INFORMATION FOR USERS OF THE HAEMATOLOGY DEPARTMENT

Transcription

1 Page 1 of 19 INFORMATION FOR USERS OF THE HAEMATOLOGY DEPARTMENT

2 Page 2 of 19 CONTENTS 1. LABORATORY LOCATION KEY STAFF CONTACT DETAILS LABORATORY OPENING TIMES TRANSPORTING SAMPLES HEALTH AND SAFETY REQUIREMENTS Collection, labelling and dispatch of specimens High Risk specimens INSTRUCTIONS FOR COMPLETING REQUEST FORMS CLINICAL ADVICE AND INTERPRETATION UNCERTAINTY OF MEASUREMENT SERVICE DESCRIPTION TIME LIMITS FOR REQUESTING ADDITIONAL EXAMINATIONS TEST REPERTOIRE TURNAROUND TIMES, RANGES AND IMPORTANT INFORMATION ADDITIONAL CLINICAL INFORMATION Oral anticoagulation treatment Thrombophilia Investigtions LABORATORY LOCATION

3 Page 3 of 19 (For Blood Transfusion please see Blood Transfusion Laboratory user handbook) The Haematology is part of (PAWS). PAWS is an integrated pathology services between Salford Royal NHS Foundation Trust and Wrightington, Wigan and Leigh NHS Foundation Trust created in February This services provides a comprehensive and wide ranging diagnostic, analytical, interpretive and clinical advisory services across the two Trusts and General Practitioners and reginal services in several specialist areas. Haematology s main laboratory site is at Salford Royal (Turnberg Building, level 2) (See site map SRFT Hospital Site Map ) with an essential service laboratory based at Royal Albert Edward Infirmary (RAEI) in Wigan (Wigan Hospital Site Map) with both laboratory s providing a comprehensive 24 hour 365 day analytical service for Salford Royal Hospitals NHS Foundation Trust (SRFT), and Wigan, Wrightington, Wigan and Leigh NHS Foundation Trust (WWL) and Salford, Wigan, Wrightington and Leigh GPs. Wigan haematology user information. There is a satellite laboratory based at Wrightington providing inpatient test, open Mon-Fri 9.00 until Haematology is fully accredited by Clinical Pathology Accreditation (CPA) and is a member of the National External Quality Assurance Scheme (NEQAS) to ensure quality of service and laboratory results. All our qualified Biomedical Scientists are also registered with the Health and Care Professions Council (HCPC) to ensure high standards of service are maintained.

4 Page 4 of KEY STAFF CONTACT DETAILS Laboratories Name Telephone No. Haematology Lab 09:00-17:30 ONLY SRFT out of hours Bleep 3077 Haematology Lab 24/ RAEI Haematology Lab 09:00-17:00 ONLY Wrightington out of hours call RAEI Blood Transfusion SRFT 09:00-17:30 ONLY out of hours Bleep Blood Transfusion RAEI 24/ RAEI Blood Transfusion 09:00-17:00 ONLY Mon - Fri Wrightington out of hours call RAEI Medical Staff Name Telephone No. Consultant and Laboratory Lead Dr Simon Jowitt (SRFT) Consultant & Lab Lead (WWL) Dr Hitesh Patel (WWL) Consultant Dr Sonya Ravenscroft (SRFT) Consultant Dr Rowena Thomas-Dewing (SRFT) Consultant Dr Claire Barnes (SRFT) Consultant Dr Chris Gregory (WWL) Consultant Dr Usman Ahmad (WWL) Specialist Registrars SRFT Specialist Registrars WWL Scientific Staff Name Telephone No. Haematology and Blood Mrs Deborah Seddon Transfusion manager Deputy Haematology and Blood Mr Jim Wesson Transfusion manager Transfusion Practitioner SRFT Mrs Lydia Baxter Transfusion Practitioner WWL Sister Louise McCreery Nursing Staff Name Telephone No. Specialist Nurse SRFT Sister Catherine Redshaw Specialist Nurse SRFT Sister Lisa Crabtree Specialist Nurse SRFT Sister Linda Ryan Specialist Nurse WWL Anticoagulation Specialist Nurse WWL Sister Louise McCreery (Transfusion) Specialist Nurse WWL Sister Susan Gee (VTE) Secretarial Support Name Telephone No. Secretary SRFT Mrs Debbie Connelly (Dr Thomas-Dewing) Secretary SRFT Mrs Linda Burns (Dr Jowitt & Dr Ravenscroft) Secretary WWL Christine Hesketh (Dr s Ahmad, Gregory, Patel) Secretary WWL Jackie Livings (Dr s Ahmad, Gregory, Patel) ** Please note that the internal numbers do not work between the two Trusts **

