of
scleroderma and 20% of patients with
generalised scleroderma (in-house test).
Confirmatory test performed only if ANA
POSITIVE - is strongly suggestive of
systemic lupus erythematosus (SLE) or
autoimmune chronic active hepatitis
(AICAH) although it is present in only 40-
60% of patients with SLE
Anti-PL7 Polymyositis/Dermatomyositis
SST tube
Anti-PL-12 Polymyositis/Dermatomyositis
Anti-endocrine gland antibodies Includes adrenal, ovarian, testicular, SST tube
thyroid, parathyroid,pancreatic antibodies.
Each antibody must me requested the
separately These antibodies are found in
Autoimmune polyendorinopathy
syndromes (APS) type I and II.
Anti-endomysial antibody (EMA) Screening test for coeliac disease SST tube
(CD)/dermatitis a herpetiformis. IgA
antibodies are clinically relevant and are
very sensitive and specific for CD (94-
100%).
Anti - epidermal antibodies Anti-intercelIular substance (anti-/CS) Ab SST tube
are found in most patients with the
blistering(bullous) skin disease pemphigus
vulgaris.
Anti-gastric parietal cell antibody GPS is done as part of the autoantibody SST tube
(GPC) screen. They are present in 95% of
patients with pernicious anaemia but also
occur in immune thyroid disease,

