User Guide Adult Biochemistry - Central Manchester University
Contents
1. 0 39 mmol L Urea 3 5 7 4 mmol L Urgent 2 hours Yellow top tube Routine 4 hours Vitamins See individual reports 1 2 weeks Vit A amp E Yellow top tube Vitamin B1 B Vitamins Purple top EDTA Vitamin B2 plasma Vitamin B6 Vitamin E 5 7 14 9 mg L 3 47 6 20 Contact Pancreatic lab ext mmol mol cholesterol 64067 before drawing blood Serum One red or yellow top Vitamin E 4 weeks tube Contact Pancreatic lab ext Vitamin A 0 407 64067 before drawing blood 1 177mg Serum One red or yellow top Vitamin A 4 weeks tube Contact Pancreatic lab before drawing blood Ext 64067 2 Vitamin C 4 20mg l 3 weeks heparinised green top tubes Zinc 10 18 umol L lt 16 yr 2 4 weeks Blue top tube 9 5 18 5 umol L adult male 9 5 22 5 umol L adult female Page 27 of 43 Adult Biochemistry user manual version 8 IGF 1 reference ranges Male range ug l Female Range ug l 0 7d 7 14 days lt 4 years gt 4y lt 9y 9 years gt 4y lt 10y 10 years 11 years 65 400 95 540 12 years 95 610 170 650 13 years 135 690 170 740 14 16years 135 830 180 830 17 years 135 630 17 20 years 135 545 18 20 years 135 490 20 30 years 108 320 30 40 years 100 275 40 50 years 90 240 50 60 years 75 215 60 70 years 68 190 70 80 years 60 160 Page 28 of 43 Adult Biochemistry user manual version 8 e Thyroid Function Tests Adequate clinical i2. Central Manchester University Hospital NHS Foundation Trust Copy no electronic Q pulse version Laboratory Medicine Version 8 Department of Clinical Biochemistry Document Number CB CLIN PI 009 Date of Issue October 2010 Author R Hinchcliffe Page8of 43 Authorised by M France 5 Telephone reporting will be used for urgent results for which the other systems would not provide a report quickly enough Results which are outside of the limits listed below will be telephoned Other results may be telephoned if they appear to be inconsistent with previous results or of particularly relevant for diagnostic or treatment ourposes Page 8 of 43 Adult Biochemistry user manual version 8 Laboratory Medicine Central Manchester University Hospital NHS Foundation Trust Copy no electronic Q pulse version Department of Clinical Biochemistry Date of Issue October 2010 PageQof 43 Telephone action limits The following abnormal results will be telephoned to users the list is not comprehensive and other clinically important results will be telephoned as required Version 8 Document Number CB CLIN PI 009 Author R Hinchcliffe Authorised by M France Test Name Limit GP OP results to be Comments c or exception These limits identify rules telephoned out of hours criteria e for holding up results for After the Surgery Office is These are general guidelines If
3. Monday Friday 8 00 am 5 00 pm Tel 0161 27 6 4375 Saturday and Sunday 8 00 am 12 00 noon Tel 0161 27 6 4375 All other times Tel 0161 27 6 4375 or bleep 2722 Access to urgent and emergency requests Analytes other than those on the list below may be analysed on an urgent or emergency basis but only after consultation and arrangement with the Biochemistry Department Requesting urgent analyses The following analytes are available at any time Albumin Amylase Bicarbonate Bilirubin Blood gases Calcium Carboxyhaemoglobin Chloride Creatinine Creatine Kinase Digoxin Ethanol Glucose Iron Lithium Liver Profile Magnesium Methaemoglobin in heparinised bottle if not sent with blood gas Osmolality Paracetamol Potassium Renal Profile Salicylate Sodium Theophylline Troponin T must be at least 12 hours post chest pain Urea Urine Paraquat phone 64375 to advise of sample being sent Quantitative BHCG blood pregnancy only Please note 1 You must arrange transport of the sample using the portering service pneumatic tube system or ward staff 2 Results of these tests are available in between one hour and two hours of receipt of the sample in the laboratory 3 The pneumatic tube must not be used for transport of blood gas samples Page 4 of 43 Adult Biochemistry user manual version 8 Central Manchester University Hospital NHS Foundation Trust Copy no electronic Q pulse version Laboratory Medicine Vers
4. Valproate 50 100 mg l 1 week Yellow top tube EDTA plasma Pre dose Page 32 of 43 Adult Biochemistry user manual version 8 URINE PLAIN BOTTLES Turnaround time 18 Hydroxy cortisol 40 550nmol 24 hrs 1 month Plain bottle This should only be requested when a diagnosis of primary hyperaldosteronism has been established Amino acids Random Collection 2 weeks Full drug history must be included with the request Albumin excretion lt 10yug minute 1 week Plain bottle Additional Preferred timed overnight collection Albumin creatinine ratio 2 working days Plain bottle Male 0 2 5 mg mmol Additional Female 0 3 5 Random sample mg mmol preferred first sample on waking Cortisol free lt 165 nmol 24 hr 2 4 weeks Plain bottle Urgent Same day Routine Next day Mon Fri 24 hour collection or Urgent Same day random Plain bottle Plain bottle Lead 1 2 weeks 24 hour collection or random Plain bottle Mercury 1 2 weeks 24 hour collection or random Plain bottle Routine Next day Mon Fri 24 hour collection or osmolality Urgent Same day random Plain Bottle PABA PABA excretion index Contact Pancreatic Lab to Contact Pancreatic PEI gt 0 70 order test Ext 64067 Lab to order test Ext 64067 Page 33 of 43 Adult Biochemistry user manual version 8 URINE PLAIN BOTTLES Porphobilin ogen Routine Next day Mon Fri Very fresh RANDOM sample sent straight to lab Protected from
5. Yellow top tube Serum Must be sent to the laboratory on ice for immediate separation Do not screen routinely for 11 hydroxylase deficiency in adults unless there is significant androgen excess and the cause is not apparent and the result would affect treatment 17 a OH Progesterone 0 10 nmol L 1 2 weeks Yellow top tube Serum 18 hydroxy cortisol Supine 0 7 6 5 nmol L Ambulant 1 6 10 7 nmol L 4 8 weeks Purple Top Tube EDTA plasma or Yellow top tube Serum Establish a diagnosis of Conn s before considering this test Acid Base status pH pCO2 arterial pO2 arterial pO2 capillary actual bicarbonate base excess male base excess female 7 36 7 44 4 5 6 0 kPa 12 0 14 7 kPa 6 7 10 7 kPa 24 30 mmol L 2 3 to 2 3 mmol L 3 0 to 1 6 mmol L Urgent 30 mins Blood gas syringe Remove needle cap syringe Additional Do not send this specimen by pneumatic tube ACTH 9am 0 46 ng L 2 4 weeks Green top tube plasma Additional Do not use glass tube Send to lab in ice immediately Requires rapid separation Adrenaline see Catecholamines ADH Argenine vasopressin 2 x Green top tubes plasma Send on ice for immediate separation 5 ml of plasma is required AFP as tumour marker lt 10 KU L 1 week Yellow top tube serum Albumin 34 48 g L Urgent 2 hours Yellow top tube serum Routine 4 hours Page 12 of 43
6. review Otherwise results closed use the GP concerned about any result will be automatically deputising service If there please contact the Duty validated is a problem contact the Biochemist in the first instance senior on call Biochemist Ammonia 2100 umol L Amylase 2 500 U L 2 500 U L higher in last 7 days Calcium 2 3 0 mmol L 2 3 5 mmol L higher in last 7 days corrected lt 1 8 mmol L lt 1 5 mmol L lower in last 7 days CO Hb 215 CK 2 5000 U L 2 5000 U L higher in last 7 days Creatinine None Digoxin 2 3 0 ug L 2 3 0 ug L higher in last 7 days Glucose lt 2 5 mmol l lt 2 5 mmol l higher in last 2 days 2 25 mmol l 2 25 mmol l lower in last 2 days refer to Senior on call for outpatients problems after the laboratory office has closed Lactate 2 4 0 mmol L higher in last 2 days Lithium 21 2 2 1 5 mmol L Magnesium 2 3 0 mmol L higher in last 2 days lt 0 4 mmol L lower in last 2 days Paracetamol None Phosphate lt 0 3 mmol L Potassium 2 6 5 mmol L 26 5 mmol L If creatinine is normal assess 2 7 0 in pre dialysis lt 1 9 mmol L carefully delayed separation patient haemolysis and contamination lt 2 5 mmol L with EDTA Salicylate None Sodium 2 160 mmol L 2 160 mmol L Unless it is clear that the lt 120 mmol L lt 120 mmol L situation is being monitored and improving Duty Biochemist will be automatically alerted on the RPC of these electrolyte abnormalities and can assess the situation Theophylline 2 37 5 mg l 2 37 5 mg l The