5 Page 5 of LABORATORY OPENING TIMES Routine laboratory opening hours are Monday to Friday from 09:00 until 17:30 but the has qualified scientific staff on-site at SRFT and RAEI at all times. Haematology Medical staff are available for advice at all times. During normal working hours they can be contacted using the phone numbers provided above and via switchboard at all other times. Out of core hours the runs a continuous processing work shift system (CPW). Main Laboratory SRFT Between 17:30 and 22:00 Monday to Friday the core laboratory is staffed by two BMS staff and a minimum of two MLA s/ap s. At weekend one BMS is on-site between 17:00 and 21:45. One BMS covers both Haematology and Blood Transfusion each night of the week between 21:45 and 09:00. One MLA staff cover 06:00 09:00 Monday to Friday. On a Weekend one MLA/AP cover 09:00 12:45. ESL RAEI Between 17:30 and 20:30 Monday to Friday the core laboratory is staffed by one BMS staff and one MLA/AP. At weekend one BMS is on-site only. One BMS covers Haematology and Blood Transfusion each night between 20:00 and 07:30 Wrightington Hospital The Laboratory is only open 09:00 17:00 Monday to Friday (excluding bank holidays) Outside these times this site is covered by the ESL RAEI 4. TRANSPORTING SAMPLES At both SRFT and RAEI an air-tube pod system is also available from certain locations within the Trust s for transporting samples to the laboratory. There are regular transports between RAEI and SRFT during core hours (provided by SRFT Royal Transport Department). Non-urgent in-patient samples should reach the laboratory s before 11.00am on weekdays and.00am on Saturdays to avoid delays in processing. All sample requests should be delivered to Central Pathology Reception. Any urgent X-match requests must be phoned through to the blood bank and the request handed to a member of staff in central reception. At SRFT a collection/delivery service for other hospitals is operated by SRFT transport (see the Timetable) and there is a messenger service for non-urgent samples

6 Page 6 of 19 within Salford Royal Hospital (see Messenger service). Salford CCG commissions transport providers for Salford GP surgeries. At WWL a collection service for GP surgeries and the Dave Whelan Centre (DW) is operated by WWL transport. There are regular transports to RAEI from Wrightington Hospital, Leigh Infirmary and the Thomas Linacre Out-Patients centre provided by WWL transport. 5. HEALTH AND SAFETY REQUIREMENTS 5.1 Collection, labelling and dispatch of specimens Staff responsible for the collection of specimens and transporting them to the laboratory for investigation are responsible under the Health & Safety at work Act and the COSHH regulations to do so in a safe manner. A common high standard of Health and Safety must be applied to all samples. This includes using appropriate specimen containers and sealing the container in the bag attached to the request card. Strict national (DOH) and international (WHO) regulations are applied to the transportation of infectious materials (including clinical specimens) by road or post. 5.2 High Risk specimens Specimens from individuals known, or suspected of Blood Borne Viruses (BBV) eg. Hepatitis B or HIV should have the following information included on the Specimen(s) and Request Card: A Danger of Infection label attached to each specimen and on the accompanying request card. Clinical details on the request form should be adequate to convey information of the suspected hazard to the staff who handle the specimens. To maintain patient confidentiality during transit to the laboratory, it is recommended to seal the specimen and request in a suitable envelope. Specimens presenting a risk of BBV Include: Blood CSF Urine Other body fluids

