Laboratory User Manual Longford Road, Mullingar, Co Westmeath Tel: 044 9394330 Doc. No: MANUAL-M/L/2...

PATHOLOGY

Longford Road, Mullingar, Co Westmeath Tel: 044 9394330

Doc. No: MANUAL-M/L/2 Doc Owner: Frances Walsh

Rev. No: N01 Active Date: 28/10/2016

Laboratory

User Manual14

th Edition, October 2016

PATHOLOGY MIDLAND REGIONAL HOSPITAL MULLINGAR


Frances Walsh Dept & Location: Pathology MRH, Mullingar

Doc Title: Laboratory User Manual

Laboratory

User ManualEdition, October 2016

Pathology MRH, Mullingar

No. Of Pg: 1 of 132

Laboratory

User Manual

PATHOLOGY




Table of Contents

1 Changes Since Last Revision ................................

2 Introduction ................................

2.1 Mission Statement ................................

2.2 Accreditation Status ................................

2.3 Patient Consent ................................

2.4 Data Protection................................

3 Quality Policy ................................

4 Hours of Operation & Location of Laboratory Services

4.1 Hours of Operation ................................

4.2 Postal Address ................................

4.3 On-call Contact Details ................................

5 Pathology Staff & Department Contact Details

5.1 Staffing ................................

5.2 Contact Details ................................

6 Laboratory Request Forms, Specimen Collection & Re

6.1 Pathology Policy on Request Form Completion & Specimen Labelling

6.2 Request Forms ................................

6.3 Completion of the Request Form

6.4 Clinical Details ................................

6.5 Specimen Types ................................

6.6 Specimen Collection ................................

6.7 Specimen Contamination

6.8 Labelling the Specimen Container

6.9 Quality of Blood Specimens, Specimen Bottles or Request Forms (Excluding Blood Transfusion)

6.10 Additional Testing Requests

6.11 Patient Preparation for Non

6.12 Instruction for Completion of 24 Hour Urine Collection

7 Health and Safety ................................

8 Delivery, Packing & Transport Requirements for all Diagnostic Specimens

8.1 Specimen Delivery within the Hospital

8.2 Packing of Diagnostic (Non

Hospital ................................................................


Hospital ................................................................

8.4 Specimen Delivery from Outside the Hospital

9 External Quality Control Assessment Programme





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Hours of Operation & Location of Laboratory Services ................................................................

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Pathology Staff & Department Contact Details ................................................................

................................................................................................................................

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Laboratory Request Forms, Specimen Collection & Result Reporting Times ................................

Pathology Policy on Request Form Completion & Specimen Labelling ................................

................................................................................................

of the Request Form ................................................................................................

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Labelling the Specimen Container ................................................................................................

Quality of Blood Specimens, Specimen Bottles or Request Forms (Excluding Blood Transfusion)

Additional Testing Requests ................................................................................................

Non-Blood Specimens ................................................................

Instruction for Completion of 24 Hour Urine Collection ................................

................................................................................................................................

ort Requirements for all Diagnostic Specimens ................................

Specimen Delivery within the Hospital ................................................................

Packing of Diagnostic (Non-infectious) Specimens for Delivery to the Laboratory from Outside the

................................................................................................

Packing of Diagnostic (Non-infectious) Specimens for Delivery to the Laboratory from Outside the

................................................................................................

Specimen Delivery from Outside the Hospital ................................................................

External Quality Control Assessment Programme ................................................................


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Quality of Blood Specimens, Specimen Bottles or Request Forms (Excluding Blood Transfusion) 24

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infectious) Specimens for Delivery to the Laboratory from Outside the

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infectious) Specimens for Delivery to the Laboratory from Outside the

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PATHOLOGY




10 Reporting of Results ................................

10.1 Frequency of Testing ................................

10.2 Result Reporting ................................

11 Laboratory Information Systems

11.1 Ward Enquiry ................................

11.2 BloodTrack Enquiry ................................

12 Services Available ................................

12.1 Pathology Services ................................

12.2 Hospital & Regional Meetings

12.3 Laboratory Supplies ................................

12.4 Storage of Examined Specimens

13 Laboratory On-call Protocol

13.1 Tests Available On-call ................................

14 Clinical Chemistry ................................

14.1 Contact Details for Key Members of Staff

14.2 Test Profiles ................................

14.3 Unexpected Results ................................

14.4 Turnaround Times ................................

14.5 Guidelines for Endocrine Testing

15 Immunology ................................


15.2 Allergy Testing ................................

15.3 Guidelines for Testing for TPO Antibodies

15.4 Notes for Immunology Tests

15.5 Turnaround Times for Immunology Testing

16 Haematology ................................


16.2 Turnaround Times for Haematology Testing

16.3 Guidelines for Use of D-Dimers (DVT or PE)

17 Sample Requirements for Diagnostic Tests

18 Microbiology ................................


18.2 Tests ................................................................

19 Blood Transfusion & Haemovigilance


19.2 Blood Transfusion Tests ................................

19.3 Confirmatory Sample Rule





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Laboratory Information Systems ................................................................................................

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Hospital & Regional Meetings ................................................................................................

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Storage of Examined Specimens ................................................................................................

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ct Details for Key Members of Staff ................................................................

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................................................................................................

lines for Endocrine Testing................................................................................................

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Contact Details for Key Members of Staff ................................................................

................................................................................................

Guidelines for Testing for TPO Antibodies ................................................................

Notes for Immunology Tests ................................................................................................

Turnaround Times for Immunology Testing ................................................................

................................................................................................................................


Turnaround Times for Haematology Testing ................................................................

Dimers (DVT or PE) ................................................................

Sample Requirements for Diagnostic Tests ................................................................

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Blood Transfusion & Haemovigilance ................................................................


................................................................................................

Confirmatory Sample Rule ................................................................................................


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PATHOLOGY




19.4 Request for Blood Component/Products

19.5 Maximum Blood Ordering Schedules

19.6 Blood Transfusion Requests

19.7 Sample Collection & Labelling

19.8 Electronic Blood Track Phase 3

19.9 Unconscious/Unidentifiable Patients

19.10 Special Requirements ................................

19.11 Patient Consent & Patient Information Leaflets

19.12 Prescription ................................

19.13 Guidelines for the Use of Blood Components & Products

19.14 Anti-D Immunoglobulin and Kleihauer Testing

19.15 Guidelines for the Use of Factor Concentrates

19.16 Traceability ................................

19.17 Transporting Blood Products

19.18 Transfusion Reactions ................................

19.19 Emergency Blood Transfusion

19.20 References ................................

20 Histopathology ................................

20.1 Histopathology Test Index

20.2 Introduction ................................

20.3 Hours of Operation & Contact Details

20.4 Pre-Testing Information ................................

20.5 Sample Rejection ................................

20.6 Sample Retention ................................

20.7 Quality Assurance ................................

21 Reference Ranges & Uncertainty of Measurement

21.1 Uncertainty of Measurement

21.2 Reference Ranges ................................

22 Indication of Cost of Various Tests & Blood Products





Request for Blood Component/Products ................................................................

Maximum Blood Ordering Schedules ................................................................

Blood Transfusion Requests ................................................................................................

Sample Collection & Labelling ................................................................................................

Electronic Blood Track Phase 3 ................................................................................................

Unconscious/Unidentifiable Patients ................................................................

................................................................................................

Patient Consent & Patient Information Leaflets ................................................................

................................................................................................

es for the Use of Blood Components & Products ................................

D Immunoglobulin and Kleihauer Testing ................................................................

Guidelines for the Use of Factor Concentrates ................................................................

................................................................................................

Transporting Blood Products ................................................................................................

................................................................................................

Emergency Blood Transfusion ................................................................................................

................................................................................................................................

................................................................................................................................

Histopathology Test Index ................................................................................................

................................................................................................................................

Hours of Operation & Contact Details ................................................................

................................................................................................

................................................................................................

................................................................................................

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Reference Ranges & Uncertainty of Measurement ................................................................

Uncertainty of Measurement ................................................................................................

................................................................................................

Indication of Cost of Various Tests & Blood Products ................................................................


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PATHOLOGY




1 CHANGES SINCE LAST REVISION

Page

Number/Section

Details of Change

Throughout All references to M00 number changed to chart number.

AMAU & EPU included in hospital department given priority/treated as urgent.

Section 3 Quality Policy updated to Rev J01 of MPL

Section 4 Postal address included.

Section 5.2 Staff details updated

Section 6.2 All request form information amalgamated

Request form types updated.

Section 6.3 Unconscious patients are now labelled with chart number instead of A&E number.

Section 6.4 Single section for clinical details included.

Section 6.5 All sample information

PCR sample types updated.

Group & Coombs for babies <4 months added to tests for Pink Micro Tube.

Section 9 Inter-laboratory comparisons included.

Section 11.1 Section on viewing National Virus Reference Results

Section 11.2 BloodTrack look

Section 12.1 Phlebotomy weekend sessions included

Section 14 All reference ranges moved to Section 21.

Section 14.2 Test profiles updated.

Section 14.5 Menopausal profile updated.

Normal synacthen results included.

Section 15 Immunology TATs specified as being in working days.

Section 15.2 Allergy guidelines amended.

Section 16.2 TAT included for ESR.

Section 17 Added cold agglutinins.

Amended some

Updated BNP stability time.

Section 18 References to faecal occult blood testing removed.

Section 18.2 Blood cultures processed 24 hours a day, 7 days a week.

Urgent TAT included for urine C&S

Gonorrhoea testing included.

Note added regarding Sputum C&S and Legionella testing. 5

sputum included.

New comment added stating culture is not performed on formed stool samples.

Reference to Sputum testing for malignant cells moved to Section 17.

Section 19 Blood transfusion accreditation statement incorporated into Section 2.2.

All reference to BT supplementary number system removed.

Sections 19.1 &

19.2

Moved crossmatching from blood transfusion test table to the request for blood table

and added emergency issu

Section 19.2 External tests marked as such.

Section 19.3 Confirmatory sample policy included.

Section 19.5 Obs/Gynae MSBOS updated to current version

Section 19.6 Single blood transfusion

Blood transfusion request forms used to order FMH/Kleihauer and anti

form).

Processing times for RhD negative post

Red cells will be returned to stock after 24 hours unless specifica





Details of Change

All references to M00 number changed to chart number.

EPU included in hospital department given priority/treated as urgent.

Quality Policy updated to Rev J01 of MPL-M/L/8.

Postal address included.

Staff details updated.

All request form information amalgamated in single request form section.

Request form types updated.

Unconscious patients are now labelled with chart number instead of A&E number.

Single section for clinical details included.

All sample information amalgamated in single sample type section

PCR sample types updated.


laboratory comparisons included.

Section on viewing National Virus Reference Results (NVRL) in Ward Enquiry included

-up procedure updated.

Phlebotomy weekend sessions included.

All reference ranges moved to Section 21.

Test profiles updated.

Menopausal profile updated.

Normal synacthen results included.

Immunology TATs specified as being in working days.

Allergy guidelines amended.

TAT included for ESR.

Added cold agglutinins.

Amended some Immunology entries.

Updated BNP stability time.

References to faecal occult blood testing removed.

Blood cultures processed 24 hours a day, 7 days a week.

Urgent TAT included for urine C&S.

Gonorrhoea testing included.

ed regarding Sputum C&S and Legionella testing. 5

sputum included.



transfusion accreditation statement incorporated into Section 2.2.

All reference to BT supplementary number system removed.


and added emergency issue of blood.

External tests marked as such. Cold Agglutinins moved to general external test.

Confirmatory sample policy included.

Obs/Gynae MSBOS updated to current version.

Single blood transfusion request form now in use.

Blood transfusion request forms used to order FMH/Kleihauer and anti

Processing times for RhD negative post-delivery cord bundles included.

Red cells will be returned to stock after 24 hours unless specifica


No. Of Pg: 5 of 132

EPU included in hospital department given priority/treated as urgent.

in single request form section.

Unconscious patients are now labelled with chart number instead of A&E number.

amalgamated in single sample type section.


(NVRL) in Ward Enquiry included.

ed regarding Sputum C&S and Legionella testing. 5-day repeat policy for



transfusion accreditation statement incorporated into Section 2.2.


Cold Agglutinins moved to general external test.

Blood transfusion request forms used to order FMH/Kleihauer and anti-D Ig (specific

delivery cord bundles included.

Red cells will be returned to stock after 24 hours unless specifically requested for

PATHOLOGY




Page

Number/Section

Details of Change

standby.

Section 19.7

Chart number is now a mandatory identifier

Sample validity for crossmatching is 72 hours

Section 19.8 EBTS labelling procedure added.

Section 19.13 RCC Compatibility table updated.

Comment regarding high titre

Plasma Compatibility table updated

Section 19.14 Anti-D prophylaxis and requesting of anti D Ig updated.

Kleihauer indications updated and sample requirements expanded.

Section 19.15 Comment stating Factor VIII & Factor IX treatment should not be delayed included.

More information on rate of HPC infusion included.

Novel Oral Anticoagulants renamed as Direct Acting Oral Anticoagulants.

Information on Idarucizumab

Algorithm for bleeding in cases of DTIs or Factor Xa inhibitors updated.

FEIBA added to table indicating related laboratory tests.

Section 19.16 Traceability using BloodTrack included.

Section 19.19 Confirmatory sample on patients with no historic group is desirable.

Massive Haemorrhage table updated.

Section 19.20 References updated

Section 20 Updated with document provided by Pathology, MRH Tullamore

Section 21 Format of reference range tables





Details of Change

Chart number is now a mandatory identifier.

Sample validity for crossmatching is 72 hours.

EBTS labelling procedure added.

RCC Compatibility table updated.

Comment regarding high titre components removed.

Plasma Compatibility table updated, now includes Group Unknown

D prophylaxis and requesting of anti D Ig updated.


Comment stating Factor VIII & Factor IX treatment should not be delayed included.

More information on rate of HPC infusion included.


Idarucizumab included.

for bleeding in cases of DTIs or Factor Xa inhibitors updated.

FEIBA added to table indicating related laboratory tests.

Traceability using BloodTrack included.

Confirmatory sample on patients with no historic group is desirable.

Massive Haemorrhage table updated.

References updated

Updated with document provided by Pathology, MRH Tullamore

Format of reference range tables standardised. Reference ranges updated as required.


No. Of Pg: 6 of 132

, now includes Group Unknown.


Comment stating Factor VIII & Factor IX treatment should not be delayed included.


for bleeding in cases of DTIs or Factor Xa inhibitors updated.

Confirmatory sample on patients with no historic group is desirable.

Updated with document provided by Pathology, MRH Tullamore

standardised. Reference ranges updated as required.

PATHOLOGY




2 INTRODUCTION MRH, Mullingar is part of the Ireland East Hospital Group comprising of the following hospitals: Mater

Misericordiae University Hospital; St. Vincent’s University Hospital; MRH Mullingar; St. Luke’s General

Hospital, Kilkenny; Wexford General Hospital; Nat

Hospital, Navan; St. Columcille’s Hospital, Loughlinstown; St. Michael’s Hospital, Dun Laoghaire; Cappagh

National Orthopaedic Hospital and Royal Victoria Eye and Ear Hospital.

The Pathology Department at Midland Regional Hospital, Mullingar comprises of the following disciplines:

Clinical Chemistry, Immunology, Haematology, Blood Transfusion and Microbiology. The laboratory offers a

wide range of pathology tests to all hospital doctors and general pra

area and specialist services to clinicians in Laois/Offaly.

The purpose of this manual is to act as a quick reference guide for all users of the pathology services. This

manual contains details of the analytical servi

reference ranges, contact numbers and the present analytical cost of selected tests for your information.

Also included is a guide to appropriate use of Blood and Blood Products, guidelines on D

and guidelines on endocrine testing. Every effort has been made to ensure that information provided in this

manual is current and accurate at the time of publishing.

refer to the following websites for the most recent version:

Internet:

http://www.hse.ie/eng/services/list/3/hospitals/mullingar/Pathology/librarypathmulligar.html

Intranet (Within Hospital):

http://hsenet.hse.ie/Intranet/Hospital_Staff_Hub/mullingar/Pathology_Services/Library_and_Documentati

on.html

It is also available as a button on Ward Enquiry. Should you have any queries or suggestions for

improvements in connection with any aspect of the pathology service, staff members will be pleased to

discuss these with you, see list of contact numbers in Sect

Fran Walsh, Laboratory Manager, Midland Regional Hospital Mullingar.





MRH, Mullingar is part of the Ireland East Hospital Group comprising of the following hospitals: Mater


Hospital, Kilkenny; Wexford General Hospital; National Maternity Hospital, Holles Street; Our Lady’s


National Orthopaedic Hospital and Royal Victoria Eye and Ear Hospital.

t at Midland Regional Hospital, Mullingar comprises of the following disciplines:


wide range of pathology tests to all hospital doctors and general practitioners in the Longford/Westmeath

area and specialist services to clinicians in Laois/Offaly.


manual contains details of the analytical services available, advice of sample collection and transport,


Also included is a guide to appropriate use of Blood and Blood Products, guidelines on D


manual is current and accurate at the time of publishing. It is updated on at least an annual basis.

tes for the most recent version:



is also available as a button on Ward Enquiry. Should you have any queries or suggestions for


discuss these with you, see list of contact numbers in Section 5.

Fran Walsh, Laboratory Manager, Midland Regional Hospital Mullingar.


No. Of Pg: 7 of 132

MRH, Mullingar is part of the Ireland East Hospital Group comprising of the following hospitals: Mater


ional Maternity Hospital, Holles Street; Our Lady’s


t at Midland Regional Hospital, Mullingar comprises of the following disciplines:


ctitioners in the Longford/Westmeath


ces available, advice of sample collection and transport,


Also included is a guide to appropriate use of Blood and Blood Products, guidelines on D-dimer requests


It is updated on at least an annual basis. Please



is also available as a button on Ward Enquiry. Should you have any queries or suggestions for


PATHOLOGY




2.1 Mission Statement The mission of the Pathology Laboratory, Midland Regional Hospital Mullingar is the provision of an

equitable, high-quality diagnostic, treatment and monito

2.2 Accreditation Status

The Pathology Laboratory, Midland Regional Hospital Mullingar is accredited by the Irish National

Accreditation Board (INAB) under registration number 195MT for Blood Transfusion, Haematology,

Chemistry, Immunology and Microbiology testing. For full scope of accreditation, refer to the following

website:

http://www.inab.ie/FileUpload/Medical

Blood Transfusion department incorporating Haemovigilance also complies with the AML

directives 2002/98/EC and 2005/61/EC and Statutory Instruments 360 and 547.

2.3 Patient Consent All procedures carried out on a patient need the informed consent of the patient. This should be obtained

as per EXT-M/HOSPQ/24 ‘National Consent Policy’. It is the responsibility of the clinician to explain the

clinical procedure to be performed

when the patient presents himself or herself with a request form and willingly submits to the collecting

procedure e.g. venepuncture. Patients in a hospital bed should normally be given t

Special procedures, including more invasive procedures, or those with an increased risk of complications to

the procedure will need a more detailed explanation and in some cases, written consent. In emergency

situations, consent might not be possible; under these circumstances, it is acceptable to carry out the

procedure, provided they are in the patient’s best interest.

2.4 Data Protection The laboratory at MRH, Mullingar compiles with the policy of the HSE regarding the legislation pertaining to

the rights of the patient and staff and to act in an ethical and responsible manner in maintaining the

security and integrity of all personal infor

include a confidentiality agreement.

3 QUALITY POLICY The Laboratory at MRH, Mullingar is committed to providing a service of the highest quality and shall be

aware and take into consideration the needs and requirements of the users.

In order to ensure that the needs and requirements of users are met, the Laboratory will:

• Operate a quality management system to integrate the organisation, procedures, processes and

resources.

• Set quality objectives and plans in order to implement this quality policy.

• Ensure that all personnel are familiar with this quality policy to ensure user satisfaction.

• Commit to the health, safety and welfare of its entire staff.

• Ensure visitors to the department will

to their safety while on site.

• Uphold professional values and is committed to good professional practice and conduct.

All departments within the Laboratory will comply with the Irish National Acc

International Standard ISO 15189:2012

standard the Blood Transfusion and haemovigilance departments adhere to the EU Directives 2002/98/EC

and 2005/61/EC and Statutory Instrument 360 (Quality & Safety of Human Blood & Blood Components) &

547 (Traceability Requirements and Notification of Serious Adverse Reactions and Events). The Laboratory





The mission of the Pathology Laboratory, Midland Regional Hospital Mullingar is the provision of an

quality diagnostic, treatment and monitoring service to the population we serve.


Accreditation Board (INAB) under registration number 195MT for Blood Transfusion, Haematology,


oad/Medical-Testing/Midland-Regional-Hospital-Mullingar

Blood Transfusion department incorporating Haemovigilance also complies with the AML

directives 2002/98/EC and 2005/61/EC and Statutory Instruments 360 and 547.

All procedures carried out on a patient need the informed consent of the patient. This should be obtained

M/HOSPQ/24 ‘National Consent Policy’. It is the responsibility of the clinician to explain the

clinical procedure to be performed to the patient. For most routine procedures, consent can be inferred


procedure e.g. venepuncture. Patients in a hospital bed should normally be given the opportunity to refuse.



ight not be possible; under these circumstances, it is acceptable to carry out the

procedure, provided they are in the patient’s best interest.

The laboratory at MRH, Mullingar compiles with the policy of the HSE regarding the legislation pertaining to


security and integrity of all personal information. All laboratory staff have signed job descriptions which

include a confidentiality agreement.

The Laboratory at MRH, Mullingar is committed to providing a service of the highest quality and shall be

n the needs and requirements of the users.


Operate a quality management system to integrate the organisation, procedures, processes and

ctives and plans in order to implement this quality policy.

Ensure that all personnel are familiar with this quality policy to ensure user satisfaction.

Commit to the health, safety and welfare of its entire staff.

Ensure visitors to the department will be treated with respect and due consideration will be given

to their safety while on site.

Uphold professional values and is committed to good professional practice and conduct.

All departments within the Laboratory will comply with the Irish National Accreditation Board (INAB),

:2012 (Requirements for Quality & Competence), in addition to this


strument 360 (Quality & Safety of Human Blood & Blood Components) &



No. Of Pg: 8 of 132

The mission of the Pathology Laboratory, Midland Regional Hospital Mullingar is the provision of an

ring service to the population we serve.


Accreditation Board (INAB) under registration number 195MT for Blood Transfusion, Haematology, Clinical


Mullingar-195MT.pdf

Blood Transfusion department incorporating Haemovigilance also complies with the AML-BB guidelines, EU

All procedures carried out on a patient need the informed consent of the patient. This should be obtained

M/HOSPQ/24 ‘National Consent Policy’. It is the responsibility of the clinician to explain the

to the patient. For most routine procedures, consent can be inferred


he opportunity to refuse.



ight not be possible; under these circumstances, it is acceptable to carry out the

The laboratory at MRH, Mullingar compiles with the policy of the HSE regarding the legislation pertaining to


mation. All laboratory staff have signed job descriptions which

The Laboratory at MRH, Mullingar is committed to providing a service of the highest quality and shall be


Operate a quality management system to integrate the organisation, procedures, processes and

Ensure that all personnel are familiar with this quality policy to ensure user satisfaction.

be treated with respect and due consideration will be given

Uphold professional values and is committed to good professional practice and conduct.

reditation Board (INAB),

(Requirements for Quality & Competence), in addition to this


strument 360 (Quality & Safety of Human Blood & Blood Components) &


PATHOLOGY




will also comply with National Standards for Safer Better Healthcare, 2012. All Inf

reported to public health & the Health Protection Surveillance Centre (HSPC) as per S.I. No. 707 of 2003.

The Blood Transfusion & haemovigilance departments at MRH, Mullingar have been INAB accredited since

June 2008. An extension to scope of accreditation was awarded in April 2010 to include testing in

Biochemistry, Regional Endocrinology, Regional Immunology and

successfully added to the scope in February 2016.

The laboratory is committed to:

• Staff recruitment, training, development and retention at all levels to provide a full and effective

service to its users.

• The proper procurement and maintenance of the equipment and other resources as are needed for

the provision of the service.

• The collection, transport and handling of all specimens in such a way as to ensure the correct

performance of laboratory examinations.

• The use of examination procedures are fit for intended use and that will ensure the highest

achievable quality of all tests performed.

• Reporting results of examinations in ways which are timely, confidential, accurate and clinically

useful.

• Providing a framework for establishing and reviewing quality objectives.

• The assessment of user satisfaction, in addition to internal audit and externa

order to produce continual quality improvement.

• The safe testing, distribution and transfusion of Blood and Blood Components.

4 HOURS OF OPERATION & LOCATION OF

4.1 Hours of Operation

Day

Monday – Friday

Saturday/Sunday/Bank Holidays

* Immunology service is 9.00am

** Routine Microbiology service on Saturday/Sunday/Bank Holiday morning from 9.00am

4.2 Postal Address Pathology Laboratory

Midland Regional Hospital Mullingar

Longford Road

Mullingar

Co. Westmeath

N91 NA43

4.3 On-call Contact Details

Haematology/Blood Transfusion

Direct Telephone

4333

044

*51836 086





will also comply with National Standards for Safer Better Healthcare, 2012. All Inf



cope of accreditation was awarded in April 2010 to include testing in

crinology, Regional Immunology and Haematology. Microbiology was

successfully added to the scope in February 2016.

uitment, training, development and retention at all levels to provide a full and effective

The proper procurement and maintenance of the equipment and other resources as are needed for

the provision of the service.

transport and handling of all specimens in such a way as to ensure the correct

performance of laboratory examinations.

The use of examination procedures are fit for intended use and that will ensure the highest

achievable quality of all tests performed.

eporting results of examinations in ways which are timely, confidential, accurate and clinically

Providing a framework for establishing and reviewing quality objectives.

The assessment of user satisfaction, in addition to internal audit and externa

order to produce continual quality improvement.

The safe testing, distribution and transfusion of Blood and Blood Components.

OCATION OF LABORATORY SERVICES

Routine Hours Emergency On

8.00am – 8.00pm * 8.00pm

No routine service** 24 hours

Immunology service is 9.00am – 5.30pm.

Routine Microbiology service on Saturday/Sunday/Bank Holiday morning from 9.00am

Midland Regional Hospital Mullingar

Haematology/Blood Transfusion Clinical Chemistry/Microbiology

Telephone Direct

044-9394333 4328

086-0081395 *51835


No. Of Pg: 9 of 132

will also comply with National Standards for Safer Better Healthcare, 2012. All Infectious diseases are



cope of accreditation was awarded in April 2010 to include testing in

Haematology. Microbiology was

uitment, training, development and retention at all levels to provide a full and effective

The proper procurement and maintenance of the equipment and other resources as are needed for

transport and handling of all specimens in such a way as to ensure the correct

The use of examination procedures are fit for intended use and that will ensure the highest

eporting results of examinations in ways which are timely, confidential, accurate and clinically

The assessment of user satisfaction, in addition to internal audit and external quality assessment, in

The safe testing, distribution and transfusion of Blood and Blood Components.

Emergency On-call Service

8.00pm – 8.00am

24 hours

Routine Microbiology service on Saturday/Sunday/Bank Holiday morning from 9.00am – 2.00pm.

Clinical Chemistry/Microbiology

Telephone

044-9394328

086-0081394

PATHOLOGY




5 PATHOLOGY STAFF & DEPARTMENT

5.1 Staffing The Pathology department team consists of the following:

o Laboratory Manager

o Consultant Pathologists

o Consultant Haematologists

o Consultant Microbiologist

o Consultant Clinical Biochemist

o Consultant Immunologist

o Heads of Department

o Medical Scientists

o Laboratory Aides

o Quality Officer

o Training Coordinator

o Laboratory Information System Scientist

o Support Services:

• Secretarial

• Household

• Phlebotomy

The laboratory has been accredited as a training laboratory by the Joint Committee for Biomedical Sciences

to provide the in-service training for student Medical Scientists.

5.2 Contact Details

Position

Histopathologist

Haematologist

Haematologist

Microbiologist

Clinical Biochemist

Immunologist

Laboratory Manager

Chief Scientist – Blood Transfusion

Chief Scientist – Haematology

Chief Scientist – Microbiology

Chief Scientist – Clinical Chemistry

Chief Scientist – Immunology

Quality Officer

IT Scientist

Training Officer

Surveillance Scientist





EPARTMENT CONTACT DETAILS

The Pathology department team consists of the following:

Consultant Clinical Biochemist

Laboratory Information System Scientist


service training for student Medical Scientists.

Name Direct (From

Within Hospital)

Consultant Staff

Dr Miriam Walsh

Dr Kanthi Perera

Dr Gerard Crotty

Dr Cathal O’Sullivan 8371

All above consultants available on mobile via switch at MRH Tullamore

Dr Graham Lee

Prof Conleth Feighery

Laboratory Staff - Management

Ms. Frances Walsh 4548

Ms. Carol Cantwell 4868

Ms. Barbara Halligan 4333

Mr. Ultan Campbell 4341

Ms. Helen Corrigan 4871

Mr. Conor Tubman 4328

Ms. Norma Mullen 4339

Laboratory Staff - Other

Ms. Jill Gillen 4260

Mr. Joe Escosio 4220

Ms. Martina Leonard 4328

Ms. Jean Wellwood 4347


No. Of Pg: 10 of 132


(From

ital)

Telephone (From

Outside Hospital)

057-9358278

057-9358276

057-9358352

057-9358349

above consultants available on mobile via switch at MRH Tullamore

01-8032000

Via Mater switch

087-9969041

044-9394548

044-9394868

044-9394333

044-9394341

044-9394328

044-9394328

044-9394339

044-9394260

044-9394220

044-9394328

044-9394347

PATHOLOGY




Position

Laboratory Office

Sample Reception

Clinical Chemistry

Immunology

Haematology

Coagulation

Blood Transfusion

Microbiology

On-call

(Haematology/Blood Transfusion

On-call

(Clinical Chemistry/Microbiology)

Laboratory Accounts

Laboratory Fax

Transfusion Surveillance Officer

Infection Control

SMO Public Health

MRH Mullingar

Laboratory MRH, Portlaoise

Blood Transfusion, MRH Portlaoise

Laboratory MRH, Tullamore

Blood Transfusion, MRH Tullamore

Histology, MRH Tullamore

Irish Blood Transfusion Services

(IBTS)

St. James’ Hospital

St. Vincent’s Hospital

Temple Street Hospital

National Virus Reference Lab (NVRL)

NVRL – Urgent Reports

6 LABORATORY REQUEST FORMS, SThis section outlines the information that is required to be documented on the laboratory request form and

the specimen bottle or container, prior to the analysis of samples.

6.1 Pathology Policy on Request Form Completion & Specimen LabellingThe purpose of this policy is to effect uniformity of requirements across the various disciplines in line with

ISO, INAB and HPRA standards. The policy ensures that:





Name Direct (From

Within Hospital)

Laboratory – General Enquiries

4330/4327

4337

4328

4339

4333

4333

4329

4332

4333

*51836

4328

*51835

4340

4342

Other Hospital Staff

Ms. Patricia Gardiner 4313

Ms. Grace Kinahan

Ms. Julie Cullen

4776

Dr. Gerard Meagher 5006

Other Useful Numbers

6283

4269

8342

8385

8338

*51240

*51074

*51080

*51049

National Virus Reference Lab (NVRL) *51503

SPECIMEN COLLECTION & RESULT REPORTING TIMES This section outlines the information that is required to be documented on the laboratory request form and

the specimen bottle or container, prior to the analysis of samples.

Pathology Policy on Request Form Completion & Specimen Labelling this policy is to effect uniformity of requirements across the various disciplines in line with

standards. The policy ensures that:



(From

ital)

Telephone (From

Outside Hospital)

044-9394330

044-9394327

044-9394337

044-9394328

044-9394339

044-9394333

044-9394333

044-9394329

044-9394332

044-9394333

086-0081395

044-9394328

086-0081394

044-9394340

044-9394342

044-9340221

Bleep 043

044-9340221

Bleep 077

044-9395006

044-9340221

01-4322800

01-4162059

01-2774390

01-8784200

01-7161323

01-7161240

This section outlines the information that is required to be documented on the laboratory request form and

this policy is to effect uniformity of requirements across the various disciplines in line with

PATHOLOGY




•••• The information on both the request form and the corresponding clinical specimen are sufficient to

unambiguously link the two together, thereby ensuring the correct results/blood products are

always issued to the correct patient.

•••• The laboratory receives adequate information on the request form.

•••• The laboratory records accurate and complete patient and speci

request received.

It is the responsibility of the requestor/person taking the sample to ensure that the laboratory is provided

with complete and accurate patient identification details on both the request form and specimen

container.

6.2 Request Forms For the service user’s convenience, one form is used for Haematology, Coagulation, Clinical Chemistry,

Immunology and external tests during the routine day. This keeps the number of request forms used by the

laboratory to a minimum. However, there are a number of different forms. These are used for different

pathology departments/tests as outlined below. It is important that the

particular test.





The information on both the request form and the corresponding clinical specimen are sufficient to

biguously link the two together, thereby ensuring the correct results/blood products are

always issued to the correct patient.

The laboratory receives adequate information on the request form.