7. 0161 27 64179 Dr S Smith Principle Clinical Biochemist Clinical Research Tel 0161 27 64179 Dr D Schofield Senior Clinical Biochemist Page 2 of 43 Adult Biochemistry user manual version 8 Central Manchester University Hospital NHS Foundation Trust Copy no electronic Q pulse version Laboratory Medicine Version 8 Department of Clinical Biochemistry Document Number CB CLIN PI 009 Date of Issue October 2010 Author R Hinchcliffe Page3of 43 Authorised by M France Pancreatobilary Laboratory PBL Tel 0161 27 64067 Mr Chris Reeves Principal Clinical Biochemist Tel 0161 90 11206 Mr Rod Hinchliffe Laboratory manager Tel 0161 27 64698 Mrs Allison Gaskell Chief BMS Auto lab Tel 0161 27 65574 Mrs Emma James POCT co ordinator Tel 0161 27 64891 Mr Neil HowarthChief BMS Specialist section Tel 0161 27 64699 Departmental Fax Tel 0161 27 64586 Results and Clinical Advice Results Line If you need to telephone for results call the Results Line 0161 276 8766 Monday Friday 8 00 am 8 00 pm Duty biochemist Clinical advice is available at all times The duty biochemist is one of the Clinical Scientists or medical staff and includes those on the list above They participate in a rota and will assist and advise on problems involving the biochemical investigation of patients and the interpretation of results The duty biochemist can be bleeped on 4375 during normal hours Out of normal hours one of the Consultant staff
8. Adult Biochemistry user manual version 8 Analyte Reference range Turnaround time Specimen notes Aldosterone 4 weeks Green top tube Plasma Samples taken a random during Must be sent to the the day 100 850 pmol L laboratory for immediate ration m n Overnight recumbent 100 450 pmol L A a usr not eneral guidance onl 9 3 y Screening for Conn s random aldosterone and renin Aldosterone Renin Ratio gt 1000 suggests 4 weeks Green top tube Plasma primary hyperaldosteronism gt 2000 indicated that the patient almost certainly has hyperaldosteronism general guidance only Must be sent to the laboratory for immediate separation but must not be sent in ice as this encourages conversion of pro renin to renin Alkaline phosphatase U L Adults Male 10 129 U I Female 35 104 U L Urgent 2 hours Routine 4 hours Yellow top tube serum Alkaline Phosphatase Qualitative 2 weeks Serum One red or yellow isoenzymes interpretation Contact top tube Pancreatic Lab ext 64067 Alpha 1 Antitrypsin 1 0 2 0 g L 1 week Yellow top tube serum Phenyotyping will be done if results are Adult lt 1 28 g L Children lt 1 5 g l Alcohol See ethanol and methanol in Toxicology section ALT 5 40 U L Urgent 2 hours Yellow top tube serum Routine 4 hours Ammonia Adults lt 40umol L Urgent 2 hours Purple top tube EDTA Routine 4 hours Additional Contact lab on 65180
9. Hormones Hammersmith Hospital Specialist TDM Guy s amp St Thomas Hospital Bile Acids Stepping Hill Hospital Stockport Page 10 of 43 Adult Biochemistry user manual version 8 Central Manchester University Hospital NHS Foundation Trust Copy no electronic Q pulse version Laboratory Medicine Version 8 Department of Clinical Biochemistry Document Number CB CLIN PI 009 Date of Issue October 2010 Author R Hinchcliffe Page 1of 43 Authorised by M France Comments Complaints Procedure Any complaints or concerns about any aspect of the service should be raised initially with the Departmental Laboratory Manager Mr Rod D Hinchliffe telephone 0161 276 4698 We are keen to know about any problems arising from the laboratory service Feedback from our users will help in our constant efforts to improve our service ACCREDITATION The department was fully inspected in November 2006 with an interim inspection in 2008 and is now Fully Accredited by CPA UK Ltd Point of Care Testing POCT services that are fully supported by the department are included in this Page 11 of 43 Adult Biochemistry user manual version 8 A Z OF TESTS These tables cover the most requested tests please contact the Duty Biochemist for any tests not on these tables Specimen requirements and reference ranges for blood analyses Analyte Reference range Turnaround time Specimen notes 11 deoxy cortisol 5 0 12 1 nmol L 4 weeks
10. PTHrp Set report 2 4 weeks Needs special tube contact laboratory on 276 5180 must be sent on ice for rapid separation A PTH should have been found to be suppressed and hypercalcaemia demonstrated However modest artefactual elevation of PTH above suppressed levels may be seen if eGFR is reduced Quantitative HCG Quantitative HCG used Urgent 2 hours Yellow top tube serum as a pregnancy test Same Day Interpretation of HCG in the If used for Ectopic Pregnancy see A result of gt 25 U L context of monitoring early Clinical Guideline would normally indicate pregnancy is not provided by a positive test But a the laboratory result of lt 25 U L does not exclude early pregnancy Renin 2 4 weeks Green top tube Plasma Samples taken at random during Must be sent to the laboratory the day 0 5 3 5 nmol L h for immediate separation but Over night recumbent 1 1 2 7 nmol L hr must not be sent in ice as 30 minutes upright 2 8 4 5 nmol L hr this encourages conversion Random 0 5 3 5 nmol L hr of pro renin to renin Retinol Binding Protein 0 0 3 mg L 1 2 weeks Yellow top tube serum Selenium 83 152yg I 3 4 weeks Serum One red or yellow top tube SHBG Male 15 47 nmol L 1 2 weeks Yellow top tube serum Female 20 110 nmol L Sodium 132 144 mmol L Urgent 2 hours Yellow top tube serum Routine 4 hours Additional Hyponatraemia Guidelines Available Thiopu
11. directed to either 0161 276 4697 or the duty biochemist Analyte Protein total Routine Next day Plain 5 ml tube obtained up to 7 days 0 4 1 1 g L Mon Fri from Biochemistry 1 4 weeks 0 2 0 8 g L Urgent Same day 7 ml of CSF if possible 1 3 months 0 2 0 7 g L required Over 3months 0 05 0 45 g L Page 37 of 43 Adult Biochemistry user manual version 8 Analyte Reference range Oligoclonal Bands Not seen in healthy subjects TAU protein To check for the presence of CSF in other fluids for example discharges from nose or ear send a few drops of fluid of doubtful origin and also patient s blood in a red top tube This assay is expensive and time consuming full clinical details are required to support this request Blood must be sent as well Bilirubin 0 0 0 001 absorbance units Oxyhaemoglobin 0 001 absorbance units Xanthochromia Screen Page 38 of 43 Routine Next day Grey top tube Mon Fri 1 ml of CSF if possible Urgent Same day required Plain 5 ml tube obtained from Biochemistry Clotted blood must be sent at same time 1 ml of CSF if possible required To check for the presence of CSF in other fluids for example discharges from nose or ear send a few drops of fluid of doubtful origin A simultaneous blood sample is also required This assay is expensive and time consuming Full clinical details are required to support this request and to aid interpretat
12. haemoglobin lt 1 5 Urgent 2 hours Routine 4 hours If sentin a blood gas syringe for additional measurement of acid base parameters remove needle and cap syringe Do not send this specimen by pneumatic tube If separate sample Green Top tube Plasma Noradrenalin see catecholamines Oestradiol Orosomucoid Male 50 165 pmol L Female follicular 110 183 pmol L Female mid cycle 550 1650 pmol L Female luteal 550 845 pmol L 300 1200 mg L Next day Mon Fri 2 4 weeks Yellow top tube Additional Measurement of Oestradiol is not recommended for monitoring of HRT Yellow top tube CRP is equally efficacious for monitoring inflammatory bowel disease Osmolality serum 275 295 mmol kg Urgent 2 hours Routine 4 hours Yellow top tube serum Page 23 of 43 Adult Biochemistry user manual version 8 Analyte Reference ranges Turnaround time Specimen notes Osmolar Gap calculated as lt 10 mmol L Urgent 2 hours Yellow top tube serum calculated osmolality Routine 4 hours measured osmolality Calculated osmolality is 2 x Na K glucose urea Oxalate 2 4 weeks Purple top EDTA Plasma Must be separated and frozen within 1hr of collection P1NP See Bone Markers PIIINP 1 7 4 2 ug L 3 4 weeks Yellow top tube serum Phosphate 0 7 mmol L 1 4mmol L Yellow top tube serum U