7 Page 7 of INSTRUCTIONS FOR COMPLETING REQUEST FORMS Each request accepted by the laboratory for examination(s) shall be considered an agreement. It is the responsibility of the requesting clinician to ensure that samples are correctly labelled and request forms completed to the agreed standard. Standard operating procedures for the receipt of samples and request forms are put in place to ensure the safety of the patient. They are intended to ensure that the appropriate investigation is performed on each sample. Clinical details must also be provided. Before accepting a clinical specimen, laboratory staff must ensure certain minimum criteria for sample identification are met. The table below outlines the acceptable minimum required information to identify a specimen on receipt in the laboratory. Without this minimum information the sample will only be processed in exceptional circumstances. Please refer to the Specimen Acceptance Policy on SRFT Synapse or the Pathology Collection, Transportation and Receipt of Clinical Specimens Policy on WWL intranet. Samples must be labelled with at least TWO unique identifiers from: Patient s Full Name i.e. Forename and Surname NHS number Date of birth Hospital number Samples that are not labelled with at least two unique identifiers will not be processed Samples must be accompanied by a request form. The request form MUST have at least TWO unique identifiers. The information on the sample must match what is on the request form.

8 Page 8 of 19 We can generate Pathology reports most effectively when the request form is completed with the following information: The patient s location/destination for the report- this can be a location code Test required Name of consultant or GP Name of the requestor and contact number (bleep or extension) Patient gender Date and time of specimen collection Anatomical site and type of specimen (where relevant) All relevant clinical information Patient address for GP requests When your patient is going to label the sample container please advise them of the labelling requirements. The sample container must also contain the date of collection. 7. CLINICAL ADVICE AND INTERPRETATION Haematology Medical staff are available to give advice at all times. They can be contacted via telephone during the normal working day and via switchboard at all other times. 8. UNCERTAINTY OF MEASUREMENT All biomedical results are subject to a degree of uncertainty. This is due to biological variation, analytical measurement imprecision and pre-analytical factors (sample stability etc.). If you are concerned about the confidence limits and interpretation of an individual result please contact the Haematology. 9. SERVICES DESCRIPTION The treats patients referred within the North West sector of Greater Manchester (Bolton, Wigan and Salford). Haematology at Salford and RAEI provides a Level 2 haemato-oncology service treating leukaemias, lymphoma and myeloma. The laboratory provides general haematology tests, haemoglobinopathy screening for Wigan (low prevalence area), thrombophilia screening and a blood transfusion service. Daily anticoagulant clinics are held at several locations within the Wigan area. Clinical haematology is supported by haematology nurses and runs a number of haematology clinics.

9 Page 9 of 19. TIME LIMITS FOR REQUESTING ADDITIONAL EXAMINATIONS Requests for additional tests on haematology samples will normally only be available for the day the specimen was taken. However the following tests can be added on within the time limits stated. SPECIMEN TYPE IN LAB TEST TO BE ADDED TIME LIMIT FROM STORAGE CONDITIONS SAMPLE BEING TAKEN ESR Within 6 hours HbA1c Within 3 days Reticulocytes Same day Infectious Mono. screen Same day G6PD Within 7 days Cold room Malarial Parasites Same day Blood film Same day Haemoglobinopathy screen Within 7 days HFE gene Within 2 days JAK2 Within 2 days BCR-ABL Within 2 days CITRATE PT,APTT,INR,Anti-Factor Xa, D-dimer, Fibrinogen and Thrombin time Same day N.B. Samples may be disposed of before time limit is reached.