The laboratory records accurate and complete patient and specimen identification for each



For the service user’s convenience, one form is used for Haematology, Coagulation, Clinical Chemistry,


However, there are a number of different forms. These are used for different

pathology departments/tests as outlined below. It is important that the correct form



The information on both the request form and the corresponding clinical specimen are sufficient to

biguously link the two together, thereby ensuring the correct results/blood products are

men identification for each



For the service user’s convenience, one form is used for Haematology, Coagulation, Clinical Chemistry,


However, there are a number of different forms. These are used for different

correct form is supplied for a

PATHOLOGY




1. Blood Transfusion form (FORM





Blood Transfusion form (FORM-M/BT/215): Pink form used for transfusion



PATHOLOGY




2. Additional Tests/Additional Blood Product Order form (FORM

requesting additional blood products or tests from Blood Transfusion





Additional Tests/Additional Blood Product Order form (FORM-M/BT/201): Red/white form used for

requesting additional blood products or tests from Blood Transfusion



M/BT/201): Red/white form used for

PATHOLOGY




3. Prophylactic Anti-D Order Form (FORM

prophylactic Anti-D from Blood Transfusion





D Order Form (FORM-M/BT/212): Green/white form used for requesting

D from Blood Transfusion



Green/white form used for requesting

PATHOLOGY




4. Microbiology form (FORM-

routine and on-call hours

5. General Request form (FORM

Clinical Chemistry, Immunology and External tests during routine hours





-M/M/41): 4-part blue form used for Microbiology tests during both

(FORM-M/L/25): 6-part pink form used for Haematology, Coagulation,

Clinical Chemistry, Immunology and External tests during routine hours



part blue form used for Microbiology tests during both

part pink form used for Haematology, Coagulation,

PATHOLOGY




6. Histology form (T/HIS/LP/001

7. D-dimer form (FORM-M/H/3): Single white





Histology form (T/HIS/LP/001-01): Single card for Histology specimens

M/H/3): Single white page used for D-dimer requests



PATHOLOGY




8. Haemochromatosis form (FORM





Haemochromatosis form (FORM-M/M/32): Single white page used for Haemochromatosis requests



Single white page used for Haemochromatosis requests

PATHOLOGY




9. Haematology On-call form (FORM

requests on-call

10. Clinical Chemistry On-call form (FORM

requests on-call





call form (FORM-M/H/59): 2-part pink form used for Haematology & Coagulation

call form (FORM-M/B/60): 2-part green form used for Clinical Chemistry



part pink form used for Haematology & Coagulation

part green form used for Clinical Chemistry

PATHOLOGY




6.3 Completion of the Request FormThe following essential information must be documented in a legible manner on all request forms,

including any back copies so that the identity of the patient is unequivocal:

1. Full name (First name & surname)

2. Date of Birth

3. Chart number

4. Test request (including anatomical site for Microbiology & Histology)

5. Ward/Location for destination of report

6. Signature of person who took sam

7. Date & time of sample collection

The following information is desirable

8. Consultant or GP’s name

9. Relevant clinical information appropriate to the tests requested e.g. history of administration of

drugs, antenatal history etc. The minimum clinical information supplied must include gender and

date of birth for interpretative purposes.

In the case of an unresponsive/unconscious patient, the following information should be supplied:

1. Unconscious Male/Female Adult

Unconscious Male/Female child as relevant

2. Chart number

It is the responsibility of the medical officer to ensure that the request forms and spe

above information.

Note: Most regularly used laboratory forms have more than one page. If using addressograph labels, they

must be placed on all leaflets of the request form.

6.4 Clinical Details The inclusion of brief clinical details including relevant medication assists the laboratory in providing the

most appropriate service for requesting doctors. Reference ranges quoted as age and gender specific

where applicable. Relevant clinical details are of particular importance for aller

examination.

All tests referred to the Microbiology department must include relevant clinical details and medications.

Immune status, antimicrobial therapy in previous 72 hours and occupational or environmental risks are

crucial to the processing of samples in Microbiology.

Clinical details should include the following:

• Immune status

• Cystic fibrosis

• Pregnancy

• Drug therapy

• Burns

• Chemotherapy

• Prosthesis

• Post-surgery

• Radiation therapy

• Foreign travel





Completion of the Request Form information must be documented in a legible manner on all request forms,

s so that the identity of the patient is unequivocal:

Full name (First name & surname)

(including anatomical site for Microbiology & Histology)

/Location for destination of report

Signature of person who took sample (Mandatory for Blood Transfusion)

Date & time of sample collection (Mandatory for Blood Transfusion)

desirable but not essential:

Relevant clinical information appropriate to the tests requested e.g. history of administration of


date of birth for interpretative purposes.

an unresponsive/unconscious patient, the following information should be supplied:

Unconscious Male/Female Adult

Unconscious Male/Female child as relevant

is the responsibility of the medical officer to ensure that the request forms and spe

: Most regularly used laboratory forms have more than one page. If using addressograph labels, they

of the request form.

ils including relevant medication assists the laboratory in providing the


where applicable. Relevant clinical details are of particular importance for allergy testing and blood film



to the processing of samples in Microbiology.

Clinical details should include the following:



information must be documented in a legible manner on all request forms,

Relevant clinical information appropriate to the tests requested e.g. history of administration of


an unresponsive/unconscious patient, the following information should be supplied:

is the responsibility of the medical officer to ensure that the request forms and specimens carry all of the

: Most regularly used laboratory forms have more than one page. If using addressograph labels, they

ils including relevant medication assists the laboratory in providing the


gy testing and blood film



PATHOLOGY




The range and type of investigations carried out are governed by this information. If it is absent or

incomplete, possible pathogens may be missed or overlooked. It is the responsibility of the requesting

doctor to convey clear and pertinent clinical detai

6.5 Specimen Types

The Greiner Vacuette system for blood collection is used in MRH, Mullingar. Details of the type and volume

of sample required for a particular assay are given in Section 17. The following blood bottle types are

commonly used:

Specimen Bottle







doctor to convey clear and pertinent clinical details if present.



Bottle Type & Information

Adult Bottles

Red Vacuette – Product No. 455071

This tube contains a polymer gel and no anticoagulant. Fill to the

mark (8.0mL). After blood collection, invert tube 5

tube is suitable for most Clinical Chemistry, Immunology and

External tests.

Purple Vacuette – Product No. 454035

This tube contains EDTA anticoagulant. Fill to the mark (2.5mL). After

blood collection, invert tube 8-10 times. This tube is suitable for

Reticulocytes, HbA1c, Ammonia, Troponin and BNP.

Blue Vacuette – Product No. 454349

This tube contains trisodium citrate anticoagulant. Fill to the mark

(3.0mL). Inadequately filled tubes CANNOT

blood collection, invert tube 4 times. This tube is suitable for

APTT, D-dimer and Fibrinogen.

Grey Vacuette – Product No. 454085

This tube contains fluoride oxalate anticoagulant. Fill to the mark

(2.0mL). After blood collection, invert tube 5

suitable for Glucose, Lactate and Ethanol testing.

Green Vacuette – Product No. 454084

This tube contains lithium heparin anticoagulant. Fill to the mark


suitable for Chromosome analysis.

Pink Vacuette – Product No. 456093



Group & Hold, Antibody screen, Crossmatching and Coombs

testing.

Black Vacuette – Product No. 45959

This tube contains sodium citrate anticoagulant. Fill to the mark


suitable for ESR only. Please place label on outer plastic container,

not inner glass tube.

Paediatric Bottles

Pink Micro Tube – Product No. 41.1395.005



paediatric FBC, Reticulocytes, Group & Coombs

months, Ammonia and Meningococcal PCR. (Separate samples)








This tube contains a polymer gel and no anticoagulant. Fill to the

mark (8.0mL). After blood collection, invert tube 5-10 times. This

most Clinical Chemistry, Immunology and


10 times. This tube is suitable for FBC,

Reticulocytes, HbA1c, Ammonia, Troponin and BNP.

This tube contains trisodium citrate anticoagulant. Fill to the mark

CANNOT be processed. After

blood collection, invert tube 4 times. This tube is suitable for PT, INR,

This tube contains fluoride oxalate anticoagulant. Fill to the mark

(2.0mL). After blood collection, invert tube 5-10 times. This tube is

Glucose, Lactate and Ethanol testing.




10 times. This tube is suitable for

Group & Hold, Antibody screen, Crossmatching and Coombs

This tube contains sodium citrate anticoagulant. Fill to the mark


Please place label on outer plastic container,



FBC, Reticulocytes, Group & Coombs for babies <4

, Ammonia and Meningococcal PCR. (Separate samples)

PATHOLOGY




Specimen Bottle






Clear Serum Micro Tube – Product No. 41.1392.005

This tube contains no anticoagulant. Fill to the mark (1.3mL). After


most Clinical Chemistry, Immunology and External tests.

Yellow Micro Tube – Product No. 41.1394.005

This tube contains fluoride anticoagulant. Fill to the mark (1.3mL).

After blood collection, invert tube 5-10 times. This tube is suitable

for Glucose and Lactate testing.

Green Micro Tube – Product No. 41.1350.005

This tube contains citrate anticoagulant. Fill to the mark (1.3mL).

Inadequately filled tubes CANNOT be processed. After blood

collection, invert tube 5-10 times. This tube is suitable for

APTT and Fibrinogen.

Orange Micro Tube – Product No. 41.1393.005



suitable for Chromosome analysis and Amino acids.

Microbiology Specimens

Urine Container

This container contains no preservative. Do not overfill and ensure

the cap is sealed correctly. This container is suitable for

Pregnancy tests, ACR and Sputum.

Faeces Container

This container is used for faeces/stool samples. Do not overfill. This

container is suitable for C&S, Ova and parasites, etc.

White Cap Container

This container is suitable for CSF.

Black Charcoal Swab

This swab is suitable for general C&S – wound, throat HVS etc.

Orange Top Fine Tip Swab

This swab is suitable for Paranasal culture e.g. Pertussis screen.

Pink Top Sterile Transport Swab

This swab is suitable for Viral culture.

Yellow Top Cobas PCR Urine Packet - Male or Female

This swab is suitable for Urine Chlamydia & Gonorrhoea

for male and female patients.

Yellow Top Cobas PCR Swab - Female

This swab is suitable for Female Chlamydia

screening.




Product No. 41.1392.005

This tube contains no anticoagulant. Fill to the mark (1.3mL). After


most Clinical Chemistry, Immunology and External tests.

Product No. 41.1394.005

This tube contains fluoride anticoagulant. Fill to the mark (1.3mL).

10 times. This tube is suitable

Product No. 41.1350.005

This tube contains citrate anticoagulant. Fill to the mark (1.3mL).

be processed. After blood

10 times. This tube is suitable for PT, INR,

Product No. 41.1393.005



o acids.

This container contains no preservative. Do not overfill and ensure

the cap is sealed correctly. This container is suitable for C&S,

This container is used for faeces/stool samples. Do not overfill. This

C&S, Ova and parasites, etc.

d, throat HVS etc.

Paranasal culture e.g. Pertussis screen.

or Female

& Gonorrhoea screening

Female Chlamydia & Gonorrhoea

PATHOLOGY




6.6 Specimen Collection It is the responsibility of the person taking the sample to:

•••• Ensure all appropriate sterile equipment is within date and all packaging is intact.

•••• Explain procedure and rationale to patient, answering any questions.

•••• Check patient identification.

•••• Ensure patient meets any special requir

•••• Take the sample into the appropriate specimen container for the tests required.

•••• Dispose of all needles into sharps bin when finished sampling.

•••• Dispose of all contaminated material into biohazard bin.

•••• Label the specimen container fully as per Section 6.7 below.

•••• Place in the bag attached to the form.

•••• Ensure the form is properly completed.

For further information on blood sampling, please refer to ‘National Clinical Policy and Procedural Guideline

for Nurses and Midwives Undertaking Venepuncture in Adults’ and

Guideline for Nurses and Midwives Undertakin

HSE website www.hse.ie. Please note that any deviations or exclusions from, or additions to the

documented collection procedure must be recorded on the request form by the sample collector.

See Section 6.12 for instructions for 24 hour urine collection.

6.7 Specimen Contamination Blood culture bottles are easily contaminated. Always fill blood culture bottles first. Anticoagulants present

in specimen bottles may cause problems if carried over from one type of container to another. Fill the

blood bottles in the correct order as

Order of Draw

1. Blood Cultures

2. Citrate

3. Serum

4. Lithium heparin

5. EDTA

6. Fluoride

7. Sodium citrate

6.8 Labelling the Specimen ContainerThe following unique identifiers must

that the identity of the patient is unequivocal:

1. Full name (First name & surname)

2. Date of Birth

3. Chart number

4. Signature of person who took sample

Addressograph labels are permitted on all laboratory samples

Transfusion samples can be labelled with Blood Track Labels

labels, please ensure that the label does not obscure the level of sample in the container. The label should

not be wrapped around itself, hanging off the container as it makes it difficult to load samples on the

various analysers.





the person taking the sample to:

Ensure all appropriate sterile equipment is within date and all packaging is intact.

Explain procedure and rationale to patient, answering any questions.

Check patient identification.

Ensure patient meets any special requirements e.g. fasting etc.

Take the sample into the appropriate specimen container for the tests required.

Dispose of all needles into sharps bin when finished sampling.

Dispose of all contaminated material into biohazard bin.

Label the specimen container fully as per Section 6.7 below.

Place in the bag attached to the form.

Ensure the form is properly completed.


Nurses and Midwives Undertaking Venepuncture in Adults’ and ‘National Clinical Policy and Procedural

Guideline for Nurses and Midwives Undertaking Venepuncture in Children’. These are available from the

. Please note that any deviations or exclusions from, or additions to the


See Section 6.12 for instructions for 24 hour urine collection.

Blood culture bottles are easily contaminated. Always fill blood culture bottles first. Anticoagulants present


blood bottles in the correct order as outlined below:

Adult Colour Paeds Colour

Blood Cultures Blue & Purple tops Silver top

Blue top Green top

Red top Clear top

Lithium heparin Green top Orange top

Purple or Pink top Pink top

Grey top Yellow top

Sodium citrate Black top/ESR Black top/ESR

Labelling the Specimen Container must be documented in a legible manner on the specimen container so

that the identity of the patient is unequivocal:

(First name & surname)

Signature of person who took sample (Mandatory for Blood Transfusion only)

Addressograph labels are permitted on all laboratory samples except Blood Transfusion

Transfusion samples can be labelled with Blood Track Labels, see Section 19.8.1.


f, hanging off the container as it makes it difficult to load samples on the



Ensure all appropriate sterile equipment is within date and all packaging is intact.

Take the sample into the appropriate specimen container for the tests required.


‘National Clinical Policy and Procedural

. These are available from the

. Please note that any deviations or exclusions from, or additions to the


Blood culture bottles are easily contaminated. Always fill blood culture bottles first. Anticoagulants present


Paeds Colour

Black top/ESR

be documented in a legible manner on the specimen container so

(Mandatory for Blood Transfusion only)

except Blood Transfusion samples. Blood

.8.1. If using addressograph


f, hanging off the container as it makes it difficult to load samples on the

PATHOLOGY




The above requirements are for both the safety of the patients and for medico

hospital staff.

6.9 Quality of Blood Specimens, Specimen Bottles

Transfusion) Laboratory personnel must inspect each blood specimen prior to testing for:

o Presence of mandatory identifiers

o Evidence of haemolysis

o Gross lipaemia

o Presence of clots (in specimens requesting full blood count

In such instances, a second sample may be requested or the test report will have a comment noting the

presence of haemolysis, lipaemia or clots, as appropriate, see table below:

Issue

Specimens unlabelled Sample is not processed

Mandatory identifier absent

(i.e. full name, DOB or chart

number)

Sample is not processed

No request form Sample is not processed

Mandatory identifier absent

(i.e. full name, DOB or chart

number)


No test requested In cases where details are correct on both

samples and request forms but no tests

are requested, the following will apply:

Sample Received

EDTA

1 Clotted

2 Clotted

Sodium Citrate

Sodium Fluoride

Evidence of haemolysis The relevant pathology department will

make a decision on whether or not the

sample is suitable for testing. A second

sample will be requested as appropriate.

The pathology department will report

results within a multi

analytes unaffected

while not reporting those affected in the

profile.

Gross lipaemia

Presence of clots (in FBC or

coagulation samples)

Age of sample

Miscellaneous quality issues

Sample leaking/soiled

containers or forms






The above requirements are for both the safety of the patients and for medico

Quality of Blood Specimens, Specimen Bottles or Request Forms (Excluding Blood

Laboratory personnel must inspect each blood specimen prior to testing for:

Presence of mandatory identifiers

Presence of clots (in specimens requesting full blood count and coagulation tests)


presence of haemolysis, lipaemia or clots, as appropriate, see table below:

Action

Specimen Issues

Sample is not processed Report is returned to clinician

stating the problem &

requesting repeat sample.




Request Form Issues

Sample is not processed Not applicable


stating the


In cases where details are correct on both

samples and request forms but no tests

are requested, the following will apply:

A comment will be applied to

the final report stating ‘No

request on form’.

Sample Received Tests Performed

EDTA FBC

1 Clotted SMAC

2 Clotted SMAC + TFT

Sodium Citrate PT/INR

Sodium Fluoride Random Glucose

Specimen Quality Issues

The relevant pathology department will

make a decision on whether or not the

sample is suitable for testing. A second

sample will be requested as appropriate.

The pathology department will report

results within a multi-test profile on

analytes unaffected by specimen quality,

while not reporting those affected in the

profile.

Report is returned to clinician


requesting repeat sample if

required.






The above requirements are for both the safety of the patients and for medico-legal protection of

or Request Forms (Excluding Blood

and coagulation tests)


Documentation





the problem &


Not applicable




A comment will be applied to

the final report stating ‘No

request on form’.



requesting repeat sample if

required.




PATHOLOGY




**In the case of an emergency, where the clinician deems mislabelled samples

can present to the laboratory to cor

responsibility for same. Please see Section 19 for Blo

6.10 Additional Testing Requests If, on sending a specimen for testing and further testing is required, please contact the appropriate

laboratory department to investigate the feasibility of using the initial specimen for analysis as age of

specimen may impact on the validity of results.

lack of a request form should not impede the processing of an urgent result. In the event of analytical

failure and where repeat testing is required, it may be necessary to request a fresh sample.

For further crossmatching of a Blood Transfusion sample, refer to Section

6.11 Patient Preparation for NonRefer to the following link for Nursing PPPGs for patient preparation:

http://hsenet.hse.ie/Hospital_Staff_Hub/mullingar/PPPG's_Midland_Area/Generic_Clinical_Nursing_PPPGs

/Generic_Clinical_Nursing_PPPGs.html

6.12 Instruction for Completion of 24 Hour Urine CollectionDepending on the tests required, the 24 hour urine container may require a special preservative. If the

container given has a sticker warning ‘Caution

to it from the collection vessel. Do not urinate directly into these bottles. This container has a small amount

of concentrated acid already added to it which is capable of causing a severe burn.

from the container. Keep out of the reach of

immediately with plenty of water. Refer to WI

These instructions are distributed with the 24 hour urine containers. Approved conta

from the Clinical Chemistry laboratory. Please ensure that the container is clearly identified with the

patient’ name, DOB, chart number and date of collection.

1. Empty the bladder on rising (or a more convenient time) and

AFTER this sample has been passed is the collection started.

2. If the test is started whilst still in the hospital, the first sample should be discarded.

sample has been passed is the collection started.

3. Do not urinate directly in to container that

from cup to 24 hour container.

4. Collect all urine in the container provided on EVERY occasion that it is passed during the next 24

hours. Keep the container in the fridge is possible.

5. Empty your bladder on rising the next morning (or at the more convenient time chosen) and ADD

this sample to the collection. This completes the 24 hour collection, which should be brought to the

hospital the same morning.

6. Please ensure that the label on the container and the request form are fully completed and the cap

is closed securely. Finally, place th

along the top.

If you forget and lose a sample down the toilet, then please throw away all the urine collected until that

time and start again the following morning. If you are making an acid c

container from the laboratory. Please refer to PPG RMD022

Patients.





**In the case of an emergency, where the clinician deems mislabelled samples unrepeatable, the requestor

can present to the laboratory to correct the error. FORM-M/L/112 must also be completed accepting

responsibility for same. Please see Section 19 for Blood Transfusion.

Additional Testing Requests If, on sending a specimen for testing and further testing is required, please contact the appropriate


specimen may impact on the validity of results. A request form should accompany all such requests but the



For further crossmatching of a Blood Transfusion sample, refer to Section 19.5.

Patient Preparation for Non-Blood Specimens Refer to the following link for Nursing PPPGs for patient preparation:


/Generic_Clinical_Nursing_PPPGs.html

Completion of 24 Hour Urine Collection Depending on the tests required, the 24 hour urine container may require a special preservative. If the

container given has a sticker warning ‘Caution – Contains Acid’, then care must be taken when adding urine

from the collection vessel. Do not urinate directly into these bottles. This container has a small amount

of concentrated acid already added to it which is capable of causing a severe burn.

from the container. Keep out of the reach of children. If acid comes in contact with the skin, rinse the area

immediately with plenty of water. Refer to WI-M/L/1 ‘Instructions for Making a 24 Hour Urine Collection’.

These instructions are distributed with the 24 hour urine containers. Approved conta


patient’ name, DOB, chart number and date of collection.

Empty the bladder on rising (or a more convenient time) and THROW AWAY

this sample has been passed is the collection started.

If the test is started whilst still in the hospital, the first sample should be discarded.

sample has been passed is the collection started.

in to container that contains acid – use cup provided and then pour slowly

container.

Collect all urine in the container provided on EVERY occasion that it is passed during the next 24

hours. Keep the container in the fridge is possible.

Empty your bladder on rising the next morning (or at the more convenient time chosen) and ADD

le to the collection. This completes the 24 hour collection, which should be brought to the

hospital the same morning.

Please ensure that the label on the container and the request form are fully completed and the cap

Finally, place the container in the Pathology Specimen bag for Urine and seal

and lose a sample down the toilet, then please throw away all the urine collected until that

time and start again the following morning. If you are making an acid collection, you need to obtain a new

container from the laboratory. Please refer to PPG RMD022 – 24 Hour Urine Collection for Hospital



unrepeatable, the requestor

M/L/112 must also be completed accepting

If, on sending a specimen for testing and further testing is required, please contact the appropriate


A request form should accompany all such requests but the




Depending on the tests required, the 24 hour urine container may require a special preservative. If the

Contains Acid’, then care must be taken when adding urine

from the collection vessel. Do not urinate directly into these bottles. This container has a small amount

of concentrated acid already added to it which is capable of causing a severe burn. Do not empty the acid

If acid comes in contact with the skin, rinse the area

M/L/1 ‘Instructions for Making a 24 Hour Urine Collection’.

These instructions are distributed with the 24 hour urine containers. Approved containers are available


THROW AWAY the sample. Only

If the test is started whilst still in the hospital, the first sample should be discarded. Only AFTER this

use cup provided and then pour slowly

Collect all urine in the container provided on EVERY occasion that it is passed during the next 24

Empty your bladder on rising the next morning (or at the more convenient time chosen) and ADD

le to the collection. This completes the 24 hour collection, which should be brought to the

Please ensure that the label on the container and the request form are fully completed and the cap

e container in the Pathology Specimen bag for Urine and seal

and lose a sample down the toilet, then please throw away all the urine collected until that

ollection, you need to obtain a new

24 Hour Urine Collection for Hospital

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7 HEALTH AND SAFETY All biological specimens should be considered as potentially hazardous and handled accordin

special precautions are necessary for obtaining and handling specimens from patients infected (or thought

to be infected) with high-risk pathogens. It is important to remember that carriers may be asymptomatic.

Infection may be acquired by spillage of blood and other bodily fluids on to recently broken skin, accidental

scratches, puncture wounds from needles, instruments or possibly by splashing into the eye, nostrils and

lips of susceptible persons. Therefore, take care with all specimens for

Please remember that it is the responsibility of the person who requests laboratory examination of the

specimen to ensure that both the form and the container are correctly labelled to indicate a risk of

infection. Specimens that carry a risk of infectious disease should be clearly identified with red stickers.

High risk categories include:

• Known HIV, Hep B & C etc.

• Suspect E coli O157 etc.

• Jaundice

• Patient from high risk group

• Viral Haemorrhagic Fever (VHF)

Faecal or other potentially hazardous fluids/liquids that leak and soil containers or forms will be

discarded without testing.

8 DELIVERY, PACKING & TRANSPORT

It is the policy of the Pathology Department to treat all specimens as potentially infectious or high risk.

Therefore, we advise taking universal precautions in the collection, packaging and the delivery of

specimens being sent to the laboratory for analys

8.1 Specimen Delivery within the Hospital

• All samples must have the lid tightly secured and placed in the plastic bag attached to the form.

• The pneumatic tube system is used for sending samples to the laboratory throughout the day and

night using chute numbers 9403 during routine hours and 9401 during on

• Blood cultures, CSF samples and suspected VHF samples cannot be sent via the chute. They must

be hand-delivered directly to the Microbiology laboratory by porter.

• Blood cultures should be time & date stamped by the porter/attendant and placed in the red box in

the 37°C incubator.

• If the pneumatic tube system is not working, samples should be hand

by hospital porters.


Outside the Hospital These specimens must be packed and transported in accordance with the European Agreement concerning

International Carriage of Dangerous Goods by Road (UNADR).

1. Ensure the cap of the sample cont

attached to the request form.

2. Ensure lids in 24hour urine jars are tightly closed and containers are placed in Urine transport bags

and sealed.

3. Place sample in a padded envelope labelled ‘Diag

containers for collection by taxi.





All biological specimens should be considered as potentially hazardous and handled accordin


risk pathogens. It is important to remember that carriers may be asymptomatic.

illage of blood and other bodily fluids on to recently broken skin, accidental


lips of susceptible persons. Therefore, take care with all specimens for your own safety and that of others.



cimens that carry a risk of infectious disease should be clearly identified with red stickers.

Patient from high risk group

ever (VHF) samples including Ebola testing


RANSPORT REQUIREMENTS FOR ALL DIAGNOSTIC SPECIMENS It is the policy of the Pathology Department to treat all specimens as potentially infectious or high risk.


specimens being sent to the laboratory for analysis.

Specimen Delivery within the Hospital

All samples must have the lid tightly secured and placed in the plastic bag attached to the form.

The pneumatic tube system is used for sending samples to the laboratory throughout the day and

numbers 9403 during routine hours and 9401 during on-call hours.

Blood cultures, CSF samples and suspected VHF samples cannot be sent via the chute. They must

delivered directly to the Microbiology laboratory by porter.

time & date stamped by the porter/attendant and placed in the red box in

f the pneumatic tube system is not working, samples should be hand-delivered to the laboratory

Packing of Diagnostic (Non-infectious) Specimens for Delivery to the Laboratory from

These specimens must be packed and transported in accordance with the European Agreement concerning

International Carriage of Dangerous Goods by Road (UNADR).

Ensure the cap of the sample container is securely closed and placed in the sealed plastic bag

attached to the request form.

Ensure lids in 24hour urine jars are tightly closed and containers are placed in Urine transport bags

Place sample in a padded envelope labelled ‘Diagnostic Specimens’ or in place plastic transport

containers for collection by taxi.



All biological specimens should be considered as potentially hazardous and handled accordingly. However,


risk pathogens. It is important to remember that carriers may be asymptomatic.

illage of blood and other bodily fluids on to recently broken skin, accidental


your own safety and that of others.



cimens that carry a risk of infectious disease should be clearly identified with red stickers.


It is the policy of the Pathology Department to treat all specimens as potentially infectious or high risk.


All samples must have the lid tightly secured and placed in the plastic bag attached to the form.

The pneumatic tube system is used for sending samples to the laboratory throughout the day and

call hours.

Blood cultures, CSF samples and suspected VHF samples cannot be sent via the chute. They must

time & date stamped by the porter/attendant and placed in the red box in

delivered to the laboratory

imens for Delivery to the Laboratory from

These specimens must be packed and transported in accordance with the European Agreement concerning

ainer is securely closed and placed in the sealed plastic bag

Ensure lids in 24hour urine jars are tightly closed and containers are placed in Urine transport bags

nostic Specimens’ or in place plastic transport

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Outside the Hospital Specimens suspected or known to contain infectious pathogens shou

follows:

1. Ensure the cap of the sample container is securely closed

2. Wrap the container in tissue or cotton wool which will act as absorbent material in the event of any

spillages.

3. Place the wrapped specimen inside the plastic container of UN approved Class 6.2 package type

(available from the laboratory).

4. Place the container inside the cardboard box.

5. The box should contain a label ‘Infectious Substance’.

6. Place the name, address and contact number of the destination laboratory on the outside of the

box.

A licensed courier must be used for the transport of infectious specimens.

8.4 Specimen Delivery from Outside the Hospital

• It is advisable to refrigerate samples prior to collection

laboratory.

• If patients are delivering samples to the Laboratory, the GP must advise patients if there is

in delivery of samples, they must be refrigerated.

• Samples are delivered by GPs, patients, couriers and

• Samples are delivered daily by taxi service from St Joseph’s Hospital, Longford and from the GP

surgeries in Longford.

• A taxi also leaves Athlone Hospital each day at 11am to facilitate Athlone GPs.

• There is a taxi service from GP surgeries in Coole, Castlepollard, Edgeworthstown

Killucan, Kinnegad and Moate

• There is also a taxi between Tullamore and Portlaoise laboratories daily.

• Couriers and taxis are require

specimens.

• Taxis are provided with transport boxes which are UN3373 compliant. The temperature of each box

is checked on arrival in the laboratory.

9 EXTERNAL QUALITY CONTROL ASSESSMENT

The Pathology Department participates in relevant available third party EQA schemes. This includes

schemes operated by:

o NEQAS – UK National External Quality Assurance Scheme

o IEQAS – Irish External Quality Assurance Scheme

o WEQAS – Welsh External Qua

o RIQAS – Randox International

o EQUALIS - External Quality Assurance

o LabQuality – Finland Quality Assurance Scheme

o DEQAS – UK External Quality Assurance Scheme

The laboratory is committed to participating in other QC schemes as they become available and are

required to ensure comprehensive assessment of the test repertoire.

not available, inter-laboratory comparisons are used.





Packing of Diagnostic (Non-infectious) Specimens for Delivery to the Laboratory from

Specimens suspected or known to contain infectious pathogens should be packed and transported as

Ensure the cap of the sample container is securely closed.

Wrap the container in tissue or cotton wool which will act as absorbent material in the event of any

Place the wrapped specimen inside the plastic container of UN approved Class 6.2 package type

(available from the laboratory).

Place the container inside the cardboard box.

The box should contain a label ‘Infectious Substance’.

and contact number of the destination laboratory on the outside of the

A licensed courier must be used for the transport of infectious specimens.

Specimen Delivery from Outside the Hospital

It is advisable to refrigerate samples prior to collection by taxi/courier for delivery to the

If patients are delivering samples to the Laboratory, the GP must advise patients if there is

in delivery of samples, they must be refrigerated.

Samples are delivered by GPs, patients, couriers and taxis to the laboratory reception area.

Samples are delivered daily by taxi service from St Joseph’s Hospital, Longford and from the GP

A taxi also leaves Athlone Hospital each day at 11am to facilitate Athlone GPs.

xi service from GP surgeries in Coole, Castlepollard, Edgeworthstown

Moate arriving in the Laboratory before 2pm.

There is also a taxi between Tullamore and Portlaoise laboratories daily.

Couriers and taxis are required to notify the laboratory of any spillage, accident or damage to

Taxis are provided with transport boxes which are UN3373 compliant. The temperature of each box

is checked on arrival in the laboratory.

SSESSMENT PROGRAMME


UK National External Quality Assurance Scheme

External Quality Assurance Scheme

External Quality Assurance Scheme

Randox International Quality Assurance Scheme

External Quality Assurance in Laboratory Medicine in Sweden

Quality Assurance Scheme

UK External Quality Assurance Scheme


required to ensure comprehensive assessment of the test repertoire. Where third party EQA schemes

laboratory comparisons are used.



infectious) Specimens for Delivery to the Laboratory from

ld be packed and transported as

Wrap the container in tissue or cotton wool which will act as absorbent material in the event of any

Place the wrapped specimen inside the plastic container of UN approved Class 6.2 package type

and contact number of the destination laboratory on the outside of the

by taxi/courier for delivery to the

If patients are delivering samples to the Laboratory, the GP must advise patients if there is a delay

taxis to the laboratory reception area.

Samples are delivered daily by taxi service from St Joseph’s Hospital, Longford and from the GP

A taxi also leaves Athlone Hospital each day at 11am to facilitate Athlone GPs.

xi service from GP surgeries in Coole, Castlepollard, Edgeworthstown, Ballymahon,

d to notify the laboratory of any spillage, accident or damage to

Taxis are provided with transport boxes which are UN3373 compliant. The temperature of each box



third party EQA schemes are

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10 REPORTING OF RESULTS

10.1 Frequency of Testing

• The frequencies stated in this handbook refer to normal working days.

• Where turnaround times (TAT)

stamped in sample reception until the time th

available to the requestor.

• TATs do not take into account those cases where testing of samples need to be repeated for

technical or quality control reasons.

• The times quoted are ‘averages’ and the labo

circumstances permitting.

• Scheduled tests refer to assays which are batched when sufficient numbers are requested.

Urgent Tests

All samples are date and time stamped on receipt in the specimen reception. Urgent samples are then

prioritised in the laboratory process. On authorisation, results are available on the Ward Enquiry system.

10.2 Result Reporting Ward Enquiry

Results, with the exception of Blood Transfusion, are available on Ward Enquiry. This system is password

controlled and available to authorised personnel only. Please contact IT scientist at 4220.

11.1 for instructions on using this system.

Blood Track Enquiry

This system can be used by clinical staff to check if blood is crossmatched for a patient. The number of red

cell units crossmatched and platelet availability can be verified. Refer to Section

using this system.

Heathlink

This is a Department of Health funded project which facilitates establishment of electronic links between

GPs/Nursing Homes and the laboratory. This allows for timely, secure transfer of clinical data. Validated

results are sent to Healthlink on a regular

Printed Reports

Hardcopy reports are issued to the wards twice daily at 12.30pm and 5.30pm, Monday to Friday. Out of

hours, printed reports are forwarded to wards regularly. Reports are also sent to GPs daily by external post

or by courier to Tullamore and Portlaoise labo

11 LABORATORY INFORMATION SYSTEMS

11.1 Ward Enquiry Ward Enquiry is designed to enable staff on wards throughout the hospital to have access to laboratory

results as soon as they have been validated. Ward Enquiry is refreshed every 25 seconds and staff

access to the previous 9 months of results on a patient. The IT medical scientist in the laboratory will

provide a password for use of Ward Enquiry on completion of training. Each user must be familiar with the

HSE Information Technology Acceptable U

Enquiry, found in the Ward Enquiry SOP folder on each computer. All signed training documents are kept in

a folder in the laboratory.