13. is available via the Trust switchboard Out of hours specialist contact Outside of normal working hours contact is made directly by mobile phone or Air Bleep via switchboard Mobile number 07771703383 Page 3 of 43 Adult Biochemistry user manual version 8 Central Manchester University Hospital NHS Foundation Trust Copy no electronic Q pulse version Laboratory Medicine Version 8 Department of Clinical Biochemistry Document Number CB CLIN PI 009 Date of Issue October 2010 Author R Hinchcliffe Page4of 43 Authorised by M France SERVICES AVAILABLE Service provision Specimen reception is open for the receipt of samples at all times Printed reports are distributed to all wards and departments twice daily Monday Friday at approximately 10 00 am and 4 00 pm If you wish to have results of specimens for routine biochemical profiles included on these reports on the same day the samples must arrive in the laboratory no later than 1 00 pm Emergency requests and blood gases The list below shows those analytes that are provided on an Urgent and Emergency basis Samples requiring these tests and labelled as Urgent will usually be analysed and reported in 60 120 minutes from receipt in the laboratory If results are required very rapidly for the immediate treatment of a patient or if you wish to send a sample for arterial blood gases and pH please contact the laboratory to let us know that the sample is coming Contact details are
14. prior to collection Sample must be fresh send to lab in ice immediately Amylase lt 100 U L Urgent 2 hours Yellow top tube serum Routine 4 hours Amylase isoenzymes Contact Pancreatic Lab 2 3 weeks Serum One red or yellow Ext 64067 top tube Androstenedione Male 2 1 10 8 nmol L 2 4 weeks Yellow top tube serum Female 1 0 11 5 nmol L Page 13 of 43 Adult Biochemistry user manual version 8 Analyte Reference range Turnaround time Specimen notes Anti Mullerian Hormone AMH Contact lab or refer to report for guideline 1 2 weeks Yellow top tube serum Separate within 2 hours Store and send cold if less than 24 hours If gt 24 hours store at 20 C Anion Gap 10 18 mmol L Urgent 2 hours Yellow top tube Serum Routine 4 hours Angeotensin converting 15 55 IU L 1 2 weeks Yellow top tube Serum enzyme ACE APO E genotype 2 4 weeks Purple top EDTA plasma This is a genetic test and the whole blood sample is required AST 5 45 U L Urgent 2 hours Yellow top tube serum Routine 4 hours Adults Page 14 of 43 Adult Biochemistry user manual version 8 Analyte Reference range Turnaround time Specimen notes Contact Pancreatic lab ext 64067 before drawing blood B Carotene 19 254 ug l Serum One red or yellow Beta corotene 4 weeks top tube Bicarbonate 24 30 mmol L Urgent 2 hours Routine
15. using anything other than Light s criteria 2 A pHh lt 7 3 is seen with emphysema tuberculosis malignancy collagen vascular disease or oesophageal rupture Glucose lt 2 2 mmol L is associated with an emphysema rheumatoid arthritis tuberculosis or malignancy Other tests may be useful 3 An exudates is more often associated than a transudate with A cholesterol level gt 11 7 mmol L A pleural serum bilirubin ratio lt 0 6 A pleural serum albumin gradient of lt 12 g L Page 42 of 43 Adult Biochemistry user manual version 8 Diagnosis of Diabetes Mellitus INVESTIGATION OF SUSPECTED GLUCOSE INTOLERANCE Diagnosis should be based on two independent glucose measurements unless the patient has symptoms of diabetes All samples should be collected into fluoride oxalate blood tubes as glucose deteriorates rapidly in inappropriate samples leading to potential errors in diagnosis The recommended initial test is either a two hour post prandial or a random blood sample A non fasting venous plasma glucose concentration less than 6 1 mmol L is normal 11 1 mmol L or greater is diagnostic for diabetes mellitus A non fasting venous plasma glucose concentration between 6 1 mmol L and 11 1 mmol L should be followed up by a fasting level A fasting venous plasma glucose concentration less than 6 1 mmol L is normal and one of 7 0 mmol L or greater is diagnostic of diabetes mellitus Between these levels an OGTT can confirm the
16. 2 hours Routine 4 hours Yellow top tube Serum Page 15 of 43 Adult Biochemistry user manual version 8 Analyte Reference range Turnaround time Specimen notes Catecholamine Plasma Adrenaline 0 1 0 nmol L Noradenaline 1 0 6 0 nmol l 4 weeks Purple top tube EDTA plasma Send to lab in ice immediately Requires rapid separation Chloride 95 110 mmol L Urgent 2 hours Yellow top tube Routine 4 hours serum Purple top tube Chromogranin A lt 60 pmol L 8 weeks EDTA plasma Chromogranin B lt 150 pmol L 8 weeks Purple top tube EDTA plasma Cholesterol JBS 2 Dec 2005 Routine 4 hours Yellow top tube treatment targets serum Total lt 4 0 mmol l Additional LDL lt 2 0 mmol L See Joint British HDL male gt 1 0 mmol l Societies 2 guideline HDL female gt 1 2 mol l LDL will only be calculated if TG lt or to 4 0 mmol L Cholinesterase Total 620 1370U L 4 weeks Yellow top tube serum Phenotype Additional See interpretive result Apnoea investigations report issued should wait until patient is fully recovered CK total Male up to 190 U L Urgent 2 hours Yellow top tube Female up to 165 U L Routine 4 hours serum CKMBmass Less than 5 ng mL Urgent 2 hours Yellow top tube serum Test only available for A amp E Chest Pain Assessment Unit MRI Page 16 of 43 Adult Biochemistry user manual version 8 Analyte R
17. 4 hours Bile Acids lt 14 umol L Next day Mon Fri Yellow top tube Serum Bilirubin total Adults lt 22 umol L Urgent 2 hours Routine 4 hours Yellow top tube Serum Adults Bilirubin Conjugated direct No range Bone Markers CTX 0 1 0 5 ng L 2 4 weeks Purple top tube plasma Fasting morning sample is P1NP Premenopausal lt 56years preferred women 30 78 pg L KA AEE aig Purple top tube Plasma s women A Men 20 76 pg L Hg Not affected by fasting Ca 125 Ca19 9 Ca15 3 CEA see tumour markers Caeruloplasmin 0 25 0 63 g L 1 week Yellow top tube serum This is measured by immunoassay not copperoxidase activity Carbohydrate deficient Negative lt 2 6 of 2 4 weeks Yellow top tube serum transferrin total transferrin Positive gt 2 6 of total transferrin This test is available only after discussion with the duty biochemist or after prior agreement Carboxyhaemoglobin lt 2 non smokers lt 10 for smokers approximate Urgent 30 mins If sent with blood gas Blood gas syringe Remove needle cap syringe Additional Do not send this specimen by pneumatic tube If separate sample Green Top tube Plasma Calcitonin lt 5 5ng L Female lt 18 9ng L Male 4 weeks Yellow top tube serum Send to lab in ice immediately Requires rapid separation Calcium total Calcium corrected 2 10 2 55 mmol L 2 10 2 55 mmol L Urgent
18. 5 7 5 mmol 24 hr 3 3 5 0 mmol 24 hr 1 week Routine Next day Mon Fri Urgent Same day Acid bottle required Acid bottle required Acid bottle required 2 4 weeks Acid bottle required Avoid metal capped MSU containers because of the danger of contamination lt 0 32 mmol 24 hr Acid bottle required 15 50 mmol 24 hr Males 0 95 5 26 umol 24 hr Females 0 6 4 2 umol 24 hr Male amp female 0 0 2 0 umol 24hr Male 0 0 5 3 umol 24hr Female 0 0 4 3 umol 24hr e These bottles contain 25 Hydrochloric Acid e Keep the bottles out of the reach of children e Incase of contact with eyes or skin rinse immediately with plenty of water and seek medical advice e DONOT breathe any fumes from the bottles e Patients must be advised NOT TO URINATE DIRECTLY into the bottle Page 35 of 43 Routine Next day Mon Fri Urgent Same day 2 4 weeks Acid bottle required Acid bottle required Adult Biochemistry user manual version 8 URINE ACID WASHED PLASTIC BOTTLES Copper lt 0 8 umol 24 hr 2 4 weeks Acid washed bottle required iron Not routinely available Contact Haematology for Haemosiderin Page 36 of 43 Adult Biochemistry user manual version 8 Reference ranges and specimen requirements for CSF analyses Urgent analysis of CSF for protein and glucose is available at all times Queries regarding any other aspect of CSF analysis can be