10 Page of TEST REPERTOIRE TURNAROUND TIMES, RANGES AND IMPORTANT INFORMATION GENERAL HAEMATOLOGY TEST REPERTOIRE TESTS Full Blood Count (FBC) Erythrocyte Sedimentation Rate (ESR) Reticulocyte count Blood film (manual differential) Infectious mononucleosis screen (Glandular fever) Malarial Parasites Haemoglobinopathy screen (Sickle screen) Glycated haemoglobin (HbA1c) Glucose-6-phosphate dehydrogenase (G6PD) Paediatric full blood count (inc. retics and nucleated red blood SPECIMEN REQUIRED 1.4 ml red top paediatric TURNAROUND TIMES SPECIAL INSTRUCTIONS KEY FACTORS AFFECTING TEST PERFORMANCE OR INTERPRETATION 4 hrs Cold red cell autoagglutinnins Lipaemia 6 hrs Minimum volume 2ml 4 hrs (these are corrected in lab) Cold red cell autoagglutinnins (test will not be reported) 24 hrs Provide relevant clinical details. 8 hrs Some patients do not produce antibody. In early stage antibody may be undetectable. 4 hrs Rapid test within If initial screen negative this 1 hr. should be repeated if strong 3 days Urgent requests will be processed suspicion of malaria present Requestor should indicate if patient has been recently transfused 2 days Test unavailable if patient has homozygous haemoglobinopathy 3 days Raised reticulocyte count may result in false normal result 4 hrs cells Bone marrow aspirate Bone marrow 14 days Discuss with Haematologist Bone marrow trephine biopsy Bone marrow 14 days Discuss with Haematologist

11 Page 11 of 19 NORMAL HAEMATOLOGICAL VALUES IN CHILDHOOD Automated FBC < 3 Days 3 Days - 12 Wks 12 Wks-1 Year 1 Year - 6 Years 6 Years -12 Years Hb G/L RBC x 12 /L HCT(PCV) ratio MCV fl MCH pg MCHC G/L RDW WBC x 9 /L Neut x 9 /L Lymph x 9 /L Mono x 9 /L Eos x 9 /L Baso x 9 /L < 0.1 < 0.1 Platelets x 9 /L Full Differential WBC (Manual) NEUTROPHILS x 9 /L LYMPHOCYTES x 9 /L MONOCYTES x 9 /L EOSINOPHILS x 9 /L BASOPHILS x 9 /L < 0.1 < 0.1 RETICULOCYTES (%) NORMAL ADULT HAEMATOLOGICAL VALUES

12 Page 12 of 19 Automated FBC Male Female Pregnancy (3rd trimester) Hb G/L RBC x 12 /L HCT(PCV) Ratio MCV Fl MCH Pg MCHC G/L RDW WBC x 9 /L Neut x 9 /L Lymph x 9 /L Mono x 9 /L Eos x 9 /L <0.4 <0.4 <0.4 Baso x 9 /L < 0.1 < 0.1 < 0.1 PLATELETS x 9 /L Full Differential WBC (Manual) Adult Male and Female NEUTROPHILS x 9 /L LYMPHOCYTES x 9 /L MONOCYTES x 9 /L EOSINOPHILS x 9 /L <0.4 BASOPHILS x 9 /L <0.1 RETICULOCYTES (%) ESR (mm in first Male Female Pregnancy hour) All ages 0-27 mm 0-27 mm HbA 2 (%) HbF (%) <5.0 Glycated Hb (HbA 1c ) mmol/mol (IFCC) mmol/mol (IFCC) COAGULATION TEST REPERTOIRE