11.1.1 Logging In

1. Double-click on the Ward Enquiry Icon as sho





The frequencies stated in this handbook refer to normal working days.

(TAT) are stated, it refers to the time from when samples are received and

stamped in sample reception until the time the result is issued from the laboratory so that it is

TATs do not take into account those cases where testing of samples need to be repeated for

technical or quality control reasons.

quoted are ‘averages’ and the laboratory at MRH,M will do their utmost to achieve them,

Scheduled tests refer to assays which are batched when sufficient numbers are requested.



exception of Blood Transfusion, are available on Ward Enquiry. This system is password

controlled and available to authorised personnel only. Please contact IT scientist at 4220.

for instructions on using this system.


cell units crossmatched and platelet availability can be verified. Refer to Section



results are sent to Healthlink on a regular basis for GP access.



or by courier to Tullamore and Portlaoise laboratories.

YSTEMS

Ward Enquiry is designed to enable staff on wards throughout the hospital to have access to laboratory

results as soon as they have been validated. Ward Enquiry is refreshed every 25 seconds and staff



HSE Information Technology Acceptable Usage Policy and must have read the User Training Guide for Ward


click on the Ward Enquiry Icon as shown in Figure 11.1 below.



are stated, it refers to the time from when samples are received and

e result is issued from the laboratory so that it is

TATs do not take into account those cases where testing of samples need to be repeated for

ratory at MRH,M will do their utmost to achieve them,

Scheduled tests refer to assays which are batched when sufficient numbers are requested.



exception of Blood Transfusion, are available on Ward Enquiry. This system is password

controlled and available to authorised personnel only. Please contact IT scientist at 4220. Refer to Section


11.2 for instructions on





Ward Enquiry is designed to enable staff on wards throughout the hospital to have access to laboratory

results as soon as they have been validated. Ward Enquiry is refreshed every 25 seconds and staff have



sage Policy and must have read the User Training Guide for Ward


PATHOLOGY




Figure 11.1: Ward Enquiry Icon

2. This will activate the Lab Result Look

Figure 11.2: Lab Result Look-up Screen

3. Enter your username as follows: First Name followed by Surname.

4. Enter your 6-10 digit password. This gives access to the search screen.

11.1.2 Searching for a Patient Search for a patient’s results using chart number, name or date of birth using the Search

Figure 11.3.

Figure 11.3: Search Screen

1. Enter the patient’s surname followed by first name and click search.

OR

2. Enter the patient’s date of birth as dd/mm/yy or ddmmyy and click search.

OR





activate the Lab Result Look-up screen, Figure 11.2. Click on the Click to

creen

Enter your username as follows: First Name followed by Surname.

10 digit password. This gives access to the search screen.

Search for a patient’s results using chart number, name or date of birth using the Search

Enter the patient’s surname followed by first name and click search.

Enter the patient’s date of birth as dd/mm/yy or ddmmyy and click search.



Click on the Click to Log On Button.

Search for a patient’s results using chart number, name or date of birth using the Search screen shown in

PATHOLOGY




3. Enter the patient’s chart number and click sea

4. The above searches will present you with a list of patient’s to choose from as shown in Figure 11.4

below.

Figure 11.4: Demographic Choice Screen

5. The patient with the most recent lab results is always displayed on the top of the list.

patient required and select OK to return the results.

6. If the patient required is not in the list, select ‘None of the Above’ to start again.

7. If you cannot find patient results, check each of the search modes i.e. Name, DOB and Chart

Number.

11.1.3 Viewing Results The View Result screen shown in Figure 11.5 below displays the results for the selected patient.

Figure 11.5: View Result Screen

• Run Date, Sample Date and Record Number are highlighted in the right

• The arrow keys on the right

in increments of one.

• The top right hand indicator check boxes inform you of the departments with results.





Enter the patient’s chart number and click search.

The above searches will present you with a list of patient’s to choose from as shown in Figure 11.4

: Demographic Choice Screen

The patient with the most recent lab results is always displayed on the top of the list.

patient required and select OK to return the results.

If the patient required is not in the list, select ‘None of the Above’ to start again.

If you cannot find patient results, check each of the search modes i.e. Name, DOB and Chart

The View Result screen shown in Figure 11.5 below displays the results for the selected patient.

Run Date, Sample Date and Record Number are highlighted in the right-hand column.

the right-hand side (beside sample date) allow movement through the records

The top right hand indicator check boxes inform you of the departments with results.



The above searches will present you with a list of patient’s to choose from as shown in Figure 11.4

The patient with the most recent lab results is always displayed on the top of the list. Highlight the

If the patient required is not in the list, select ‘None of the Above’ to start again.

If you cannot find patient results, check each of the search modes i.e. Name, DOB and Chart

The View Result screen shown in Figure 11.5 below displays the results for the selected patient.

hand column.

(beside sample date) allow movement through the records

The top right hand indicator check boxes inform you of the departments with results.

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• Clicking on the Tabs above the results moves between the departments.

• The Print Icon allows printing of the result displayed on the screen.

• Cumulative Icon allows viewing of cumulative results. Placing the cursor over the Sample ID and

date displays the patient’s address.

• Cumulative results can be printed by clicking on th

11.1.4 Viewing Microbiology Results1. Search for patient results as per Section 11.1.2 above.

2. Highlight the patient required and select OK to return the results.

3. Click on the Microbiology tab. The most recent microbiology sample received and samp

this patient is displayed in the right

they will also be displayed.

4. Highlight the most recent sample date or if previous results are required, highlight the relevant

sample date. Once the relevant sample date and the relevant sample type is highlighted, the results

are displayed on the screen as per Figure 11.6 below.

Figure 11.6: Microbiology Result Screen

5. Check the patient details and then click on the print icon on the bott

the Microbiology results.

6. To return to the main results screen, click on the Biochemistry

7. To search for another patient, click on the exit icon on the bottom right of the screen.

11.1.5 Viewing National Virus Reference1. Search for patient as per Section 11.1.2

2. Select the correct patient from the list of patients returned and click OK

3. The Results Overview Screen opens, select the





Clicking on the Tabs above the results moves between the departments.

The Print Icon allows printing of the result displayed on the screen.

Cumulative Icon allows viewing of cumulative results. Placing the cursor over the Sample ID and

date displays the patient’s address.

Cumulative results can be printed by clicking on the Print Icon.

Viewing Microbiology Results Search for patient results as per Section 11.1.2 above.

Highlight the patient required and select OK to return the results.

Click on the Microbiology tab. The most recent microbiology sample received and samp

this patient is displayed in the right-hand column. If there are any previous samples on this patient,

Highlight the most recent sample date or if previous results are required, highlight the relevant

nce the relevant sample date and the relevant sample type is highlighted, the results

are displayed on the screen as per Figure 11.6 below.

: Microbiology Result Screen

Check the patient details and then click on the print icon on the bottom right of the screen to print

To return to the main results screen, click on the Biochemistry-Haematology

To search for another patient, click on the exit icon on the bottom right of the screen.

onal Virus Reference Results (NVRL) in Ward Enquiry Search for patient as per Section 11.1.2

Select the correct patient from the list of patients returned and click OK.

The Results Overview Screen opens, select the ‘Externals Tab’ as per Figure 11.7 below.



Cumulative Icon allows viewing of cumulative results. Placing the cursor over the Sample ID and

Click on the Microbiology tab. The most recent microbiology sample received and sample type for

hand column. If there are any previous samples on this patient,

Highlight the most recent sample date or if previous results are required, highlight the relevant

nce the relevant sample date and the relevant sample type is highlighted, the results

om right of the screen to print

Haematology-Coagulation tab.

To search for another patient, click on the exit icon on the bottom right of the screen.

as per Figure 11.7 below.

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Figure 11.7: Results Overview Screen

4. If results are available from the NVRL

You may need to scroll through previous lab encounters

the screen to find the returned result

Figure 11.8: Arrows and Highlighted Medibridge Button

5. Click ‘Medibridge Results’.

6. A new window opens displaying the NVRL results

printed by selecting the print icon within the result viewer.





: Results Overview Screen

If results are available from the NVRL, the ‘Medibridge Results’ button will be highlighted in yellow

You may need to scroll through previous lab encounters using the arrows on the right hand side of

o find the returned result as shown in Figure 11.8.

: Arrows and Highlighted Medibridge Button

A new window opens displaying the NVRL results, see Figure 11.9 below

print icon within the result viewer.



button will be highlighted in yellow.

using the arrows on the right hand side of

, see Figure 11.9 below. These results may be

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Figure 11.9: Medibridge Viewer

11.1.6 Printer Set-up 1. To set up a new printer or to reactivate a printer, right

2. Input the password ‘temo’. Click OK.

3. From the list of printers, select the name of the printer connected to the PC in use.

4. Highlight the name of this printer and click on Save.

5. Click Exit.

Notes

• Print all results. Please do not transcribe results to paper.

• User passwords expire every 90

entered.

• Remember your password and don’t give it to others.

• If you believe your password is compromised, contact IT medical scientist for a new one (Ext. 4220).

• Only validated results are available for viewing.

• An audit of all look-ups is maintained by the system.

11.2 BloodTrack Enquiry This system allows viewing of crossmatched red cell units and platelets issued to a patient from ward PCs.

11.2.1 Viewing Issue Fridge Inventory1. Double-click on the BloodTrack Enquiry icon on the desktop.

2. Highlight and right-click on ‘Mullingar Issue Fridge’ as per Figure 11.10 below.

Figure 11.10: BloodTrack Enquiry Screen





To set up a new printer or to reactivate a printer, right-click on the printer icon.

Input the password ‘temo’. Click OK.

From the list of printers, select the name of the printer connected to the PC in use.

Highlight the name of this printer and click on Save.

Print all results. Please do not transcribe results to paper.

User passwords expire every 90 days. The system will prompt for a new 6-

Remember your password and don’t give it to others.

If you believe your password is compromised, contact IT medical scientist for a new one (Ext. 4220).

available for viewing.

ups is maintained by the system.

This system allows viewing of crossmatched red cell units and platelets issued to a patient from ward PCs.

Viewing Issue Fridge Inventory he BloodTrack Enquiry icon on the desktop.

click on ‘Mullingar Issue Fridge’ as per Figure 11.10 below.

: BloodTrack Enquiry Screen



click on the printer icon.

From the list of printers, select the name of the printer connected to the PC in use.

-10 digit password to be

If you believe your password is compromised, contact IT medical scientist for a new one (Ext. 4220).

This system allows viewing of crossmatched red cell units and platelets issued to a patient from ward PCs.

click on ‘Mullingar Issue Fridge’ as per Figure 11.10 below.

PATHOLOGY




3. Click ‘View Inventory’ from the drop

4. All units currently scanned into the Issue Fridge will now be visible. Platelets issued to patients will

also be visible.

11.2.2 Viewing RCC & Platelets Available for Particular Patient1. Click the ‘Product Available’ button.

2. Select ‘All Products’.

3. Type in the patient’s Chart number and click Search.

4. Confirm patient details.

5. The number of units available

12 SERVICES AVAILABLE

12.1 Pathology Services

Service

Haemovigilance The Haemovigilance service in MRH, Mullingar is a Consultant

a Transfusion Surveillance Officer (TSO) based on site. The National

Haemovigilance scheme is dedicated to the achievement of a national standard

practice and quality of care for

completion of transfusion. Further information can be obtained from the TSO

at EXT 4313. See also Section 19.

Consultant Service Two Consultant Haematologists are available for advice on Haematology &

Blood Transfusion issues. The Blood Transfusion and Haematology

departments offer a clinical service, both for diagnosis and patient

management advice.

Histopathology, Cli

Section 5.2 for contact details.

Phlebotomy A phlebotomy service is available for in

phlebotomists visit the wards Monday to Friday during routine hours. There is

also a phlebotomy session 9am

taking specimens at all other times. The phlebotomy service is under the

control of the Director of Nursing.

Warfarin Clinic An outpatient Warfarin clinic is available. This clinic operates on Tuesdays,

Thursdays and

between 12.30pm and 3pm. Contact phlebotomy for details.

Point of Care Support The Clinical Chemistry department supports some Point of Care (POC)

instruments in the hospital. This includes Blood Gas ana

and the Labour ward and a number of POC instrumentation in Primary Care.

Autopsies Please inform Nursing Administration, who will contact the Coroner (if

required) and Pathologist on

Slides for Presentations,

etc.

The Pathologist needs a minimum of 2 days’ notice, preferably one week, as

the sections must first be sent back from Tullamore for photography.

Complaints Handling

Procedure

The Laboratory documents all perceived or real grievances from clinicians,

patients o

following the laboratory complaint procedure. Refer to QP

Improvement Processes (Including Non

Preventative Actions and Improvement Ideas) current

cannot be resolved at a local level, the complainant is advised of their right to

an independent review by the Hospital Complaints Officer and if not resolved

at that stage, an independent review by the Ombudsman.





Click ‘View Inventory’ from the drop-down list.

All units currently scanned into the Issue Fridge will now be visible. Platelets issued to patients will

Viewing RCC & Platelets Available for Particular Patient Click the ‘Product Available’ button.

Type in the patient’s Chart number and click Search.

available for this patient will then be visible.

Description

The Haemovigilance service in MRH, Mullingar is a Consultant



practice and quality of care for all patients before, during and following


at EXT 4313. See also Section 19.

Two Consultant Haematologists are available for advice on Haematology &



management advice. There is also a medical Consultant available in

Histopathology, Clinical Microbiology, Immunology and

Section 5.2 for contact details. A phlebotomy service is available for in-patients and out


also a phlebotomy session 9am-2pm at weekends. NCHDs are responsible for


control of the Director of Nursing.

An outpatient Warfarin clinic is available. This clinic operates on Tuesdays,

Thursdays and Fridays between 9.30am and 12pm and on Wednesdays


The Clinical Chemistry department supports some Point of Care (POC)

instruments in the hospital. This includes Blood Gas ana


Please inform Nursing Administration, who will contact the Coroner (if

required) and Pathologist on-call.

Pathologist needs a minimum of 2 days’ notice, preferably one week, as



patients or other related parties and investigates theses as formal complaints

following the laboratory complaint procedure. Refer to QP

Improvement Processes (Including Non-conformances, Complaints,

Preventative Actions and Improvement Ideas) current






All units currently scanned into the Issue Fridge will now be visible. Platelets issued to patients will

The Haemovigilance service in MRH, Mullingar is a Consultant-led service with



all patients before, during and following


Two Consultant Haematologists are available for advice on Haematology &



There is also a medical Consultant available in

nical Microbiology, Immunology and Clinical Chemistry. See

patients and out-patients. The


weekends. NCHDs are responsible for


An outpatient Warfarin clinic is available. This clinic operates on Tuesdays,

Fridays between 9.30am and 12pm and on Wednesdays


The Clinical Chemistry department supports some Point of Care (POC)

instruments in the hospital. This includes Blood Gas analysers in ED, ICU, SCBU


Please inform Nursing Administration, who will contact the Coroner (if

Pathologist needs a minimum of 2 days’ notice, preferably one week, as



r other related parties and investigates theses as formal complaints

following the laboratory complaint procedure. Refer to QP-M/L/8 ‘Quality

conformances, Complaints,

revision. If a complaint




PATHOLOGY




Service

Advisory Services The Laboratory Consultants and Senior Scientific staff provide an extensive

advisory service to all users of the service. Senior Medical Scientific staff are

authorised to give advice on logistic and scientific information such as the user

of the labor

12.2 Hospital & Regional MeetingsThe Pathology department has representatives on a number of Hospital and Regional committees. These

include Hospital Transfusion Committee, Regional

Hospital Healthcare Records Management Committee, National LIS Committee, Hospital Performance and

Governance Committee and Hospital Quality Risk Governance Committee.

Feedback is given to the Nursing staff from Transfusion Committees by the TSO at CNM meetings when

relevant. Feedback from all other committees is given to laboratory staff at bi

management meetings.

12.3 Laboratory Supplies

• The Pathology Department supplies blood bottles, urine & stool containers and request forms to all

users of the service. Supplies can be obtained by contacting Specimen Reception at 044

9am – 5.30pm, Monday to Friday.

• Urine dipsticks and pregnancy tests are suppl

• Point of Care supplies are provided to GPs involved in the Near Patient Testing pilot scheme.

Supplies can be obtained by filling out the appropriate order form and faxing to 044

12.4 Storage of Examined SpecimensExamined specimens are stored for archive and look

‘Retention of Records & Specimens

Laboratory Records and Diagnostic Material

Specimen Description Storage Location

Primary Transfusion and

Antenatal Samples

Reagent Fridge

Cold Room

Whole Blood Clinical Chemistry /

Immunology Fridges

Whole Blood Haematology

Microbiology Samples Microbiology

13 LABORATORY ON-CALL PROTOCOL

This service is for genuine medical emergencies only, where the results are likely to influence immediate

management of the patient.

• On-call service is provided Monday

Holidays.

• The emergency on-call service is provided by two medical scientists. One is responsible for

Haematology and Blood Transfusion and the other is responsible for Clinical Chemistry and

Microbiology.

• Calls after midnight should be curtailed as much as possible.





Description

The Laboratory Consultants and Senior Scientific staff provide an extensive



of the laboratory service and interpretation of laboratory results.

Hospital & Regional Meetings The Pathology department has representatives on a number of Hospital and Regional committees. These

include Hospital Transfusion Committee, Regional Transfusion Committee, Medical Devices Committee,


Governance Committee and Hospital Quality Risk Governance Committee.


relevant. Feedback from all other committees is given to laboratory staff at bi

partment supplies blood bottles, urine & stool containers and request forms to all

users of the service. Supplies can be obtained by contacting Specimen Reception at 044

5.30pm, Monday to Friday.

Urine dipsticks and pregnancy tests are supplied to GPs.

Point of Care supplies are provided to GPs involved in the Near Patient Testing pilot scheme.

Supplies can be obtained by filling out the appropriate order form and faxing to 044

Storage of Examined Specimens stored for archive and look-back purposes as per Royal College of Pathologists

Retention of Records & Specimens’ 5th

edition, 2015 and NPAAC ‘Requirements for the Retention of

Laboratory Records and Diagnostic Material’ 6th

edition, 2013.

Storage Location Minimum Retention

Time

Reagent Fridge

Cold Room

7 days Chief Medical Scientist

Blood Transfusion

Clinical Chemistry /

Immunology Fridges

3-10 days

(storage permitting)

Chief Medical Scientist

Relevant Departments

Haematology 3-7 days

(storage permitting)


Haematology

Microbiology 7 days Chief Medical Scientist

Microbiology

ROTOCOL This service is for genuine medical emergencies only, where the results are likely to influence immediate

call service is provided Monday – Friday from 8pm to 8am and on Saturdays, Sundays and Bank

call service is provided by two medical scientists. One is responsible for


Calls after midnight should be curtailed as much as possible.



The Laboratory Consultants and Senior Scientific staff provide an extensive



atory service and interpretation of laboratory results.

The Pathology department has representatives on a number of Hospital and Regional committees. These

, Medical Devices Committee,



relevant. Feedback from all other committees is given to laboratory staff at bi-monthly pathology

partment supplies blood bottles, urine & stool containers and request forms to all

users of the service. Supplies can be obtained by contacting Specimen Reception at 044-9394337

Point of Care supplies are provided to GPs involved in the Near Patient Testing pilot scheme.

Supplies can be obtained by filling out the appropriate order form and faxing to 044-9394342.

Royal College of Pathologists

Requirements for the Retention of

Responsibility


Blood Transfusion


Relevant Departments


Haematology


Microbiology

This service is for genuine medical emergencies only, where the results are likely to influence immediate

Friday from 8pm to 8am and on Saturdays, Sundays and Bank

call service is provided by two medical scientists. One is responsible for


PATHOLOGY




• On-call staff must be contacted prior to sending the sample to the Laboratory particularly post

midnight.

• To contact scientific staff, please phone:

Blood Transfusion/Haematology

Landline: 4333 (Haem) or 4329 (BT)

Mobile: 086 0081395

Speed Dial: *51836

• The request form accompanying the emergency sample must be fully completed

Refer to Section 6.2 for which forms to complete on

• Tests will not be reported unless name, DOB & chart number are given.

• Results of tests performed during emergency service hours are returned to the location stated on

the request form via the pneumatic tube system. If no location is provided, results will

to ED.

13.1 Tests Available On-call To request tests other than those listed below, the Consultant in charge of the patient must contact the

Medical Scientist directly.

Department

Haematology o FBC

o ESR

o PT, INR, APTT

only be requested if clinical findings or history indicate a coagulation defect)

o D-dimer

except suspected DIC.)

o Fibrinogen

o Malaria Screen

o Sickle Cell Screen

Blood Transfusion o Group & Screen

o Group & Crossmatch (Emergencies only, not elective surgery)

o Group & Coombs

deemed urgent (e.g. maternal antibody, jaundiced baby, neonatal anaemia)

o Antibody Identification

o Packing of blood for transport to another location

o Issuing of Platelets/Blood Products

Clinical Chemistry o U&E

o Creatinine

o Glucose

o Calcium/Albumin

o CRP

o Amylase

o Bilirubin on neonates

o Blood Alcohol

o Salicylate

o Paracetamol

o Gentamycin

o Magnesium

o LFTs





call staff must be contacted prior to sending the sample to the Laboratory particularly post

To contact scientific staff, please phone:

Blood Transfusion/Haematology Clinical Chemistry/Microbiology

4333 (Haem) or 4329 (BT) Landline: 4328

086 0081395 Mobile: 086 0081394

*51836 Speed Dial: *51835

The request form accompanying the emergency sample must be fully completed

6.2 for which forms to complete on-call.

Tests will not be reported unless name, DOB & chart number are given.

Results of tests performed during emergency service hours are returned to the location stated on

the request form via the pneumatic tube system. If no location is provided, results will

To request tests other than those listed below, the Consultant in charge of the patient must contact the

Tests Available

PT, INR, APTT (To monitor anticoagulant therapy. Coagulation screen should


dimer (To rule out DVT or PT only. Well’s Score must be provided in all cases

except suspected DIC.)

Fibrinogen (e.g. PPH, severe sepsis, massive haemorrhage, new leukaemias)

Malaria Screen

Sickle Cell Screen (for pre-ops only)

Group & Screen

Group & Crossmatch (Emergencies only, not elective surgery)

Group & Coombs – on Fridays, Saturdays & Sundays up to


Antibody Identification

Packing of blood for transport to another location

Issuing of Platelets/Blood Products

Creatinine

Glucose

Calcium/Albumin

Amylase

Bilirubin on neonates

Blood Alcohol

Salicylate (not required routinely)

Paracetamol

Gentamycin

Magnesium



call staff must be contacted prior to sending the sample to the Laboratory particularly post-

Clinical Chemistry/Microbiology

4328

086 0081394

*51835

The request form accompanying the emergency sample must be fully completed as per Section 6.3.

Results of tests performed during emergency service hours are returned to the location stated on

the request form via the pneumatic tube system. If no location is provided, results will be returned

To request tests other than those listed below, the Consultant in charge of the patient must contact the

anticoagulant therapy. Coagulation screen should


(To rule out DVT or PT only. Well’s Score must be provided in all cases

severe sepsis, massive haemorrhage, new leukaemias)

Group & Crossmatch (Emergencies only, not elective surgery)

on Fridays, Saturdays & Sundays up to 10pm or any time if


PATHOLOGY




Department

o Lactate

o Urinary Na, K, Amylase

o Osmolality

o Urate (PET only)

o BNP

o Troponin

o Urine PCR

Microbiology o Urine for Microscopy and C&S in paediatric cases

routinely processed

o Urine for Microscopy and C&S on 3

Paediatrician

o Positive Blood

o CSF Examination

o Pregnancy Test





Tests Available

Lactate

Urinary Na, K, Amylase

Osmolality (Performed off-site in MRHP if required)

(PET only)

Troponin

PCR (In pregnancy at weekends/Bank holidays only)

Urine for Microscopy and C&S in paediatric cases –

routinely processed

Urine for Microscopy and C&S on 3-16 year old by request by Consultant

Paediatrician

Positive Blood Culture

CSF Examination

Pregnancy Test



(In pregnancy at weekends/Bank holidays only)

– under 3 years old is

16 year old by request by Consultant

PATHOLOGY




14 CLINICAL CHEMISTRY The Clinical Chemistry department uses biochemical knowledge and techniques to understand human

health and to assist in the detection, diagnosis and treatment of disease. The department provides a

comprehensive analytical service for indices of renal funct

metabolism and for various enzymes, therapeutic drugs and many other chemical and biochemical

compounds. This service is provided to MRH, Mullingar and all GPs and nursing homes in the Longford and

Westmeath area.

The department also uses immunoassay techniques to assist in the diagnosis and monitoring of disorders of

the endocrine system. A wide portfolio of hormone assays is available as an aid to investigating diseases

such as thyroid, reproductive system dis

as a regional service to MRH, Mullingar

Longford/Westmeath/Laois/Offaly area


Title Name

Chief Medical Scientists Ms. Helen Corrigan

Mr. Conor Tubman

Senior Medical

Scientists

Mr. Paul Crowley

Ms. Martina Leonard

Senior Medical Scientist

Point of Care

Coordinator (PCCC)

Ms. Hannora Martyn

Consultant Clinical

Biochemist

Dr. Graham Lee

14.2 Test Profiles The following table describes the tests analysed within the profiles stated. Only the profile names stated

below are to be used. Non-specific and vague profiles e.g. ‘bioprofile’ or ‘toxicology’ may result in missed

analyses. Please carefully specify the t

testing.

Profile Name

U&E or Renal

CE (Cardiac Enzymes)

LFT or Liver Function

Bone

Lipids

PET

TFT or Thyroid Function

Fertility Profile (Menopausal)

Fertility Profile (Pre-menopausal)





The Clinical Chemistry department uses biochemical knowledge and techniques to understand human


comprehensive analytical service for indices of renal function, liver function, carbohydrate and lipid





such as thyroid, reproductive system disorders, anaemia, vitamin deficiencies and diabetes. This is provided

MRH, Mullingar, MRH, Tullamore, MRH Portlaoise

Longford/Westmeath/Laois/Offaly area and nursing homes in the midlands region.

for Key Members of Staff

Name Telephone Number

Ms. Helen Corrigan 044-9394871 [email protected]

Mr. Conor Tubman 044-9394328 [email protected]

Mr. Paul Crowley 044-9394328

[email protected]

Ms. Martina Leonard [email protected]

Ms. Hannora Martyn 044-9394213 [email protected]

Dr. Graham Lee Contactable on mobile via

MRH Mullingar

044-9340221

Or via switch at the Mater

01-8032000

[email protected]

The following table describes the tests analysed within the profiles stated. Only the profile names stated

specific and vague profiles e.g. ‘bioprofile’ or ‘toxicology’ may result in missed

analyses. Please carefully specify the tests needed. See also Section 14.6 for guidelines on endocrinology

Assays Included in Profile

Urea, Creatinine, Sodium, Potassium, Chloride

CK, AST

ALP, ALT, AST, GGT, Total Bilirubin

Ca, PO4, ALP, Albumin

Cholesterol, Triglyceride, HDL, LDL

U&E, LFT, Uric Acid

Free T4, TSH

Fertility Profile (Menopausal) FSH, Oestradiol

menopausal) FSH, LH, Day 21 Progesterone



The Clinical Chemistry department uses biochemical knowledge and techniques to understand human


ion, liver function, carbohydrate and lipid





orders, anaemia, vitamin deficiencies and diabetes. This is provided

, MRH, Tullamore, MRH Portlaoise and all GPs in the

Email

[email protected]

[email protected]

[email protected]

[email protected]

[email protected]

[email protected]

The following table describes the tests analysed within the profiles stated. Only the profile names stated

specific and vague profiles e.g. ‘bioprofile’ or ‘toxicology’ may result in missed

ests needed. See also Section 14.6 for guidelines on endocrinology

Assays Included in Profile

Urea, Creatinine, Sodium, Potassium, Chloride

PATHOLOGY




14.3 Unexpected Results Artefactual results may arise from difficulties or errors in, for example, sample collection, choice of

specimen bottle, specimen transport or specimen storage. Artefactual results will also occur when samples

are drawn from a site proximal to an infusion, when there has been prolonged venous stasis during

collection or as a result of difficult or traumatic sample collection. It is important that the Laboratory is

informed as soon as possible if results appear to be incon

with previous results.

14.4 Turnaround Times Samples labelled urgent, or samples from ICU, ED, SCBU AMAU and EPU are given priority. The following

table indicates TAT for such urgent samples:

U&E

Glucose

Calcium

Amylase

Salicylate

Paracetamol

Alcohol

hCG

Troponin I

BNP

All non-urgent biochemical tests have a 24 hour turnaround time unless batched for analysis (e.g. ACR, RF)

or if they arrive in the laboratory after 4pm on a Friday. Samples received

Friday will be reported as soon as possi

Endocrine tests have a turnaround time of 5 working days.

Section 17 lists the tests available, type of sample required and the approximate frequency of

Clinical Chemistry/Immunology/Haematology/Coagulation testing.

14.5 Guidelines for Endocrine Testing Guidelines are only one type of information that healthcare professionals use when making decisions about

patient care. It is assumed that these guidelines will be used by

to bear their clinical knowledge and judgement in making decisions about caring for individual patients. It is

not always appropriate to apply either specific recommendations or general messages in this manual to

each individual or in every circumstance. The availability of r

patient care, including the adoption of recommendations.

14.5.1 Thyroid Function Sample Required: 8 mL Serum

Possible Interpretative Difficulties

Please give the laboratory full clinical details when requesting TFT

the patient is pregnant, or on T4, T3, antithyroid treatment, amiodarone etc. This will ensure that the most

appropriate tests are performed, the correct comment appears on the report and the results are not

delayed because of unnecessary tests. See table below for drugs that interfere with TFT results:





Artefactual results may arise from difficulties or errors in, for example, sample collection, choice of


from a site proximal to an infusion, when there has been prolonged venous stasis during


informed as soon as possible if results appear to be inconsistent with the patient’s condition or at variance

Samples labelled urgent, or samples from ICU, ED, SCBU AMAU and EPU are given priority. The following

table indicates TAT for such urgent samples:

Test Turnaround Time

1 hour

Glucose 1 hour

Calcium 1 hour

Amylase 1 hour

Salicylate 1 hour

Paracetamol 1 hour

Alcohol 1 hour

2 hours

Troponin I 1.5 hours

3 hours

urgent biochemical tests have a 24 hour turnaround time unless batched for analysis (e.g. ACR, RF)

or if they arrive in the laboratory after 4pm on a Friday. Samples received in the laboratory after 4pm on a

will be reported as soon as possible.

Endocrine tests have a turnaround time of 5 working days.

Section 17 lists the tests available, type of sample required and the approximate frequency of

Immunology/Haematology/Coagulation testing.

Endocrine Testing Guidelines are only one type of information that healthcare professionals use when making decisions about

patient care. It is assumed that these guidelines will be used by healthcare professionals

al knowledge and judgement in making decisions about caring for individual patients. It is


each individual or in every circumstance. The availability of resources may also influence decisions about

patient care, including the adoption of recommendations.

8 mL Serum

Please give the laboratory full clinical details when requesting TFTs, in particular, information as to whether



yed because of unnecessary tests. See table below for drugs that interfere with TFT results:



Artefactual results may arise from difficulties or errors in, for example, sample collection, choice of


from a site proximal to an infusion, when there has been prolonged venous stasis during


sistent with the patient’s condition or at variance

Samples labelled urgent, or samples from ICU, ED, SCBU AMAU and EPU are given priority. The following

urgent biochemical tests have a 24 hour turnaround time unless batched for analysis (e.g. ACR, RF)

in the laboratory after 4pm on a

Section 17 lists the tests available, type of sample required and the approximate frequency of testing for

Guidelines are only one type of information that healthcare professionals use when making decisions about

healthcare professionals who will also bring

al knowledge and judgement in making decisions about caring for individual patients. It is


esources may also influence decisions about

s, in particular, information as to whether



yed because of unnecessary tests. See table below for drugs that interfere with TFT results:

PATHOLOGY




Drug

Glucocorticoids In large doses, this can lower T3 and inhibit TSH secretion

Propranolol Sometimes used to treat manifestations of thyrotoxicosis and has an inhibitory

effect in T4 and T3 conversion. Propranolol when given to thyroid patients can

cause an elevation in TSH as a result of the impaired T4 to T3 conversion.

Iodine Can cause both

Amiodarone This can induce the development of hypo

patients with normal thyroid function or pre

Phenytoin

Carbamazepine

Furosemide/Fursemide

These drugs may competitively inhibit thyroid hormone binding to serum

proteins in the sample and acutely increase free T4 resulting in a serum total T4

values through a feedback mechanism.

Heparin IV IV heparin through in vitro stimulation of lipoprote

acids which inhibit T4 binding to serum proteins and falsely elevate free T4.

Guideline 1

Free T3 will only be measured if:

1. Patient has a normal Free T4 with a TSH <0.10 mIU/L

2. There is a stated clinical suspicion of T3 toxico

3. Requested by hospital Consultant

Guideline 2

Investigation of sub-clinical hypothyroidism:

• Raised TSH (5.5-10.0 mIU/L): Check TPO antibodies (See Immunology Section

history of thyroid disease and presence of goitre.

• TSH still raised: If the TPO antibody is positive and TSH >10 mIU/L (or

presence of hypothyroid symptoms), consider commencing thyroid replacement therapy.

Subclinical hypothyroidism is a relatively common disorder that occurs in

characterised by the finding of a slight to moderate increase in serum TSH with normal free T4

concentrations. TSH is not raised to levels of diagnostic hypothyroidism and levels return to normal during

the recovery phase.