19. 8 Test Therapeutic Range Turnaround Time Specimen Notes Lamotrigine 3 0 15 0 mg l 1 week Yellow top tube serum Pre dose Lithium 0 4 1 0 mmol l Routine same day Yellow top tube Urgent 2 hours serum 12 0 5 hours post dose Methanol Routine same day Grey Fluoride Urgent 2 hours oxalate plasma Mon Fri Urgent analysis out of hours can sometimes be arranged but cannot be guaranteed Methotrexate Action as protocol Routine 2 working Yellow top tube days serum Urgent same day Collect as protocol Mon Fri Urgent by Urgent analysis out arrangement of hours can sometimes be arranged but cannot be guaranteed Paracetamol 10 20 mg l Routine same day Yellow top tube In overdose refer to Urgent 2 hours serum treatment nonagram At least 4 hours after overdose Record times of ingestion and sample collection Phenobarbitone 10 30 mg l 1 week Yellow top tube serum Pre dose Phenytoin 8 20 mg l 1 week Yellow top tube serum Pre dose Salicylate Routine same day Yellow top tube analgesic 20 100 mg l Urgent 2 hours serum anti inflammatory 100 250 mg l Repeated Overdose see Toxbase or BNF measurement may be required Record times of ingestion and sample collection Sirolimus 5 10ug LI Overdose see Toxbase or BNF 1 week Purple top tube EDTA plasma Pre dose Theophylline 10 20 mg l Routine same day Urgent 2 hours Yellow top tube serum Pre dose
20. Central Manchester University Hospital NHS Foundation Trust Copy no electronic Q pulse version Laboratory Medicine Version 8 Department of Clinical Biochemistry Document Number CB CLIN PI 009 Date of Issue October 2010 Author R Hinchcliffe Page1of 43 Authorised by M France i A 4 F A 4 4 4 Central Manchester University Hospitals Mig NHS Foundation Trust Department of Clinical Biochemistry User Guide Adult Biochemist Page 1 of 43 Adult Biochemistry user manual version 8 Central Manchester University Hospital NHS Foundation Trust Copy no electronic Q pulse version Laboratory Medicine Version 8 Department of Clinical Biochemistry Document Number CB CLIN PI 009 Date of Issue October 2010 Author R Hinchcliffe Page2of 43 Authorised by M France CLINICAL BIOCHEMISTRY This guide describes the Clinical Biochemistry service provided for adult patients patients over 16 years old Please see the separate paediatric Biochemistry guide for children and neonates Location The Clinical Biochemistry Department provides a comprehensive service for the care of patients within the Trust and the wider community served by both the Primary and Tertiary sectors The high volume testing including the urgent and 24 hour access assays are carried out in the Autolab on the ground floor of the Clinical Sciences Building CSB3 This also houses the main specimen reception and most of Haematology including Blood Transfusion Specialist ass
21. advice Blood samples AVOID CONTAMINATION When taking a series of blood specimens it essential that the yellow top serum sample is taken first followed by green top Lithium heparin samples then the grey top Fluoride Oxalate samples and any EDTA tubes last of all Failure to adhere to this sequence will lead to contamination of blood samples with anticoagulants preservatives This contamination produces spurious and invalid results Avoid haemolysis drip contamination adverse temperatures over 30 C or less than 10 C unless otherwise stated and prolonged venous constriction Ensure thorough and instant mixing of blood with anticoagulant heparin fluoride oxalate or potassium EDTA for plasma samples Do not transfer blood from one tube to another e g EDTA to Lithium heparin Do not leave Clinical Biochemistry blood samples in the fridge 4 C or overnight at room temperature If in doubt please contact the laboratory Duty Biochemist bleep 4375 for advice Leaking blood tubes will be discarded DO NOT send blood gas samples to the laboratory via the pneumatic tube systems DO NOT send blood gas samples to the laboratory with the needle attached Urine samples General points e The assays listed in the table on page 34 are normally reported as a 24 hour output and a full 24 hour collection is required Please ensure that start and end dates and times are noted on the bottle label e Random samples or overnight collecti
22. ays are carried out in laboratories on the 1 and 2 floor of CSB3 The Point of Care team are housed on the 4 floor of the new Children s Hospital Opening Hours The core opening hours of the laboratory are 8 00 am to 5 00 pm Monday Friday Outside of these hours a reduced service is available as part of the CPP service Continuous Process Pathology We aim to provide an extensive range of routine assays e g Renal Bone Liver Lipid and Cardiac profiles at all times A full emergency service is always available and this is listed separately below The out of hours service is manned by a limited number of staff from 5pm to 8 30 pm and only one Biomedical Scientist available between 8 30 pm and 8 30 am Please keep use of the service to a minimum between these times to enable us to provide the most efficient urgent and emergency service in these periods General information The department is manned by various clinical and technical staff below is a list of all key personal Dr M France Consultant Chemical Pathologist Specialist interest in Metabolic Biochemistry Tel 0161 27 64284 Dr G Ayers Consultant Clinical Biochemist Specialist interest in Toxicology Tel 0161 27 64594 M s K Hayden Consultant Clinical Biochemist Specialist interest in endocrinology and automated services Tel 0161 90 11106 Dr A C Holt Senior Clinical Biochemist Clinical Trials Tel 0161 27 64579 Dr AP Yates Principal Clinical Biochemist Clinical Research Tel
23. cated in the A Z of analytes and conform to the NPIS ACB Joint Guidelines for Laboratory Services for Acute Poisoning Tests for the identification of a wide range of common toxic drugs and other poisons are available by arrangement during normal laboratory hours 8 00am 5 00pm Monday to Friday excluding Bank Holidays telephone the Toxicology Laboratory on 0161 276 4699 or bleep the Duty Biochemist In all unconscious patients and cases of suspected poisoning with drugs the first available urine specimen should be retained Measurement of blood concentrations of the drugs included in the A Z of Tests is provided for individual optimisation of dose TDM and to allow a rational approach to re instating treatment following overdose Blood for lithium measurement should be collected 12 0 5 hours post dose For most other TDM pre dose trough sampling is preferred After initiation or dose adjustment at least 5 plasma half lives should be allowed to elapse before sampling to allow a steady state to be achieved before checking for adequacy of dose For pharmacokinetic data and information on dose adjustment see TDM sample guide Page 30 of 43 Adult Biochemistry user manual version 8 Theraputic Drug Monitoring Guide Test Therapeutic Range Turnaround Time Specimen Notes Amiodarone 0 6 2 5 mg l 4 weeks Yellow top tube serum Pre dose By arrangement only Amitriptyline 50 150 ug l 4 weeks Yellow to
24. cimen notes Iron and iron status Transferrin iron saturation 7 29 umol L 2 0 3 6 g L 15 45 Urgent 2 hours Routine 4 hours Yellow top tube serum Ferritin provided by haematology is a better test of iron deficiency Measurement of iron is not necessary Iron saturation is more sensitive than ferritin for detecting iron overload Lactate Adults 0 7 2 1 mmol L Urgent 2 hours Grey top tube plasma Specimen to be sent to laboratory immediately within an hour but must be separated immediately so lab staff must be alerted Lead Environmental exposure guidelines Adult lt 250 ug L Routine 5 working days Purple top tube EDTA Plasma If environmental testing in the work place is undertaken arrangements must be made to store a sample for confirmatory testing LDH 240 480 U L Routine 4 hours Yellow top tube serum Additional By special arrangement LH Female male 2 14 Next day Mon Fri Yellow top tube IU L serum Female mid cycle 15 50 IU L Post menopause gt 15 IU L Magnesium Adults 0 6 1 0 Urgent 2 hours Yellow top tube mmol L Routine 4 hours serum Adults Page 22 of 43 Adult Biochemistry user manual version 8 Analyte Reference range Turnaround time Specimen notes Manganese lt 1 year 7 18 ug L gt 1yr 4 12 ug 2 4 weeks Purple top tube EDTA Plasma Met
