HEFT Directorate of Pathology Blog

Welcome to the Directorate of Laboratory Medicine blog. Here you will find all the latest news and informaiton relevant to the directorate and its services.

 

 

Urine Analysis Issues

on Wednesday, 21 March 2018.

There has been an unexpected delay in the analysis of routine urine samples. This has led to us having to reject a number of samples for analysis. 

We have been working to determine exact stability of each analyte and have found urine albumin to be less than had previously been established which has contributed to the  increased the number of samples we have had to reject. We would like to apologise for this delay and any inconvenience it may cause for you and your patients.

Please be assured that this incident has been fully investigated and processes have been put in place to stop such an incident occurring in the future.

Update on Blood Transfusion Service - HGS Pathology

Written by Craig Webster on Tuesday, 02 October 2018. Posted in Homepage, Haematology, General

Update on Blood Transfusion Service - HGS Pathology

On the 1st October 2018, the current UKAS accredited Blood Group and Antibody screen offered by HGS laboratories will no longer be performed on the Biorad blood grouping analysers. We are currently in the process of validating the replacement Grifols blood grouping analysers. An extension to scope has been submitted for this test to be accredited at our UKAS assessment in October 2018.

Notification of change in service for the diagnosis of H Pylori Infections

on Monday, 09 January 2017. Posted in Biochemistry

Notification of change in service for the diagnosis of H Pylori Infections

The laboratories at HEFT are changing the way we diagnose H. pylori infections. Urease breath tests (UBT) and blood tests (helicobacter serology) will no longer be available from our laboratories with immediate effect. These tests are being replaced with a Stool Antigen Test (SAT).

Guidance released in 2012 on the management of H. pylori (Management of Helicobacter pylori infection—the Maastricht IV/ Florence Consensus Report) indicates that the SAT is equivalent to UBT in terms of diagnostic performance and does not require a hospital appointment like UBT. Helicobacter serology is also not recommended by updated PHE guidelines for most patients (PHE H. pylori guideline).

The stool antigen is reliable for both diagnosis and post eradication testing, provided the patient has avoided PPIs for 2 weeks and antibiotics for 4 weeks prior to sample collection.

A stool sample is required and samples must arrive in the laboratory within 48 hours of collection. Patients should be advised to bring the properly labelled stool sample in a blue topped sample pot (picture below) to the GP surgery or laboratory reception as soon as possible after collection, ideally same day or next morning.

If you have any queries relating to this notice, please do not hesitate to contact us:

Duty Biochemist:

Telephone: 0121 424 2000 (Bleep 2506)

Troponin testing in suspected ACS patients at HEFT

on Wednesday, 26 October 2016. Posted in Biochemistry

Troponin testing in suspected ACS patients at HEFT

The Trust guidance on Cardiac Troponin testing has been revised in line with the European Society of Cardiology guidance.

This process will be in place from 10th October 2016 and will be subject to audit. The trust uses gender specific Troponin results – for Males <34ng/l and for Females <16ng/l are considered to be within normal range.

The main change is that patients with chest pain >6hrs ago, and remaining pain free during their hospital attendance, will only require a single troponin in order to exclude an ACS. If the hs-TnI is undetectable, risk stratification is also favourable and the patient is pain free then the patient can be considered for discharge with arrangements for outpatient investigation if appropriate.

Paired troponin samples should still be sent at 0h and 3h for patients with onset of chest pain within the last 6 hrs or with ongoing chest pains whilst in hospital.

The ICE requesting system will incorporate a prompt box to ask clinicians to clearly specify if the request is for a single or paired troponin. There will also be a reminder message on the results screen of the Troponin results.

The flowchart below summarises this change and is a reminder of the role troponin plays in the suspected ACS pathway. 

 

Change to Haematology Reference Ranges

on Friday, 27 May 2016. Posted in Haematology

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:
Age
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

 

 

Update on Vitamin D Analysis 5/10/2015

Written by Craig Webster on Monday, 05 October 2015. Posted in Biochemistry

Update on Vitamin D Analysis 5/10/2015

The vitamin D equipment is now fixed and operational. We have now started working through our backlog. We estimate that our backlog is approx 21 days. If you require any further infomation, please contact the laboratory.

PHE Newsletter January 2015 Edition

on Thursday, 22 January 2015. Posted in Microbiology

Please find the January 2015 edition of the PHE Birmingham Newsletter here

Action to Be Taken on Finding a New Monoclonal Protein in a Patient

Written by Steve Rimmer on Wednesday, 19 November 2014. Posted in Immunology

Action to Be Taken on Finding a New Monoclonal Protein in a Patient

New guidance on action to take on finding a monoclonal protein can be found here.

Changes in Renin and Aldosterone Service

on Thursday, 01 March 2018. Posted in Biochemistry

Due to difficulties in obtaining sufficient kit supplies for our Renin workload, it is with regret that we will no longer be able to offer the measurement of Renin, and subsequently Aldosterone , from this laboratory.

