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Booking a GTT at Good Hope Hospital

To book a GTT at God Hope please telephone Katherine Taylor (ext 47246) or Mandy Simpson (ext 49253).  Alternatively complete a biochemistry request form with GTT in the additional tests box and send via post or internal mail to one of the above.

Cellular Immunology

The enumeration of lymphocytes and their subsets and assessment of lymphocyte and neutrophil function in-vitro requires varying volumes of blood in plain tubes, EDTA-containing tubes and heparin-containing tubes. Sterile conditions also apply in some assays. Such investigations are not available without prior arrangements with the laboratory (please phone ext 42184).  Full details of specimens required will be given when tests are arranged. For lymphocyte surface markers in known HIV disease (CD3, CD4, CD8), 4mL of blood in EDTA should be taken and sent directly to the laboratory, which should be informed by telephone. Please contact the laboratory before taking the blood.

If you have any doubts about sample requirements, contact the laboratory for advice.

Clinical Referrals (Immunology)

All clinical queries may be directed to a member of the medical staff. We are happy to assess in-patients following telephone arrangement. Out-patient referrals may be made, in writing, to Dr Huissoon. Urgent referrals should be discussed by telephone.

Connective Tissue Disease and Vasculitis

Blood tests to help in the investigations of these conditions are listed below and a guide to their use may be found in Test Profiles.

Connective Tissue Disease

This covers a wide range of relatively rare conditions including systemic lupus erythematosus (SLE), scleroderma, polymyositis and Sjorgren's syndrome.  Rheumatoid arthritis is common, and may present initially with similar features.  However, the early involvement of other organs (e.g. skin, kidneys, eyes, Raynaud's) may suggest an alternative diagnosis.

Vasculitis

Includes a heterogeneous group of diseases, characterised by inflammation and necrosis of blood vessel walls.  Presenting features may include fever, weight loss, fatigue, multi-system involvement (skin, nasal bleeding/crusting, arthralgia, myalgia, neuropathy), with raised inflammatory markers and abnormal urinalysis.  As with connective tissue disease, rapid diagnosis and treatment is essential to prevent organ damage and death. Serological markers such as ANCA may be helpful, but are not diagnositc and their absence does not exclude vasculitis.  Biopsy evidence of vasculitis is always preferable to confirm the clinical suspicion.

Clinical advice regarding the management of these conditions may be obtained from the department Medical Staff, or from the relevant clinical specialty (e.g. renal, medicine, rheumatology).  Patients may be referred to Immunology or to Rheumatology for assessment.

Advice for Medical Practitioners

Advice regarding the investigation, treatment or referral of all patients with possible connective tissue disease and vasculitis is available from the medical staff.  Advice out of normal working hours can be obtained from the on-call rheumatology, renal or medical teams (depending on the patient's particular problem).

Haemoglobin A1c and the diagnosis of diabetes mellitus

Conventionally diabetes mellitus has been diagnosed by high fasting or random blood glucose concentrations, or abnormal oral glucose tolerance tests (OGTT). Haemoglobin A1c (HbA1c) has been used to monitor longer term glycaemic control in patients with known diabetes mellitus.

In 2011, the World Health Organisation (WHO 2011) recommended that HbA1c measurements should also be used to diagnose diabetes in the majority of asymptomatic individuals, and this recommendation has been agreed in the UK (NHS Diabetes 2011).

HbA1c of 48 mmol/mol or more (≥ 6.5%) is consistent with diabetes: if the patient has no symptoms then a second HbA1c result must be obtained within 2 weeks, and if ≥ 48 mmol/mol (≥ 6.5%) confirms diabetes mellitus.

HbA1c values of 42 to 47 mmol/mol (6.0 to 6.4%) suggest a high risk of future diabetes. Such individuals should be offered structured lifestyle education and support to delay/prevent development of diabetes, and have an annual HbA1c test

Haemoglobinopathy Screening

Screening for thalassaemia and variant haemoglobins (such as Sickle haemoglobin) is performed within the Haematology laboratory at Heartlands Hospital for all Trust sites and GP's. Patients may require haemoglobinopathy testing as part of ante-natal screening or pre-operative assessment.

Requests should be made on a Haematology request form and sent with a 4ml EDTA sample for analysis. We are unable to reflex haemoglobinopathy screening on suspected full blood counts results without a request. Ante-natal requests should be accompanied with a Family Origin Questionnaire.

Occasionally samples are referred to Central Middlesex Hospital, London or John Radcliffe Hospital, Oxford for confirmation of new or unusual variants or for alpha thalassaemia testing.

For further information or advice please contact the laboratory on extension 40198 or check the Test Database.

Immunology Reporting

Printed reports will be dispatched to the patient location when all requested tests have been reported and authorised. In the case of multiple requests on a single specimen, some results may be available prior to the issue of the written report. If you require any result, they may be available by telephone or via the Trust Intranet reporting module. The office staff will be able to give you the result or indicate when it is likely to be ready. Please mark all requests which are urgent as such and give clear details of where the result should be returned to. We endeavour to process all such requests as quickly as possible. The laboratory staff attempt to issue telephone results on all results deemed urgent.

If you have a query about any result or its interpretation, please telephone for assistance.

Requesting Immunology Tests

All tests should, if possible, be requested on the standard Immunology request form. Please take the extra time to furnish clinical details, registration data and hazard information. This assists quicker and safer processing and more accurate interpretation of laboratory data. If it is likely that the volume available at venepuncture will be limited, please contact the laboratory before phlebotomy to discuss the absolute minimum required to perform the requested tests.

Additional tests may also be performed on previously received specimens if sufficient is available in storage. Contact the laboratory by telephone to see if this is possible.

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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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