25. degree of glucose intolerance DIAGNOSIS OF DIABETES MELLITUS By measuring venous plasma glucose concentration four possible states of glucose metabolism may be defined Normal Impaired fasting glycaemia IFG Impaired glucose tolerance IGT Diabetes mellitus DM ON gt IFG and IGT are intermediate states of carbohydrate intolerance and are risk factors not only for subsequent development of diabetes mellitus but also cardiovascular disease and should form part of a cardiovascular risk assessment These conditions are defined as follows in terms of plasma glucose concentration 1 Normal fasting venous plasma glucose of less than 6 1 mmol L 2 IFG fasting venous plasma glucose of 6 1 to less than 7 0 mmol L and if measured 2 hr post 75g glucose load less than 7 8 mmol L 3 IGT fasting venous plasma glucose less than 7 0 mmol L and 2 hr post glucose load of 7 8 to less than 11 1 mmol L 4 DM i Venous plasma glucose of 11 1 mmol L or greater at any time ii Fasting venous plasma glucose of 7 0 mmol L or greater iii Post 75g OGTT 2hr venous plasma glucose of 11 1 mmol L or greater Page 43 of 43 Adult Biochemistry user manual version 8
26. eference range Turnaround time Specimen notes Copper 11 20 umol L 2 4 weeks Blue top tube serum Cortisol Mid night 60 250 nmol L 9am 200 650 nmol L Next day Mon Fri Yellow top tube serum Random cortisol is not an effective means of screening for Cushing s syndrome use 1 mg overnight dexamethasone suppression or 24 hour urinary free cortisol All samples taken as part of a Synacthen test should be sent to the laboratory in a single batch A baseline and thirty minute sample is required Page 17 of 43 Adult Biochemistry user manual version 8 Analyte Reference range Turnaround time Specimen notes C peptide Level depends on glucose concentration 4 weeks Yellow top tube Serum Must be sent to the laboratory on ice for immediate separation If the test is requested because of hypoglycaemia then an appropriately low glucose taken simultaneously is required and will only be measured if insulin is raised inappropriately C reactive protein CRP 0 3 5 0 mg L Urgent 2 hours Yellow top tube Routine 4 hours serum CRP is useful to monitor inflammatory processes and is at least as useful as Orosomucoid for monitoring inflammatory bowel disease for which purpose CRP is preferred Creatinine Urgent 2 hours Yellow top tube Adults Routine 4 hours serum Male 62 106 moll Female 44 80 umol l May be elevated by c
27. haemoglobin 2 weeks Contact Pancreatic lab ext 64067 before drawing blood One purple top EDTA Page 19 of 43 Adult Biochemistry user manual version 8 Analyte Reference range Turnaround time Specimen notes Glycated Non diabetic 4 5 Next day Mon Fri Purple top tube Haemoglobin 6 5 26 48 mmol mol EDTA plasma The HbA1c Well controlled diabetic presence of a variant up to 7 53 haemoglobin will be mmol mol reported Further investigation of these requires patient consent for further analysis which is performed in haematology GTT Interpretation of results Analysed same day as Doctors working in the is provided with each report following WHO guidelines test carried out on ward hospital contact Programmed Investigation Unit to arrange ward appointment GP referral to Clinical Biochemistry with full contact details of patient Growth Hormone Level dependant on 2 4 weeks Yellow top tube age sex and clinical serum circumstance Standardised against ng ml 1S98 574 To compare with previous measurements expressed in mU L multiply the mass unit by 3 Random measurements are of little use see IGF1 Gut hormones 4 weeks Patient MUST be Gastrin lt 40 pmol L fasting Glucagon lt 50 pmol L Neurotensin lt 100 pmol l Must send in ice and Pancreatic polypeptide lt 300 pmol L collected in special Somatostatin lt 150 pmol L tube provided by the VIP lt 30
28. han those quoted in textbooks diaries etc as both methods and units vary from department to department These should not be published as methodology changes in line with the introduction of new techniques the ranges become outdated and therefore are subject to constant review The current reference therapeutic range is always included with the final report 5 of the healthy population will have results marginally outside the quoted reference range Ranges may be affected by age gender ethnic group pregnancy time of sampling and many other factors Detailed information or advice on interpretation is always available from the laboratory Validity of results Results are automatically validated if they are within preset ranges and have no error flags from the instruments e g Haemolysis Lipaemia and Icterus Ranges have been discussed and approved by senior scientists and consultant staff Results outside these ranges are scrutinised by qualified staff and authorised HPC registered Biomedical Scientists or the duty Biochemist Medic or Consultant Comments may be appended and additional analyses undertaken based on the clinical details provided and on previous results Whilst internal and external quality assurance programmes are in operation to ensure accuracy and precision of results occasionally random errors may occur and escape detection The clinician is often best placed to detect such errors Therefore if you doubt the validity of a result
29. ine clearance UCRO x 694 units are ml minute PCR where 1 the factor 694 takes into account the difference in units and the number of minutes in 24 hours 2 UCRO urine creatinine output in mmol 24 hour 3 PCR plasma creatinine in pmol L If any doubts about the calculations please contact the duty Biochemist Bleep 4375 Page 40 of 43 Adult Biochemistry user manual version 8 POINT OF CARE TESTING POCT POCT is laboratory testing performed in the clinical setting by non laboratory healthcare professionals One of the first and still most commonly used POCT devices are blood glucose meters there are 200 meters in use on the Central Site used to measure over 1000 glucose levels each day However in recent years there has been a large growth in the variety of tests that can now be performed by POCT These include tests that are performed in Biochemistry Haematology Immunology and Microbiology Laboratories Changing clinical practices are also leading to more extensive use of POCT The variety of POCT devices in use on the Central Site can be seen from the POCT homepage Internet access http Awww cmme nhs uk directorates labmedicine departments poct pocthome asp Intranet access http intranet cmht nwest nhs uk directorates labmed poct web pocthome asp There are advantages with POCT compared with conventional laboratory testing For example results are available more quickly as time is not lost by transporting samples t
30. ing programs further details available via POCT webpage protocols for checking and documenting the correct functioning of the device regular proficiency testing schemes for staff to demonstrate their continued skills acquired at training quality auditing to identify potential problems with advice and troubleshooting if any are found The Trust POCT Policy accessible via POCT webpage is based on guidelines produced by the Medicines and Healthcare products Regulatory Agency MHRA One of the core criteria of both is Only staff whose training and competence has been established and recorded are permitted to carry out POCT If you would like any further information regarding POCT on the please contact the POCT Coordinator Page 41 of 43 Adult Biochemistry user manual version 8 Light s criteria for evaluating pleural fluid Analysis The following tests should be performed e Pleural fluid protein glucose and LDH and serum protein glucose and LDH if available e Pleural fluid pH if a specimen in a blood gas syringe is available The sample connot be analysed if it is not suitable for analysis on the blood gas analyser Interpretation Light s Criteria for a transudate 1 The ratio of pleural fluid protein to serum protein is less than 0 5 The ratio of pleural fluid me plasma LDH less than 0 6 The pleural fluid LDH is less ae of the upper reference limit Although these criteria have been re evaluated there is no clear cut case for