14.5.2 Haematinics Sample Required: 8 mL Serum

Serum Ferritin

Purpose of the test:

• Screens for iron deficiency

• Measures iron storage

• Distinguishes between iron deficiency and inflammation

Interpretation of ‘High’ result:

• Acute or chronic infection

• Chronic haemolytic anaemia

• Chronic kidney disease

• Hodgkin’s disease

• Iron overload

• Leukaemia

• Acute or chronic liver disease





Interference

In large doses, this can lower T3 and inhibit TSH secretion

Sometimes used to treat manifestations of thyrotoxicosis and has an inhibitory



Can cause both hypo- and hyper-thyroidism

This can induce the development of hypo- or hyperthyroidism in 14

patients with normal thyroid function or pre-existing abnormalities.



values through a feedback mechanism.

IV heparin through in vitro stimulation of lipoprotein can liberate free fatty


Patient has a normal Free T4 with a TSH <0.10 mIU/L

There is a stated clinical suspicion of T3 toxicosis

Requested by hospital Consultant

clinical hypothyroidism:

10.0 mIU/L): Check TPO antibodies (See Immunology Section

history of thyroid disease and presence of goitre.

TSH still raised: If the TPO antibody is positive and TSH >10 mIU/L (or 5.5


Subclinical hypothyroidism is a relatively common disorder that occurs in asymptomatic patients. It is



8 mL Serum

Distinguishes between iron deficiency and inflammation

haemolytic anaemia

Acute or chronic liver disease



In large doses, this can lower T3 and inhibit TSH secretion

Sometimes used to treat manifestations of thyrotoxicosis and has an inhibitory



or hyperthyroidism in 14-18% of

existing abnormalities.



in can liberate free fatty


10.0 mIU/L): Check TPO antibodies (See Immunology Section 15); verify family

5.5-10.0 mIU/L with the


asymptomatic patients. It is



PATHOLOGY




Interpretation of ‘Low’ result:

• Iron deficiency

Other factors that may affect test results:

• A recent blood transfusion can increase

• If the tourniquet is applied on the arm too long (over 1 minute)

It is not advised to re-check ferritin subsequent to treatment, rather recheck FBC.

TIBC is a second line test measured only after confirming a high ferritin.

Serum Folate and Vitamin B12

Purpose of the test:

• Helps to confirm the diagnosis of megaloblastic anaemia

• Helps to distinguish between folic acid and B12 deficiency

• Assesses the amount of folic acid stored in pregnancy

Patient Preparation:

It is recommended that the patient fast for 12 hours prior to the sample being taken.

Interpretation of ‘High’ result (rare event)

• Leukaemia

• Acute or chronic liver disease

Interpretation of ‘Low’ result:

• Inadequate ingestion of folic acid

• Low levels of intrinsic factor antibo

• Hyperthyroidism

• Pernicious anaemia

• Use of metformin in type 2 diabetes and PCOS


• Phenytoin

• Pyrimethamine

• Alcohol

• Failure to fast overnight

• If the tourniquet is applied on the arm too long

Guideline 3

Please note that samples for B12 and folate must not be more than two days old when received in the lab

to avoid loss of vitamins in the sample.

Guideline 4

It is recommended that an FBC be taken prior to asses

to check the B12 for several weeks after an IM injection.






A recent blood transfusion can increase ferritin levels

If the tourniquet is applied on the arm too long (over 1 minute)

check ferritin subsequent to treatment, rather recheck FBC.

TIBC is a second line test measured only after confirming a high ferritin.

Helps to confirm the diagnosis of megaloblastic anaemia

Helps to distinguish between folic acid and B12 deficiency

Assesses the amount of folic acid stored in pregnancy

e patient fast for 12 hours prior to the sample being taken.

(rare event):

Acute or chronic liver disease

Inadequate ingestion of folic acid

Low levels of intrinsic factor antibody necessary for B12 absorption in pernicious anaemia

Use of metformin in type 2 diabetes and PCOS


is applied on the arm too long


to avoid loss of vitamins in the sample.

It is recommended that an FBC be taken prior to assessing the vitamin status of the patient. It not advised

to check the B12 for several weeks after an IM injection.



e patient fast for 12 hours prior to the sample being taken.

dy necessary for B12 absorption in pernicious anaemia


sing the vitamin status of the patient. It not advised

PATHOLOGY




Folate Deficiency

Anaemia (macrocytic)

Raised MCV (usually)

Megaloblastics in bone marrow

Neuropathy (very rarely)

Serum folate decreased

Anaemia responds to folic acid

Anaemia shows no response to Vitamin B12

The following guideline must be used when requesting a haematinic profile:

FBC and red cell indices should be checked prior to requesting haematinics.

exceptions:

1. Characteristic pallor

2. Known coeliac

3. Vegan

4. Alcoholic

5. Patients with neurological symptoms

6. Previous gastric or bowel problems

7. Findings of malabsorption

8. Extensive inflammatory bowel disease

9. In the case of ferritin, signs & symptoms of

Appropriate red cell indices for haematinic requesting would include:

1. Low Hb, normal MCV and high RDW

2. Low Hb, low MCV and low MCH

3. Low Hb with high MCV

It is imperative that full clinical details are written on the request form.

circumstance where you feel it necessary to request haematinics outside of this guideline.

Vitamin B12 and folate levels should not be repeated within a 3

be repeated within 6 weeks of last testing.

We appreciate that it is convenience that results in the ordering of a haematinic profile at the same time as

the FBC is requested. However examination of test reports during audit has shown that the vast majority of

requests have a normal FBC report with no requirement for a haematinic profile.

This is cost saving exercise but it is also best practice. Without your participation, the service will continue

to be inappropriately used and future improvements in the service will be made a lot

14.5.3 Hormone Profile Sample Required: 8 mL Serum

Guideline 5

The Clinical Chemistry department has sought guidance from Dr Gannon, Consultant Obs/Gynae on the

official policy of requesting serum ThCG. He has advised that serum ThCG should o

purpose of monitoring pregnancy and that urine HCG is still the tool for diagnosing pregnancy.





Folate Deficiency Vitamin B12 Deficiency


Anaemia responds to folic acid

Anaemia shows no response to Vitamin B12

Anaemia (macrocytic)

Raised MCV (usually)


Neuropathy (sometimes)

Serum folate normal

Anaemia responds to folic acid and B1

Neuropathy responds to Vitamin B12

The following guideline must be used when requesting a haematinic profile:

FBC and red cell indices should be checked prior to requesting haematinics.

Patients with neurological symptoms

Previous gastric or bowel problems

Extensive inflammatory bowel disease

In the case of ferritin, signs & symptoms of haemochromatosis or family history of same

propriate red cell indices for haematinic requesting would include:

Low Hb, normal MCV and high RDW

Low Hb, low MCV and low MCH

It is imperative that full clinical details are written on the request form. Feel free to discuss any


Vitamin B12 and folate levels should not be repeated within a 3-month interval. Ferritin levels should not

last testing.



FBC report with no requirement for a haematinic profile.


to be inappropriately used and future improvements in the service will be made a lot

8 mL Serum


official policy of requesting serum ThCG. He has advised that serum ThCG should only be requested for the




Vitamin B12 Deficiency


Anaemia responds to folic acid and B12

Neuropathy responds to Vitamin B12

FBC and red cell indices should be checked prior to requesting haematinics. With the following

or family history of same

Feel free to discuss any


month interval. Ferritin levels should not




to be inappropriately used and future improvements in the service will be made a lot more difficult.


nly be requested for the


PATHOLOGY




Selection of Hormone Tests for Common Clinical Problems

Guideline 5: Female Infertility with Regular Cycles

Request: Luteal phase progesterone

The progesterone peak, which occurs between days 18 and 24, gives an indication of ovulation. This is

sometimes called ‘Day 21 progesterone’ but in fact the progesterone peak occurs about 7 days before the

onset of menses. Therefore progesterone should be measured on day 24 for a 31 day cycle or day 18 for a

25 day cycle.

Guideline 7: Amenorrhoea/Oligomenorrhoea

Request: LH, FSH and Prolactin

The sample should be taken in the early follicular phase (Day 1

Polycystic Ovarian Syndrome (PCOS)

Request: LH & FSH

In PCOS, the LH is sometimes raised relative to normal or low normal FSH. The LH is also raised at mid

peak; therefore if LMP is unknown, a raised LH should be checked two weeks from the date of the first

specimen. Interpretation should be made in co

Guideline 8: Galactorrhoea

Request: Prolactin

Thyroid function should also be requested as hypothyroidism is occasionally a cause of

hyperprolactinaemia. Macroprolactin will be measured in samples with a value of

Guideline 9: Assessment of Menopausal Status

Request: FSH & Oestradiol only

Due to the highly unpredictable nature of the perimenopausal era, endocrine investigations are not

recommended as they only offer a snapshot interpretation. FSH is the more sensitive indicator of declining

ovarian function. The menopause can only be identi

Please state if the patient is on HRT or taking oral contraceptives.

Guideline 10: Male Infertility

Request: LH, FSH, Prolactin, Ferritin & Testosterone

Guideline 11: Monitoring Hormone Replacement

Patients with implants: Request oestradiol

This should be measured 2 weeks prior to insertion of a new implant to ensure that levels are not high as

there is risk of tolerance to the dose.

Patients on oral HRT: Hormone measurements are difficult

and routine measurement of FSH or oestradiol is not indicated. However, if symptoms persist at the

maximum recommended dose then measurement of

absorption problems.

Relevant clinical details, especially the date of the last menstrual cycle, are crucial to deriving maximum

benefit from such protocols. In the event of no clinical details or of mass ordering, the following protocol

will apply:

• Patient aged <45 years: FSH & Prolactin

• Patient aged >45 years: FSH





Selection of Hormone Tests for Common Clinical Problems:

Guideline 5: Female Infertility with Regular Cycles

phase progesterone



gesterone should be measured on day 24 for a 31 day cycle or day 18 for a

Guideline 7: Amenorrhoea/Oligomenorrhoea

The sample should be taken in the early follicular phase (Day 1-7).

Syndrome (PCOS)

In PCOS, the LH is sometimes raised relative to normal or low normal FSH. The LH is also raised at mid


specimen. Interpretation should be made in conjunction with the clinical presentation.


hyperprolactinaemia. Macroprolactin will be measured in samples with a value of >700 mIU/L.

Guideline 9: Assessment of Menopausal Status



ovarian function. The menopause can only be identified with certainty at least one year after the event.

Please state if the patient is on HRT or taking oral contraceptives.

: LH, FSH, Prolactin, Ferritin & Testosterone

Guideline 11: Monitoring Hormone Replacement Therapy

: Request oestradiol


there is risk of tolerance to the dose.

: Hormone measurements are difficult to interpret in patients receiving oral oestrogen


maximum recommended dose then measurement of FSH and oestradiol may identify possible GI tract



5 years: FSH & Prolactin

45 years: FSH & Oestradiol will be assayed





gesterone should be measured on day 24 for a 31 day cycle or day 18 for a

In PCOS, the LH is sometimes raised relative to normal or low normal FSH. The LH is also raised at mid-cycle


njunction with the clinical presentation.


>700 mIU/L.



fied with certainty at least one year after the event.


to interpret in patients receiving oral oestrogen


may identify possible GI tract



PATHOLOGY




14.5.4 Cortisol Sample Required: 8 mL Serum

Guideline 12

Random cortisol samples will no longer be analysed except in acutely ill patients with suspected adrenal

insufficiency. A midnight or 9am sample is recommended initially to check the circadian rhythm. If adrenal

insufficiency or Cushings Syndrome is suspec

Dexamethasone Overnight Suppression Test

This is to diagnose Cushing’s syndrome/disease. Investigation of Cushing’s syndrome is only recommended

if there is a high degree of clinical suspicion. The overnight suppression test

for outpatient and GP patients.

1. 1mg dexamethasone is given orally at 11pm.

2. A blood sample is taken a 9am for cortisol measurement.

Result is normal if cortisol is suppressed to

False positive results may be caused by:

• Depressive illness

• Alcoholism & obesity

• Drugs – Phenytoin, Phenobarbitone, Carbamazepine & Rifampicin

• Oestrogen containing drugs

• Stress

Synacthen Test

This is a screening test for adrenal insufficiency. Preferably the test should start at 9am. Please labels

bottles with specific times.

1. At 9am, take blood samples for Cortisol (serum sample) and ACTH (EDTA on ice). ACTH must be

sent to the lab immediately for

2. Inject 250 μg of Synacthen IM ideally (or IV).

3. Take another blood sample at 30 minutes for cortisol.

If baseline is >450 nmol/L, it is unlikely to be adrenal insufficiency.

Normal results:

Serum cortisol after Synacthen (assuming test done at 9am):

• Increment of >200 nmol/L from baseline OR

• Peak of >600 nmol/L

Primary adrenal insufficiency:

Impaired cortisol response and ACTH >200 ng/L

Secondary adrenal insufficiency:

Impaired cortisol response and ACTH

14.5.5 PSA Sample Required: 8 mL Serum

Guideline 13

• Elevated levels are found in benign prostatic hypertrophy (BPH) and prostatitis. Therefore repeat

after one month if there is any evidence of infection.

• Elevated levels are also found in





8 mL Serum



insufficiency or Cushings Syndrome is suspected, seek specialist advice.

Dexamethasone Overnight Suppression Test


if there is a high degree of clinical suspicion. The overnight suppression test is a convenient screening test

1mg dexamethasone is given orally at 11pm.

A blood sample is taken a 9am for cortisol measurement.

Result is normal if cortisol is suppressed to < 50 nmol/L.

caused by:

Phenytoin, Phenobarbitone, Carbamazepine & Rifampicin

Oestrogen containing drugs

is a screening test for adrenal insufficiency. Preferably the test should start at 9am. Please labels

At 9am, take blood samples for Cortisol (serum sample) and ACTH (EDTA on ice). ACTH must be

sent to the lab immediately for separation and freezing.

g of Synacthen IM ideally (or IV).

Take another blood sample at 30 minutes for cortisol.

If baseline is >450 nmol/L, it is unlikely to be adrenal insufficiency.

cortisol after Synacthen (assuming test done at 9am):

nmol/L from baseline OR

Impaired cortisol response and ACTH >200 ng/L

Impaired cortisol response and ACTH <10 ng/L

8 mL Serum

Elevated levels are found in benign prostatic hypertrophy (BPH) and prostatitis. Therefore repeat

after one month if there is any evidence of infection.

found in primary and metastatic prostatic carcinoma.






is a convenient screening test

is a screening test for adrenal insufficiency. Preferably the test should start at 9am. Please labels

At 9am, take blood samples for Cortisol (serum sample) and ACTH (EDTA on ice). ACTH must be

Elevated levels are found in benign prostatic hypertrophy (BPH) and prostatitis. Therefore repeat

carcinoma.

PATHOLOGY




• PSA should fall with a half-

suppresses prostate activity.

• BPH: Please state in clinical details when treated with f

testosterone to di-hydroxytestosterone

• UTIs, insertion of catheters and digital rectal examination may result in a transient increase in PSA

levels.

14.5.6 Testosterone Sample Required: 8 mL Serum

Guideline 14

Purpose of the test is to investigate:

• Delayed or precocious puberty

• Decreased sex drive

• Erectile dysfunction

• Infertility

• Testicular tumours

• Hypothalamus or pituitary disorders

What a high result may indicate:

• Testicular tumours

• Adrenal tumours that are producing testosterone

• Use of anabolic steroids

• Early puberty of unknown cause in boys

• Hyperthyroidism

• Congenital adrenal hyperplasia

What a low result may indicate:

• Hypothalamic or pituitary disease

• Genetic diseases such as Klei

• Testicular failure and infertility as in myotonic dystrophy

• Impaired testosterone production because of acquired damage to the testes

It should also be noted that alcohol and liver disease in males can decrease

as androgens and steroids can decrease testosterone levels also. Prostatic cancer responds to androgens,

therefore many men with advanced prostate cancer receive drugs that lower testosterone levels. In

addition, drugs such as anticonvulsants, barbiturates and clomiphene can cause testosterone levels to rise.

14.5.7 Digoxin Sample Required: 8 mL Serum

Guideline 15

Oral administration: Peak concentration following oral therapy usually reached in 60

administration of dose.

Toxic Effects:

• Cardiac: atrial fibrillation

• Gastrointestinal: anorexia, nausea, diarrhoea

• Neurological: headache, fatigue, colour vision





PSA should fall with a half-life of 2.2 days after radical prostatectomy and when treatment fully

suppresses prostate activity.

BPH: Please state in clinical details when treated with finasteride as this blocks the conversion of

testosterone and halves the PSA levels.

UTIs, insertion of catheters and digital rectal examination may result in a transient increase in PSA

mL Serum

:

Delayed or precocious puberty

Hypothalamus or pituitary disorders

Adrenal tumours that are producing testosterone

Early puberty of unknown cause in boys

Congenital adrenal hyperplasia

Hypothalamic or pituitary disease

Genetic diseases such as Kleinfelter’s, Kallman’s or Prader-Willi Syndrome

Testicular failure and infertility as in myotonic dystrophy

Impaired testosterone production because of acquired damage to the testes

It should also be noted that alcohol and liver disease in males can decrease testosterone levels. Drugs such



as anticonvulsants, barbiturates and clomiphene can cause testosterone levels to rise.

8 mL Serum

Oral administration: Peak concentration following oral therapy usually reached in 60

Gastrointestinal: anorexia, nausea, diarrhoea

Neurological: headache, fatigue, colour vision



life of 2.2 days after radical prostatectomy and when treatment fully

inasteride as this blocks the conversion of

UTIs, insertion of catheters and digital rectal examination may result in a transient increase in PSA

Impaired testosterone production because of acquired damage to the testes

testosterone levels. Drugs such



as anticonvulsants, barbiturates and clomiphene can cause testosterone levels to rise.

Oral administration: Peak concentration following oral therapy usually reached in 60-90 minutes after

PATHOLOGY




14.5.8 HbA1c Sample Required: 2.5 mL EDTA

Guideline 16

HbA1c is a measure of the average plasma glucose over the preceding 8

as a diagnostic test for diabetes but this may cha

HbA1c measurement intervals should not be less than 3

IFCC aligned in MRH, Mullingar.

14.5.9 Haemochromatosis Genetic Testing (HFE)Sample Required: 2.5 mL EDTA

Reference Ranges: Normal/Hete

(See each individual report for interpretative comments)

Hereditary Haemochromatosis is associated in most patients with mutations of HFE gene, C282Y and H63D.

Guideline 17

These criteria are in keeping with accepted guidelines which were published in 2006 by the National Centre

for Medical Genetics, Our Lady’s Children’s Hospital, Crumlin. Only samples which demonstrate the

following criteria will be considered for HFE testi

• Fasting transferrin saturation levels

• Positive spouse or first degree relative

All test requests for Haemochromatosis testing should include an EDTA sample for HFE genotyping and a

FASTING serum sample for the transferrin saturation test. These

appropriate request form (FORM-M/M/32

form information.

A fasting serum sample is required for % transferrin to exclude a false high result.

Special requests for HFE testing based on high serum ferritin with a normal transferrin saturation level may

be discussed with Dr Perera, Consultant Haematologist for further consideration. Information regarding

such correspondence must be included in the clinical deta

14.5.10 Vitamin D

Sample Required: 8 mL Serum

Only accepted from GPs Monday –

Guideline 18

Although not always required, measurement of serum parathyroid hormone (PTH) level may help establish

the diagnosis of vitamin D insufficiency

insufficiency, indicating secondary hyperparathyroidism

Screening for vitamin D deficiency is recommended only in those individuals who are at high risk, including

the following:

• Patients with osteoporosis

• Patients with malabsorption syndrome

• Black and Hispanic individuals

• Obese persons (Body mass index





EDTA

HbA1c is a measure of the average plasma glucose over the preceding 8-12 weeks. At present, it is not used

as a diagnostic test for diabetes but this may change in the future.

HbA1c measurement intervals should not be less than 3-monthly except in gestational diabetes. HbA1c is

Haemochromatosis Genetic Testing (HFE) EDTA

Heterozygous/Homozygous

(See each individual report for interpretative comments)




following criteria will be considered for HFE testing:

Fasting transferrin saturation levels ≥45%

Positive spouse or first degree relative


FASTING serum sample for the transferrin saturation test. These must be submitted along with the

M/M/32) which incorporates patient consent. See Section 6.2 for request

A fasting serum sample is required for % transferrin to exclude a false high result.

sts for HFE testing based on high serum ferritin with a normal transferrin saturation level may


such correspondence must be included in the clinical details when requesting the Haemochromatosis test.

8 mL Serum

Thursday


of vitamin D insufficiency. PTH levels are often elevated in patients with vitamin D

insufficiency, indicating secondary hyperparathyroidism.


Patients with malabsorption syndrome

Black and Hispanic individuals

Obese persons (Body mass index > 30kg/m2)



12 weeks. At present, it is not used

monthly except in gestational diabetes. HbA1c is





must be submitted along with the

) which incorporates patient consent. See Section 6.2 for request

sts for HFE testing based on high serum ferritin with a normal transferrin saturation level may


ils when requesting the Haemochromatosis test.


. PTH levels are often elevated in patients with vitamin D


PATHOLOGY




• Patients with disorders that affect the metabolism of vitamin D and phosphate (e.g. chronic kidney

disease)

14.5.11 Parathyroid Hormone (PTH)Sample Required: 8 mL Serum

Only accepted from GPs Monday –

Guideline 18

Please note exceptionally high level of biotin may cause interference in the PTH method. These may be

found in nutritional supplements such as those promoted for skin, hair and nail health and in end

renal disease patients taking multiple daily cours

falsely low PTH results. All PTH results should be interpreted with a serum calcium value in the context of

patient clinical status. The patient should be assessed with other markers such as phosphoro

and alkaline phosphatase.

References

• Demers L et al (2006). Laboratory Support for the Diagnosis and Monitoring of Thyroid Disease.

• McIntosh A et al (2002). Guidelines for Type 2 Diabetes.

• Newell-Price J et al (1998). The Diagnosis and Diff

Pseudo Cushing’s States. Endocrinology Reviews 19(5): 647

• Marshall W (2000). Clinical Chemistry, 4

• Ashwood ER (2001). Tietz Fundamentals of Clinical Chemistry, 5

• King C et al (2006). Best Practice Guidelines for the Molecular Genetic Diagnosis of Type 1 (HFE

related) Hereditary Haemochromatosis. BMC Medical Genetics, 7, 81: 2006.





Patients with disorders that affect the metabolism of vitamin D and phosphate (e.g. chronic kidney

Parathyroid Hormone (PTH) 8 mL Serum

Thursday


found in nutritional supplements such as those promoted for skin, hair and nail health and in end

renal disease patients taking multiple daily courses of biotin supplementation. This may impact in giving


patient clinical status. The patient should be assessed with other markers such as phosphoro

(2006). Laboratory Support for the Diagnosis and Monitoring of Thyroid Disease.

(2002). Guidelines for Type 2 Diabetes.

(1998). The Diagnosis and Differential Diagnosis of Cushing’s Syndrome and

Pseudo Cushing’s States. Endocrinology Reviews 19(5): 647-672.

Marshall W (2000). Clinical Chemistry, 4th

Edition.

Ashwood ER (2001). Tietz Fundamentals of Clinical Chemistry, 5th

Edition.

Best Practice Guidelines for the Molecular Genetic Diagnosis of Type 1 (HFE




Patients with disorders that affect the metabolism of vitamin D and phosphate (e.g. chronic kidney


found in nutritional supplements such as those promoted for skin, hair and nail health and in end-stage

es of biotin supplementation. This may impact in giving


patient clinical status. The patient should be assessed with other markers such as phosphorous, magnesium

(2006). Laboratory Support for the Diagnosis and Monitoring of Thyroid Disease.

erential Diagnosis of Cushing’s Syndrome and

Best Practice Guidelines for the Molecular Genetic Diagnosis of Type 1 (HFE –


PATHOLOGY




15 IMMUNOLOGY The Immunology department investigates the boy’s immune response to disease e.g. specialised protein

investigation, serum protein electrophoresis, coeliac disease, allergy testing and autoimmune disease

investigations.

The Immunology department provide a regional service to MRH Mullingar, Tullamore and Portlaoise and all

GPs and nursing homes in the Longford/Westmeath/Laois/Offaly area. For SPE, Protein and Albumin are

processed by the referring laboratory i.e. MRH Tulla

Immunology report for interpretation of the SPE results. The reference ranges for these tests should be

taken from the relevant Chemistry report.


Title Name

Chief Medical Scientist Ms. Norma Mullen

Senior Medical

Scientist

Ms. Martina Collins

Clinical Advisory

Service

Prof. Conleth Feighery

Dr. Kanthi Perera

(Electrophoresis)

Dr. Gerard Crotty

(Electrophoresis)

15.2 Allergy Testing Allergic disorders usually have a very clear cut manner of presentation. The aeroallergens typically result in

conjunctivitis and rhinitis. Food allergy can affect many different organ systems and may result in

symptoms affecting a combination of the oral

cardiovascular system. Food allergy is quite rare, affecting approximately 2% of the adult UK population

and only 6–8 % of children have a proven food allergy

the case of food allergy, a rapid reaction with typical symptoms is most common. Suspecting allergy as the

cause of a diverse range of symptoms can lead to excessive investigations and over

particularly the case with atypical symptoms such as fatigue, constipation etc. which are very unlikely to be

caused by allergy. Failure to recognise symptoms as unlikely to be caused by allergy can result in

unnecessary and costly investigations, medications, and referrals

Allergic reactions are initiated by binding of the patient’s Immunoglobulin E (IgE) to the specific allergen

which leads to rapid onset of symptoms. The majority of these IgE mediated reactions occur within 30

minutes of exposure to the allergen and many occur

caused by organic substances (proteins) and only proteins can cause true allergic reactions.

The most important part of the initial assessment of a patient, suspected of having allergic disease, is a

thorough clinical history. From the history alone, the likely allergen(s) can often be identified and should

help determine whether the mechanism of the reaction is likely to be IgE

Please refer to NICE guidelines below

identify which allergen, if any, is causing the patient’s problem.





The Immunology department investigates the boy’s immune response to disease e.g. specialised protein




processed by the referring laboratory i.e. MRH Tullamore or MRH Portlaoise. The results are included in the


taken from the relevant Chemistry report.

Contact Details for Key Members of Staff


Ms. Norma Mullen 044-9394339 [email protected]

Ms. Martina Collins 044-9394339 [email protected]

Prof. Conleth Feighery 087-9969041 [email protected]

Dr. Kanthi Perera

(Electrophoresis)

057-9358276

Contactable on mobile via

MRH Tullamore

057-9321501

[email protected]

Dr. Gerard Crotty

(Electrophoresis)

057-9358352


MRH Tullamore

057-9321501

[email protected]

Allergic disorders usually have a very clear cut manner of presentation. The aeroallergens typically result in


symptoms affecting a combination of the oral cavity, airways, lungs, gastrointestinal tract, skin and


dren have a proven food allergy1. Skin symptoms typically result in hive


cause of a diverse range of symptoms can lead to excessive investigations and over

atypical symptoms such as fatigue, constipation etc. which are very unlikely to be


unnecessary and costly investigations, medications, and referrals2.

gic reactions are initiated by binding of the patient’s Immunoglobulin E (IgE) to the specific allergen


minutes of exposure to the allergen and many occur even more rapidly than this. Allergic reactions are



rough clinical history. From the history alone, the likely allergen(s) can often be identified and should

help determine whether the mechanism of the reaction is likely to be IgE-mediated or no

below on how to perform an allergy focused patient history, which will likely

identify which allergen, if any, is causing the patient’s problem.



The Immunology department investigates the boy’s immune response to disease e.g. specialised protein




more or MRH Portlaoise. The results are included in the


Email

[email protected]

[email protected]

[email protected]

[email protected]

[email protected]

Allergic disorders usually have a very clear cut manner of presentation. The aeroallergens typically result in


cavity, airways, lungs, gastrointestinal tract, skin and


. Skin symptoms typically result in hives or wheals. In


cause of a diverse range of symptoms can lead to excessive investigations and over-diagnosis. This is

atypical symptoms such as fatigue, constipation etc. which are very unlikely to be


gic reactions are initiated by binding of the patient’s Immunoglobulin E (IgE) to the specific allergen


even more rapidly than this. Allergic reactions are



rough clinical history. From the history alone, the likely allergen(s) can often be identified and should

mediated or non-IgE-mediated.

perform an allergy focused patient history, which will likely

PATHOLOGY




IgE levels can show marked variation between healthy individuals, and may increase several hundred or

thousand-fold in response to certain stimuli. However, some individuals who don’t have clinical allergy may

have IgE levels in the hundreds or even thousands. Levels of several thousand can be seen in patients with

eczema and/or asthma, even in the absence of clinical allergy, a

initial condition has been outgrown. Therefore a raised total Ig

symptoms of allergy present.

The interpretation of specific IgE results depends on a number of factors and shoul

in light of the clinical presentation. Thus, the panel of available tests can only be correctly chosen in the

laboratory when the history is made available. It is also important to remember that a raised specific IgE

reveals “sensitisation” and is not confirmatory evidence that an allergen is causing a clinical disorder.

The NICE guidelines state that clinicians should only think about testing by skin prick testing or specific IgE

tests when you have a patient with a history of an I

and specific than specific IgE tests –

available, it is also speedier and less expensive!

Challenge is the ultimate investigation in food and drug allergy investigations. Clearly this is only available

in clinical centres, but is necessary if possibly lifelong decisions are to be taken about allergen avoidance.

The optimal use of resources for the diagnosis of allergy dep

between requesting clinicians and the Immunology Dept. It is impossible to know which tests to perform

when ‘allergy screen’, ‘RAST’ or ‘allergy testing please’ are the only pieces of information on the request

form. Likewise, an extensive list of allergen tests, not based on an accurate allergy focused history is not

ideal.

From 1st May, specific IgE testing is only

clinical history. If this is not given, only total IgE will be measured, with a comment requesting the clinician

to contact Immunology if specific allergen tests are required. The sample will be stored for 7 days to allow

for this further testing.

See below for allergens associated with partic

tests will only be performed if other relevant clinical details are included.

Perennial allergic rhinitis panel: total IgE, house dust mite, mixed moulds, cat and dog dander.

Asthma panel: total IgE, house dust mite, mixed moulds, cat and dog dander.

Seasonal allergic rhinitis panel: total IgE, mixed grass, mixed trees

Eczema panel: total IgE, house dust mite, milk, egg white

Food allergy panel: total IgE, wheat, soya bean, milk, egg

95% predicative values have been published (by Phadia) as follows:

Allergen Eggs

Predicative

Value

6 kU/L

Values greater than or equal to these levels should be taken as conclusive of allergy.






se to certain stimuli. However, some individuals who don’t have clinical allergy may


eczema and/or asthma, even in the absence of clinical allergy, and high levels can persist even when the

initial condition has been outgrown. Therefore a raised total IgE can be seen even when there are

The interpretation of specific IgE results depends on a number of factors and shoul



isation” and is not confirmatory evidence that an allergen is causing a clinical disorder.


tests when you have a patient with a history of an IgE mediated reaction. Skin prick testing is more sensitive

– but is essentially providing similar information to the blood test. If it is

available, it is also speedier and less expensive!

vestigation in food and drug allergy investigations. Clearly this is only available


The optimal use of resources for the diagnosis of allergy depends upon an appropriate partnership



ikewise, an extensive list of allergen tests, not based on an accurate allergy focused history is not

is only carried out on patient samples when accompanied by a relevant

only total IgE will be measured, with a comment requesting the clinician


See below for allergens associated with particular conditions. If allergens outside these lists are requested,

tests will only be performed if other relevant clinical details are included.

: total IgE, house dust mite, mixed moulds, cat and dog dander.


: total IgE, mixed grass, mixed trees

: total IgE, house dust mite, milk, egg white

: total IgE, wheat, soya bean, milk, egg white, cod

95% predicative values have been published (by Phadia) as follows:

Eggs Milk Peanut

6 kU/L 32 kU/L 15 kU/L





se to certain stimuli. However, some individuals who don’t have clinical allergy may


nd high levels can persist even when the

E can be seen even when there are no

The interpretation of specific IgE results depends on a number of factors and should always be interpreted



isation” and is not confirmatory evidence that an allergen is causing a clinical disorder.


gE mediated reaction. Skin prick testing is more sensitive

but is essentially providing similar information to the blood test. If it is

vestigation in food and drug allergy investigations. Clearly this is only available


ends upon an appropriate partnership



ikewise, an extensive list of allergen tests, not based on an accurate allergy focused history is not

carried out on patient samples when accompanied by a relevant

only total IgE will be measured, with a comment requesting the clinician


ular conditions. If allergens outside these lists are requested,


Fish (Cod)

20kU/L


PATHOLOGY




The following are the allergen panels available:

Panel

Food Egg White, Milk, Fish, Peanut, Wheat, Soya Bean

Nut Peanut*, Hazelnut, Brazil

Seafood Fish (Cod), Shrimp, Blue Mussel, Tuna, Salmon

Fruit Orange, Apple, Banana, Peach

Individual Foods Egg White, Milk, Fish, Peanut, Wheat, Soya Bean, Hazelnut, Brazil Nut, Almond,

Coconut, Shrimp, Blue Mussel, Tuna, Salmon

Animal Danders Cat, Dog, Horse, Cow

Individual Danders Cat, Dog, Horse, Cow

Moulds Penicillium notatum, Cladosporium herbarum, Aspergillus fumigates, Alternaria

alternata

Individual Moulds Penicillium notatum, Cladosporium herbarum, Aspergillus

alternata

Grasses Timothy, Cultivated Rye, Sweet Vernal Grass, Rye, Velvet grasses

Tree Pollen Box-elder, Hazel, London Plane, Oak, Silver Birch

House Dust Mite D. Pternonyssinus

Penicillin V

Penicillin G

For GPs, component testing (Ara h 2) for peanut positive results will only be carried out on results 3.0

kUA/L. Results <3.0 kUA/L suggest low level sensitisation to peanut, but if there is a clinical history

suggesting peanut allergy, please contact I

>5.0 kUA/L suggests strong sensitisation to peanut; thus peanuts should be avoided if there is a clinical

history suggesting peanut allergy, and referral to an allergist is recommended. Ara h 2 t

out on all peanut positive results requested by Paediatric Consultants.