13 Page 13 of 19 TESTS Clotting Screen (PT + APTT) INR (oral anticoagulation) APTT ratio (unfractionated heparin) Anti-factor Xa (Low molecular weight heparin) D-Dimer (DD) Fibrinogen (FIBC) Thrombin time (TT) Clotting tests (paediatric) Coagulation factors (II,V,VII,VIII,IX,X,XI,XII, FXIII:Ag) Von Willebrand Screen (VWD) (FVIII, FVIII:Ag, FVIII: Act) Lupus anticoagulant screen Thrombophilia screen (AT, PC, FPS, APC, Lupus, TT) SPECIMEN REQUIRED 4.3ml green top citrate 4.3ml green top citrate 4.3ml green top citrate 4.3ml green top citrate 4.3ml green top citrate 4.3ml green top citrate 4.3ml green top citrate 1.4 ml citrate paediatric green tube 2 x 4.3ml green top citrate 2 x 4.3ml green top citrate 3 x 4.3ml green top citrate 3 x 4.3ml green top citrate TURNAROUND TIMES 3 hours 3 hours 3 hours 3 hours 3 hours 3 hours 3 hours 3 hours Weekly Weekly SPECIAL INSTRUCTIONS Discuss with Haematologist Discuss with Haematologist KEY FACTORS AFFECTING TEST PERFORMANCE OR INTERPRETATION All coagulation tests require a good clean venepuncture to avoid sample activation 2 weeks Indicate if patient on anticoagulants 2 weeks See guidelines below Patient should be minimum 1 month post anticoagulant therapy or post thrombotic episode NOTES ON COAGULATION TESTS Where indicated advice from Consultant Haematologist should be sort prior to request. Some tests e.g. thrombophilia screens should only be requested according to protocol (refer below to 12.2). These tests are expensive. For advice on anticoagulant treatment please refer to the following Trust policies: For SRFT: Trust Oral Anticoagulant Policy. Prevention of Hospital Acquired Thrombosis (HAT) For WWL: Trust Anticoagulation Guidelines NORMAL ADULT COAGULATION RANGES

14 Page 14 of 19 TESTS NORMAL RANGE Clotting Screen (PT + APTT) INR (oral anticoagulation) APTT ratio (unfractionated heparin) Anti-factor Xa (Low molecular weight heparin) D-Dimer (DD) Fibrinogen (FIBC) Thrombin time (TT) Clotting tests (paediatric) Coagulation factors (II,V,VII,VIII,IX,X,XI,XII, FXIII:Ag) Von Willebrand Screen (VWD) (FVIII, FVIII:Ag, FVIII: Act) Lupus anticoagulant screen Thrombophilia screen (AT, PC, FPS, APC, Lupus, TT) PT APTT <230 ng/ml g/l - 17 sec iu/dl sec sec FVIII iu/dl FVIII: Ag iu/dl FVIII:Act iu/dl Antithrombin iu/dl Protein C iu/dl Free Prot. S (Female) 53 9 iu/dl Free Prot. S (Male) iu/dl Act. Prot. C resist ratio TESTS REFERRED TO OTHER HOSPITALS

15 Page 15 of 19 TEST Haemochromatosis gene (HFE) JAK2 Gene analysis (JAK2) BCR-ABL (BCR) Factor V Leiden (F5LM) Prothrombin gene variant (PTGV) VWF Multimers (VWD) Factor VIII inhibitor screen (F8IN) Hb DNA studies Plasma viscosity (PV) Confirmation haemoglobinopathy screen (HBOR) PNH Screen (PNH) Vitamin K and PIVKA Oncology Cytogenetics SPECIMEN REQUIRED.0 ml red top EDT A (3 tubes).0 ml red top (3 tubes) 4.3 ml green CITRATE 4.3 ml green CITRATE 4.3 ml green CITRATE 4.3 ml green CITRATE TURNAROUND TIME 3 weeks 4 weeks 4 weeks 2 weeks 2 weeks 4 weeks 24 hrs 2 6 weeks (depends on complexity) SPECIAL INSTRUCTIONS Discuss with Haematologist Discuss with Haematologist 2-5 working days DO NOT refrigerate 9ml clotted (brown GEL) Marrow/3.4 ml red top 2 weeks 2-5 working days Needs to be tested within 24 hrs. 3 weeks Protect from light 4 weeks ADAMTS13 Citrate and Serum 2 weeks Double spin samples. Divide into 4 aliquots. Keep frozen at -70.Must be sent on dry ice REFERRED TO Molecular Diagnostics Centre Molecular Diagnostics Centre Molecular Diagnostics Centre Molecular Diagnostics Centre Molecular Diagnostics Centre Molecular Diagnostics Centre Specialist Coagulation Lab Molecular Diagnostics Centre South Manchester Hospitals NHS Trust Queens Medical Centre, Nottingham HMDS St James s University Hospital, Leeds Haemophilia Centre St. Thomas Hospital, London Christie Hospital Sheffield Haemophilia and Thrombosis Centre