41
 Appendix 5 continued
Test Name
Anti glomerular basement
membrane antibody (GBM)
Anti-islet cell antibody
Anti-liver kidney microsomal
antibody (LKM )
Anti-mitrochondrial antibody
(AMA)
Anti-myeloperoxidase antibody
(MPO)
Anti-nuclear antibody (ANA) or
anti-nuclear factor (ANF)
Anti-neuronal antibodies
Anti-neutrophill cytoplasmic
antibody (ANCA)
Anti-ovarian antibodies
Anti-pancreatic antibodies
Anti-parathyroid antibodies
Test Details Tube
Diagnostic test for Goodpasture’s SST tube
syndrome (>90% sensitivity). Out-of-hours
GBM requests can be sent directly to the
Regional Immunology Laboratory, RVI,
Newcastle subject to previous arrangement
(telephone: 0191 2825292) .
Predictive of future insulin requirements in SST tube
patients presenting with NIDDM and in
relatives of IDOM patients .
Identifies a sub-group of patients with SST tube
autoimmune chronic active hepatitis (CAH
type 2). This is the most common form of
CAH in childhood and has a poor
prognosis. There is no known association
with infection
AMA is done as part of the autoantibody SST tube
screen. High titres occur in 95% of patients
with primary biliary cirrhosis (PBC) but low
titres may also be found in chronic active
hepatitis.
Confirmatory test performed only if ANCA
POSITIVE. MPG is the target antigen for
the majority of pANCA associated with
microscopic polyangitis.
ANF is done as part of the autoantibody SST tube
screen. Indicated in the investigation of
suspected “connective tissue disorders”
(see also under autoantibody screen).
Often also referred to as anti-Purkinje cell SST tube
antibodies, or paraneoplastic antibodies
(see below).
Indicated in the investigation of vasculitis. SST tube
ANCA titers correlate with disease activity
and are useful for disease monitoring. Two
main patterns are recognised, cytoplasmic
(cANCA) and perinuclear (pANCA) cANCA
are associated with Wegener’s
granulomatosis, pANCA are associated
with microscopic polyangitis, particularly
the renal limited forms of the disease.
See anti-endocrine gland
See anti-endocrine gland
See anti-endocrine gland
Test Name
Anti-phospholipid antibody
Anti-proteinase 3 antibody (PR3) Confirmatory test performed only if ANCA
Anti-reticulin antibody (ARA)
Anti-skeletal muscle antibody
Anti-smooth muscle antibody
(SMA)
Anti-testicular antibodies
Anti-thyroid antibody
Autoantibody Screen
Bence-Jones Proteins
Test Details Tube
Also known as anti--cardiolipin antibodies. SST tube
Found in the Anti-phospholipid syndrome
(APS), primary or occur as a secondary
complication of SLE or other connective
tissue diseases.
POSITIVE. PR3 is the major target antigen
for cANCA. The detection of anti PR3 in
association with ANCA increases the
positive predictive value of cANCA.
ARA is done as part of the autoantibody SST tube
screen IgA R1- ARA have high specificity
98% but low sensitivity 30% for untreated
coeliac disease. Other patterns/classes are
less specific. Positive sera are routinely
tested for anti-endomysial Ab
Anti-skeletal muscle Ab are SST tube
characteristically found in patients with
thymoma often associated with myasthenia
gravis. They also occur in some patients
with nuclear hepatitis, acute viral infections
and polymyositis Low titres may occur in
viral infections notably EBV and infectious
hepatitis.
SMA is done as part of the autoantibody SST tube
screen. Higher titers are found in patients
with chronic active hepatitis both viral and
autoimmune. Lower titers can also be seen
in PBC or infections.
See anti-endocrine gland SST tube
Elevated titres of anti-thyroid microsomal SST tube
antibodies are found in primary
myxoedema, Hashimot thyroiditis and
Graves’s disease. Anti-thyroglobulin
antibodies are no longer measured.
Includes anti-nuclear antibody, anti- SST tube
mitochondrial antibody, anti-smooth
muscle antibody, anti-reticulin antibody and
rheumatoid factor.
See Urine Electrophoresis
42
 Appendix 5 continued
Test Name Test Details
Beta 2 microglobulin (B2M) Indicated in the monitoring of patients with SST tube
increased lymphocyte activity and turn-around
such as multiple myeloma, Sjorgens Syndrome,
HIV related disease, organ transplants .
C3 and C4 Levels are useful in the investigation and
monitoring of a wide range of inflammatory
disorders caused by infection, autoimmunity or
malignancy. Serial rather than one point
measurements are recommended.
C3 Nephritic Factor (C3nef) NB: Must be received in Laboratory within 3hrs SST tube
of being taken An auto-
antibody associated with member ano-
proliferative glomerulonephritis (type II) and
partial lipodystrophy (see complement section).
Classical haemolytic (CH50/100) & NB! must reach Lab within 3hrs of being taken SST tube
alternative haemolytic (AP100) because of spontaneous breakdown. A
pathway activity screening test for classical and alternative
complement pathways
C1 esterase inhibitor (C1-INH) level Low levels of C1-INI-I are found in 85% of
patients with hereditary angioedema (HAE) but
15% can have normal levels of a non-functional
protein see below),
C3d ( C3 degredation products) Test no longer available
Ceruloplasmin Decreased concentrations seen when hepatic
synthetic ability is suppressed.
Cryoglobulins NB Sample must be kept warm; contact
Laboratory prior to collection (x54129)
Cryoglobulins are proteins which precipitate
and form complexes below body temperature,
Cryofibrinogen NB! EDTA and Red top (NOT SST) samples
must be kept warm; contact Laboratory prior to plain tube
collection (x54129)
This is of less clinical importance but may be
mistaken for cryoglobulins.
Cyclic Citrullinated Peptide (CCP) Referred test available ONLY after discusion
antibodies with lab (x54129).
Tube Test Name Test Detail Tube
Ganglioside (GQ1b) antibodies Seen in Miller-Fisher syndrome and SST tube
Chronic sensory neuropathy
Glutamic Acid Decarboxylase Seen in 'Stiff Man Syndrome' and SST tube
(GAD) Cerebellar ataxia
Haptoglobin For the diagnosis and assessment of SST tube
SST tube haemolytic conditions
Immunoglobulins (IgG. IgA, IgM) For relevant interpretation of SST tube
immunoglobulin results, serum protein
electrophoresis (SPE) is performed in
parallel.
IgG subclasses The measurement of lgG subclasses is of SST tube
limited value and should only be
considered of identifying primary immune
deficiency or assessing
hypergamaglobulinemia (but not normal
lgG levels) in suspected Sjogren's
Syndrome
IgE Measurement of total serum IgE is of value SST tube
in the assessment of patients with allergic
and some parasitic diseases. Levels may
SST tube also be increased in some rare
immunodeficiency disorders
Myelin associated glycoprotein Seen in chronic sensorimotor neuropathies SST tube
(MAG) and Guillain-Barre syndrome
Oligoclonal band analysis NB! Paired CSF and serum sample must Paired CSF
be sent for meaningful interpretation. sample
Single CSF samples will be stored in Lab (sterile
up to 14 days awaiting serum sample but sealed
SST tube will not routinely be assessed without container)
accompanying serum sample. and SST
tube
Red top (no
Paraneoplastic antibodies Often also referred to as neuronal SST tube
gel) tube ( Hu,Yo, Ri, Ma) antibodies. They are associated with
neoplasms and cause associated
paraneoplastic neurological syndromes
(Lamber-t-Eaton acquired neuromyotonia).
EDTA plus Paraprotein quantitation Performed as part of Immunoglobulin and
serum electrophoresis testing. Useful for
monitoring disease progression and
response to therapy The technique used to
quantitate paraproteins is different to that
used to measure the total immunoglobulin
level and results are not directly
comparable
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 Appendix 5 continued
Test Name Test Details Tube
Rheumatoid Factor (RF) SST tube RF is done as part of the SST tube
autoantibody screen but can also be
requested separately. It is indicated in the
investigation of inflammatory arthropathies.
Differentiates sero-negative arthritides from
RA.