For all positive specific IgE results, please interpret in context of the clinical history.

High total IgE levels can result in low level positivity (up to 3

the case when the total IgE is more than 1000 kU/L. Please interpret in context of the clinical history.

The food allergen panel is particularly of use in children <

value in children >3 years.

Useful Websites for Allergy Information

• Irish Food Allergy Network –

• Allergy Education – www.allergyeducation.co.uk

Guidelines for Allergy Testing

The NICE guideline recommends that allergy diagnosis should be based on a combination of good history

and appropriate testing. The following questions

whether you are dealing with a case of suspected food allergy and, if so, whether the reaction is likely to be

IgE-mediated or not. These are an example of how to take an allergy history (taken from

www.allergyeducation.co.uk):

1. Is there a personal or family history of allergic problems?

• E.g. eczema, asthma, hay fever or food allergy.

• If a family history of allergy exists, it is more likely the underlying





The following are the allergen panels available:

Allergens Included

Egg White, Milk, Fish, Peanut, Wheat, Soya Bean

Peanut*, Hazelnut, Brazil Nut, Almond, Coconut

Fish (Cod), Shrimp, Blue Mussel, Tuna, Salmon

Orange, Apple, Banana, Peach

Egg White, Milk, Fish, Peanut, Wheat, Soya Bean, Hazelnut, Brazil Nut, Almond,

Coconut, Shrimp, Blue Mussel, Tuna, Salmon

Cat, Dog, Horse, Cow

Cat, Dog, Horse, Cow

Penicillium notatum, Cladosporium herbarum, Aspergillus fumigates, Alternaria

Penicillium notatum, Cladosporium herbarum, Aspergillus

Timothy, Cultivated Rye, Sweet Vernal Grass, Rye, Velvet grasses

elder, Hazel, London Plane, Oak, Silver Birch

D. Pternonyssinus

For GPs, component testing (Ara h 2) for peanut positive results will only be carried out on results 3.0

suggest low level sensitisation to peanut, but if there is a clinical history

suggesting peanut allergy, please contact Immunology and further testing may then be performed. Results

suggests strong sensitisation to peanut; thus peanuts should be avoided if there is a clinical

history suggesting peanut allergy, and referral to an allergist is recommended. Ara h 2 t

out on all peanut positive results requested by Paediatric Consultants.

For all positive specific IgE results, please interpret in context of the clinical history.

High total IgE levels can result in low level positivity (up to 3.5 kUA/L) in specific IgE tests. This is particularly


The food allergen panel is particularly of use in children <3 years, while the inhalant panel is principally of

Useful Websites for Allergy Information (Both for Clinician and Patient)

– www.ifan.ie

www.allergyeducation.co.uk

guideline recommends that allergy diagnosis should be based on a combination of good history

and appropriate testing. The following questions can form the basis of a patient history and indicate


mediated or not. These are an example of how to take an allergy history (taken from

Is there a personal or family history of allergic problems?

E.g. eczema, asthma, hay fever or food allergy.

If a family history of allergy exists, it is more likely the underlying symptoms may be allergic



Egg White, Milk, Fish, Peanut, Wheat, Soya Bean, Hazelnut, Brazil Nut, Almond,



Timothy, Cultivated Rye, Sweet Vernal Grass, Rye, Velvet grasses

For GPs, component testing (Ara h 2) for peanut positive results will only be carried out on results 3.0-5.0

suggest low level sensitisation to peanut, but if there is a clinical history

mmunology and further testing may then be performed. Results

suggests strong sensitisation to peanut; thus peanuts should be avoided if there is a clinical

history suggesting peanut allergy, and referral to an allergist is recommended. Ara h 2 testing will be carried

) in specific IgE tests. This is particularly


3 years, while the inhalant panel is principally of

guideline recommends that allergy diagnosis should be based on a combination of good history

can form the basis of a patient history and indicate


mediated or not. These are an example of how to take an allergy history (taken from

symptoms may be allergic

PATHOLOGY




2. Is there a personal history of eczema? What was the age of onset and level of severity?

• There is a close association between how early eczema begins in life, how severe it is and

the likelihood of IgE

3. What was the age/situation of onset?

• Most food allergy develops early in infancy.

• Consider when symptoms start in relation to a change in diet e.g. move to cow’s milk from

formula.

4. What food(s) are causing concern?

• The majority of IgE reactions are caused by cow’s m

shellfish, soya, wheat, kiwi and sesame.

• Non-IgE reactions are more likely linked to milk and less so with egg.

5. What symptoms are triggered?

• In IgE-mediated allergy look for cutaneous symptoms such as urticaria, angio

itchiness, GI symptoms such as oral pruritus, vomiting or diarrhoea

• Involvement of the respiratory system and less commonly the cardiovascular system

indicates anaphylaxis.

• In non-IgE-mediated reactions look for persistent symptoms involving mai

GI system such as eczema, gastro

faltering growth plus one or more GI symptom especially those symptoms that do not

respond to first-line treatment.

6. What is the time between exposure

• IgE-mediated reactions are more acute in onset and rapidly progressive

• Non-IgE-mediated reactions are more likely to cause chronic symptoms

7. What quantity of food is needed to trigger a reaction?

• With IgE-mediated reactions, very

reaction.

• With non-IgE-mediated reactions, larger quantities may be needed.

Following the clinical history and physical examination, if you suspect:

• Non-IgE-mediated allergy, consider consulting a diet

• IgE-mediated allergy, consider conducting a diagnostic test such as a Specific IgE blood test.

Just eight food allergens are responsible for 90% of allergic reactions:

Figure 15.1: Eight Most Common Food Allerge

Image from http://www.slu.edu/blogs/healthinsitiutestl/files/2014/08/Causes





Is there a personal history of eczema? What was the age of onset and level of severity?

There is a close association between how early eczema begins in life, how severe it is and

the likelihood of IgE-mediated allergy.

he age/situation of onset?

Most food allergy develops early in infancy.

Consider when symptoms start in relation to a change in diet e.g. move to cow’s milk from

What food(s) are causing concern?

The majority of IgE reactions are caused by cow’s milk, eggs, peanuts, tree nuts, fish,

shellfish, soya, wheat, kiwi and sesame.

IgE reactions are more likely linked to milk and less so with egg.

What symptoms are triggered?

mediated allergy look for cutaneous symptoms such as urticaria, angio

itchiness, GI symptoms such as oral pruritus, vomiting or diarrhoea.

Involvement of the respiratory system and less commonly the cardiovascular system

indicates anaphylaxis.

mediated reactions look for persistent symptoms involving mai

GI system such as eczema, gastro-oesophageal reflux, loose stools, pallor and tiredness,


line treatment.

What is the time between exposure and the onset of symptoms?

mediated reactions are more acute in onset and rapidly progressive

mediated reactions are more likely to cause chronic symptoms

What quantity of food is needed to trigger a reaction?

mediated reactions, very small amounts of exposure can be enough to trigger a

mediated reactions, larger quantities may be needed.

Following the clinical history and physical examination, if you suspect:

mediated allergy, consider consulting a dietician with the appropriate competencies.

mediated allergy, consider conducting a diagnostic test such as a Specific IgE blood test.

Just eight food allergens are responsible for 90% of allergic reactions:

: Eight Most Common Food Allergens

http://www.slu.edu/blogs/healthinsitiutestl/files/2014/08/Causes-of-food



Is there a personal history of eczema? What was the age of onset and level of severity?

There is a close association between how early eczema begins in life, how severe it is and

Consider when symptoms start in relation to a change in diet e.g. move to cow’s milk from

ilk, eggs, peanuts, tree nuts, fish,

IgE reactions are more likely linked to milk and less so with egg.

mediated allergy look for cutaneous symptoms such as urticaria, angiodema and

.

Involvement of the respiratory system and less commonly the cardiovascular system

mediated reactions look for persistent symptoms involving mainly the skin and

oesophageal reflux, loose stools, pallor and tiredness,


mediated reactions are more acute in onset and rapidly progressive

mediated reactions are more likely to cause chronic symptoms

small amounts of exposure can be enough to trigger a

mediated reactions, larger quantities may be needed.

ician with the appropriate competencies.

mediated allergy, consider conducting a diagnostic test such as a Specific IgE blood test.

food-allergies.png

PATHOLOGY




15.3 Guidelines for Testing for TPO AntibodiesThyroid peroxidise (TPO) is an enzyme involved in thyroid hormone synthesis. TPO antibodies can be seen

in patients with both hypo- and hyperthyroidism and they are surprisingly common in patients without any

thyroid disease (10-15%). Therefore, detection

investigating patients with suspected autoimmune thyroid disease. Anti

complement and are thought to be significantly involved in thyroid dysfunction and the pathogenesis

hypothyroidism.

Appropriate reasons for measuring TPO antibodies:

• Hypothyroidism – low T4 with high TSH

• Thyrotoxicosis – high T4 with undetectable TSH

• Newly diagnosed patients with goitre, regardless of TFT

• As part of the work-up of patients with th

• Pregnant women with newly diagnosed thyroid hormone derangement

Measurement of TPO antibodies is not indicated:

• If the TFTs are normal and the patient does not have goitre

• Without knowledge of the TFTs

• If measured before and there has not been any marked change in symptoms

• In patients on thyroxine replacement

Interpretation

• The expected values in a normal population are <60

population may test positive for these antibodies.

• Antibodies are found in 95% of patients with Hashimoto’s thyroiditis and 60

Grave’s disease.

• If detected during pregnancy, it may indicate a risk of post

• May be found in patients with other autoimmune diseases including pernicious anaemia, Addison’s

disease and Sjögren’s syndrome and may predict future autoimmune hypothyroidism.

• If detected in asymptomatic individuals may be predictive of future hypothyroidism.

15.4 Notes for Immunology Tests

• SPE will not be carried out on patients that have had SPE done within the previous four weeks

unless specifically arranged with the Immunology department.

• Requests for Immunoglobulins will have SPE carried out if the results are

reference range. (Note: This will not apply if there has been an SPE done on the same patient

within the previous three months that did not show abnormal bands.)

• Positive anti-mitochondrial antibody samples will be forwarded for pyruvate

analysis if not done previously.

• Endomysial antibodies (EMA) will not be repeated on patients with previous positive tTG & EMA

/known coeliac patients – only tTG analysis will be done to monitor dietary compliance.

• ANA will not be repeated if done within the previous 6 months.

• As the substrate used for autoantibody testing included Anti

Muscle Antibodies, Anti-Mitochondrial Antibodies and Gastric Parietal Cell Antibodies, all four of

these results will be reported on all requests for autoantibodies or any combination of the

individual antibodies above.

• All adults are screened at titre 1:80 for the above antibodies while paediatrics (<18 years) are

screened at titre 1:20.





Guidelines for Testing for TPO Antibodies Thyroid peroxidise (TPO) is an enzyme involved in thyroid hormone synthesis. TPO antibodies can be seen

and hyperthyroidism and they are surprisingly common in patients without any

%). Therefore, detection and quantification of these antibodies is of limited value in

investigating patients with suspected autoimmune thyroid disease. Anti-TPO antibodies activate

complement and are thought to be significantly involved in thyroid dysfunction and the pathogenesis

Appropriate reasons for measuring TPO antibodies:

low T4 with high TSH

high T4 with undetectable TSH

Newly diagnosed patients with goitre, regardless of TFT

up of patients with thyroid cancer (Ann Clin Biochem 2003; 40: 435)

Pregnant women with newly diagnosed thyroid hormone derangement

Measurement of TPO antibodies is not indicated:

If the TFTs are normal and the patient does not have goitre

Without knowledge of the TFTs

measured before and there has not been any marked change in symptoms

In patients on thyroxine replacement

The expected values in a normal population are <60 IU/mL; however 10

population may test positive for these antibodies.

Antibodies are found in 95% of patients with Hashimoto’s thyroiditis and 60

If detected during pregnancy, it may indicate a risk of post-partum thyroiditis.

ound in patients with other autoimmune diseases including pernicious anaemia, Addison’s


If detected in asymptomatic individuals may be predictive of future hypothyroidism.

Notes for Immunology Tests

SPE will not be carried out on patients that have had SPE done within the previous four weeks

unless specifically arranged with the Immunology department.

Requests for Immunoglobulins will have SPE carried out if the results are


within the previous three months that did not show abnormal bands.)

mitochondrial antibody samples will be forwarded for pyruvate

analysis if not done previously.

Endomysial antibodies (EMA) will not be repeated on patients with previous positive tTG & EMA

only tTG analysis will be done to monitor dietary compliance.

eated if done within the previous 6 months.

As the substrate used for autoantibody testing included Anti-Nuclear Antibodies, Anti

Mitochondrial Antibodies and Gastric Parietal Cell Antibodies, all four of

be reported on all requests for autoantibodies or any combination of the

individual antibodies above.

All adults are screened at titre 1:80 for the above antibodies while paediatrics (<18 years) are



Thyroid peroxidise (TPO) is an enzyme involved in thyroid hormone synthesis. TPO antibodies can be seen

and hyperthyroidism and they are surprisingly common in patients without any

and quantification of these antibodies is of limited value in

TPO antibodies activate

complement and are thought to be significantly involved in thyroid dysfunction and the pathogenesis of

2003; 40: 435)

measured before and there has not been any marked change in symptoms

however 10-15% of the normal

Antibodies are found in 95% of patients with Hashimoto’s thyroiditis and 60-80% of patients with

partum thyroiditis.

ound in patients with other autoimmune diseases including pernicious anaemia, Addison’s


If detected in asymptomatic individuals may be predictive of future hypothyroidism.

SPE will not be carried out on patients that have had SPE done within the previous four weeks

Requests for Immunoglobulins will have SPE carried out if the results are outside the normal


mitochondrial antibody samples will be forwarded for pyruvate dehydrogenase (PDH)

Endomysial antibodies (EMA) will not be repeated on patients with previous positive tTG & EMA

only tTG analysis will be done to monitor dietary compliance.

Nuclear Antibodies, Anti-Smooth

Mitochondrial Antibodies and Gastric Parietal Cell Antibodies, all four of

be reported on all requests for autoantibodies or any combination of the

All adults are screened at titre 1:80 for the above antibodies while paediatrics (<18 years) are

PATHOLOGY




• All ANA positive paediatric

testing if not done within the previous 12 months.

• TPO (Thyroid peroxidase) analysis will not be repeated if done in the previous 12 months.

15.5 Turnaround Times for Immunology Testing

Analytes

IgG

IgA

IgM

Complement C3

Complement C4

Alpha-1 Antitrypsin

Ceruloplasmin

Haptoglobin

B2-Microglobulin

Urinary Electrophoresis

Serum Electrophoresis

Immunofixation

Anti-Nuclear Antibodies

Smooth Muscle Antibodies

Gastric Parietal Cell Antibodies

Mitochondrial Antibodies

DNA Antibodies*

Tissue Transglutaminase (tTG)**

IgA Endomysial Antibodies (EMA)

Total IgE

Specific IgE

Thyroid peroxidase (TPO)

The TAT for these tests is for when the result is not abnormal. The TAT will increase if further

testing/investigations are indicated.

* DNA testing is only carried out if the ANA is positive.

** EMA testing is only carried out on tTG results of >





All ANA positive paediatric patients and adults with a positive ANA of ≥1:320 will be sent for ENA

testing if not done within the previous 12 months.

TPO (Thyroid peroxidase) analysis will not be repeated if done in the previous 12 months.

Turnaround Times for Immunology Testing

TAT

(Working Days)

Frequency of Testing

2

2

2

2

2

2

2

2

2

9

3

3

3

3

3

3

3

7

5

10

10

9


testing/investigations are indicated.

DNA testing is only carried out if the ANA is positive.

EMA testing is only carried out on tTG results of >7.0 U/mL.



≥1:320 will be sent for ENA

TPO (Thyroid peroxidase) analysis will not be repeated if done in the previous 12 months.

Frequency of Testing

Daily

Daily

Daily

Daily

Daily

Daily

Daily

Daily

Daily

Weekly

Daily

Daily

Daily

Daily

Daily

Daily

Daily

Weekly

Weekly

Weekly

Weekly

Weekly


PATHOLOGY




16 HAEMATOLOGY The Haematology department performs a wide range of tests including coagulation studies. This

department provides a service to MRH Mullingar and all GPs and nursing homes in the

Longford/Westmeath area.

16.1 Contact Details for Key Me

Title Name

Chief Medical Scientist Ms. Barbara Halligan

Senior Medical

Scientist

Ms. Ciara Shanley

Consultant

Haematologists

Dr. Kanthi Perera

Dr. Gerard

16.2 Turnaround Times for Haematology TestingSamples labelled urgent, or samples from ICU, ED, SCBU, AMAU and EPU are

table indicates TAT for Haematology samples:

Urgent

Non-urgent (Ward)

Non-urgent (GP & OPD)

Non-urgent

16.3 Guidelines for Use of D-Dimers (DVT or PE)

This test may only be requested by Registrars or Consultants. The Wells score must be provided on the D

Dimer Request form. D-Dimer will only be done where the

A negative D-Dimer assay is only of use in patients with low pre

embolism. A negative result means that no further diagnostic testing is required. While the D

should only be requested if there is some suspicion of venous thromboembo

exclude venous thromboembolism, there is a need for further clinical investigations and confirmatory tests.





The Haematology department performs a wide range of tests including coagulation studies. This




Ms. Barbara Halligan 044-9394333 [email protected]

Ms. Ciara Shanley 044-9394333 [email protected]

Dr. Kanthi Perera 057-9358276


MRH Tullamore

057-9321501

[email protected]

Dr. Gerard Crotty 057-9358352


MRH Tullamore

057-9321501

[email protected]

Turnaround Times for Haematology Testing Samples labelled urgent, or samples from ICU, ED, SCBU, AMAU and EPU are given priority. The following

table indicates TAT for Haematology samples:

Test Turnaround Time

FBC 1 hour

Coagulation Tests 1 hour

ESR 1 hour

Sickle Cell Screen 1 hour

Malaria Screen 1 hour

Infectious mononucleosis 1 hour

Blood Films 1 hour

FBC Same day

ESR Same day

Coagulation Tests Same day

FBC 24 hours

ESR 24 hours

Coagulation Tests 24 hours

Infectious mononucleosis 48 hours

Blood Films 3 working days

Dimers (DVT or PE)

This test may only be requested by Registrars or Consultants. The Wells score must be provided on the D

Dimer will only be done where the Wells score is less than 2.

is only of use in patients with low pre-test probability of DVT or pulmonary

embolism. A negative result means that no further diagnostic testing is required. While the D

should only be requested if there is some suspicion of venous thromboembolism, if the test does not




The Haematology department performs a wide range of tests including coagulation studies. This


Email

[email protected]

[email protected]

[email protected]

[email protected]

given priority. The following

Turnaround Time

1 hour

1 hour

1 hour

1 hour

1 hour

1 hour

1 hour

Same day

Same day

Same day

24 hours

24 hours

24 hours

48 hours

3 working days

This test may only be requested by Registrars or Consultants. The Wells score must be provided on the D-

Wells score is less than 2.

test probability of DVT or pulmonary

embolism. A negative result means that no further diagnostic testing is required. While the D-Dimer test

lism, if the test does not


PATHOLOGY




The combination of a negative D-Dimer

0.4% chance of DVT over the next three months. Kearon et al reported a negative predictive value of 99.6 %

during a three month follow up. This means that one could be 99.6 % sure that no DVT would occur during

3 month follow-up.

Similarly for suspected pulmonary embolism,

yields a negative predictive value of 99.5% during a three month follow up.

Question 1: Have you a suspicion of venous thromboembolism? If not, there is no need for D

Clinical Model for predicting Pre-test Probability of DVT

1. Active cancer: Patient receiving treatment within 6 months or receiving palliative care (+1 point)

2. Paralysis or recent plaster immobilisation of lower limb(s) (+1 point)

3. Recently bedridden for 3 or

regional anaesthesia ( +1 point)

4. Localised tenderness along the distribution of the deep venous system (+1 point)

5. Entire leg swollen (+1 Point)

6. Calf swelling at least 3cms larger than asym

(+1 Point)

7. Pitting oedema confined to symptomatic leg (+1 point)

8. Collateral non-varicose superficial veins (+1 point)

9. Previous documented DVT (+1 point)

10. Alternative diagnosis at least as likely as DVT (

A score of less than 2 indicates a LOW

Clinical Model for predicting Pre-test probability of

1. Clinical signs of DVT (objectively measured leg swelling and pain with palpitat

region) (+3 Points)

2. Heart rate > 100/min (+1.5 points)

3. Immobilisation for 3 or more days or surgery in previous 4 weeks (+1.5 Points)

4. Past history of objectively diagnosed DVT or PE (+1.5 Points)

5. Haemoptysis (+1 Point)

6. Active cancer ( patient receiving treatment within 6 months or receiving palliative care) (+1 Point)

7. PE as likely or more likely than any alternative diagnosis (+3 Points)

A score of less than 2 indicates a LOW pre

Please Note: D-Dimer assay should be used with caution in the following clinical settings where unreliable

test results are likely to make the test of little use.

• Patients with active cancer

• Presence of severe sepsis

• Pregnancy

• Patients being treated with heparin……Contact

and any other points that are relevant.

If suspicion of DVT or Pulmonary embolism is judged to be of sufficient magnitude that testing for same will

be pursued in any event then there is no point in doing a

Above restrictions do not of course apply to coagulation disorders such as DIC





Dimer AND a low pre-test probability of DVT means that there is only a

over the next three months. Kearon et al reported a negative predictive value of 99.6 %


Similarly for suspected pulmonary embolism, a negative D-Dimer combined with a low pre

yields a negative predictive value of 99.5% during a three month follow up.

Question 1: Have you a suspicion of venous thromboembolism? If not, there is no need for D

test Probability of DVT (Wells Score):

Active cancer: Patient receiving treatment within 6 months or receiving palliative care (+1 point)

Paralysis or recent plaster immobilisation of lower limb(s) (+1 point)

Recently bedridden for 3 or more days or major surgery within the 3 months requiring general or

regional anaesthesia ( +1 point)

Localised tenderness along the distribution of the deep venous system (+1 point)

Entire leg swollen (+1 Point)

st 3cms larger than asymptomatic side measured 10 cm below tibial tuberosity.

Pitting oedema confined to symptomatic leg (+1 point)

varicose superficial veins (+1 point)

Previous documented DVT (+1 point)

Alternative diagnosis at least as likely as DVT (minus-2 points)

A score of less than 2 indicates a LOW pre-test probability for DVT.

test probability of Pulmonary Embolism (Wells Score):

Clinical signs of DVT (objectively measured leg swelling and pain with palpitat

Heart rate > 100/min (+1.5 points)

Immobilisation for 3 or more days or surgery in previous 4 weeks (+1.5 Points)

Past history of objectively diagnosed DVT or PE (+1.5 Points)

tient receiving treatment within 6 months or receiving palliative care) (+1 Point)

PE as likely or more likely than any alternative diagnosis (+3 Points)

A score of less than 2 indicates a LOW pre-test probability for pulmonary embolism

imer assay should be used with caution in the following clinical settings where unreliable

test results are likely to make the test of little use.

ted with heparin……Contact Consultant Haematologist for advic

and any other points that are relevant.


be pursued in any event then there is no point in doing a D-Dimer.

Above restrictions do not of course apply to coagulation disorders such as DIC



test probability of DVT means that there is only a

over the next three months. Kearon et al reported a negative predictive value of 99.6 %


Dimer combined with a low pre-test probability

Question 1: Have you a suspicion of venous thromboembolism? If not, there is no need for D-Dimer.

Active cancer: Patient receiving treatment within 6 months or receiving palliative care (+1 point)

more days or major surgery within the 3 months requiring general or

Localised tenderness along the distribution of the deep venous system (+1 point)

ptomatic side measured 10 cm below tibial tuberosity.

(Wells Score):

Clinical signs of DVT (objectively measured leg swelling and pain with palpitation in deep vein

Immobilisation for 3 or more days or surgery in previous 4 weeks (+1.5 Points)

tient receiving treatment within 6 months or receiving palliative care) (+1 Point)

imer assay should be used with caution in the following clinical settings where unreliable

for advice on this point


PATHOLOGY




References:

1. Wells PS et al. Evaluation of D

349: 1227-35.

2. Kearon C et al. Management of Suspected De

assessment and D-Dimer testing. Ann Intern Med. 2001; 135: 108

3. Wells PS et al. Excluding Pulmonary Embolism at the bedside without Diagnostic Imaging:

Management of patients with suspected pulmonary

Department by using a simple clinical model and D





Wells PS et al. Evaluation of D-Dimer in diagnosis of suspected Deep Vein Thrombosis. NEJM 2003;

Kearon C et al. Management of Suspected Deep Vein Thrombosis in Outpatients by using Clinical

Dimer testing. Ann Intern Med. 2001; 135: 108-111.

Wells PS et al. Excluding Pulmonary Embolism at the bedside without Diagnostic Imaging:

Management of patients with suspected pulmonary embolism presenting to the emergency

Department by using a simple clinical model and D-Dimer. Ann Intern Med; 135: 98



Dimer in diagnosis of suspected Deep Vein Thrombosis. NEJM 2003;

ep Vein Thrombosis in Outpatients by using Clinical

Wells PS et al. Excluding Pulmonary Embolism at the bedside without Diagnostic Imaging:

embolism presenting to the emergency

Dimer. Ann Intern Med; 135: 98-107.

PATHOLOGY




17 SAMPLE REQUIREMENTS FOR DIAGNOSTIC

This section outlines the tests that are available in the different Pathology departments.

described under the following disciplines:

• Haematology (H)

• Clinical Chemistry (CC)

• Immunology (I)

• External (X) – tests sent to referral laboratories

Each test will be described under the following headings:

• Test name

• Specimen type/volume/colour code. Note: containers and colour code are as per adult bottles. For

paediatric equivalent, please see Section 6.

• Specimen requirements and comments

• Frequency of testing

• Department where analysis takes place

Where turnaround time is described, it is defined as the time from specimen receipt in the Pathology

department to the time results are available.

Tests performed within the Pathology Laboratory, MRH Mullingar and currently accredited by INAB to ISO

15189 are indicated with a *. For the current scope of accreditation, please refer to the following website:

http://www.inab.ie/FileUpload/Medical





IAGNOSTIC TESTS This section outlines the tests that are available in the different Pathology departments.

described under the following disciplines:

tests sent to referral laboratories

Each test will be described under the following headings:

olour code. Note: containers and colour code are as per adult bottles. For

paediatric equivalent, please see Section 6.5.

Specimen requirements and comments

Department where analysis takes place


department to the time results are available.



http://www.inab.ie/FileUpload/Medical-Testing/Midland-Regional-Hospital-Mullingar



This section outlines the tests that are available in the different Pathology departments. They will be

olour code. Note: containers and colour code are as per adult bottles. For




Mullingar-195MT.pdf

PATHOLOGY




Test Dept. Sample Volume

17-Hydroxyprogesterone X Blood 8 mL

17-Hydroxysteroids X Urine 24 hour

5-HIAA X Urine 24 hour

Acetaminophen

(Paracetamol)*

CC Blood 8 mL

Acetyl Choline X Blood 8 mL

ACTH X Blood 2.5 mL

Adenovirus X Blood 8 mL

Adrenal Antibodies X Blood 8 mL

Albumin* CC Blood 8 mL

CC Urine 30 mL

Alcohol (Ethanol)* CC Blood 2 mL

Aldolase X Blood 8 mL

Aldosterone X Blood 2 x 8 mL

Alkaline phosphatase* CC Blood 8 mL

Alkaline phosphatase

isoenzymes

X Blood 8 mL

Alpha fetoprotein X Blood 8 mL

Alpha-1 Antitrypsin I Blood 8 mL

Alpha-1 Antitrypsin DNA X Blood 3 x 2.5 mL

ALT* CC Blood 8 mL

Amikacin X Blood 8 mL

Amino acids – Adult X Blood 4

Amino acids – Paeds X Blood 1.3 mL

Amino acids X Urine 30 mL




28/10/2016 Doc Title: Laboratory User Manual

Volume Container Colour Code Frequency

8 mL Gel tube Red top External – 14 days

24 hour Plain Yellow External – 10 days

24 hour Strong Acid Green top External – 10 days Advise patient of handling

precautions. Contact

container

8 mL Gel tube Red top Daily Take sample 4 hours post overdose.

State time on form


2.5 mL EDTA Purple top External - Scheduled Send to lab immediately for freezing

8 mL Gel tube Red top External – 10 days Clinical details vital


8 mL Gel tube Red top Daily

30 mL Plain Yellow Daily Morning sample preferable

2 mL Na Fluoride Grey Daily Not for medico


2 x 8 mL Gel tube Red top External – 14 days Take 2 samples, resting &

ambulatory. Send to lab immediately

for freezing

8 mL Gel tube Red top Daily Higher in children & pregnancy

8 mL Gel tube Red top External – 10 days Consultant request only

8 mL Gel tube Red top External – 10 days Tumour marker associated with liver

and testes, give clinical details


3 x 2.5 mL EDTA Purple top External – 14 days

8 mL Gel tube Red top Daily Aged/haemolysed samples

unsuitable

8 mL Gel tube Red top External Pre and post dose levels

4 mL Li Heparin Green top External – 10 days Send to lab immediately for freezing

1.3 mL Li Heparin Orange top External – 10 days

30 mL Plain Yellow External – 10 days



Comment

Advise patient of handling

precautions. Contact lab for acidified

container

Take sample 4 hours post overdose.

State time on form

Send to lab immediately for freezing

Clinical details vital

Morning sample preferable

Not for medico-legal purposes

Take 2 samples, resting &

ambulatory. Send to lab immediately

for freezing

Higher in children & pregnancy

Consultant request only

Tumour marker associated with liver


Aged/haemolysed samples

unsuitable

Pre and post dose levels


PATHOLOGY





Ammonia – Adult* CC Blood 2.5 mL

Ammonia – Paeds* CC Blood 1.3 mL

Amylase* CC Blood 8 mL

CC Urine 24 hour

ANCA X Blood 8 mL

Androgen profile X Blood 8 mL

Androstenedione X Blood 8 mL

Angiotensin Converting

Enzyme

X Blood 8 mL

Anti-cardiolipin antibodies X Blood 8 mL

Anti-DNA antibodies* (DNA) I Blood 8 mL

Anti-endomysial antibodies*

(EMA)

I Blood 8 mL

Anti-Gastric Parietal Cell Abs

(GPC)*

I Blood 8 ml

Anti-mitochondrial

antibodies* (AMA)

I Blood 8 mL

Anti-nuclear antibodies

(ANA)*

I Blood 8 mL

Anti-smooth muscle

antibodies* (ASMA)

I Blood 8 mL

Anti-streptolysin titre (ASOT) M Blood 8 mL

Anti-TSH receptor

antibodies

X Blood 8 mL

Aspergillus antibodies X Blood 8 mL

AST* CC Blood 8 mL






2.5 mL EDTA Purple top Arrange with lab Higher in smokers. Send to lab

immediately

1.3 mL EDTA Pink top Daily Send to lab immediately


24 hour Plain Yellow Daily Values may remain elevated in urine

post


8 mL Gel tube Red top External – 10 days SHBG & Testosterone only




8 mL Gel tube Red top Daily Marker for

positive

8 mL Gel tube Red top Weekly Only performed on positive or

borderline tTG

Coeliac patients)

8 ml Gel tube Red top Daily Indications: Pernicious anaemia

8 mL Gel tube Red top Daily Indications: 1° Biliary Cirrhosis

8 mL Gel tube Red top Daily Indications: SLE, RA, mixed

connective

CREST

8 mL Gel tube Red top Daily Indications: Active chronic hepatitis

8 mL Gel tube Red top 10 days






Comment

Higher in smokers. Send to lab

immediately

Send to lab immediately

Values may remain elevated in urine

post-acute attack

SHBG & Testosterone only

Marker for SLE, only assayed if ANA is

positive

Only performed on positive or

borderline tTG (Not done on known

Coeliac patients)

Indications: Pernicious anaemia

Indications: 1° Biliary Cirrhosis

Indications: SLE, RA, mixed

connective tissue disease, Raynaud’s,

CREST

Indications: Active chronic hepatitis

PATHOLOGY





B2-microglobulin I Blood 8 mL

Bile Acids/Bile Salts X Blood 8 mL

Bilirubin – Direct* CC Blood 8 mL

Bilirubin – Total* CC Blood 8 mL

Blood Gas

(ICU/ED/SCBU/Labour ward)

POC Blood 2 mL

BNP* CC Blood 2.5 mL

Borrellia (Lyme disease) X Blood 8 mL

Bromide X Blood 8 mL

Brucella agglutination (BAT) M Blood 8 mL

Calcium* CC Blood 8 mL

CC Urine 24 hour

CA 125 X Blood 8 mL

CA 15.3 X Blood 8 mL

CA 19.9 X Blood 8

Calcitonin X Blood 8 mL

Cannabis X Urine 30 mL

Carbamazepine* CC Blood 8 mL






8 mL Gel tube Red top Daily Useful in paraproteinaemia as an

index of


8 mL Gel tube Red top Daily Haemolysis interferes with assay.

Only assayed if Total Bilirubin > 28

μmol/L

8 mL Gel tube Red top Daily Haemolysis interferes with assay

2 mL Hep Syringe Daily Mix well to prevent clots. Expel air

bubbles from syringe.

2.5 mL EDTA Purple top Daily

available within hospital

8 mL Gel tube Red top External – 10 days Clinical details important

8 mL Gel tube Red top External – 2-3 weeks

8 mL Gel tube Red top 10 days

8 mL Gel tube Red top Daily Avoid venous stasis

24 hour Acid Green top Daily Advise patient of handling


container

8 mL Gel tube Red top External – 10 days Used for monitoring response to

treatment in ovarian cancer, give

clinical details

8 mL Gel tube Red top External – 10 days Tumour marker associated with

breast, give clinical details

mL Gel tube Red top External – 10 days Tumour marker associated with

pancreas & stomach, give clinical

details

8 mL Gel tube Red top External – 10 days Send to lab immediately for freezing

30 mL Plain Yellow External – 10 days Within guardian consent required if

patient <16 years

8 mL Gel tube Red top Daily Steady state 2

immediately prior to next dose



Comment

Useful in paraproteinaemia as an

index of the extent of disease

Haemolysis interferes with assay.