16 Page 16 of 19 Pyruvate Kinase >1.0 ml red top Patient & date matched control sample. 1 week Retic count and FBC results of patient. Stained & unstained/unfixed blood film of patient. Control FBC results Pathology Centre G Block Hammersmith Hospital Hereditary Spherocytosis Screen (EMA-eosi- 5-maleimide) binding assay. 24 hrs. Sample must be kept at room temperature DO NOT refrigerate Immunology Department PFA-0 (Platelet function assay) 2 x 4.3 ml green CITRATE 24 hrs. Please contact laboratory to discuss arranging this test. Sent directly to specialist coagulation lab at Central Manchester. Must arrive within 2 hrs. The lab will arrange taxi. Specialist Coagulation Lab TCGR (T-cell receptor gene rearrangement) Bone marrow or ml days Molecular Diagnostics Centre Samples should preferably be less than 24hrs old but no older than 48hrs Positive Malaria Slides Liverpool School of Tropical Medicine

17 Page 17 of 19 NOTES ON REFERRED TESTS Factor V Leiden will only be requested by the laboratory to confirm a positive Activated Protein C result. Prothrombin gene variant will only be requested on advice of Consultant Haematologist. The laboratory will screen all referred tests to ensure they are clinically appropriate. Turnaround times will be periodically audited. ADDRESSES OF REFERRAL HOSPITALS Molecular Diagnostics Centre TOP Floor Multipurpose Building Manchester Royal Infirmary Oxford Rd Manchester Tel: Autolab Manchester Royal Infirmary Oxford Rd Manchester. Tel: HMDS Level 3 Bexley Wing St James s University Hospital Beckett St Leeds LS9 7TF Tel: Haematology Department South Manchester Wythenshawe Hospital Wythenshawe Manchester Tel: Haematology Laboratory Red Cell Laboratory Queens Medical Centre Derby Rd Nottingham NG7 2UH

18 Page 18 of 19 Sheffield Haemophilia and Thrombosis Centre Coagulation Laboratory Floor H Royal Hallamshire Hospital Glossop Rd. Sheffield S 2JF Tel: Haemophilia Centre 1 st Floor Wing St. Thomas Hospital Lambeth Palace Rd London SE1 7EH Oncology Cytogenetics Pathology Department Christie Hospital Withington Rd Tel: Lynn Robertson Principle Biomedical Scientist Diagnostic Haematology Pathology Centre G Block Hammersmith Hospital Du Cane Rd London W12 0HS Tel: Liverpool School of Tropical Medicine Pembroke Place Liverpool L3 5QA Tel:

19 Page 19 of ADDITIONAL CLINICAL INFORMATION 12.1 Oral anticoagulation treatment SRFT please refer to Trust Oral Anticoagulant Policy WWL please refer to Trust Anticoagulation Guidelines 12.2 Thrombophilia investigations Investigation of patients for an inherited marker of Thrombophilia is frequently unnecessary and seldom has a significant impact on the clinical management of a patient. It may be considered, along with other tests, in the following circumstances: Spontaneous venous thrombosis at <45years age. Venous thrombosis at unusual sites. A strong family history of venous thrombosis. A history of recurrent fetal losses. Patients should first have a full clinical assessment for evidence of an acquired cause for a prothrombotic tendency, as well as a full blood count to exclude such conditions as iron deficiency, myeloproliferative disorders, haemolytic anaemia and PNH. Screening for a Lupus Anticoagulant/Anti Phospholipid Syndrome should be considered in all patients with recurrent fetal losses or an apparent tendency to venous and/or arterial thrombosis. A screen for inherited markers of a predisposition to venous thromboembolism, if indicated, will include tests for Activated Protein C Resistance, Antithrombin III, Protein C and Protein S. Avoid taking the relevant samples around the time of an acute thrombotic event or when the patient is receiving anticoagulant therapy. If the APCR is positive, the presence of the Factor V (Leiden) mutation will be confirmed by genetic testing, but this, and testing for the Prothrombin Gene Variant, are not routinely performed in all cases.