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  • Group and Save - Two Sample Rule

    Group and Save - Two Sample Rule

    Item Author Mark Hill

    With effect from 1st September 2016, Blood Bank are introducing the two sample rule for requests for blood and blood components (blood, fresh frozen plasma, cryoprecipitate, platelets, granulocytes).

    What is the two sample rule?

    Blood Bank need to ensure that there are two distinct samples from a patient that have generated the same blood group from both samples. If Blood Bank have seen the patient before and already have a historic blood group (after 20th October 2015) then you only need to make a request for group and save or X-match as you normally do. If the patient has no previous records in Blood Bank then you MUST repeat the group and save or X-match with a second sample.

    Why is this rule being introduced?

    Wrong blood in tube (WBIT) is a 'never event', it should not happen, however on occasions it does. The consequences of transfusing somebody with blood of the incorrect blood group is very serious and can lead to death. WBIT is a SHOT (Serious Hazards of Transfusion) reportable  incident. The two sample rule is a national guideline to improve patient safety when receiving transfusions.

    How does the two sample rule work?

    If the patient is not known to Blood Bank then the two sample rule is invoked. The two samples must come from separate venepuncture events and ideally should be carried out by two different people. Separate request forms should be completed for each sample. It is NOT acceptable to take two samples at one venepuncture event and send them to Blood Bank on separate request forms. This will not negate the possibility of WBIT. There is no limit on the time between samples as long as Blood Bank have a historic blood group on record after 20th October 2015.

    How will I know if a second sample is required?

    If you are unsure if Blood Bank already have a historic blood group you can check iCare or ICE for requests after 20th October 2015. If you are still unsure then please telephone Blood Bank on 40706 (BHH), 47279 (GHH) or 44527 (Sol).

    What happens in an emergency situation?

    If blood is required in an emergency eg massive bleed procedure invoked, the two sample rule will not apply however a second sample should be sent as soon as possible. Blood will be issued as per the massive bleed procedure and will not be delayed.


  • Change to Haematology Reference Ranges

    Change to Haematology Reference Ranges

    Item Author Mark Hill

    Please note from June 1st 2016 the reference ranges for the full blood count will be changing, the most notable of which include haemoglobin, red cell count and neutrophil count.
    New ranges:
    RBC Male 4.3-5.7 *1012/L
    Female 3.7-5.1*1012/L
    Hb Male 133-166 g/L
    Female 110-147g/L
    Neutrophils 1.5-4.7 *109/L


    The Erythrocyte Sedimentation Rate (ESR) reference ranges will also be changed from June 1st to reflect the new method used in the laboratory. These are as follows:
    2-14   2-34
    15-50 (Female) 2-39
    15-50 (Male) 2-30
    51-70 (Female) 2-45
    51-70 (Male) 2-44
    >70 3-55


    For more information regarding these changes please  contact the laboratory on extension 40908



  • Change to Feto-Maternal Haemorrhage (FMH) Anti-D Calculation

    Change to Feto-Maternal Haemorrhage (FMH) Anti-D Calculation

    Item Author Mark Hill

    From 25/04/16 we have adjusted the way Anti-D is calculated in our FMH screen by flow cytometry. The bleed is still reported in millilitres as previously however the suggested dose of Anti-D required to cover the bleed also takes into account the uncertainty of measurement of this technique in our laboratory. This may result in a slightly higher dose than expected but will ensure that bleeds are appropriately covered, especially those requiring multiple injections. For further information click here or contact the laboratory on 0121 42(40704)

  • Apixaban & Rivaroxaban

    Apixaban & Rivaroxaban

    Item Author Mark Hill

    Haematology are now offering assays to measure the new oral anticoagulant drugs Apixaban and Rivaroxaban. Both drugs are direct factor Xa inhibitors. Apixaban is recommended by the National Institute for Health and Clinical Excellence for the prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation and at least one of the following risk factors: prior stroke or transient ischemic attack, age 75 years or older, diabetes mellitus, or symptomatic heart failure. Apixaban and other newer anticoagulants (dabigatran and rivaroxaban) appear equally effective as warfarin in preventing non-hemorrhagic stroke in people with atrial fibrillation and are associated with lower risk of intracranial bleeding. For further information please contact the laboratory on 0121 424 0908 (internal ext 40908) or for clinical advice please contact the On Call Haematologist via switchboard.
  • 24/7 Provision of Ethylene Glycol Measurement at Heartlands Hospital

    24/7 Provision of Ethylene Glycol Measurement at Heartlands Hospital

    Item Author Alex Lawson

    From the 9th of February 2016, ethlene glycol measurement is available 24 hours a day, 7 days a week at Birmingham Heartlands Hospital.

    Ethylene glycol is an odourless and highly toxic compound found in various household products. Cases of ethylene glycol poisoning are rare but often fatal unless treated promptly. Early recognition is thus critical for treatment and recovery of patients. Patients with ethylene glycol poisoning typically present in the acute setting with a high anion gap metabolic acidosis, altered mental status and acute kidney injury. Indirect testing of ethylene glycol ingestion (e.g. lactate, osmolar gap & anion gap), although potentially helpful, are not accurate estimators of the presence of ethylene glycol. Urgent, accurate measurement of ethylene glycol should be sought if ingestion is suspected. Measurement of ethylene glycol
    has not always been readily available due to specialised methodologies required; and often comes at a prohibitively high price for access to these assays out of normal working hours.

    We have therefore implemented a rapid, automated, cost effective assay for the measurement of ethylene glycol which is readily available 24/7.
    GC-MS measurement of ethylene glycol and diethylene glycol is still available on specific request. 

    Additional Information:
    Please contact the laboratory (41185 / 0121 424 1185) and ask to speak to a biomedical scientist or biochemist before sending a specimen.

    If you wish to discuss a particular patient please bleep the duty biochemist / toxicologist on 2506 or 3289 in work hours, or the on-call consultant via switchboard (0121 424 2000).

    For external users, please send samples urgently via courier to: Pathology Reception, Birmingham Heartlands Hospital, Bordesley Green East, B9 5SS. Couriers should use the Yardley Green Road Entrance to the hospital. At night, vehicular access is limited but access on foot is available via the pedestrian gate.


Written by Craig Webster on .

This handbook encompasses all disciplines of Laboratory Medicine at Birmingham Heartlands, Solihull and Good Hope Hospitals. It has been designed to provide the busy general practitioner and hospital doctor more readily available information regarding our services. 


You can search or browse our test directory here. This database includes details on all our tests and recommended profiles for the investigation of common presenting complaints.

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