Only assayed if Total Bilirubin > 28

μmol/L

Haemolysis interferes with assay

Mix well to prevent clots. Expel air

bubbles from syringe.

>7 hours old unsuitable, hence only

available within hospital

Clinical details important

Avoid venous stasis – no tourniquet



container

Used for monitoring response to


clinical details

Tumour marker associated with

breast, give clinical details


pancreas & stomach, give clinical

details


Within guardian consent required if

patient <16 years

Steady state 2-6 days. Take sample

immediately prior to next dose

PATHOLOGY





Carboxyhaemoglobin POC Blood 2 mL

Carnitine (Child) X Blood 1.3 mL

Carotene X Blood 8 mL

Catecholamine X Blood 4 mL

X Urine 24 hour

CD4, CD8+ A158+ X Blood 2 x 2.5 mL

CD59, CD16 X Blood 2 x 2.5 mL

CEA X Blood 8 mL

Ceruloplasmin I Blood 8 mL

Cholesterol* CC Blood 8 mL

Chlamydia M Urine 30 mL

M Swab

X Blood 8 mL

Chromosome Analysis

(Adult)

X Blood 4 mL

Chromosome Analysis

(Paeds)

X Blood 1.3 mL

Chromogranin A X Blood 8 mL

CK* CC Blood 8 mL

Clozapine (Clozaril) X Blood 2.5 mL

Coag Screen (PT/APTT)* H Blood 4 mL






2 mL Hep Syringe Daily On all blood gas

1.3 mL Li Heparin Orange top External – 2-3 weeks

8 mL Gel tube Red top External – 10 days Protect from light

4 mL Li Heparin Green top External – 10 days Send to lab

24 hour Strong Acid Green top External – 10 days Advise patient of handling


container

2 x 2.5 mL EDTA Purple top External – Weekly Fresh sample by

2 x 2.5 mL EDTA Purple top External – Weekly Fresh sample by lunchtime with FBC

8 mL Gel tube Red top External – 10 days Tumour marker associated with liver,

lung, breast & pancreas, give clinical

details


8 mL Gel tube Red top Daily Check 3

30 mL Plain Yellow Weekly

See microbiology, Section


4 mL Li Heparin Green top External – 3 weeks Fill out appropriate form. Consent

form signed by patient & clinician

must accompany request. Form

available at

laboratory

1.3 mL Li Heparin Orange top External – 3 weeks Fill out appropriate form.


8 mL Gel tube Red top Daily Elevated by haemolysis, IM injection,

exercise, surgery

2.5 mL EDTA Purple top External – 14 days Send to lab immediately for freezing

4 mL Na Citrate Blue top Daily Fill to mark, send to lab within 4

hours of Phlebotomy



Comment

On all blood gas analysers

Protect from light




container

Fresh sample by lunchtime with FBC

Fresh sample by lunchtime with FBC

Tumour marker associated with liver,

lung, breast & pancreas, give clinical

details

Check 3-6 months if on treatment

See microbiology, Section 18

Fill out appropriate form. Consent

form signed by patient & clinician

must accompany request. Form

available at www.genetics.ie or from

laboratory

Fill out appropriate form.

Elevated by haemolysis, IM injection,

exercise, surgery


Fill to mark, send to lab within 4

hours of Phlebotomy

PATHOLOGY





Cold Agglutinins X Blood 1 X 6ml

1 X 8ml

Complement C3/C4 I Blood 8 mL

Copper X Blood 8 mL

Cortisol X Urine 24 hour

Cortisol* CC Blood 8 mL

C-reactive Protein (CRP)* CC Blood 8 mL

Creatinine* CC Blood 8 mL

CC Urine 24 hour

Creatinine Clearance* CC Blood &

Urine

As above

Cryoglobulins X Blood 8 mL

Cyclosporin X Blood 2.5 mL

Cysteine X Blood 4 mL

X Urine 30 mL

Cystic Fibrosis X Blood 2 x 2.5 mL

Cytomegalovirus (CMV) X Blood 8 mL

D-dimer* H Blood 4 mL

DHEAS X Blood 8 mL

Dibucaine Number X Blood 8 mL

Digoxin* CC Blood 8 mL

Diptheria Antibodies X Blood 8 mL

Drugs of Abuse Screen X

- Barbiturates X Blood 8 mL

X Urine 30 mL






1 X 6ml

1 X 8ml

EDTA

Gel tube

Pink top

Red top

External - 7 days Send to lab immediately for

separation at 37°C




8 mL Gel tube Red top Daily Take samples at 9am, 4pm &

midnight. State times clearly on

sample bottles



24 hour Plain Yellow Daily Refrigerate

As above As above As above Daily Take blood sample

collection

8 mL Gel tube Red top External – 10 days Special requirements for taking

sample, contact Blood Transfusion in

advance

2.5 mL EDTA Purple top External

4 mL Li Heparin Green top External – 7 days Send to lab immediately

30 mL Plain Yellow External – 7 days Send to lab immediately

2 x 2.5 mL EDTA Purple top External – 3 weeks


4 mL Na Citrate Blue top Daily To out rule DVT or PE only. Complete

Wells score form.



8 mL Gel tube Red top Daily Steady state at 6 days. Take sample 6

hours post oral dose.


Not

8 mL Gel tube Red top External <7 days

30 mL Plain Yellow External <7 days



Comment

Send to lab immediately for

separation at 37°C

Take samples at 9am, 4pm &

midnight. State times clearly on

sample bottles

Refrigerate

Take blood sample during urine

collection

Special requirements for taking

sample, contact Blood Transfusion in

advance



To out rule DVT or PE only. Complete

Wells score form.

Steady state at 6 days. Take sample 6

hours post oral dose.

Not for medico-legal purposes

PATHOLOGY





- Benzodiazepines X Blood 8 mL

X Urine 30 mL

-Cannabis X Urine 30 mL

- Ecstasy X Urine 30 mL

- MAOI’s X Urine 30 mL

- Phenothiazines X Urine 30 mL

- Tricyclics X Blood 8 mL

X Urine 30 mL

Echinococcus serology X Blood 8 mL

Electrophoresis*

- Serum Protein (SPE)* I Blood 8 mL

- Urine Protein (UPE)* I Urine 30 mL

Urine 24 hour

Entamoeba Antibodies X Blood 8 mL

Epstein Barr Virus X Blood 8 mL

Erythropoietin X Blood 8 mL

ESR* H Blood 2.5 mL

H Blood 2.5 mL

Ethosuximide X Blood 8 mL

Extractable Nuclear Antigen X Blood 8 mL

Farmer’s Lung Antibodies X Blood 8 mL

FBC* H Blood 2.5 mL

Ferritin* CC Blood 8 mL

Fibrinogen* H Blood 4 mL

Flecanide X Blood 8 mL








30 mL Plain Yellow External <7 days Written guardian consent if patient

<16 years for screen purposes30 mL Plain Yellow External <7 days






8 mL Gel tube Red top Daily Clinical details vital. Send urine also

as a percentage of myeloma are only

in urine

30 mL Plain Yellow Weekly

24 hour Plain Yellow Weekly




2.5 mL Na Citrate Vacu-tec Daily Used for hospital patients & GPs

sending ESRs to lab

2.5 mL Na Citrate Black top Daily Fill to mark. Used for GPs, not

suitable for sending to lab




2.5 mL EDTA Purple top Daily Send two EDTA samples if HbA1c is

also required


4 mL Na Citrate Blue top Daily Only as part of a DIC investigation

8 mL Gel tube Red top External – 14 days Send to lab immediately for freezing.

Clinical details required.



Comment

Written guardian consent if patient

<16 years for screen purposes

Clinical details vital. Send urine also

as a percentage of myeloma are only

in urine

Used for hospital patients & GPs

sending ESRs to lab

Fill to mark. Used for GPs, not

suitable for sending to lab

Send two EDTA samples if HbA1c is

also required

Only as part of a DIC investigation

Send to lab immediately for freezing.

Clinical details required.

PATHOLOGY





Folate* CC Blood 8 mL

Fragile X – Adult X Blood 2 x 2.5 mL

Fragile X – Paeds X Blood 2 x 1.3 mL

Free Fatty Acids X Blood 8 mL

FSH* CC Blood 8

FTA Absorption X Blood 8 mL

G6PD X Blood 2.5 mL

Gastrin X Blood 8 mL

Gentamicin* CC Blood 8 mL

GGT* CC Blood 8 mL

Glomerular Basement

Membrane Antibodies

X Blood 8 mL

Glucose* CC Blood 2 mL

Glutamase X Blood 4 mL

Glutarate X Urine 30 mL

Growth Hormone X Blood 8 mL

Haemoglobin A1c (HbA1c) CC Blood 2.5 mL

Haemoglobin

Electrophoresis

X Blood 2 x 2.5 mL

Hamm Test (PNH) X Blood 2.5 mL

Haptoglobin I Blood 8

HDL Cholesterol* CC Blood 8 mL

Hepatitis B PCR X Blood 2 x 2.5 mL

Hepatitis C PCR X Blood 2 x 2.5 mL







2 x 2.5 mL EDTA Purple top External < 6 months Consent form signed by patient &

clinician to accompany request

2 x 1.3 mL EDTA Pink top External < 6 months


8 mL Gel tube Red top Daily Indicates ovarian failure,

confirmation of menopause


2.5 mL EDTA Purple top External – 7 days Doctor must phone Haematology

SHO in St James’ Hospital

8 mL Gel tube Red top External – Scheduled Send to lab immediately for freezing

8 mL Gel tube Red top Daily Take trough sample (pre

peak sample at 30 min (IV) or 60 min

(IM)

8 mL Gel tube Red top Daily Haemolysis may interfere with result


2 mL Na Fluoride Grey Daily May be analysed on gel sample if <1

hour old, state time of sampling

4 mL Li Heparin Green top External – 10 days

30 mL Plain Yellow External – 7 days Send to lab immediately for freezing

8 mL Gel tube Red top External Send to lab immediately for freezing

2.5 mL EDTA Purple top Daily Used only to monitor

diabetics


2.5 mL EDTA Purple top External – 10 days



2 x 2.5 mL EDTA Purple top External – 10 days Send to lab immediately for freezing

2 x 2.5 mL EDTA Purple top External – 10 days Send to lab immediately for freezing



Comment

Consent form signed by patient &

clinician to accompany request

Indicates ovarian failure,

confirmation of menopause

Doctor must phone Haematology

SHO in St James’ Hospital


Take trough sample (pre-dose) and

peak sample at 30 min (IV) or 60 min

(IM)

Haemolysis may interfere with result

May be analysed on gel sample if <1

hour old, state time of sampling



Used only to monitor known

diabetics



PATHOLOGY





Hepatitis Screen X Blood 8 mL

HIV X Blood 8 mL

T-hCG* CC Blood 8 mL

β-hCG X Blood 8 mL

HLA B27 X Blood 2 x 2.5 mL

HLA-H (Haemochromatosis) CC Blood 2.5 mL

HLA Tissue Typing X Blood 8 mL

Homocysteine X Blood 2.5 mL

X Urine 30 mL

H. pylori* M Stool

Huntington’s Chorea X Blood 2 x 2.5 mL

Hydroxyproline X Urine 24 hour

Infectious Mononucleosis

Screen*

H Blood 2.5 mL

Immunoglobulins

- IgA, IgG, IgM I Blood 8 mL

- IgE (Total & Specific)* I Blood 8 mL

INR (PT)* H Blood 4 mL

Insulin X Blood 8 mL






8 mL Gel tube Red top External – 10 days Clinical details important: exposure

risk, needle stick etc.

8 mL Gel tube Red top External – 10 days Patient consent required. For needle

stick injury, contact Occupational

Health

8 mL Gel tube Red top Daily To monitor pregnancy. Give clinical

details


testicular cancer. Give clinical details

2 x 2.5 mL EDTA Purple top External – 10 days Do not take over weekend, must be

analysed within 24 hours

2.5 mL EDTA Purple top Batched Refer to guidelines,

8 mL Gel tube Red top External > 14 days Send within 24 hours. Separate &

store at 2

hours. Freeze at

2.5 mL EDTA Purple top External – 7 days Send to


Plain Blue Cap Daily May indicate recent or past infection.

Negative= unlikely to be H. pylori

2 x 2.5 mL EDTA Purple top External > 14 days


2.5 mL EDTA Purple top Daily Indications: Lymphadenopathy


8 mL Gel tube Red top Weekly See guidelines for requesting

allergens

4 mL Na Citrate Blue top Daily Fill to mark. Analysis can be delayed

for up to 2 days (warfarin patients

only), store at 4°.

8 mL Gel tube Red top External – Scheduled Send to lab immediately for freezing



Comment

Clinical details important: exposure

risk, needle stick etc.

Patient consent required. For needle

stick injury, contact Occupational

Health

To monitor pregnancy. Give clinical

details


testicular cancer. Give clinical details

Do not take over weekend, must be

analysed within 24 hours

Refer to guidelines, Section 14.6.11

Send within 24 hours. Separate &

store at 2-8° for no longer than 48

hours. Freeze at -50 to -80°.


May indicate recent or past infection.

Negative= unlikely to be H. pylori

Indications: Lymphadenopathy

See guidelines for requesting

allergens

Fill to mark. Analysis can be delayed




PATHOLOGY





Insulin Growth Factor 1 X Blood 8 mL

Ionised Calcium POC Blood 2 mL

Iron* CC Blood 8 mL

Islet Cell Antibodies X Blood 8 mL

Jo1 Antibodies X Blood 8 mL

Lactate* CC Blood 2 mL

Lamotrigine (Lamictal) X Blood 8 mL

LATS X Blood 8 mL

LDH* CC Blood 8 mL

LDL Cholesterol* CC Blood 8 mL

Lead X Blood 2.5 mL

Legionella X Blood 2.5 mL

Leptospirosis X Blood 8 mL

Leucocyte Enzyme X Blood 2.5 mL

Levetiracetam (Keppra) X Blood 8 mL

LH* CC Blood 8 mL

Lipase X Blood 8 mL

Lipid Profile* CC Blood 8 mL

Lithium* CC Blood 8 mL

Magnesium* CC Blood 8 mL

Malaria Screen * H Blood 2.5 mL

Meningococcal PCR X Blood 2.5 mL

Mercury X Blood 2 x 2.5 mL

Metabolic Screen – Adult X Blood 4 mL






8 mL Gel tube Red top External – 14 days Send to lab immediately for freezing

2 mL Hep Syringe Daily On blood gas analysers in ICU & ED

8 mL Gel tube Red top Daily Fasting preferred. Indications: Iron

overdose, Haemochromatosis. Not

for iron

8 mL Gel tube Red top External > 14 days


2 mL Na Fluoride Grey Daily Send to lab immediately. State

sample time



8 mL Gel tube Red top Daily Any haemolysis interferes with test


2.5 mL EDTA Purple top External – 2-3 weeks


8 mL Gel tube Red top External – 10 days Incubation period 4

2.5 mL EDTA Purple top External > 14 days


8 mL Gel tube Red top Daily See guidelines Section 14.6.3


8 mL Gel tube Red top Daily See Cholesterol, Triglyceride, HDL &

LDL. Patient should be fasting for 9

12 hours. Wait for 12 post MI


12 hours post dose


2.5 mL EDTA Purple top Daily Sample as fresh as possible

2.5 mL EDTA Purple top External < 7 days To confirm meningococcal disease in

hospitalised patients

2 x 2.5 mL EDTA Purple top External – 2-3 weeks Contact Clinical Chemistry 4345




Comment


On blood gas analysers in ICU & ED

Fasting preferred. Indications: Iron

overdose, Haemochromatosis. Not

for iron deficiency

Send to lab immediately. State

sample time

Any haemolysis interferes with test

Incubation period 4-19 days

See guidelines Section 14.6.3

See Cholesterol, Triglyceride, HDL &

LDL. Patient should be fasting for 9-

12 hours. Wait for 12 post MI

Steady state 3-7 days. Take sample

12 hours post dose

Sample as fresh as possible

To confirm meningococcal disease in

hospitalised patients

Contact Clinical Chemistry 4345

PATHOLOGY





Metabolic Screen – Paeds X Blood 1.3 mL

Mucopolysaccharide X Urine 30 mL

Mycoplasma X Blood 8 mL

Myoglobin X Urine 30 mL

Neutrophil Antibodies X Blood 8 mL

Oligoclonal Banding X Blood 8 mL

X CSF 300

Oestradiol* CC Blood 8 mL

Oestrogen Receptors X Blood 8 mL

Organic Acids X Urine 30 mL

Osmolality X Blood 8 mL

X Urine 30 mL

Oxalate X Urine 24 hour

Parvovirus B19 X Blood 8 mL

Paternity Testing X

Pertussis Antibodies X Blood 8 mL

Phenobarbitone* CC Blood 8 mL

Phenylalanine CC Blood 4 mL

Phenytoin* CC Blood 8 mL

Philadelphia Chromosome X Bone

Marrow

1 mL

Phosphate (Inorganic)* CC Blood 8 mL

Platelet Antibodies X Blood 8 mL






1.3 mL Li Heparin Orange top External – 10 days

30 mL Plain Yellow External > 14 days


30 mL Plain Yellow External – 4 days Fresh morning sample. Only

indicated if positive for blood.


8 mL Gel tube Red top External – 14 days For investigation of Multiple

Sclerosis. Both Serum and CSF

required.

300 μL Plain White Cap



30 mL Plain Yellow External – 7 days Send to lab immediately for freezing



24 hour Acid Green top External – 10 days Indications: Renal calculi


Doctor

Alan Dobson, Tel: 021

021


8 mL Gel tube Red top Daily Steady state adult 10

8

prior to next dose.


8 mL Gel tube Red top Daily Take sample immediately prior to

next dose

1 mL Li Heparin Green top External – 3 weeks Send to lab immediately

8 mL Gel tube Red top Daily Delay in separation of sample and

haemolysis may increase values

8 mL Gel tube Red top External – 10 days Not done for ITP



Comment

Fresh morning sample. Only

indicated if positive for blood.

For investigation of Multiple

Sclerosis. Both Serum and CSF

required.


Indications: Renal calculi

Doctor or patient to contact Prof

Alan Dobson, Tel: 021-4902743 or

021-4901946

Steady state adult 10-25 days, child

8-15 days. Take sample immediately

prior to next dose.

Take sample immediately prior to

next dose


Delay in separation of sample and

haemolysis may increase values

Not done for ITP

PATHOLOGY





Platelet Associated IgG X Blood 4 x 2.5 mL

Platelet Count* H Blood 2.5 mL

Pneumococcus Antibodies X Blood 8 mL

Pneumococcus PCR X CSF 500

Porphyrin Screen X Blood 3 x 2.5 mL

X Blood 2 x 4 mL

X Urine 30 mL

X Urine 24 hour

X Stool 10 g

Potassium* CC Blood 8 mL

Primidone X Blood 8 mL

Progesterone* X Blood 8 mL

Prolactin* X Blood 8 mL

Proline X Blood 4 mL

Protein* CC Blood 8 mL

CC Urine 24 hour

PSA* CC Blood 8 mL

Psitticosis Antibodies X Blood 8 mL






4 x 2.5 mL EDTA Purple top External – 14 days Store at room temperature



500 μL Plain White Cap External < 7 days

3 x 2.5 mL EDTA Purple top External – 14 days One sample type required.

Protect

Stool and urine samples to be

refrigerated.

2 x 4 mL Li Heparin Green top External – 14 days



10 g Plain Blue Cap External – 14 days

8 mL Gel tube Red top Daily Aged/haemolysed samples

unsuitable. Do not force blood

through needle into tube. Do not

pour blood from EDTA bottle into gel

tube. Do not take blood from drip

arm.

8 mL Gel tube Red top External – 7 days Send to lab immediately for freezing.


next dose.

8 mL Gel tube Red top Daily Indication: Confirmation of ovulation

8 mL Gel tube Red top Daily Indications: pituitary tumour. May be

elevated after epileptic fit or stress.





8 mL Gel tube Red top Daily Do not request if patient has acute

renal retention, post TURP, post

needle biopsy or cystoscopy as PSA

may be falsely elevated

8 mL Gel tube Red top External – 10 days (Farmer’s Lung)



Comment

Store at room temperature

One sample type required.

Protect all samples from light.

Stool and urine samples to be

refrigerated.

Aged/haemolysed samples

unsuitable. Do not force blood

through needle into tube. Do not

pour blood from EDTA bottle into gel

tube. Do not take blood from drip

arm.

Send to lab immediately for freezing.


next dose.

Indication: Confirmation of ovulation


Indications: pituitary tumour. May be

elevated after epileptic fit or stress.


Refrigerate

Do not request if patient has acute




(Farmer’s Lung)

PATHOLOGY





PT (INR)* H Blood 4 mL

PTH* CC Blood 8 mL

Pyruvate X Blood

Renin X Blood 2 x 2.5 mL

Reticulocyte Count* X Blood 2.5 mL

Rheumatoid Factor* CC Blood 8 mL

Rickettsioses X Blood 8 mL

Rubella X Blood 8 mL

Salicylate CC Blood 8 mL

Schilling Test X Urine

SHBG X Blood 8 mL

Sickle Cell Screen X Blood 2 x 2.5 mL

Sickle Cell Screen* H Blood 2.5 mL

Sodium* CC Blood 8 mL

CC Urine 24 hour

CC Urine 30 mL

Somatomedin X Blood 8 mL

Sputum – Malignant Cells X Sputum 30 mL






4 mL Na Citrate Blue top Daily Fill to mark. Analysis can be delayed



8 mL Gel tube Red top Daily, Mon – Thurs Only accepted from

Thursday

Contact Biochemistry, Crumlin for

sample requirements

2 x 2.5 mL EDTA Purple top External – 14 days Take two sample, supine & upright






Collected post radioactive dose.

Dr must contact Department of

Nuclear Medicine, St. Vincent’s

8 mL Gel tube Red top External – Scheduled


2.5 mL EDTA Purple top Daily If urgently required only

8 mL Gel tube Red top Daily Aged samples unsuitable. Do not

force blood through needle into

tube. Do not pour blood from other

bottles into gel tube. Do not take

blood from drip arm.


30 mL Plain Yellow Daily Refrigerate


30 mL Plain Yellow External – 7 days Mouth should be rinsed with water

beforehand. Salivary samples are of

no value & will be discarded without

testing.



Comment

Fill to mark. Analysis can be delayed



Only accepted from GP’s Monday to

Thursday

Contact Biochemistry, Crumlin for

sample requirements

Take two sample, supine & upright

Collected post radioactive dose.

Dr must contact Department of

Nuclear Medicine, St. Vincent’s

If urgently required only

Aged samples unsuitable. Do not

force blood through needle into

tube. Do not pour blood from other

bottles into gel tube. Do not take

blood from drip arm.

Refrigerate

Refrigerate

Mouth should be rinsed with water

beforehand. Salivary samples are of

no value & will be discarded without

testing.

PATHOLOGY





Synacthen Test CC Blood 8 mL

Syphilis X Blood 8 mL

T cell X Blood 2.5 mL

Testosterone – Male* CC Blood 8 mL

Testosterone – Female X Blood 8 mL

Theophylline* CC Blood 8 mL

Therapeutic Drug

Monitoring*

CC Blood 8 mL

Thyroxine – Free (FT4)* CC Blood 8 mL

Tissue Polypeptide Specific

Antigen (TPS)

X Blood 8 mL

Tissue Transglutaminase

(tTG)*

I Blood 8 mL

Tobramycin X Blood 8 mL

TORCH X Blood 8 mL

Toxicology Screen X

Toxoplasma X Blood 8 mL

TPHA X Blood 8 mL

Trace Metals X Urine 30 mL

X Blood

Transferrin* CC Blood 8 mL

Transferrin Saturation* CC Blood 8 mL

Triglyceride* CC Blood 8 mL

Troponin I* CC Blood 2.5 mL

Thrombophilia Screen – X Blood 6 x 4 mL






8 mL Gel tube Red top Daily Samples taken at 0 and 30 minutes

post synacthen injection for Cortisol





8 mL Gel tube Red top Daily Take sample immediately prior to

next dose

8 mL Gel tube Red top Daily See individual drugs: Phenytoin,

Phenobarbitone, Carbamazepine,

Theophylline, Digoxin,

8 mL Gel tube Red top Daily May be slightly elevated in non

thyroidal illness


8 mL Gel tube Red top Weekly Marker for Coeliac Disease

8 mL Gel tube Red top External < 7 days


See Drugs of Abuse



30 mL Plain Yellow External – 2-3 weeks

External – 2-3 weeks Contact lab for special bottle


8 mL Gel tube Red top Daily Calculated from Iron and Transferrin

8 mL Gel tube Red top Daily Raised levels/lipaemia can interfere

with HDL/LDL cholesterol assays

2.5 mL EDTA Purple top Daily Unsuitable when >2 hours old. Only

available to hospital patients

6 x 4 mL Na Citrate Blue top External – 10 days All 9 samples required. To be



Comment

Samples taken at 0 and 30 minutes

post synacthen injection for Cortisol


next dose

See individual drugs: Phenytoin,

Phenobarbitone, Carbamazepine,

Theophylline, Digoxin, Gentamicin

May be slightly elevated in non-

thyroidal illness

Marker for Coeliac Disease

See Drugs of Abuse

Contact lab for special bottle

Calculated from Iron and Transferrin

Raised levels/lipaemia can interfere

with HDL/LDL cholesterol assays

Unsuitable when >2 hours old. Only

available to hospital patients

All 9 samples required. To be

PATHOLOGY





Adult X Blood 2 x 2.5 mL

X Blood 8 mL

Thrombophilia Screen –

Paeds

X Blood 2 x 1.3 mL

X Blood 1 x 1.3 mL

X Blood 1 x 1.3 mL

Triiodothronine – Free

(FT3)*

CC Blood 8 mL

TPO* I Blood 8 mL

Trypsin X Stool

TSH* CC Blood 8 mL

Tumour Markers X

- AFP X Blood 8 mL

- βhCG X Blood 8 mL

- CA 125 X Blood 8 mL

- CA 15.3 X Blood 8 mL

- CA 19.9 X Blood 8 mL

- CEA X Blood 8 mL

- PSA* CC Blood 8 mL

Urate* CC Blood 8 mL

CC Urine 24 hour

Urea* CC Blood 8 mL






2 x 2.5 mL EDTA Purple top External – 10 days organised with phlebotomy, fresh

samples to arrive in lab by 9am. 8 mL Gel tube Red top External – 10 days

2 x 1.3 mL Na Citrate Green top External – 10 days All 4 samples required. Fresh samples

to arrive in lab by 9am. 1 x 1.3 mL EDTA Pink top External – 10 days

1 x 1.3 mL Serum Clear top External – 10 days

8 mL Gel tube Red top Daily Not routinely analysed on patients

on treatment

8 mL Gel tube Red top Weekly See guidelines, Section 15.4

Plain Blue Cap External – Scheduled Fresh sample required


8 mL Gel tube Red top External – 10 days Tumour marker associated with liver



testicular cancer, give

8 mL Gel tube Red top External – 10 days Used for monitoring response to


clinical details


breast

8 mL Gel tube Red top External – 10 days Tumour marker related to pancreas

& stomach, give clinical details

8 mL Gel tube Red top External – 10 days Tumour marker associated with liver,

lung &

8 mL Gel tube Red top Daily Do not request if patient has acute




8 mL Gel tube Red top Daily Effected by dietary factors

24 hour Plain Yellow Daily Effected by dietary factors




Comment

organised with phlebotomy, fresh

samples to arrive in lab by 9am.

All 4 samples required. Fresh samples

to arrive in lab by 9am.

Not routinely analysed on patients

on treatment

See guidelines, Section 15.4

Fresh sample required

Tumour marker associated with liver



testicular cancer, give clinical details

Used for monitoring response to


clinical details


breast cancer, give clinical details

Tumour marker related to pancreas

& stomach, give clinical details

Tumour marker associated with liver,

lung & breast, give clinical details

Do not request if patient has acute




Effected by dietary factors

Effected by dietary factors

PATHOLOGY





CC Urine 24 hour

Urinary albumin* CC Urine 30 mL

CC Urine 24 hour

Valporate (Epilim)* CC Blood 8 mL

Vancomycin X Blood 8 mL

Varicella X Blood 8 mL

VDRL/TPHA X Blood 8 mL

Vigabatrin (Sabril) X Blood 8 mL

VIP X Blood 4 mL

Viral Load X Blood 2 x 2.5 mL

Viscosity X Blood 2 x 2.5 mL

Vitamin A X Blood 8 mL

Vitamin B12* CC Blood 8 mL

Vitamin D* CC Blood 8 mL

Vitamin E X Blood 8 mL

Vitamin K X Blood 8 mL

VMA X Urine 24 hour

Von Willebrand’s Factor X Blood 6 x 4 mL

Widal (Salmonellosis) X Blood 8 mL

Yersina X Blood 8 mL






24 hour Plain Yellow Daily Refrigerate. Effected by dietary

factors

30 mL Plain Yellow Daily Useful in monitoring diabetic

patients. Morning sample preferred.

24 hour Plain Yellow Daily


immediately prior to next dose.

8 mL Gel tube Red top External Pre and Post samples. Samples must

be received in lab by 10am




4 mL Li Heparin Green top External > 14 days

2 x 2.5 mL EDTA Purple top External – 10 days Fresh sample required

2 x 2.5 mL EDTA Purple top External – 10 days Store at room temperature

8 mL Gel tube Red top External > 14 days Protect from light


8 mL Gel tube Red top Daily Mon- Thurs Only available to GPs Monday

Thursday


8 mL Gel tube Red top External > 14 days Protect from light

24 hour Strong Acid Green top External – 10 days Advise


container

6 x 4 mL Na Citrate Blue top External – 10 days





Comment

Refrigerate. Effected by dietary

factors

Useful in monitoring diabetic

patients. Morning sample preferred.

Steady state 2-3 days. Take samples

immediately prior to next dose.

Pre and Post samples. Samples must

be received in lab by 10am

Fresh sample required

Store at room temperature

Protect from light

Only available to GPs Monday –

Thursday

Protect from light



container

PATHOLOGY




18 MICROBIOLOGY The Microbiology department provides a wide range of testing to MRH Mullingar and all GPs and nursing

homes in the Longford/Westmeath area. This department also provides regional services for Chlamydia and

Mycology to MRH Tullamore, MRH Portlaoise and GPs

both diagnosis and patient management advice, see contact details below. Please refer to MRHM

guidelines for the use of antibiotics available at the following intranet location:

http://hsenet.hse.ie/Hospital_Staff_Hub/mullingar/Infection/infectionsepsis.html


Title Name

Chief Medical Scientist Mr. Ultan Campbell

Senior Medical

Scientists

Mr. Mark McKeon

Mr. Colin Murtagh

Consultant

Microbiologist

Dr. Cathal O’Sullivan

18.2 Tests

18.2.1 CSF (Cerebrospinal Fluid)Sample Required:

Three samples (>1 mL each) are taken into three universal containers included in CSF pack, and labelled as

1, 2 and 3. Where Xanthochromia is specifically required, a separate CSF sample with a minimum of 1 mL

volume must be tapped directly into a light

laboratory. This should be accompanied by a blood glucose sample. If oligoclonal banding investigation is

required, a clotted blood sample must accompany the CSF sample.

CSF samples must not be placed in the f

Turnaround Times: Processed on receipt

Report

Microscopy Report

Final negative culture

Final positive culture

Note: Minimum CSF volumes required for additional

Test

Xanthochromia

Viral PCR

TB AFB & Culture

TB PCR

Meningococcal PCR

Cryptococcal antigen





The Microbiology department provides a wide range of testing to MRH Mullingar and all GPs and nursing


Mycology to MRH Tullamore, MRH Portlaoise and GPs in Laois and Offaly. A clinical service is offered for


guidelines for the use of antibiotics available at the following intranet location:

http://hsenet.hse.ie/Hospital_Staff_Hub/mullingar/Infection/infectionsepsis.html



Mr. Ultan Campbell 044-9394341 [email protected]

Mr. Mark McKeon 044-9394332

[email protected]

Mr. Colin Murtagh [email protected]

Dr. Cathal O’Sullivan 057-9358349/8371


MRH Mullingar

044-9340221

[email protected]

CSF (Cerebrospinal Fluid)

1 mL each) are taken into three universal containers included in CSF pack, and labelled as


volume must be tapped directly into a light-protected container. These are available upon request from the


required, a clotted blood sample must accompany the CSF sample.

CSF samples must not be placed in the fridge or sent through the pneumatic chute system.

Processed on receipt

Report TAT

<2 hours

Final negative culture 48 hours

48-72 hours

: Minimum CSF volumes required for additional testing:

Test Minimum Volume

1 mL

0.5 mL

0.25 mL

0.25 mL

0.25 mL

0.5 mL



The Microbiology department provides a wide range of testing to MRH Mullingar and all GPs and nursing


in Laois and Offaly. A clinical service is offered for


Email

[email protected]

[email protected]

[email protected]

[email protected]

1 mL each) are taken into three universal containers included in CSF pack, and labelled as


r. These are available upon request from the


ridge or sent through the pneumatic chute system.

Minimum Volume

PATHOLOGY




18.2.2 Blood Cultures Samples Required:

Patient

Adult

Paeds

• Do not cover the bottle’s barcode label as this is scanned as part of the analytical process.

• Specimens must be sent to the laboratory immediately for incubation at 37°C.

• Do not send through the pneumatic chute system.

• Blood cultures are incubated for 5 days.

• Please indicate if Infective Endocarditis (IE), fungal infection or Brucella is suspected as incubation is

extended for these cases.

