Pathology @ Heartlands, Good Hope and Solihull Hospitals
For a list of our accredited tests please visit the UKAS Website HEFT or UKAS PHE
The pathology department at Heartlands Hospital is part of University Hospitals Birmingham and serves Heartlands, Good Hope and Solihull Hospitals and in addition to providing services for GPs in and around Birmingham and Solihull
Directorate News
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New Analysers Go Live in Biochemistry on the Heartlands Site
Abbott Alinity analysers are now in place on the Birmingham Heartlands site to provide biochemistry and serology services. Assays provided on this site now lie outside our scope of accreditation as assessed by UKAS. UKAS have been informed and will assess the assays on the new instrumentation as an extension to scope of our accreditation in Autumn 2020.
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DOAC STOP
Direct Oral Anticoagulants (DOACs) are a relatively new class of anticoagulants that have several advantages over traditional anticoagulation agents such as Warfarin. This includes rapid onset of action, few drug interactions and predictable pharmacokinetics which result in no requirement for routine laboratory monitoring. As a result, the use of DOAC’s in clinical practice has grown. The DOAC’s are problematic for the laboratory as they have been reported to interfere with most coagulation tests to varying degrees.
Currently when testing a patient for a thrombophilia a patient is required to be free from anticoagulation to obtain a valid result, however due to the risk of thrombosis these patients are also required to be anticoagulated. This paradox is problematic for both the laboratory and the clinician.
DOAC-Stop tablets can be used to efficiently remove all types of DOACs including dabigatran, apixaban, rivaroxaban and edoxaban, from test plasmas with minimal effect on plasma proteins involved in the clotting mechanism. This will allow clinicians to get an accurate result while the patient is anticoagulated with a DOAC, preventing the need for cessation for an accurate result and therefore reducing the risk of thrombosis.
If you are requesting a thrombophilia or lupus anticoagulant screen and your patient is on a DOAC, please state clearly on the request form, together with which anticoagulant, so DOAC Stop can be applied.
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Corona Virus Update
Due to the current demand on all Pathology services in relation to the Corona virus and the impact on processing samples some non-urgent tests may see a delayed turnaround time. Please be assured that this wil not impact on urgent requests.
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Changes to Biochemistry Phone Limits
From Monday 17th June the Biochemistry phone limits at Heartlands/Good Hope and Solihull will change (see table below). The new limits are already in place on the Queen Elizabeth site and so we will now be phoning the same results across all sites. The new limits reflect changes to the Royal College of Pathologists guidance.
Analyte
Phone results below or equal to:
Phone results above or equal to:
Units
Notes
Sodium
120
150
mmol/L
Potassium
2.5
6.5
mmol/L
Urea
-
30
mmol/L
Creatinine
-
Paediatrics: >354
umol/L
Except those on renal wards or under renal consultants.
eGFR
Adults: <15
-
ml/min
AKI
-
2
Not CKD patients
Glucose
2.5
25
mmol/L
Calcium adjusted
1.8
3.5
mmol/L
Magnesium
0.4
-
mmol/L
Phosphate
0.3
-
mmol/L
AST
-
600
U/L
ALT
-
600
U/L
Total CK
-
5000
U/L
Amylase
-
500
U/L
Digoxin
-
2.5
ng/mL
Theophylline
-
25
mg/L
Phenytoin
-
25
mg/L
Lithium
-
>1.5
mmol/L
Troponin T
-
GP only: >14
ng/L
GP only
Ammonia
-
100
umol/L
Ethanol
-
Paediatrics only: any detectable
mg/L
Paediatrics only
Paracetamol
-
10
mg/L
Not ED patients
Salicylate
-
300
mg/L
Not ED patients
Conj bilirubin (DBIL)
-
Paediatrics only:
25
umol/L
Paediatrics only
Total bilirubin
-
Paediatrics only: 225
umol/L
Paediatrics only
Carbamazepine
-
25
ug /mL
Iron
-
ED only: 70
umol/L
ED only
Phenobarbitone
-
70
mg/L
CSF Gluc
-
5.0
mmol/L
CSF Prot
-
0.45
g/L
Lactate
-
2.3
CRP
-
300
Total bile acids
-
20
Methotrexate
Phone all
umol/L
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CLL - Residual Disease Update
Website update for CLL MRD
Minimal residual disease for CLL is performed by flow cytometry within the Cell Markers Lab in Haematology. The procedure for measurement has been reviewed and updated in line with current recommendations1. The new panel provides clearer delineation of CLL populations and is able to exclude other minor B cell populations such as haematogones and plasma cells.
Sample requirements remain the same: either 1-2mls of Bone marrow or 4-5 mls PB in EDTA (although additional sample may be advisable in patients who are leucopenic).
Samples should be received and tested within 48 hours to ensure meaningful results (note that the laboratory is not open at weekends).
Reporting of CLL MRD has also been updated to provide additional information and will include:
A summary statement
A quantitation (%) ONLY if the level is at or above the limit of quantitation
Limit of detection (LOD) The percentage above which CLL cells can be recognised but there are too few to be reliably quantified.
Limit of quantitation (LOQ) The minimum percentage at which CLL cells may be quantified.
LOD and LOQ are calculated for each patient sample.
The procedure has been optimised to achieve an LOD of 0.004% and an LOQ of 0.01%, but this is dependent upon the cellularity of the sample and may therefore be higher (and thus less sensitive).
1A complementary role of multiparameter flow cytometry and high-throughput sequencing for minimal residual disease detection in chronic lymphocytic leukaemia: a European Research Initiative on CLL study.
Rawstron et al
Leukaemia2016 Apr;30(4):929-36. doi: 10.1038/leu.2015.313. Epub 2015 Dec 7
Copyright heftpathology 2013, 2014, 2015, 2016, 2017, 2018
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