31. ion Blood must be sent as well Same day Mon Friday for samples received by 3pm CSF for xanthochromia should be collected in the last tube in a series to reduce contamination with blood A minimum of 1 ml CSF is required It should be protected by placing ina brown envelope A simultaneous blood sample is required for LFT to help interpretation of the bilirubin level in CSF A fluoride oxalate blood sample is also required for glucose for general examination Absence of bilirubin excludes sub arachnoid haemorrhage but the lab may not be able to exclude it in the presence of bilirubin if haemoglobin is present Adult Biochemistry user manual version 8 Reference ranges and specimen requirements for faeces Analyte a Turnaround ener notes a time 3 day Faecal Fat 10 18 mmol 24 hr 2 weeks a BE COLLECTED INTO PRE WEIGHED CONTAINER SUPPIED BY THE LABORATRY phone extn 64697 NO OTHER CONTAINERS WILL BE ACCEPTED Occult blood Por aA as positive 2 3 days Send 3 consecutive Carta or Por aA Faecal Elastase gt 200 oo stool 3 weeks Ss formed stool sample Contact Pancreatic lab Extn 64067 for collection tube Porphyrins mince as positive 1 2 weeks Very fresh RANDOM sample or negative sent straight to lab protected from light Testing of PBG will undertaken to exclude acute porphyria Out of hours the urgency should be discussed with the consultant on call An EDTA blood sample should also be sent to all
32. ion 8 Department of Clinical Biochemistry Document Number CB CLIN PI 009 Date of Issue October 2010 Author R Hinchcliffe Pagedof 43 Authorised by M France Requests for Investigations Hospital in patients and out patients All requests should be made using the hospital computer system This is the Clinical Work Station CWS of the Patient Administration System PAS For those areas not covered by CWS the pre printed biochemistry request form should be used with patient labels if possible Primary Care requests We provide multi discipline request cards for all practices which we have an agreement to provide services for See the section on GP services in section 3 of this document for contact information All samples and request cards should have as much information on as possible to enable us to positively identify the patient that the sample has come from to ensure that the sample and card relate to the same person and to identify which tests need doing and any other requirements For some assays it is essential that we know the time that the sample was taken This is especially important in the case of therapeutic drug monitoring It is preferred that samples are labelled with pre printed labels from the patient s notes If handwritten the tube should as a minimum be labelled with surname first name and hospital record number or other unique identifier such as NHS number Specimen Acceptance A copy of the Directorate Specimen Accepta
33. it is vital that you contact the relevant Advice Interpretation extension at once so that we can investigate and re test samples whenever possible Please remember that certain factors may affect and possibly invalidate some test results causing potential biological and analytical interference For example blood transfusion and other intravenous fluids antibiotics anticoagulants drugs timing of specimen in relation to drug dose type of tube Please remember to give details of recent or current treatment on the request forms Reporting of results All results will be issued on a printed report unless clinical users specifically request that this is not done This may take several forms 1 A Cumulative report giving a maximum of the four most recent results is issued for the majority of profiles and commonly requested single tests 2 Single shot reports are issued for all tests not on Cumulative reports 3 Interim or Ward reports are also issued in some circumstances or to meet special requirements of some wards These are temporary reports and should not be stored in the patient s notes 4 Electronic Reporting This can be carried out in two different ways The first is results reporting back to OCM for those requests made by that system The second is direct to a department s clinical system but this will only be done through a special development arranged with the laboratories Page 7 of 43 Adult Biochemistry user manual version 8
34. light Porphyrins Screen 1 2 hours Very fresh RANDOM sample sent straight Quantitation if positive to lab Protected from 1 2 weeks light EDTA blood sample Porphyrin screen Whether patient s present with an acute porphyria or a skin rash a similar approach is taken requiring a fresh random urine sample protected from light and an EDTA blood sample If there is a known family history of acute porphyria an EDTA sample for genetic analysis is required and also faecal analysis may be necessary but faeces need not be sent in the first instance Protein lt 150 mg 24 hr Routine Next day Mon Fri Plain bottle Urgent Same day Protein creatinine ratio A positive test for Used as a screening proteinuria in adults is test for proteinuria UK greater than 45 CKD guidelines mg mmol creatinine Page 34 of 43 Adult Biochemistry user manual version 8 URINE PLAIN BOTTLES cont Analyte ae Routine Next day Mon Fri Urgent Same day Routine Next day Mon Fri Plain bottle a Urobilin ogen Quantitative test Urgent Same day Routine Next day Mon Fri Urgent Same day URINE ACID PRESERVATIVE BOTTLES Plain bottle Random urine 5 HIAA Calcium Citrate Cystine homocystine Magnesium Oxalate Phosphate Total metadrenalines Hope Hospital issues the following guidelines on individual analytes Metadrenalines Normetadrenaline Health and Safety Notice 0 50 umol 24 hr 2
35. low top tube serum gt 12m 60 80g L Yellow top tube serum Provided as part of iron profile and used as the denominator to calculate iron saturation New high sensitivity assay introduced 6the Oct 2010 of reference range and limit of detection Routine 4 hours Triglycerides Fasting guideline JBS 2 Same day Yellow top tube serum Dec 2005 treatment target an optimal level lt 1 7 mmol l Troponin T lt 14 0 ng L 99 centile Urgent 1 hour Yellow top tube serum NICE has recommended a testing protocol at admission and 6 hours later for hs cTnT This will involve an increased number of samples and the cost has not been funded We would prefer single testing at 12 hours after the event to maximize diagnostic sensitivity in a single sample but recognize that serial testing may be necessary in difficult cases Page 26 of 43 Adult Biochemistry user manual version 8 Analyte Reference ranges Turnaround time Specimen notes TSH 0 2 5 0 mU L Same day Yellow top tube Tumour Markers CA 15 3 lt 32 KU L All 1 2 weeks Yellow top tube serum CA 19 9 lt 31 U mL Fluid other than blood should CA 125 lt 21 U mL be put into a yellow top tube CEA 0 3 0 ug L non However non of the tumour smoker markers are validated on non serum fluids and no interpretation is offered Urate males 0 17 0 48 mmol L Routine 4 hours Yellow top tube females 0 14