Turnaround Times: Blood Cultures are moni

Positive Results:

Positive results are phoned to the ward when they are processed, with a written interim report issued on

the same day. Direct susceptibility testing will be available on organisms isolated

within 24 hours. Standardised susceptibility testing results and final report will be issued within 24

hours.

Negative Results:

Negative reports are issued after 5 days incubation (10 days if Infective Endocarditis, fungal infec

Brucella is suspected).

18.2.3 Urine – Culture & SensitivitySamples Required: Using a 60 mL sterile urine container, half

required is 10 mL, maximum permitted is 30 mL.

Turnaround Times:

Urgent

Routine

Notes:

• Urine dipstick for glucose, protein

• It is unnecessary to routinely send urines to the laboratory on all patient’s attending Out

clinic except for the following patients:

o Diabetic patients

o Patients with known renal disease

o Patients with acute symptoms suggesting urinary tract infections e.g. urgency, frequency,

dysuria, haematuria, fever.





Patient Sample Bottles

Aerobic Bottle (Blue)

Anaerobic Bottle (Purple)

Paediatric Bottle (Pink)

Do not cover the bottle’s barcode label as this is scanned as part of the analytical process.

Specimens must be sent to the laboratory immediately for incubation at 37°C.

through the pneumatic chute system.

Blood cultures are incubated for 5 days.

Please indicate if Infective Endocarditis (IE), fungal infection or Brucella is suspected as incubation is

: Blood Cultures are monitored continuously and processed 24 hours a day


the same day. Direct susceptibility testing will be available on organisms isolated

within 24 hours. Standardised susceptibility testing results and final report will be issued within 24

Negative reports are issued after 5 days incubation (10 days if Infective Endocarditis, fungal infec

Culture & Sensitivity : Using a 60 mL sterile urine container, half-fill and tighten lid securely. Minimum volume

required is 10 mL, maximum permitted is 30 mL.

Report

Microscopy Report 2 hours

Negative culture 24 hours

Positive culture 48-72 hours

Microscopy Report Same day

Negative culture 48 hours

Positive culture 48-72 hours

Urine dipstick for glucose, protein etc. is not routinely performed on urines in the laboratory.

It is unnecessary to routinely send urines to the laboratory on all patient’s attending Out

clinic except for the following patients:

Patients with known renal disease

Patients with acute symptoms suggesting urinary tract infections e.g. urgency, frequency,

dysuria, haematuria, fever.



(Blue)

Anaerobic Bottle (Purple)

Paediatric Bottle (Pink)

Do not cover the bottle’s barcode label as this is scanned as part of the analytical process.

Specimens must be sent to the laboratory immediately for incubation at 37°C.

Please indicate if Infective Endocarditis (IE), fungal infection or Brucella is suspected as incubation is

tored continuously and processed 24 hours a day.


the same day. Direct susceptibility testing will be available on organisms isolated for clinical guidance

within 24 hours. Standardised susceptibility testing results and final report will be issued within 24-48

Negative reports are issued after 5 days incubation (10 days if Infective Endocarditis, fungal infection or

fill and tighten lid securely. Minimum volume

TAT

2 hours

24 hours

72 hours

Same day

48 hours

72 hours

is not routinely performed on urines in the laboratory.

It is unnecessary to routinely send urines to the laboratory on all patient’s attending Out-Patients

Patients with acute symptoms suggesting urinary tract infections e.g. urgency, frequency,

PATHOLOGY




18.2.4 Urine Pregnancy Test Sample Required: Collect early morning urine directly into a 60 mL sterile urine container. Do not transfer

from another container. Do not use boric acid container.

Turnaround Times:

Report

Urgent samples

Routine samples

18.2.5 Urine – TB Culture Sample Required: Three consecutive early morning urines

This test must be arranged with St James’ Hospital TB lab in advance.

18.2.6 Urine – Chlamydia & Gonorrhoea Sample Required: One first void urine of 20

Urine samples >60 mL will be discarded (over

A separate midstream urine (MSU) sample is required for C&S as first void urine is not suitable for C&S.

Turnaround Times: 5 days.

18.2.7 Swab – Chlamydia & GonorrhoeaSample Required: Female collection kits are available from Microbiology.

Turnaround Times: 5 days.

18.2.8 Sputum – Culture & SensitivitySample Required: Use plain 60 mL sterile

Salivary/mucoid samples are of no value and will be discarded without testing.

C&S and AFB require separate samples for each.

Repeat samples will not be processed within a 5 day period.

Note: These samples are not routinely cultured for L

screened for Legionella/Pneumococcal antigen on request. For all other requests

consultant microbiologist through the hospital switchboard

Turnaround Times:

Report

Negative culture

Positive culture

18.2.9 Sputum – AFB Sample Required: Use plain 60 mL sterile

Do not wash teeth or use oral hygiene products before collection.


C&S and AFB require separate samples for each. Single samples wi





: Collect early morning urine directly into a 60 mL sterile urine container. Do not transfer

ther container. Do not use boric acid container.

Report TAT

1 hour

Same day

: Three consecutive early morning urines

This test must be arranged with St James’ Hospital TB lab in advance.

& Gonorrhoea : One first void urine of 20-30 mL.

Urine samples >60 mL will be discarded (over-dilute).


& Gonorrhoea emale collection kits are available from Microbiology.

Culture & Sensitivity 60 mL sterile container.


C&S and AFB require separate samples for each.

processed within a 5 day period.

are not routinely cultured for Legionella. Urine samples from ICU p

egionella/Pneumococcal antigen on request. For all other requests

consultant microbiologist through the hospital switchboard

Report TAT

24 hours

48-72 hours

60 mL sterile container. Send three consecutive purulent specimens.

Do not wash teeth or use oral hygiene products before collection.


C&S and AFB require separate samples for each. Single samples will be processed for routine C&S only.



: Collect early morning urine directly into a 60 mL sterile urine container. Do not transfer


from ICU patients routinely

egionella/Pneumococcal antigen on request. For all other requests, please contact the

. Send three consecutive purulent specimens.

ll be processed for routine C&S only.

PATHOLOGY




Turnaround Times: Samples are referred to the

Hospital. This laboratory operates a specimen acceptance policy with regards to repeat submission of

samples, available from IMRL.

Report

Microscopy

Negative culture

Positive culture

18.2.10 Swabs – Culture & SensitivitySample Required: Use transport swabs. Please indicate type e.g., vaginal, throat etc.

If wound swab, indicate site and also if skin lesion or deep

Turnaround Time: Final report 48-72 hours.

18.2.11 Swabs – PernasalSample Required: Use ENT swabs (orange), clearly label.

Turnaround Time: Final report 48-72 hours.

18.2.12 Stool – Culture

Sample Required: Use blue-capped faeces container, 5

Notes:

• All samples will be screened for

parasites or not.

• Stool samples are routinely screened for Salmonella, Shigella, Verotoxigenic E. Coli and

Campylobacter.

• Patients less than 4 years old are screened for Rotavirus and Adenovirus also.

• Clinical details are essential e.g. if the patient has recently been ab

diagnosed case of enteritis, etc.

• Request for C&S does not include C. difficile toxin.

• Culture is not performed on formed stool samples.

Turnaround Time: Final report within 72 hours.

18.2.13 Stool – C. difficile Toxin Sample Required: Use blue-capped faeces container, 5

C. difficile toxin is only performed on patients with diarrhoea.

If C. difficile is negative and diarrhoea persists, it may be appropriate to request more extensive culture.

There is no value in repeat tests for C. difficile on patients for whom there is a previous positive result.

Turnaround Time: C. difficile toxin tests are performed twice weekly, Mondays and Thursdays.

Urgent request can be accommodated by contacting the Cons

18.2.14 Stool – Norovirus (Winter Vomiting Bug)Sample Required: Use blue-capped faeces container, 5

Samples are referred to the National Virus Reference Laboratory after clearance by Consultant

Microbiologist and/or Infection Control.





Samples are referred to the Irish Mycobacteria Reference Laboratory


Report TAT

2 days

8 weeks

Refer to IMRL for detailed breakdown

Culture & Sensitivity : Use transport swabs. Please indicate type e.g., vaginal, throat etc.

If wound swab, indicate site and also if skin lesion or deep-seated.

72 hours.

Pernasal (orange), clearly label.

72 hours.

capped faeces container, 5-10g sample. Do not fill container.

All samples will be screened for Cryptosporidium and Giardia regardless of request for ova &

Stool samples are routinely screened for Salmonella, Shigella, Verotoxigenic E. Coli and

Patients less than 4 years old are screened for Rotavirus and Adenovirus also.

Clinical details are essential e.g. if the patient has recently been abroad or in contact with a

diagnosed case of enteritis, etc.

Request for C&S does not include C. difficile toxin.

Culture is not performed on formed stool samples.

Final report within 72 hours.

C. difficile Toxin capped faeces container, 5-10g sample. Do not fill container.

C. difficile toxin is only performed on patients with diarrhoea.


is no value in repeat tests for C. difficile on patients for whom there is a previous positive result.

C. difficile toxin tests are performed twice weekly, Mondays and Thursdays.

Urgent request can be accommodated by contacting the Consultant Microbiologist or Infection Control.

Norovirus (Winter Vomiting Bug) capped faeces container, 5-10g sample. Do not fill container.


Microbiologist and/or Infection Control.



Irish Mycobacteria Reference Laboratory (IMRL), St James’s


Refer to IMRL for detailed breakdown

: Use transport swabs. Please indicate type e.g., vaginal, throat etc.

fill container.

and Giardia regardless of request for ova &

Stool samples are routinely screened for Salmonella, Shigella, Verotoxigenic E. Coli and

Patients less than 4 years old are screened for Rotavirus and Adenovirus also.

road or in contact with a

fill container.


is no value in repeat tests for C. difficile on patients for whom there is a previous positive result.

C. difficile toxin tests are performed twice weekly, Mondays and Thursdays.

ultant Microbiologist or Infection Control.

fill container.


PATHOLOGY




Turnaround Time: Refer to National Virus Reference Laboratory

18.2.15 Stool – Ova & Parasites (O&P)Sample Required: Use blue-capped faeces container, 5

Positive findings are rare. This methodology is very demanding on scientist’s time and should only be

requested where there are clear clinical indications. If in doubt, contact the Microbiology

Sudden onset of diarrhoea is not an indication for screening for O&P except in the following circumstances:

• When foreign travel has occurred

• In patients from areas where enteric parasites are endemic

• Other indications of possible parasite in

18.2.16 Stool – Rotavirus/AdenovirusSample Required: Use blue-capped faeces container, 5

Routinely tested on children aged 3 and under.

Turnaround Time: 24 hours.

18.2.17 Stool – Helicobacter pylori AntigenSample Required: Use blue-capped faeces container, 5


18.2.18 Semen Analysis Sample Required: Contact the Microbiology laboratory for instructions. Sample must be received in

laboratory before 3pm for processing.


18.2.19 Virology Screen Serology is the principle diagnostic technique in virology. Please specify viral screen required or contact the

Consultant Microbiologist. All virology testing in performed at the National Virus Reference Laboratory in

Dublin. Please refer to https://nvrl.ucd.ie/usermanual





Refer to National Virus Reference Laboratory

Ova & Parasites (O&P) capped faeces container, 5-10g sample. Do not fill container.


requested where there are clear clinical indications. If in doubt, contact the Microbiology


hen foreign travel has occurred

patients from areas where enteric parasites are endemic

Other indications of possible parasite infestation

Rotavirus/Adenovirus capped faeces container, 5-10g sample. Do not fill container.

Routinely tested on children aged 3 and under.

Helicobacter pylori Antigen capped faeces container, 5-10g sample. Do not fill container.

Contact the Microbiology laboratory for instructions. Sample must be received in

ing.

Serology is the principle diagnostic technique in virology. Please specify viral screen required or contact the


https://nvrl.ucd.ie/usermanual for virology queries.



fill container.


requested where there are clear clinical indications. If in doubt, contact the Microbiology laboratory.


fill container.

fill container.

Contact the Microbiology laboratory for instructions. Sample must be received in

Serology is the principle diagnostic technique in virology. Please specify viral screen required or contact the


PATHOLOGY




19 BLOOD TRANSFUSION & HAEMOVIGILANCE

The Blood Transfusion Department provides a routine and emergency blood transfusion service to MRH

Mullingar and an antenatal blood g

the Longford/Westmeath area. This department also provides regional antenatal testing services to MRH

Tullamore, MRH Portlaoise and GPs in Laois and Offaly. Clinical, technical and hae

services are also provided.


Title Name

Chief Medical Scientist Ms. Carol Cantwell

Senior Medical

Scientists

Mr. Eunan Connolly

Ms. Orla Dowling

Transfusion

Surveillance Officer

Ms. Patricia Gardiner

Consultant

Haematologists

Dr. Kanthi Perera

Dr. Gerard Crotty

19.2 Blood Transfusion Tests

Test/Profile Specimen

Group & Screen Blood

Direct Antiglobulin Test Blood

Group & DAT Blood

Antenatal Group & Screen Blood

Kleihauer Test* Blood

Anti D Quantitation* Blood

Anti c Quantitation* Blood

* Tests referred externally, not covered under MRH Mullingar’s scope of accreditation.

** Sample requirements for Paediatric patients:

o Babies <4months of age

o Babies/Children

possible.

Turnaround times given above refer to routine working days. However, in the event of rare multiple

antibodies, the TAT for group and screen or group and crossmatch may exceed 1 day depending on

antibody specificity.





AEMOVIGILANCE The Blood Transfusion Department provides a routine and emergency blood transfusion service to MRH

Mullingar and an antenatal blood group and antibody screening service to all GPs and antenatal clinics in


Tullamore, MRH Portlaoise and GPs in Laois and Offaly. Clinical, technical and hae



Ms. Carol Cantwell 044-9394868 [email protected]

Mr. Eunan Connolly 044-9394329 [email protected]

Ms. Orla Dowling 044-9394868 [email protected]

Patricia Gardiner 044-9394313

Bleep #043

[email protected]

Dr. Kanthi Perera 057-9358276


MRH Tullamore

057-9321501

[email protected]

Dr. Gerard Crotty 057-9358352


MRH Tullamore

057-9321501

[email protected]

Specimen

Type

Adult Sample

Requirement

Special

Requirements

Blood EDTA – 6 mL** None

Blood EDTA – 6 mL** None

Blood EDTA – 6 mL** Cord Sample

Blood EDTA – 6 mL None

Blood EDTA – 6 mL or

EDTA – 2.5ml

None



Tests referred externally, not covered under MRH Mullingar’s scope of accreditation.

Sample requirements for Paediatric patients:

<4months of age: EDTA Red top bottle, 1.3mL

Babies/Children ≥4months of age: EDTA Pink top 6mL tube with sample





The Blood Transfusion Department provides a routine and emergency blood transfusion service to MRH

roup and antibody screening service to all GPs and antenatal clinics in


Tullamore, MRH Portlaoise and GPs in Laois and Offaly. Clinical, technical and haemovigilance advisory

Email

[email protected]

[email protected]

[email protected]

[email protected]

[email protected]

[email protected]

Turnaround Time

Routine -1 Day

Urgent - 90 minutes

1 Day

1 Day

5 Days

3-5 Days

7 Days

14 Days

Tests referred externally, not covered under MRH Mullingar’s scope of accreditation.

: EDTA Pink top 6mL tube with sample ≥2 mL if



PATHOLOGY




19.3 Confirmatory Sample RuleThere is a second sample for confirmatory group

cells. If a patient does not have a historical group in the laboratory information system then a second pre

transfusion sample must be taken from the patient in a separate draw. This is to prevent

transfusion due to a wrong blood in tube error. A specific confirmatory sample pack will be sent to the

clinical area by blood transfusion staff to be used in sample collection if the primary sample has been taken

within the last 12 hours.

In emergency situations where transfusion is required and there is insufficient time to collect the

confirmatory sample group O and Rh

be delayed due to the requirement of a confirmat

19.4 Request for Blood Component/Products

Request Specimen

Type

Group and full

serological

crossmatch

Blood

Add-on crossmatch

with a valid sample

in laboratory

Blood

Emergency

uncrossmatched O

Negative red cells

for adult patient

Blood

Emergency

uncrossmatched O

Negative red cells

for neonatal patient

Blood

Group

specific/Group O

RhD matched

uncrossmatched

blood

Blood

Plasma (Frozen) Blood





Rule second sample for confirmatory group policy in place in the hospital for the transfusion of red

cells. If a patient does not have a historical group in the laboratory information system then a second pre

transfusion sample must be taken from the patient in a separate draw. This is to prevent




firmatory sample group O and RhD matched red cells will be issued. Issue of compatible units will

be delayed due to the requirement of a confirmatory sample.

Request for Blood Component/Products

Sample Requirement Comments

EDTA – 6 mL** Valid sample must be

taken within 72 hours

of transfusion

N/A Send additional test

request form

(sample valid for 72

hours)

Uncrossmatched O

Negative red cells can be

requested before a

sample is taken but a 6mL

EDTA blood sample

should be taken before

transfusion if possible

2 units of O Negative

red cells are stored in

the blood transfusion

laboratory issue fridge

for immediate use

Uncrossmatched O

Negative red cells can be

requested before a

sample is taken but a

1.3mL EDTA blood sample

should be taken before

transfusion if possible


red cells suitable for

neonatal use is stored

in the blood

transfusion laboratory

issue fridge for

immediate use

EDTA – 6 mL Valid sample must be


of transfusion (historic

group or confirmatory

sample required for

group specific)

EDTA – 6 mL



policy in place in the hospital for the transfusion of red

cells. If a patient does not have a historical group in the laboratory information system then a second pre-

transfusion sample must be taken from the patient in a separate draw. This is to prevent an incompatible




D matched red cells will be issued. Issue of compatible units will not

Turnaround Time

Valid sample must be


Routine - 1 Day

Urgent (non-

bleeding) - 90

minutes

Urgent (patient

bleeding ) - 60

minutes

Send additional test

(sample valid for 72

45 minutes


red cells are stored in

the blood transfusion

issue fridge

Immediately


red cells suitable for

neonatal use is stored

transfusion laboratory

Immediately

sample must be


(historic

group or confirmatory

sample required for

15-45 minutes

30 minutes

PATHOLOGY




Request Specimen

Type

Platelets Blood

Anti-D Blood

Albumin – 5% None

Albumin – 20% None

Human Prothrombin

Complex (Octaplex)

None

Factor VIII

e.g. Advate

None

Factor IX

e.g. Benefix

None

Activated Factor VII

e.g. Novoseven

None

Fibrinogen

e.g. Riastap

None

Factor VIII & vWF

e.g. Wilate

None

Factor VIII Inhibiting

Bypass Activity -

FEIBA

None

** Sample requirements for Paediatric patients:

o Babies <4months of age

o Babies/Children

possible.

19.5 Maximum Blood Ordering Schedules These schedules are in place as a maximum blood ordering guide to prevent unnecessary ordering of blood

and have been agreed by the consultants. Where

differs from the agreed schedule, please indicate your reason clearly on the Blood Transfusion request

form.

Check for the latest versions at the following location:

http://hsenet.hse.ie/Hospital_Staff_Hub/mullingar/PPPG's_Midland_Area/Acute_Hospital_Services/Haem

ovigilance/Haemovigilance_MRH_Mullingar/





Sample Requirement Comments

EDTA – 6 mL

EDTA – 6 mL Valid sample must be


of administration for

inpatients (1 week for

RAADP clinic)

None

None

None Discuss with

Consultant

Haematologist via

Tullamore switch

None Discuss with NCCD in

St James or Crumlin


St James or Crumlin

None Discuss with

Consultant

Haematologist via

Tullamore switch

None


St James or Crumlin


St James or Crumlin

Sample requirements for Paediatric patients:

<4months of age: EDTA Red top bottle, 1.3mL

Babies/Children ≥4months of age: EDTA Pink top 6mL tube with sample

Maximum Blood Ordering Schedules These schedules are in place as a maximum blood ordering guide to prevent unnecessary ordering of blood

and have been agreed by the consultants. Where your requirements for a specified


Check for the latest versions at the following location:


nce/Haemovigilance_MRH_Mullingar/



Turnaround Time

2-3 hours for

transport from

IBTS

Valid sample must be

hours

of administration for

(1 week for

Immediately if

valid blood group

available

Immediately

Immediately

Immediately

Discuss with NCCD in

St James or Crumlin

Immediately


Crumlin

Immediately

Immediately

Immediately


James or Crumlin

Immediately


St James or Crumlin

Immediately

: EDTA Pink top 6mL tube with sample ≥2 mL if

These schedules are in place as a maximum blood ordering guide to prevent unnecessary ordering of blood

your requirements for a specified elective procedure



PATHOLOGY




19.5.1 Maximum Surgical Blood Ordering Sc

Procedure

Appendectomy – Open

Appendectomy – Laparoscopic

Cholecystectomy – Open

Cholecystectomy – Laparoscopic

Colectomy – Total

Colectomy – Hemi/Sigmoid

Colon Resection (Laparoscopic)

Colostomy/Iliostomy

(Closure/Revision)

Gastrectomy

Haemorrhoidectomy

Hartman’s Procedure/Reversal of

Hernia Repair – Inguinal/Paraumbilical

Hernia Repair – Laparoscopic

Laparoscopy(Diagnostic)

Splenectomy

Thyroidectomy(Subtotal/Total)

Tracheostomy

Amputation- Above/Below Knee

Varicose Veins

Angiogram/Angioplasty/ERCP

Bronchoscopy

Hickman/Portocath lines (Insertion)

Liver Biopsy

19.5.2 Maximum Obs/Gynae Blood Ordering ScPlease reserve a Group & Antibody Screen for Patients attending

Assessment Clinics and who are scheduled for elective procedures requiring a General Anaesthetic.

Procedure

Dilation and Curettage (D&C)

Ectopic Pregnancy

Endometrial Ablation

ERPC

Hysteroscopy

Laparoscopy/Tubal Ligation

LSCS

LSCS for Placenta Praevia

Myomectomy

Ovarian Cystectomy





Maximum Surgical Blood Ordering Schedule

No Pre-Transfusion

Test

Group & Screen

�

�

�

�

�

�

Inguinal/Paraumbilical �

�

�

�

�

Vascular Surgery

�

�

Other Procedures

Check with hospital performing procedure

�

an/Portocath lines (Insertion) �

�

Blood Ordering Schedule reserve a Group & Antibody Screen for Patients attending Obstetrics/Gynaecology

are scheduled for elective procedures requiring a General Anaesthetic.

No Pre-Transfusion

Test

Group & Screen

�

�

�

�

�

�

�

�

�



Group & Screen X-Match

(No of units)

2

2

2

2

2

2

Check with hospital performing procedure

/Gynaecology OPD/Pre-

are scheduled for elective procedures requiring a General Anaesthetic.


(No of units)

2

>2 if clinically

indicated

PATHOLOGY




Procedure

Total Abdominal Hysterectomy (TAH)

TAH & Bilateral Salpingo-Oophorectomy

Vaginal Hysterectomy

Vaginal Repair

Note: Patient’s admitted with Placenta Praevia:

� COMPLETE Placenta Praevia: 2 RCC on standby while in

� OTHER GRADES of Placenta Praevia: Transfusion requirements to be confirm

Obstetrician*

� See above for LSCS for Placenta Praevia

*If a Group & Screen/Crossmatch is required on an on

repeated every 72 hours. Please discuss with the Blood Transfusion Laboratory Staff

19.6 Blood Transfusion RequestsRefer to Section 6.2 for Blood Transfusion request forms.

19.6.1 Routine Requests

• For elective transfusion requ

core hours (9am-5pm) the day before surgery/anticipated transfusion to ensure requirements are

met. Samples that arrive after this time will not be processed until the following morning.

pre-op samples are not processed at the weekends.

• If red cells are required for a specific time or date, this should be stated on the request form.

• To ensure optimal stock management, the laboratory staff will restock crossmatched units of red

cells into general stock after

longer than 24 hours, it must be

• Optimal timing of transfusion

day as there are more nursing and medical staff on duty and the patient is more alert and easier to

observe.

• The RhD Negative post-delivery cord bundle will be tested within the hours of 9

day of the week, refer to Section 19.14.4 for further

19.6.2 Urgent Requests

During routine hours, please telephone urgent requests directly to Blood Transfusion on extension 4329 to

ensure priority processing and to ensure Group & Screen results are available for patients going to theatre.

Out-of-hours, the medical scientist on

Blood Transfusion specimens required out of hours. The medical scientist can be contacted directly using

speed-dial *51836.

19.6.3 Completion of Request For

• The Blood Transfusion request form

o Group and Antibody Screen

o Group, Screen & Crossmatch

o Plasma, Platelets or Fibrinogen

o Anti-D immunoglobulin (specific request form)

o Coagulation Factors and other laboratory b

o Group for cord bloods

o Direct Antiglobulin Test





No Pre-Transfusion

Test

Group & Screen

Total Abdominal Hysterectomy (TAH) �

Oophorectomy �

�

�

: Patient’s admitted with Placenta Praevia:

RCC on standby while in-patients until delivery *

OTHER GRADES of Placenta Praevia: Transfusion requirements to be confirmed by a Consultant

See above for LSCS for Placenta Praevia

*If a Group & Screen/Crossmatch is required on an on-going basis, the pre-transfusion sample is


Blood Transfusion Requests Refer to Section 6.2 for Blood Transfusion request forms.

For elective transfusion requests, the pre-transfusion sample must be received for testing during

5pm) the day before surgery/anticipated transfusion to ensure requirements are

met. Samples that arrive after this time will not be processed until the following morning.

op samples are not processed at the weekends.

If red cells are required for a specific time or date, this should be stated on the request form.

To ensure optimal stock management, the laboratory staff will restock crossmatched units of red

ells into general stock after 24 hours. If the availability of crossmatched red cell

hours, it must be specifically requested.

Optimal timing of transfusion: Routine blood transfusions should only be performed during the

y as there are more nursing and medical staff on duty and the patient is more alert and easier to

delivery cord bundle will be tested within the hours of 9

day of the week, refer to Section 19.14.4 for further information.

, please telephone urgent requests directly to Blood Transfusion on extension 4329 to


, the medical scientist on-call for Haematology & Blood Transfusion must be contacted for all


Completion of Request Form

The Blood Transfusion request forms (See Section 6.2 also) are used to request:

Group and Antibody Screen

Group, Screen & Crossmatch

Plasma, Platelets or Fibrinogen

D immunoglobulin (specific request form)

Coagulation Factors and other laboratory based products

Group for cord bloods

Direct Antiglobulin Test




(No of units)

ed by a Consultant

transfusion sample is


transfusion sample must be received for testing during

5pm) the day before surgery/anticipated transfusion to ensure requirements are

met. Samples that arrive after this time will not be processed until the following morning. Elective

If red cells are required for a specific time or date, this should be stated on the request form.

To ensure optimal stock management, the laboratory staff will restock crossmatched units of red

24 hours. If the availability of crossmatched red cells is required for

: Routine blood transfusions should only be performed during the

y as there are more nursing and medical staff on duty and the patient is more alert and easier to

delivery cord bundle will be tested within the hours of 9am to 8pm every

, please telephone urgent requests directly to Blood Transfusion on extension 4329 to


call for Haematology & Blood Transfusion must be contacted for all


used to request:

PATHOLOGY




o FMH estimation/Kleihauer test

o Quantitation of antibodies for antenatal patients

• A current addressograph label is

verifying patient details with the patient/carer where appropriate.

• In the absence of an addressograph label, the patient details are to be recorded in legible hand

writing. Printing of patient details is advised.

• All sections of the request form should be completed in

this on the form.

• The provision of clinical details, transfusion history and known antibody status on the request form

enhances the safety of transfusion for your patient.

• When completing the request form fo

19.5 for guidance.

• The doctor is responsible for ordering the correct blood component/product taking into account

special requirements e.g. CMV negative and/or irradiated blood components, refer to

• The request is signed by both:

o The individual completing the

o The person who reserved the blood transfusion sample

• Date of completion of the request form, date and time sample was reserved, MCRN and bleep

numbers should also be included.

19.6.4 Telephone/Add-on RequestsRequests for additional blood products or components are made by completing an additional test/blood

product request form, FORM-M/BT/201

a. Patient’s full name

b. DOB

c. Chart number

d. Ward

e. Consultant

f. Number of units or product required

g. Special requirements e.g. CMV negative (Refer to Section

h. Time product/component is required

i. Requestor’s name

In an urgent situation e.g. massive haemorrhage, a telephone request to the Blood Transfusion laboratory

will be permitted initially with the written request to be sent as soon as possible. There will not be a delay

in providing blood.

19.7 Sample Collection & LabellingA correctly labelled sample is critical to ensure safety in Blood Transfusion. Collection of the pre

sample using Electronic Blood Track Phase 3 is

1. The patient is requested to state his/her name and DOB which is verified with the patient’s identity

(ID) bracelet.

2. If the patient is not wearing a hospital ID bracelet (in

one is applied. If at any stage an ID bracelet is removed e.g. for cannulation, then it is the

responsibility of the person who removed it to re

3. It is recommended, where possible, to take the sample from an alternative limb to the one where

fluids are infusing. Where the sample must be taken from the same limb, stopping the infusion

before taking the sample and choosin

4. Use disposable gloves.





FMH estimation/Kleihauer test

Quantitation of antibodies for antenatal patients

A current addressograph label is preferred on the request form. Ensure the details are accurate by

t details with the patient/carer where appropriate.

In the absence of an addressograph label, the patient details are to be recorded in legible hand

writing. Printing of patient details is advised.

All sections of the request form should be completed in full. If information is not available, indicate

The provision of clinical details, transfusion history and known antibody status on the request form

enhances the safety of transfusion for your patient.

When completing the request form for elective surgical procedures, refer to the MBOS in Section

The doctor is responsible for ordering the correct blood component/product taking into account

special requirements e.g. CMV negative and/or irradiated blood components, refer to

The request is signed by both:

The individual completing the form (who requested the test)

The person who reserved the blood transfusion sample

Date of completion of the request form, date and time sample was reserved, MCRN and bleep

numbers should also be included.

on Requests additional blood products or components are made by completing an additional test/blood

M/BT/201 (See Section 6.2). The following information is required:

oduct required

Special requirements e.g. CMV negative (Refer to Section 19.10)

Time product/component is required


nitially with the written request to be sent as soon as possible. There will not be a delay

Sample Collection & Labelling A correctly labelled sample is critical to ensure safety in Blood Transfusion. Collection of the pre

sample using Electronic Blood Track Phase 3 is desirable. Refer to Section 19.8 below.

The patient is requested to state his/her name and DOB which is verified with the patient’s identity

If the patient is not wearing a hospital ID bracelet (in-patients only), blood must not be taken until


responsibility of the person who removed it to re-apply a new ID bracelet immediately.

It is recommended, where possible, to take the sample from an alternative limb to the one where


before taking the sample and choosing a vein distal to the infusion is recommended (NHO, 2002).



on the request form. Ensure the details are accurate by

In the absence of an addressograph label, the patient details are to be recorded in legible hand-

full. If information is not available, indicate

The provision of clinical details, transfusion history and known antibody status on the request form

r elective surgical procedures, refer to the MBOS in Section

The doctor is responsible for ordering the correct blood component/product taking into account

special requirements e.g. CMV negative and/or irradiated blood components, refer to Section 19.10

Date of completion of the request form, date and time sample was reserved, MCRN and bleep

additional blood products or components are made by completing an additional test/blood

. The following information is required:


nitially with the written request to be sent as soon as possible. There will not be a delay

A correctly labelled sample is critical to ensure safety in Blood Transfusion. Collection of the pre-transfusion

below.

The patient is requested to state his/her name and DOB which is verified with the patient’s identity

patients only), blood must not be taken until


new ID bracelet immediately.

It is recommended, where possible, to take the sample from an alternative limb to the one where


g a vein distal to the infusion is recommended (NHO, 2002).

PATHOLOGY




5. Apply tourniquet and withdraw sample. The Vacutainer system is used for sampling adults in MRH,

Mullingar.

6. After blood collection, invert tube 5

7. Addressograph labels are not

and labelled immediately after sampling at the patient’s bedside (NBUG, 2004).

never be pre-labelled.

8. Mandatory information on the sample label:

a. Patient’s full name

b. DOB

c. Chart number (or address for GP patients)

d. Signature of sample taker

The only exception to the above is an unconscious/unidentifiable patient, refer to

below.

9. The sample label should also contain the following patient information:

a. Ward/Department

b. Patient address

c. Date & time sample was taken

10. It is laboratory policy to only accept samples that meet the required criteria. If these criteria are not

met, the Blood Transfusion department will request a new sample and the original sample

discarded.

19.8 Electronic Blood Track Phase 3Blood Track Tx involves the use of a Personal Digital Assistant (PDA) at the patient bedside for recording

sample collection and confirming transfusion details.

barcode containing their electronic signature and the patient must be wearing an electronic wristband

with name, date of birth chart number and gender recorded in both a 2D barcode format and an eye

readable format. This enhances patient safety and allows for single administrator checking.

Contact Haemovigilance Bleep 043 or Ext

If you are not registered as a user you must handwrite BT sample and record administration checks

manually (two person check). Refer to

information.

19.8.1 Sample Collection using Blood Track Tx1. Ask the patient to state their name and date of birth.

• The wristband that the patient is wearing

• The request form.

2. Take the blood sample as per the MRHM venepuncture procedure.

3. Tap collect samples on the main menu of the PDA.

4. Scan the barcode on your staff ID badge

5. Scan the 2D barcode on the patient’s wristband

PDA screen. Once confirmed, tap

6. The reminders list will then display. Once all reminders have been completed tick each one to

select and tap next.

7. Print the sample collection label. The number of labels to pr

print more by selecting the desired number of labels and tap

8. Scan barcode on printer and the labels will then be printed.

9. Place a label on the sample bottle aligning it with the current sample label (so not to obsc

window or expiry date).

10. Place second label on request form in ‘

number.