Serum protein electrophoresis SPE is performed on all specimens SST tube

(SPE) submitted for immunoglobulin quantitation
to check whether the immunoglobulins are
polyclonal or monoclonal proteins.
Polyclonal increases are due to and
increased activity of numerous different
lymphocytes

Specific antibody responses The quantitive measurement of antibody SST tube

(SPECs) to Pneumococcal, responses to specific antigens(SPECs) are
Tetanus and Hib of value in investigating humoral immune
deficiency.

Tissue Transglutaminase IgA Not currently available - See anti-

antibodies (TTG) endomysial antibodies antibodies.
Thyroid Peroxidase antibodies Not currently available - See anti- thyroid
(TPO) antibodies
Tryptase NB. samples must be taken <3hr following EDTA tube
onset of reaction. Time of onset of
reaction and sample time MUST be stated.
Mast cell tryptase levels are a specific
measure of mast cell activation and thus
indirectly of histamine release which is the
main mediator of allergiclpseudoallergic
reactions.
Urine electrophoresis (Bence- Essential for detecting free light chain EMU no
Jones proteins) myeloma as well as free light chain added
production in cases of monoclonal protein preservative
presence. (white top
universal)
Quantitative Bence Jones NB! Indicated in KNOWN monoclonal 24 hour
Proteins patients only. A 24 hour urine sample collection
without preservatives is required for free with NO
light chain quantitation as part of disease additives.
monitoring.

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 Appendix 6 - Phonebook
Division of Pathology Cellular Pathology
Dr John Drury Chief of Service 01642 835681 Fax, JCUH 01642 854384
Pauline Blanchard P.A/Secretary Supervisor 01642 854161 Results/Enquires JCUH Cellular Pathology office 01642 854383
Ingrid Walker Divisional Manager 01642 854361 Dr U Earl Clinical Director 01642 835647
Jane Hill P.A. 01642 854362 Sue Neville Secretary 01642 854131
Administration Jacqui Richards Cellular Pathology Services Manager 01642 835699

Martin Sturdy Admin 01642 854363 Chris Dunne Histology Laboratory Manager 01642 854126
Pam O'Neill Histology Laboratory Manager 01642 854126
Quality Manager
John Brewerton Histology Laboratory Manager 01609 763038
Alex Dutton Quality Manager 01642 854364
Dr Richard Jones Consultant Histopatholgist 01642 835670
Central Sort Janice Regan Secretary/Team Leader 01642 835671
Co-ordinator to Central Sort Dr Sri Nagarajan Consultant Histopatholgist 01642 835694
Andrea Humphreys 01642 835239
and Service reception
Dr Adrienne Mutton Consultant Histopatholgist 01642 854176
Brenda Spencer Team Leader 01642 854385
Dr V Martin Consultant Histopatholgist 01642 854163
Phlebotomy Manager and
Julie Monnier Friarage Central Sort Team 01609 763039 Dr A Svec Consultant Histopatholgist 01642 835647
Leader
Dr David Henderson Consultant Histopatholgist 01609 763032
JCUH Reception 01642 854385
Dr Kolanu Prasad Consultant Histopatholgist 01609 764210
JCUH Reception 01642 835236
Val Nicholson Secretary for Dr Henderson/Dr Prasad 01609 763040
JCUH Results/Enquires 01642 835233
JCUH Main Laboratory 01642 854126
FHN Results/Enquires 01609 763039
FHN Main Laboratory 01609 763038
FHN Data Entry 01609 763052

