Telephone the laboratory on 0121 424 2252 or 0121 424 1185 and inform staff that an urgent sample is on its way. Please include the patient’s NHS number, name, date of birth, where is sample is arriving from, which tests are required and indicate on the form that the sample is urgent. If possible also give an indication of when the sample will arrive
Staff in the laboratory will record this information in the “Urgent GP Request form” (document code) CIT.F010 located on a clipboard in the hot cell area of specimen reception
Book a courier to transfer the sample from the GP Practice to Heartlands Hospital, Biochemistry department. Urgent samples can be transported with the routine courier service however please be aware this may result in delay
If the urgent sample is transported alongside routine work, please ensure that it is easily identifiable ie in an envelope marked “Urgent”
To assess prednisolone metabolism in steroid dependent asthmatics
Justification:
Small group of asthmatics remain symptomatic despite long term treatment with oral corticosteroids “prednisolone”, with major implication in terms of steroid induced side effects. The cause of this lack of effect could be due to poor adherence, malabsorption, rapid metabolism or genetically mediated resistance to steroids. The aim of this test is to assess the cause of the apparent lack of responsiveness to steroids in a patient.
Except those on renal wards or under renal consultants.
eGFR
Adults: 15
-
ml/min
AKI
-
3
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 I
-
16 (female or unknown)
34 (male)
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
3.3
-
mmol/L
CSF Prot
-
0.45
g/L
Lactate
-
2.3
mmol/L
CRP
-
300
mg/L
GP only
Total bile acids
-
20
umol/L
Antenatal only
Urine protein:creatinine ratio
30
mg/mmol
Antenatal only, first raised result only
Methotrexate
Phone all
umol/L
Haematology
Haemoglobin
White Blood Cell Count
<8.0 g/dl normochromic and normocytic
Low result – neutropenia <0.5 x 10 9/L
<7.0 g/dl microcytic and hypochromic
High result – White cell count >40 x 10 9/L
<7.0 g/dl macrocytic
or Lymph count > 20 x 10 9/L
<5.0 g/dl renal patients
Any presence of blast cells
Platelets
Clotting Studies
Lower limit - <70 x 10 9/L
INR - >5.0
Upper limit - >1000 x 10 9/L
PTT - >180 seconds
Fibrinogen < 1.0g/l
All Positive Malaria Screens
All Anti FXa results >1.20 iu/ml
If the patient is known to the department and has had a similar result within the previous 7 days then the urgent contact is not necessary.
Immunology
CD4 count <200 cells/cumm or <10% on new patients (paediatric levels are different, but agreed with Paed consultants)
Lymphocyte subsets in infants <2yo: Any T cell subset below age-related normal range, any other abnormality suggesting SCID (e.g. MHC class II deficiency). (Note this is not exclusive: any abnormality may be discussed with requesting clinician)
New positive GBM antibodiest
New positive MPO antibodies
New positive PR3 antibodies
New paraprotein IgG , A or M > 20g/L
IgD or IgE (any size)
serum monoclonal free light chains (any size, whether or not with intact paraprotein)
HPA Microbiology
Bacteriology
Gram stain results of positive blood culture on Day 1
Positive CSF results
Positive sterile site results
Significant in-patient results from enteric bench
Multi resistant gram negative and gram positive isolates including mupirocin resistant MRSA
Group B streptococcal isolates from neonates
Group A in patient isolates
Positive Legionella urinary antigen and Pneumococcal urine antigen results
Smear and culture positive Mycobacteria
Antibiotic assay results outside normal ranges
Any other significant results at the discretion of Medical Microbiologists
Virology
Serological evidence of acute infection with Hep A, Hep B and in pregnant patients CMV, Parvovirus and Rubella
New diagnoses of HIV
VZV IgG negative from exposed patients at risk of severe VZV infection
New diagnosis of Hep B, Hep C and HIV in haemodialysis patients
Evidence of Hep B/Hep C and HIV in needle stick injury source patients
Clinically important positive respiratory PCR results i.e.: influenza, RSV in immunocompromised patients
Positive PCR results in outbreaks
Positive blood PCR for CMV and Adenovirus
Negative blood results for CMV PCR
Significant blood PCR results for EBV and Polyomavirus