36. nce policy is included in the DLM handbook In summary a minimum of 3 of the following items of informatiom must be provided 1 Patient Forename 2 Patient Surname 3 Patient date of birth 4 Hospital number or NHS number or any other unique identifier The sender of the sample will be notified as soon as possible if the sample is inadequately labelled so that the investigation can be repeated if it is still required Inadequately labelled or unlabelled samples will not be analysed The request form should be sent to the laboratory with the appropriate specimen sealed in a plastic bag by the specimen transport system pneumatic tube or by messenger porter or ward staff The forms must be kept separate from the samples Specimens and forms for individual Laboratory Medicine Departments must be sent in individual specimen bags to avoid delays in processing An electronic request via CWS is preferred If tests are requested using the CWS system an electronic report will be sent back to the unit from which the request was made Specimen requirements and reference ranges Specimen requirements and reference ranges are shown in the following tables analytes arranged alphabetically Please note e Ranges are for adults e Desirable values rather than population reference ranges are given for lipids e Information from or copies of the various guidelines referred to e g European Arthrosclerosis Society Guidelines can be obtained by con
37. nformation including a drug history is essential in order to provide information of most value in the diagnosis and management of thyroid disorders The first line investigation is freeT4 and TSH Further tests including total T3 will be performed as considered appropriate Generally T3 is always elevated if FT4 is elevated and so its measurement is unnecessary T3 is added to detect T3 toxicosis when FT4 is normal but the TSH is below normal and to monitor T3 toxicosis and to monitor thyroid function in patients on amiodarone Otherwise it will not be measured unless there is some other complicating factor that has been discussed with the duty biochemist Other assays such as free hormone investigations and TBG are sometimes helpful but not usually necessary The use of these assays and any interpretative problems can be discussed with the Duty Biochemist Specimen requirements and reference ranges for blood analyses Paediatric See Children s Biochemistry User Guide Page 29 of 43 Adult Biochemistry user manual version 8 Specimen requirements for Toxicology and Therapeutic Drug Monitoring TDM Time of specimen collection and time of last dose or exposure for poisoning should be recorded on the request form Dose per 24 hours should also be recorded Time of specimen collection should be recorded on the sample tube Tests required to diagnose and facilitate specific emergency treatment e g with antidote are available at as indi
38. o the laboratory This can be vital when managing critically ill patients Also in less acute settings the fast turnaround time can lead to broader efficiencies and or an improved patient experience There are also disadvantages with POCT compared with conventional laboratory testing such as the cost per test being more expensive for POCT Furthermore all analytical tests whether performed in the laboratory or not can run into problems For example in situations of decreased peripheral blood flow glucose levels in capillary finger stick samples may not reflect the true physiological state Examples include but are not limited to dehydration shock septicaemia peripheral vascular disease diabetic ketoacidosis or hyperglycaemic hyperosmolar non ketotic states This limitation applies to all POCT glucose meters and has led to two fatalities in Greater Manchester Any POCT service must provide significant patient benefits to ensure limited NHS resources are used appropriately The quality of results and hence patient safety can also be affected by inadequate training or inappropriate use of devices Therefore all proposals to introduce a new POCT service must be referred to the multi disciplinary POCT Committee The Chair of the Committee is Dr Niall O Keeffe Consultant Anaesthetist niall o keeffe cmft nhs uk The POCT Support Service is managed by the POCT Coordinator emma james cmft nhs uk telephone 64891 and includes structured train
39. ons are adequate for some tests and these are marked in the table Page 6 of 43 Adult Biochemistry user manual version 8 Central Manchester University Hospital NHS Foundation Trust Copy no electronic Q pulse version Laboratory Medicine Version 8 Department of Clinical Biochemistry Document Number CB CLIN PI 009 Date of Issue October 2010 Author R Hinchcliffe Page 7of 43 Authorised by M France e Some analyses require a specific preservative in the collection bottle see table check before starting collection Special bottles are held by the Biochemistry Department and can be collected from there or the reception area in the Clinical sciences building by the portering service or ward staff e Please complete the bottle label as well as the request form e Creatinine clearances can only be calculated only if the blood creatinine is measured within 24 hours of the 24 hour urine e Pleural fluid samples General biochemistry into a red or yellow top tube glucose into a fluoride oxalate grey top and sample for acid base assessment collected into a blood gas syringe and treated as a blood gas specimen A simultaneous blood sample for general biochemistry into a yellow top tube and glucose into a fluoride oxalate grey top tube will be helpful for interpretation See page 41 for Light s critera for evaluating pleural fluid Reference ranges Reference ranges are supplied strictly for guidance only and these should be used rather t
40. ophylline around 75 mg l has been used to identify toxicity requiring haemoperfusion Troponin None use preset procedures for GP OP only reporting to A E Urea None Page 9 of 43 Adult Biochemistry user manual version 8 Central Manchester University Hospital NHS Foundation Trust Copy no electronic Q pulse version Laboratory Medicine Version 8 Department of Clinical Biochemistry Document Number CB CLIN PI 009 Date of Issue October 2010 Author R Hinchcliffe Page10of 43 Authorised by M France Time limits for requesting additional tests For most general and endocrine requests it is not possible to add on an additional test more than 24 hours from the time that the original results were authorised This only applies to analytes that are stable at 2 8 C Referred tests Some specialized or low volume assays are referred to external laboratories for analysis In line with CPA requirement we endeavour to use CPA accredited laboratories whenever possible A full list of the tests referred out and the laboratories that are used is available from us however the more common ones are listed below Test External Laboratory Downs Screening Bolton Royal Hospital Tumour markers CA19 9 CA15 3 quantitative Christie Hospital Light chains Specific Proteins A1AT phenotype Carbohydrate Deficient Sheffield Protein Reference Unit Transferrin Androgens and Steroids D Sulphate A dione female Hope Hospital Salford testosterones Gut
41. ow full characterisation of a defect in porphyrin metabolism Page 39 of 43 Adult Biochemistry user manual version 8 Miscellaneous Dynamic Function Tests Dynamic function test protocols are available from Biochemistry laboratory or the Programmed Investigation Unit Please discuss these tests with the Duty Biochemist or one of the Departmental Clinical Scientists or Medical Staff before embarking upon them Sweat Tests These are carried out by the Biochemistry Department at the Royal Manchester Children s Hospital please contact them to arrange for the test to be carried out Creatinine clearance calculation If creatinine clearance is specifically requested and a 24 urine and blood sample are received the clearance will be calculated automatically and reported in the normal way A Information used in the calculation Creatinine clearance UxV P where U urinary creatinine in mmol L V urinary flow rate in ml minute see note 1 below P plasma creatinine in mmol L see note 2 below Additional notes 1 Fora 24 hour urine collection V total volume in ml divided by 1440 2 Plasma creatinine on biochemistry reports is in pmol L therefore P plasma creatinine umol L divided by 1000 B Example of calculation Assuming a full 24 hour urine collection the creatinine clearance may be calculated from the reported results for urine creatinine output and plasma creatinine concentration as shown below Creatin