We have been working closely with our colleagues at University Hospital Birmingham (UHB) and will be sending work there from the 28/2/2018. The Renin assay provided by UHB is an Immunoassay method (IDS iSYS) for renin mass with reference ranges comparable to the ones used at Heartlands.  See attached information.  The aldosterone method is a comparable assay by LC/MSMS.

The UHB laboratory is a UKAS accredited laboratory.  The aldosterone assay is already UKAS accredited and the Renin immunoassay will be assessed by UKAS as part of their next extension to scope application.

The aldosterone assay is in essence identical to the one used at Heartlands. It is a mass spec method and should have the same characteristics. The http://www.heftpathology.com/item/aldosterone.html information should be applicable.

There will be a slight change in the ratio cut offs used to take into account the renin method. We will be using the Endocrine guidelines ranges and use the 91 cut off with and Aldosterone greater than 750 as a “screen” positive interpretation. This is taken from the Endocrine guidelines on the investigation of Conns. https://academic.oup.com/jcem/article/93/9/3266/2596343

From a sample processing point of view continue to send the samples to Heartlands and we will  transport the samples to UHB.

Please contact the lab or duty biochemist if you have any queries

HbA1c Analysis Affected by Extreme Environmental Factors

on Wednesday, 12 July 2017.

Over the weekend of 8-9 July 2017 there was a failure of the air conditioning in the laboratory that performs HbA1c analysis. As a result the samples were exposed to unprecedented temperatures that ultimately affected the stability of the glycated haemoglobin in these samples.

These samples have unfortunately had to be deemed unsuitable for analysis.

We apologies for the inconvenience to anyone affected by this incident and have put steps in place to prevent this happening again.

If you have any further queries about this incident, please don’t hesitate to contact us.

Notification of Assay Change: Vitamin D

on Monday, 09 January 2017. Posted in Biochemistry

We are changing our Vitamin D method to the Abbott Total 25OH-Vitamin D method from Monday 16th January 2017. This is to allow us to process more rapidly the very large number of requests for vitamin D.

Reference ranges and specimen requirements will not change.

The circulating form of vitamin D is hydroxylated colecalciferol (vitamin D3). Most patients with vitamin D deficiency are also treated with vitamin D3, but a small number of patients are given ergocalciferol (vitamin D2) instead. Since the Abbott method cannot detect vitamin D2 in equimolar concentrations (up to 50% under-recovery), those given ergocalciferol will require their serum vitamin D levels to be measured using the mass spectroscopy method.

The mass spectrometry method can be requested for patients on D2 using ICE requesting. If ICE requesting is not available, please use the clinical details section to document this or alternatively request “VITDMS” in the tests request section.

All paediatric samples will be run on the mass spectrometer due to the smaller sample volume requirements on this method.

The new abbott Vitamin D assay is awaiting accreditation and will be assessed by UKAS against ISO 15189 standards at our next annual inspection.

For further information about vitamin D and the methods we offer please visit the test database. If you have any queries relating to this notice, please do not hesitate to contact us: Duty Biochemist: 0121 424 2000 (Bleep 2506)

Group and Save - Two Sample Rule

on Thursday, 01 September 2016. Posted in Haematology

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 Feto-Maternal Haemorrhage (FMH) Anti-D Calculation

on Wednesday, 27 April 2016. Posted in Haematology

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)

PHE Newsletter Spring 2015 Edition

on Monday, 27 April 2015. Posted in Microbiology

Please find the Spring 2015 edition of the PHE Birmingham Newsletter here

Guidance on Testing for Paroxysmal Nocturnal Haemoglobinuria

Written by Mark Hill on Thursday, 08 January 2015. Posted in Haematology, General

Guidance on Testing for Paroxysmal Nocturnal Haemoglobinuria

Paroxysmal Nocturnal Haemoglobinuria (PNH) is an acquired haematopoietic stem cell disorder resulting in a partial or total deficiency of proteins normally linked to cell membranes by a glycosylphosphatidylinositol (GPI) anchor. Classical features are;

  • intravascular haemolysis
  • bone marrow failure
  • thrombotic tendency
  • may also include abdominal pain, dysphagia, erectile dysfunction, renal failure, lethargy

It can often go undiagnosed for months or even years. Flow cytometry can provide a definitive diagnosis.

Click here for further guidance on PNH testing. Contact the laboratory on 0121 424 0704.

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HTA licence number is 12366

Protection of Personal Information – Laboratory Medicine comply with the Trust Data Protection Policy and have procedures in place to allow the Directorate and it’s employees to comply with the Data Protection Act 1998 and associated best practice and guidance.

The Trust Laboratories at Heartlands Hospital, Good Hope Hospital and Solihull Hospital were awarded UKAS (United Kingdom Accreditation Service) accreditation to the internationally recognised ISO 15189 standard in May 2015. For a list of accredited tests and other information please visit the test database http://www.heftpathology.com/frontpage/test-database.html.
Tests not appearing on this scope are either under consideration or in the process of accreditation and so currently remain outside of our scope of accreditation. However, these tests have been validated to the same high standard as accredited tests and are performed by the same trained and competent staff.

For further information contact Louise Fallon, Quality Manager, 0121 424 1235

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