Biochemistry Cytology
Dr John Drury Clinical Director 01642 835681 Callum Bowler Cytology Advanced Practitioner 01642 854338

Pauline Blanchard P.A/Secretary Supervisor 01642 854161 Janet Wood Cytology Laboratory Manager 01642 835690
Tina Porter Biochemistry Services Manager 01642 282634 Screening Laboratory 01642 835688
Dr Brian Webb Clinical Biochemist 01642 835678 Cytology Reception 01642 854131
Gill Wheater Principal Healthcare Scientist 01642 835678
Neuropathology
Automation Laboratory 01642 854371
Dr David Scoones Consultant Neuropathologist 01642 854388
Endocrine Laboratory 01642 835675
Janice Regan Secretary 01642 835671
Special Laboratory 01642 835676
FHN Laboratory/Out of Hours 01609 763036
JCUH Out of Hours 01642 282631

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 Appendix 6 continued
Blood Transfusion Immunology
Chris Elliott Transfusion Lab Manager 01642 282632 Helen Crabbe Senior Biomedical Scientist 01642 854129
JCUH Main Laboratory 01642 282630 Immunology Laboratory 01642 854129
JCUH Out of Hours 01642 282630
FHN Main Laboratory 01609 763124
Microbiology
FHN Out of Hours 01609 763037 Fax Number 01642 850346

Transfusion Practitioners 01642 282802 Dr J Hovenden 01642 282604

Dr C Marodi 01642 282604
Haematology
Dr M Kalra 01642 835213
Fax Number 01642 835684
Dr I Budai 01642 835213
Dr A Wood Clinical Director 01642 835639
K Hubbert Microbiology Services Manager 01642 282602
N Hoare Secretary 01642 854377
Dr D Plews Clinical Lead for Laboratory Haematology 01642 835693 Amanda Scott Secretary 01642 282604

Emma Debbie Moss Secretary 01642 282604

Secretary for Dr D Plews & Dr C Millar 01642 854381
Thompson C Dunn Admin 01642 835214/01642 835211
Dr JE Chandler Consultant 01642 835696
JCUH Virology Lab 01642 835219
Dr R Dang Consultant 01642 835635
JCUH Microbiology Enquires 01642 835640
Dr C Millar Consultant 01642 282242
Graham Cole FHN Lead BMS in Microbiology 01609 763033
Secretary for Dr JE Chandler & Dr R Dang
A Hammond 01642 854139 FHN Microbiology Enquires 01609 763034/01609 763035
at JCUH
Secretary for Dr JE Chandler & Dr R Dang Infection Control 01642 854800/01642 282572
Heidi McLellan 01609 763051
at FHN
Chris Shaw Haematology Services Manager 01642 282633
Mortuary
01642 855697 and Bleep number Ritchie Styan Mortuary Manager 01642 854387
Specialist Registrars
5697 Enquires 01642 835632
JCUH Laboratory/Enquires 01642 835691
PM Room JCUH 01642 835634
JCUH Coagulation 01642 854315
FHN Mortuary Fax 01609 763041
JCUH Microscope Laboratory 01642 854382
Mr AR Cooper Senior Anatomical Pathology Technician 01609 763042
JCUH Out of Hours 01642 282630
FHN Haematology 01609 763037
FHN Out of Hours 01609 763037
24 hour advice available from Haematologist on call Please contact via switchboard

46