42. p tube serum Pre dose By arrangement only Carbamazepine 4 10 mg l Routine 1 week Urgent 4 hours Yellow top tube serum Pre dose Urgent by arrangement Clomipramine 150 450 ug L 4 weeks Yellow top tube serum Pre dose Cyclosporin ciclosporin 100 300 ug l In patients same day Mon Fri if in lab before 10 30am Purple top tube EDTA plasma Pre dose Digoxin 1 0 2 0 ug l Routine same day Urgent 2 hours Yellow top tube serum Pre dose or at least 6 hours post dose Urgent by arrangement Dothiepin 20 60 ug l 4 weeks Yellow top tube serum Pre dose By arrangement only Ethanol as antidote e g methanol 800 1200 mg l Routine same day Urgent 2 hours Grey Fluoride oxalate plasma or yellow top tube Legal limit for driving 800 mg l serum Ethosuximide 40 100 ug l 4 weeks Yellow top tube serum Pre dose By arrangement only Ethylene glycol 2 3 days Grey Fluoride Urgent analysis out oxalate plasma of hours can sometimes be arranged but cannot be guaranteed FK506 tacrolimus 3 15 ug l Same day Mon Fri if Purple top tube Prograf in lab before ETDA plasma 10 30am Pre dose Flecainide 0 4 1 0 mg l 4 weeks Yellow top tube serum Pre dose By arrangement only Imipramine 10 110 ug l 4 weeks Yellow top tube serum Pre dose By arrangement only Page 31 of 43 Adult Biochemistry user manual version
43. pmol L laboratory contact 276 5180 HCG as tumour marker 0 2 IU L 1 week Yellow top tube serum Follow up testing of trophoblastic tumours usually requires testing of urine HCG and is arranged directly with the clinician by the designated national centre Sheffield in our case Page 20 of 43 Adult Biochemistry user manual version 8 Analyte Reference range Turnaround time Specimen notes Homocysteine lt 15 umol L 2 4 weeks Grey Top Fl ox plasma Must be sent to the laboratory for immediate separation Fasting sample preferred Not routinely available as a cardiovascular risk factor Immuno reactive trypsin See report 2 4 weeks Green top tube whole blood or preferably blood spots Inhibin B 80 150 pg ml 2 4 weeks Yellow top tube serum Routinely available only as a granulosa cell tumour marker Insulin 2 3 26 0 mIU L fasting 1 week Yellow top tube Serum Must be sent to the laboratory on ice for immediate separation A simultaneous fluoride oxalate sample for glucose must be provided Insulin Like Growth Factor 1 IGF 1 Complex age related ranges these are listed in a separate table on page 19 1 2 weeks Red top tube Serum Preferred test for screening for acromegally Page 21 of 43 Adult Biochemistry user manual version 8 Analyte Reference range Turnaround time Spe
44. reatine supplements CTX See Bone Markers DHEA sulphate male female 2 2 15 2 umol L 1 0 12 0 umol L 2 4 weeks Yellow top tube serum Page 18 of 43 Adult Biochemistry user manual version 8 Analyte Reference range Turnaround time Specimen notes FSH female pre menopause post menopause male 2 15 IU L 2 15 IU L gt 20 IU L Urgent 2 hours Routine 4 hours Yellow top tube serum Fructosamine 2 55 3 60 mmol L 2 3 weeks Yellow top tube serum Provide where an analytically correct measurement of HbA1c cannot be obtained due to the presence of a variant haemoglobin Target ranges for control of diabetes are not well validated Measurement of HbA 1c by different means may solve the problem NICE suggests direct measurement of glucose day curves for which HbA1c is a proxy Gamma GT Male 10 71 U L Female 6 42 U L Routine 4 hours Yellow top tube serum Mainly used to distinguish between liver and other causes of a raised alkaline phosphatise Should not form part of a routine assessment of liver function GHRH See report 4 8 weeks Red Top serum Glucose Fasting adult 3 0 6 0 mmol L Urgent 2 hours Routine 4 hours Grey top tube plasma See appendix for diagnosis of diabetes according to WHO criteria Glutathione whole blood 1078 1753umol L or 7 49 12 21 mol g
45. rgent 2 hours Adults Routine 4 hours Potassium Urgent 2 hours Yellow top tube serum adults 3 5 5 5 mmol L Routine 4 hours Pregnancy test see Quantitative HCG Progesterone follicular lt 3 nmol L Next day Mon Yellow top tube serum luteal peak 20 70 nmol L Fri Prostate Specific Antigen PSA Next day Mon Yellow top tube serum 50 59 yrs lt 3 0 ng ml Fri 60 69 yrs lt 4 0 ng ml 70 and over lt 5 0 ng ml Free PSA by equimolar Department of Health Referral Guidelines 2002 Yellow top tube analysis Interpretation is by close scrutiny of latest Variable evidence depending on demand Prolactin Next day Mon Yellow top tube serum Male 86 324 mU L Fri Free prolactin will be Total Female 102 496 mU I measured if there are two Free Prolactin Male 67 251 mU L Female 79 384 mU L consecutive elevated prolactins not explained by hypothyroidism antidoaminergic drugs or pregnancy However samples referred from Endocrinology will automatically be assessed for free prolactin if prolactin is elevated Free prolactin will only be estimated once in each patient Protein total 60 80 g L Urgent 2 hours Routine 4 hours Yellow top tube serum Adults Page 24 of 43 Adult Biochemistry user manual version 8 Analyte Reference ranges Turnaround time Specimen notes PTH 10 60 pg ml Same day Purple top EDTA plasma
46. rine Methyltransferase nmol g Hb hour 1 2 weeks Pink or Purple top EDTA TPMT lt 5 deficient plasma 6 34 low 35 79 normal Recent blood transfusion may gt 80 high mask a deficient TPMT result Tri oidothinoine Free free T3 not routinely available Tri iodothinoine Total T3 1 3 3 1 nmol L 1 2 weeks Yellow top tube serum Additional Not standard part of Thyroid Function Test Page 25 of 43 Adult Biochemistry user manual version 8 Analyte Reference ranges Turnaround time Specimen notes Testosterone Male 10 35 nmol L Female lt 1 8 nmol L Yellow top tube serum SHBG and FAI will be reported with all female testosterone results Thyroglogulin Thyro lt 55 ug L 1 2 weeks Yellow top tube serum Used as a tumour marker Thyroglobulin antibodies may interfere with the assay and levels will be reported with the test result Thyroid Binding Globulin TBG See report 1 2 weeks Yellow top tube Serum Not usually necessary as part of TFT because free T4 is measured Thyroxine Free free T4 9 24 pmol L 1 2 weeks Yellow top tube serum Low levels of binding protein usually reflected by a low albumin cause low results High levels of TBG as occur in pregnancy or HRT have no effect Total Protein Transferrin lt 1 month 51 68g I 1m 12 m 56 72 g L 2 0 3 60 g L Routine same day Routine same day Yel
47. tacting the Duty Biochemist e To simplify requesting a number of organ specific blood profiles are available The tests included in these are listed below Renal profile sodium potassium urea creatinine eGFR Page 5 of 43 Adult Biochemistry user manual version 8 Central Manchester University Hospital NHS Foundation Trust Copy no electronic Q pulse version Laboratory Medicine Version 8 Department of Clinical Biochemistry Document Number CB CLIN PI 009 Date of Issue October 2010 Author R Hinchcliffe Page6of 43 Authorised by M France Bone profile calcium corrected calcium albumin alkaline phosphatase phosphate Liver profile ALT alkaline phosphatase total bilirubin aloumin total protein Lipid profile cholesterol triglyceride HDL Must be fasting sample for full profile Thyroid profile TSH and free T4 other tests are added if necessary by laboratory clinical scientists Iron profile Iron transferrrin and iron saturation Sample Volumes One fully filled 4 5 ml yellow topped Vacutainer will generally contain sufficient blood for analysis of all profiles listed above However this does depend on the MCV of the patient and assumes that a minimum of 2 mls of serum is able to be separated For single analytes 1 ml of whole blood is usually sufficient For all assays not quoted above please send one full tube of the correct type if collection of multiple tubes causes a problem please call the duty biochemist for
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