Apply tourniquet and withdraw sample. The Vacutainer system is used for sampling adults in MRH,

After blood collection, invert tube 5-10 times.

not permitted on the sample tube. The sample tube must be handwritten

and labelled immediately after sampling at the patient’s bedside (NBUG, 2004).

Mandatory information on the sample label:

Chart number (or address for GP patients)

Signature of sample taker

The only exception to the above is an unconscious/unidentifiable patient, refer to

The sample label should also contain the following patient information:

Date & time sample was taken

It is laboratory policy to only accept samples that meet the required criteria. If these criteria are not

met, the Blood Transfusion department will request a new sample and the original sample

Electronic Blood Track Phase 3 Blood Track Tx involves the use of a Personal Digital Assistant (PDA) at the patient bedside for recording

sample collection and confirming transfusion details. To use the system, the staff member must have a 2D



enhances patient safety and allows for single administrator checking.

043 or Ext 4313 to REGISTER as a USER


Refer to MANUAL-M/HV/1: Electronic Blood Track User Manual for further

using Blood Track Tx Ask the patient to state their name and date of birth. Check this information against:

nd that the patient is wearing

Take the blood sample as per the MRHM venepuncture procedure.

on the main menu of the PDA.

Scan the barcode on your staff ID badge

Scan the 2D barcode on the patient’s wristband - the patient demographics will display on the

PDA screen. Once confirmed, tap next.

The reminders list will then display. Once all reminders have been completed tick each one to

Print the sample collection label. The number of labels to print defaults to 2 however you may

the desired number of labels and tap print.

Scan barcode on printer and the labels will then be printed.

Place a label on the sample bottle aligning it with the current sample label (so not to obsc

econd label on request form in ‘Blood taken and labelled by’ space



Apply tourniquet and withdraw sample. The Vacutainer system is used for sampling adults in MRH,

permitted on the sample tube. The sample tube must be handwritten

and labelled immediately after sampling at the patient’s bedside (NBUG, 2004). Samples must

The only exception to the above is an unconscious/unidentifiable patient, refer to Section 19.9

It is laboratory policy to only accept samples that meet the required criteria. If these criteria are not

met, the Blood Transfusion department will request a new sample and the original sample will be

Blood Track Tx involves the use of a Personal Digital Assistant (PDA) at the patient bedside for recording

To use the system, the staff member must have a 2D



enhances patient safety and allows for single administrator checking.


M/HV/1: Electronic Blood Track User Manual for further

Check this information against:

atient demographics will display on the

The reminders list will then display. Once all reminders have been completed tick each one to

int defaults to 2 however you may

Place a label on the sample bottle aligning it with the current sample label (so not to obscure the

’ space – write contact

PATHOLOGY




11. The labels will contain the patient demographics, the identity of the sampler and date/time of

sampling – hence you will not b

Note: Only the Labels printed using

IPMs addressograph labels is not permissible and will result in your sample being rejected.

Figure 19.1: Example of Label printed using the Printer and the PDA

Note: Patient demographics are above the line.

of sample collection.

19.9 Unconscious/Unidentifiable Patients

In an emergency situation where

mandatory for the completion of the Blood Transfusion request for and labelling of the sample tube:

a. Gender of the patient i.e. unconscious adult male/female

b. Chart number

c. Signature of sample taker

Date & time sample was taken should also be provided on the request form and/or sample bottle.

The laboratory should be informed when more information regarding the patient’s identity becomes

available. A fresh sample should be reserved with the patient’s details as they become available and the

patient is stabilised.

An arbitrary DOB of 01/01/1900 will be assigned to these patients in the laboratory to facilitate computer

requirements. This will be printed on all reports and compatibility labels and should be disregarded by

clinical staff.

19.10 Special Requirements The following table is a summary of indications for use of CMV negative and irradiated blood components.

Refer to Haemovigilance Guideline HVGL

Negative and Irradiated Blood Components’ current revision for detailed information. This

clinical areas.





The labels will contain the patient demographics, the identity of the sampler and date/time of

hence you will not be required to write on the sample bottle.

Labels printed using Blood Track Tx are permissible on the transfusion sample

not permissible and will result in your sample being rejected.

Example of Label printed using the Printer and the PDA

demographics are above the line. Under the line are the sampler’s details with date and time

Unconscious/Unidentifiable Patients

the patient is unconscious or unidentifiable, the following details are


Gender of the patient i.e. unconscious adult male/female

sample taker

should also be provided on the request form and/or sample bottle.



0 will be assigned to these patients in the laboratory to facilitate computer


f indications for use of CMV negative and irradiated blood components.

Refer to Haemovigilance Guideline HVGL-M/HV/11 ‘Guideline for the Use of Cytomegalovirus (CMV)

Negative and Irradiated Blood Components’ current revision for detailed information. This



The labels will contain the patient demographics, the identity of the sampler and date/time of

Tx are permissible on the transfusion sample. Use of

not permissible and will result in your sample being rejected.

Under the line are the sampler’s details with date and time

the patient is unconscious or unidentifiable, the following details are


should also be provided on the request form and/or sample bottle.



0 will be assigned to these patients in the laboratory to facilitate computer


f indications for use of CMV negative and irradiated blood components.

M/HV/11 ‘Guideline for the Use of Cytomegalovirus (CMV)

Negative and Irradiated Blood Components’ current revision for detailed information. This is available in all

PATHOLOGY




Cytomegalovirus (CMV) Negative Blood Components

AUTOLOGOUS Haemopoietic Stem

Cell Transplant (HSCT)

Required Pre and Post AUTOLOGOUS Haemopoietic Stem Cell

Transplant (HSCT) 7 days prior to

post-transplant or as indicated by the Haematology Team

ALLOGENEIC HSCT Required Post ALLOGENEIC HSCT where the donor is also CMV

negative (Not a Lifelong requirement)

Potential recipients of ALLOGENEIC

HSCT

Required for Potential recipients of ALLOGENEIC HSCT

Acute Myeloid Leukaemia, Hodgkin’s disease, possibly Non

Hodgkin’s Disease)

Haematology team

Hodgkin’s Disease

Check with Haematology team: Hodgkin’s

who are potential recipients of Allogeneic HSCT may require

CMV Neg Components

Donors:

� Donors of allogeneic Marrow.

� Donors awaiting autologous stem

cell harvest

HSC Donors require CMV negative components

(before and after their donation)

Anti-thymocyte globulin (ATG) Not routinely required but confirm with Haematology team

Specific purine analogue therapies CMV negative components






Irradiated Blood Components

Required Pre and Post AUTOLOGOUS Haemopoietic Stem Cell

Transplant (HSCT) 7 days prior to harvest and up to 3 months

transplant or as indicated by the Haematology Team

Required for all recipients of Haemopoietic Stem Cell

Transplants (HSCT) from tim

chemo/radiotherapy and continued while patient receives

GvHD prophylaxis (usually six months post

CD4 count >200x10

present or if continued immunosuppressive tre

required, irradiated blood components should be given

indefinitely. (Not

ALLOGENEIC HSCT where the donor is also CMV

negative (Not a Lifelong requirement)

Required for Potential recipients of ALLOGENEIC HSCT - (e.g.

Acute Myeloid Leukaemia, Hodgkin’s disease, possibly Non-

Hodgkin’s Disease) - for additional clarification, contact

Haematology team

Irradiated Components required

conditioning. The attending Consultant Haematologist will

decide when Irradiated Components are no longer required.

For Hodgkin’s Disease refer to row below

Check with Haematology team: Hodgkin’s Disease patients

who are potential recipients of Allogeneic HSCT may require

CMV Neg Components

Irradiated components required (

HSC Donors require CMV negative components

(before and after their donation)

Irradiated components required for 7 days prior to or during

harvest

Not routinely required but confirm with Haematology team Required for all pat

with anti-thymocyte globulin (ATG) e.g. Aplastic Anaemia

patients– usually for six months post treatment or until CD4

count >200x109/l whichever is first.

CMV negative components not required Lifelong requirement for patients who receive specific purine

analogue therapies e.g. Fludarabine, Pentostatin

(Deoxycoformicin), Cladribine, Clofarabine, Bendamustine. This

list is subject to change and is not exhaustive. Required also for

patients who receive newer purine analogues until evidence of

their safety is established

Haematology team.




Required for all recipients of Haemopoietic Stem Cell

Transplants (HSCT) from time of initiation of conditioning

chemo/radiotherapy and continued while patient receives

GvHD prophylaxis (usually six months post-transplant or until

CD4 count >200x109/l whichever is first). If chronic GvHD is

present or if continued immunosuppressive treatment is

required, irradiated blood components should be given

Not a Lifelong requirement)

Irradiated Components required but only from Day 1 of

conditioning. The attending Consultant Haematologist will

decide when Irradiated Components are no longer required.

For Hodgkin’s Disease refer to row below

Irradiated components required (Lifelong requirement)

Irradiated components required for 7 days prior to or during

Required for all patients receiving immunosuppressive therapy

thymocyte globulin (ATG) e.g. Aplastic Anaemia

usually for six months post treatment or until CD4

/l whichever is first.

Lifelong requirement for patients who receive specific purine

analogue therapies e.g. Fludarabine, Pentostatin

(Deoxycoformicin), Cladribine, Clofarabine, Bendamustine. This

list is subject to change and is not exhaustive. Required also for

patients who receive newer purine analogues until evidence of

their safety is established – for additional clarification contact

Haematology team.

PATHOLOGY





Patients receiving Alemtuzumab

(anti-CD52)

CMV negative components required if potential recipie

HSCT. Check with Haematology team

Granulocyte transfusions CMV negative components routinely required

Post Solid Organ Transplant

Patients who are post

negative blood components if known to be CMV negative or

CMV status is unknown,

transplanted organs.

Ante-Natal CMV negative comp

Haematology /Oncology Children CMV negative components required for shared care with

OLCHC unless otherwise specified.

Intra-uterine Transfusion &

subsequent transfusions

CMV negative components required & for up to 1 year of age

Exchange transfusions of the newborn CMV negative components required

Babies < 1 year old CMV negative components required

Blood donations from 1st

and 2nd

degree relatives

CMV negative components not routinely required

HLA matched Platelets CMV negative components not routinely required

Suspected and confirmed severe T

Lymphocyte immunodeficiency

syndromes

CMV negative components not routinely required (unless < 1

year)







CMV negative components required if potential recipient of

HSCT. Check with Haematology team

Irradiated components required for patients receiving

alemtuzumab (anti

or until CD4 count >200x10

Note – not required for rituximab (anti

CMV negative components routinely required Irradiated components required for all Granulocyte

transfusions

who are post solid organ transplant require CMV

negative blood components if known to be CMV negative or

CMV status is unknown, regardless of the status of the

transplanted organs. (Lifelong requirement)

Irradiated components not required

CMV negative components required Irradiated components not required

CMV negative components required for shared care with

OLCHC unless otherwise specified.

Irradiated components required for all Paediatric Haematology

/Oncology children (s

unless otherwise specified

CMV negative components required & for up to 1 year of age Intra-uterine & subsequent transfusions require irradiated

components up to 6 months after expected delivery date (40

weeks gestation)

CMV negative components required Irradiated components required.

CMV negative components required Irradiated components not required unless they meet other

criteria (exchange/intrauterine transfusion/shared care with

OLCHC/blood donation from relative/ all suspected and

confirmed severe T Lymphocyte immunodeficiency syndromes

(See LIST 7.4)

CMV negative components not routinely required Irradiated component

are to receive blood donations from1

CMV negative components not routinely required Irradiated Platelets required.

CMV negative components not routinely required (unless < 1 Irradiated components required for all suspected and

confirmed severe T Lymphocyte immunodeficiency syndromes,

see list below.




Irradiated components required for patients receiving

alemtuzumab (anti-CD52) (usually six months post treatment

or until CD4 count >200x109/l whichever is first).

not required for rituximab (anti-CD20)

Irradiated components required for all Granulocyte



Irradiated components required for all Paediatric Haematology

/Oncology children (shared care agreement with OLCHC)

unless otherwise specified

subsequent transfusions require irradiated

components up to 6 months after expected delivery date (40

weeks gestation)

Irradiated components required.

Irradiated components not required unless they meet other

criteria (exchange/intrauterine transfusion/shared care with

onation from relative/ all suspected and

confirmed severe T Lymphocyte immunodeficiency syndromes

Irradiated components required for all adults & children who

are to receive blood donations from1st

and 2nd

degree relatives

Irradiated Platelets required.

Irradiated components required for all suspected and

confirmed severe T Lymphocyte immunodeficiency syndromes,

PATHOLOGY




Congenital T Lymphocyte Immunodeficiency states which require irradiated blood components:

• Severe combined immunodeficiency (SCID), not otherwise classified

• SCID with dwarfism

• Wiskott-Aldrich syndrome

• 3rd

and 4th

arch/pouch syndrome (Di George’s)

• Purine nucleoside phosphorylase deficiency

• Cell-mediated immunodeficiency, not otherwise classified

• Reticular dysgenesis

• Adenosine deaminase deficiency

• MHC Class 1 & Class 2 deficiency

• Leucocyte adhesion deficiency

• Immunodeficiency with eosinophilia (Omenn’s syndrome)

• Ataxia telangiectasia

• CHARGE syndrome with T-cell immunodeficiency

19.11 Patient Consent & Patient Information LeafletsA verbal consent is required for blood transfusion with the exception of eme

of consent must be recorded by the attending doctor in the patient’s Healthcare record.

• To assist in informed consent, a Blood Transfusion Information Leaflet should be provided to the

patient before commencing their transfus

unconscious) then they should be informed by their clinician that they received a transfusion

when/if the recover.

• Tick boxes should be completed on the front of the Blood Component/Product Transfu

Prescription Record Sheet for documenting the gaining of patient’s verbal consent and the

provision of the Patient Information Leaflet.

• If the patient is unable to understand the leaflet e.g. child or language barrier then the information

should be related to them in a language they understand. This may necessitate requesting an

interpreter.

• Day patients discharged from hospital following transfusion should be supplied with the Post

Transfusion Information Leaflet for Day Patients. This lists the s

reactions and provides contact details of

19.12 Prescription Refer to HVG/L-M/HV/8 ‘The Completion and Use of the Blood Component/Product Transfusion &

Prescription Record Sheet’ current revision and HVG/L

Products’ current revision for detailed information.

• Red cells, Plasma, Platelets, Albumin and Factor Concentrates are prescribed by a medical

practitioner on the Blood Component/Product Transfusion & Prescription Rec

• Anti-D is prescribed on the Drug Prescription Record Sheet.

• Each unit is to be prescribed individually on a unit by unit basis (use mLs for paeds) and each row

applies to a single unit. The only exception to this is in a massive transf

where the prescription of multiple units together in an emergency situation is permitted.

• The doctor must also record the clinical indication for the transfusion and the number of units to be

transfused in the patient’s medical

• A transfusion prescription is valid for 2 days.

• Transfusion prescriptions can be cancelled by a medical practitioner by drawing a single line

through the prescription. The doctor is required to record their signature and the date cancelled as

per HVG/L-M/HV/8 ‘The Completion and Use of the Blood Compone

Prescription Record Sheet’ current revision.






Severe combined immunodeficiency (SCID), not otherwise classified

arch/pouch syndrome (Di George’s)

Purine nucleoside phosphorylase deficiency

mediated immunodeficiency, not otherwise classified

Adenosine deaminase deficiency

MHC Class 1 & Class 2 deficiency

deficiency

Immunodeficiency with eosinophilia (Omenn’s syndrome)

cell immunodeficiency

Patient Consent & Patient Information Leaflets A verbal consent is required for blood transfusion with the exception of emergency situations. The gaining


To assist in informed consent, a Blood Transfusion Information Leaflet should be provided to the

patient before commencing their transfusion. If the patient is unable to receive the leaflet (e.g.


Tick boxes should be completed on the front of the Blood Component/Product Transfu


provision of the Patient Information Leaflet.

If the patient is unable to understand the leaflet e.g. child or language barrier then the information

related to them in a language they understand. This may necessitate requesting an

Day patients discharged from hospital following transfusion should be supplied with the Post

Transfusion Information Leaflet for Day Patients. This lists the signs and symptoms of transfusion

reactions and provides contact details of the hospital.

M/HV/8 ‘The Completion and Use of the Blood Component/Product Transfusion &

Prescription Record Sheet’ current revision and HVG/L-M/HV/6 ‘Administration of Blood Component and

Products’ current revision for detailed information.

lasma, Platelets, Albumin and Factor Concentrates are prescribed by a medical

practitioner on the Blood Component/Product Transfusion & Prescription Rec

D is prescribed on the Drug Prescription Record Sheet.

Each unit is to be prescribed individually on a unit by unit basis (use mLs for paeds) and each row

applies to a single unit. The only exception to this is in a massive transfusion, see reverse of BTPRS


The doctor must also record the clinical indication for the transfusion and the number of units to be

transfused in the patient’s medical notes.

A transfusion prescription is valid for 2 days.

Transfusion prescriptions can be cancelled by a medical practitioner by drawing a single line



Prescription Record Sheet’ current revision.




rgency situations. The gaining


To assist in informed consent, a Blood Transfusion Information Leaflet should be provided to the

ion. If the patient is unable to receive the leaflet (e.g.


Tick boxes should be completed on the front of the Blood Component/Product Transfusion &


If the patient is unable to understand the leaflet e.g. child or language barrier then the information

related to them in a language they understand. This may necessitate requesting an

Day patients discharged from hospital following transfusion should be supplied with the Post-

igns and symptoms of transfusion


Administration of Blood Component and

lasma, Platelets, Albumin and Factor Concentrates are prescribed by a medical

practitioner on the Blood Component/Product Transfusion & Prescription Record Sheet (BTPRS).

Each unit is to be prescribed individually on a unit by unit basis (use mLs for paeds) and each row

usion, see reverse of BTPRS


The doctor must also record the clinical indication for the transfusion and the number of units to be

Transfusion prescriptions can be cancelled by a medical practitioner by drawing a single line


nt/Product Transfusion &

PATHOLOGY




• The prescription must include the following:

o Date of transfusion

o Component/Product type (state actual volume for paediatrics)

o Indication if special requirements are necessary, refer to Section 19.8.

o Rate of transfusion of component/product

o Pre-transfusion haematology/coagulation result

o Reason for transfusion

o If any specific drugs are to be administered pre, post or with the tran

be prescribed on the Drug Prescription Record Sheet. Complete tick box on BTPRS if

transfusion related medication is required.

o Doctor’s signature, printed name and MCRN where required.

19.13 Guidelines for the Use of Blood Components & P

19.13.1 Red Cell Concentrate (RCC)Objective: To increase oxygen carrying capacity in order to improve tissue oxygen delivery.

Indications: No single criterion can be identified as a ‘trigger for transfusion’ as there is no readily available

indicator of critical tissue oxygenation. Each patient should be considered individually and on a unit by unit

basis. For many patients, a transfusion of a single unit may suffice to meet the clinical needs of the patient

and to reverse the clinical signs that led to t

Complications: Refer to HVG/L-M/HV/5 ‘Management of Adverse Transfusion Reactions and Events’

current revision for complications of RCC transfusion.

Ordering: RCC is requested from the Blood Transfusion laboratory by completing

request form and providing a correctly labelled & filled sample. If a Group & Screen was sent within the

previous 72 hours, completion of FORM

Administration:

• RCC must be administered through an appropriate blood giving set with a 170

• An individual unit should be transfused in approximately 2 hours in an uncompromised patient or

at a rate of 2-4mL/kg/hour. The length of transfusion of one unit shoul

due to the risk of bacterial proliferation.

• Patients at risk of cardiac failure

o Clinical assessment of

patient’s age, body weight and concomitant medical

Transfusion Associated Circulatory Overload (TACO). These factors should be considered

when prescribing the volume and rate of the transfusion, and in deciding whether diuretics

should be prescribed (BCSH, 2012).

o As a general guide, transfusing a volume of 4mL/kg will typically give a Hb increment of

1g/dL. The concept that one unit of red cells gives a Hb increment of 1g/dL should only be

applied as an approximation for a 70

prescription should be reduced (BCSH, 2012).

o Single unit red cell transfusions are recommended where possible, especially in non

bleeding patients (BCSH, 2012).

o Restricting transfusion to one unit of RCC in each 12 hour period and transfusing during

normal working hours with optimum medical/nursing cover should reduce the risk of TACO

(NBUG, 2004).

o Consider a rate of 1mL/kg/hour (NHO, 2010).

o Infusion pumps are recommended for transfusion of RCC.

• Red cells, plasma and platelets must never be mixed in the same giving set.

• The administration set is changed after ever two units of RCC or after every 6 hours whichever

comes first and if changing to a different blood component/product.





The prescription must include the following:

Component/Product type (state actual volume for paediatrics)

Indication if special requirements are necessary, refer to Section 19.8.

Rate of transfusion of component/product

transfusion haematology/coagulation result

Reason for transfusion

If any specific drugs are to be administered pre, post or with the tran


transfusion related medication is required.

Doctor’s signature, printed name and MCRN where required.

Guidelines for the Use of Blood Components & Products

Red Cell Concentrate (RCC) : To increase oxygen carrying capacity in order to improve tissue oxygen delivery.

: No single criterion can be identified as a ‘trigger for transfusion’ as there is no readily available

critical tissue oxygenation. Each patient should be considered individually and on a unit by unit


and to reverse the clinical signs that led to the decision to transfuse.

M/HV/5 ‘Management of Adverse Transfusion Reactions and Events’

current revision for complications of RCC transfusion.

: RCC is requested from the Blood Transfusion laboratory by completing


previous 72 hours, completion of FORM-M/BT/201 (See Section 19.5.4) to place your request is acceptable

t be administered through an appropriate blood giving set with a 170

An individual unit should be transfused in approximately 2 hours in an uncompromised patient or

4mL/kg/hour. The length of transfusion of one unit should never exceed four hours

due to the risk of bacterial proliferation.

Patients at risk of cardiac failure:

Clinical assessment of patients at risk of cardiac failure should include an evaluation of the

patient’s age, body weight and concomitant medical conditions that predispose to



should be prescribed (BCSH, 2012).

guide, transfusing a volume of 4mL/kg will typically give a Hb increment of


applied as an approximation for a 70-80kg patient. For patients of lower body weight, the

prescription should be reduced (BCSH, 2012).

Single unit red cell transfusions are recommended where possible, especially in non

bleeding patients (BCSH, 2012).

Restricting transfusion to one unit of RCC in each 12 hour period and transfusing during

l working hours with optimum medical/nursing cover should reduce the risk of TACO

Consider a rate of 1mL/kg/hour (NHO, 2010).

Infusion pumps are recommended for transfusion of RCC.

cells, plasma and platelets must never be mixed in the same giving set.

The administration set is changed after ever two units of RCC or after every 6 hours whichever

comes first and if changing to a different blood component/product.



Indication if special requirements are necessary, refer to Section 19.8.

If any specific drugs are to be administered pre, post or with the transfusion. These should


: To increase oxygen carrying capacity in order to improve tissue oxygen delivery.

: No single criterion can be identified as a ‘trigger for transfusion’ as there is no readily available

critical tissue oxygenation. Each patient should be considered individually and on a unit by unit



: RCC is requested from the Blood Transfusion laboratory by completing the Blood Transfusion


M/BT/201 (See Section 19.5.4) to place your request is acceptable

t be administered through an appropriate blood giving set with a 170-200 micron filter.

An individual unit should be transfused in approximately 2 hours in an uncompromised patient or

d never exceed four hours

patients at risk of cardiac failure should include an evaluation of the

conditions that predispose to



guide, transfusing a volume of 4mL/kg will typically give a Hb increment of


80kg patient. For patients of lower body weight, the

Single unit red cell transfusions are recommended where possible, especially in non-

Restricting transfusion to one unit of RCC in each 12 hour period and transfusing during

l working hours with optimum medical/nursing cover should reduce the risk of TACO

cells, plasma and platelets must never be mixed in the same giving set.

The administration set is changed after ever two units of RCC or after every 6 hours whichever

PATHOLOGY




• If the cannula becomes tissued, it must be re

as otherwise the unit is discarded.

• On completion of the unit, do not flush any remaining component/product in the administration

set with any other intravenous fluids.

• Drugs must never be added to blood components/products.

• If a unit of RCC is collected and then not required, it must be returned to the Blood Transfusion

fridge within 30 minutes. Failure to do so will result in the unit being wasted.

Compatibility Table for RCC

R

E

C

E

I

V

E

R

S

O- O+

AB+

19.13.2

AB-

*

A+

A-

*

B+

B-

*

O+

O- *

* In an emergency RhD positive RCC can be given to Rh

all possible in the case of potentially child

19.13.3 Plasma

Plasma is available as Octaplas LG for Group

Objective: To replace clotting factors where there is evidence of critical deficiencies.

Indications: The correction of coagulation disorders where treatment is needed and no other specific

therapy is available e.g.

• Haemostatic failure associated with major blood loss

• Acute Disseminated Intravascular Coagulation (DIC)

• Replacement of single factor plasma deficiencies where no licensed virally

recombinant single factor concentrate is available e.g. Factor V de

• Liver disease in the presence of haemorrhage

(Octaplex) is an alternative. Haematology advice is recommended

• Emergency warfarin reversal where Human Prothrombin Complex Concentrate (Octaplex) is

unavailable or contraindicated

• The treatment of choice in Thrombotic Thrombocytopaenia Purpura (TTP) in conjunction with

plasma exchange

Contraindications: Severe deficiencies of Protein S

Complications:

• Circulatory overload





mes tissued, it must be re-sited and the transfusion re-started within 30 minutes

as otherwise the unit is discarded.

On completion of the unit, do not flush any remaining component/product in the administration

set with any other intravenous fluids.

gs must never be added to blood components/products.

If a unit of RCC is collected and then not required, it must be returned to the Blood Transfusion


O+ B- B+ A- A+

* *

*

*

ositive RCC can be given to RhD negative patients but this should be avoided if at

all possible in the case of potentially child-bearing females.

Plasma is available as Octaplas LG for Group A, B, O and Uniplas for Group AB.

: To replace clotting factors where there is evidence of critical deficiencies.

: The correction of coagulation disorders where treatment is needed and no other specific

static failure associated with major blood loss

Acute Disseminated Intravascular Coagulation (DIC)

Replacement of single factor plasma deficiencies where no licensed virally

recombinant single factor concentrate is available e.g. Factor V deficiency

Liver disease in the presence of haemorrhage – Human Prothrombin Complex Concentrate

(Octaplex) is an alternative. Haematology advice is recommended

Emergency warfarin reversal where Human Prothrombin Complex Concentrate (Octaplex) is

or contraindicated

The treatment of choice in Thrombotic Thrombocytopaenia Purpura (TTP) in conjunction with

: Severe deficiencies of Protein S



started within 30 minutes

On completion of the unit, do not flush any remaining component/product in the administration

If a unit of RCC is collected and then not required, it must be returned to the Blood Transfusion


AB- AB+

*

this should be avoided if at

: To replace clotting factors where there is evidence of critical deficiencies.

: The correction of coagulation disorders where treatment is needed and no other specific

Replacement of single factor plasma deficiencies where no licensed virally-inactivated or

Human Prothrombin Complex Concentrate

Emergency warfarin reversal where Human Prothrombin Complex Concentrate (Octaplex) is

The treatment of choice in Thrombotic Thrombocytopaenia Purpura (TTP) in conjunction with

PATHOLOGY




• Anaphylactic reactions

• Febrile reactions

• Urticarial reactions

• Transfusion Associated Acute Lung Injury (TRALI)

Dosage: The dose of plasma is determined by the clinical condition of the patient and the underlying

disease. 12-15mL/kg is a generally accepted started d

Ordering: Plasma is requested from the Blood Transfusion laboratory by completing the Blood Transfusion

request form and providing a correctly labelled & filled sample. If a previous Group & Screen was sent,

completion of FORM-M/BT/201 (See Section 1

laboratory to place your request is acceptable.

Where the indication for plasma is unclear, the medical scientist may advise the requesting doctor to

contact the Haematology team for guidance.

Administration:

• Administration of plasma must be based on ABO blood group compatibility.

• It is thawed in the laboratory and takes approximately 30 minutes from the time the request is

received. It is usual to defrost two units at a time.

• Once thawed, plasma should be transfused within 8 hours when stored at room temperature or

within 24 hours when refrigerated in

• Plasma should be administered through an appropriate blood giving set.

• A unit of plasma (200mL) can be transfused to an uncomplicated adult over 30 minutes. However,

for an elderly patient, very small and/or cardiac or respiratory compromised patient, the infusion

rate should not exceed 2-4mL/kg/hour due to the risk of transf

• Red cells, plasma and platelets must never be mixed in the same administration set.

• The administration set should always be changed at the

• Drugs must never be added to Plasma

• The appropriate laboratory tests e.g.

assess the effectiveness of treatment. Please send coagulation samples to the laboratory within 30

minutes of completion of treatment.

Plasma Selection:

• LG Plasma is available as Octaplas in Groups A, B, AB and O and Uniplas.

• In Emergencies, Uniplas can be given to

Group AB Octaplas is currently not available.

• SD plasma is not RhD specific

• Octaplas is given as group specific

be used for Group O patients.

• CMV is not transmitted in SD Plasma





Transfusion Associated Acute Lung Injury (TRALI) – only with Fresh Frozen Plasma

: The dose of plasma is determined by the clinical condition of the patient and the underlying

15mL/kg is a generally accepted started dose.

: Plasma is requested from the Blood Transfusion laboratory by completing the Blood Transfusion


M/BT/201 (See Section 19.5.4) with a telephone request to the Blood Transfusion

laboratory to place your request is acceptable.


contact the Haematology team for guidance.

Administration of plasma must be based on ABO blood group compatibility.

It is thawed in the laboratory and takes approximately 30 minutes from the time the request is

received. It is usual to defrost two units at a time.

should be transfused within 8 hours when stored at room temperature or

within 24 hours when refrigerated in a laboratory controlled fridge.

Plasma should be administered through an appropriate blood giving set.

A unit of plasma (200mL) can be transfused to an uncomplicated adult over 30 minutes. However,


4mL/kg/hour due to the risk of transfusion overload.

cells, plasma and platelets must never be mixed in the same administration set.

The administration set should always be changed at the end of the transfusion.

Drugs must never be added to Plasma

The appropriate laboratory tests e.g. PT/INR and APTT should be carried out pre and post Plasma to


minutes of completion of treatment.

as Octaplas in Groups A, B, AB and O and Uniplas.

In Emergencies, Uniplas can be given to patients of Groups AB and patients of unknown group.

Group AB Octaplas is currently not available.

specific

Octaplas is given as group specific where possible; however Octaplas of Group A and Group B can

be used for Group O patients.

CMV is not transmitted in SD Plasma



only with Fresh Frozen Plasma

: The dose of plasma is determined by the clinical condition of the patient and the underlying

: Plasma is requested from the Blood Transfusion laboratory by completing the Blood Transfusion


9.5.4) with a telephone request to the Blood Transfusion


Administration of plasma must be based on ABO blood group compatibility.

It is thawed in the laboratory and takes approximately 30 minutes from the time the request is

should be transfused within 8 hours when stored at room temperature or

A unit of plasma (200mL) can be transfused to an uncomplicated adult over 30 minutes. However,


usion overload.

cells, plasma and platelets must never be mixed in the same administration set.

end of the transfusion.

PT/INR and APTT should be carried out pre and post Plasma to


of Groups AB and patients of unknown group.

where possible; however Octaplas of Group A and Group B can

PATHOLOGY




Compatibility Table for Plasma: Key:

19.13.4 Platelets

Indications:

• Thrombocytopenic bleeding associated with

therapy or irradiation. The advice of a Consultant Haematologist should be sought. (For paediatric

patients receiving shared care with Our Lady’s Children’s Hospital

manual).

• Prevention and treatment of haemorrhage in patients with thrombocytopenia or platelet function

defects.

• Note: patients with Thrombotic Thrombocytopenia Purpura (TTP), Heparin

Thrombocytopenia (HIT) or Autoi

platelets except for major haemorrhage.

• Massive transfusion

• DIC

• Prophylaxis for surgery to meet below targets:

o 50 x 109/L – Major surgery

o 100 x 109/L – Central Nervous System (CNS) or Eye surgery or

Management of Surgical Patients on Clopidigrel

• If possible, withhold anti-platelet therapy for one or two weeks prior to surgery.

• If anti-platelet agents are continued, platelets should b

is begun but should only be transfused if there is excessive small

surgery.

• A single dose should be transfused and the therapeutic effect observed.

• Platelet transfusion is indicated in these settings regardless of the circulating platelet count

(National Blood Transfusion Committee, 2012)

Complications:

• Bacterial contamination

• Urticarial reactions

• Transfusion Associated Acute Lung Injury (TRALI)

• Febrile reactions

• Anaphylactic reactions

Ordering:

• Platelets are requested from the Blood Transfusion laboratory by completing the Blood Transfusion

request form and providing a correctly labelled & filled sample. If a previous Group & Screen was

Patient’s

ABO

Group

Unknown





Key: �� = Give �� = Don’t give

Thrombocytopenic bleeding associated with bone marrow failure caused by disease, cytotoxic


patients receiving shared care with Our Lady’s Children’s Hospital Crumlin, refer to shared care

Prevention and treatment of haemorrhage in patients with thrombocytopenia or platelet function

Note: patients with Thrombotic Thrombocytopenia Purpura (TTP), Heparin-Induced

Thrombocytopenia (HIT) or Autoimmune Thrombocytopenia should not be transfused with

platelets except for major haemorrhage.

Prophylaxis for surgery to meet below targets:

Major surgery

Central Nervous System (CNS) or Eye surgery or abnormal platelet function

Management of Surgical Patients on Clopidigrel (Plavix)/Aspirin/GP IIb/IIIa Inhibitors

platelet therapy for one or two weeks prior to surgery.

platelet agents are continued, platelets should be readily available in MRHM before surgery

is begun but should only be transfused if there is excessive small-vessel bleeding during or after

A single dose should be transfused and the therapeutic effect observed.

indicated in these settings regardless of the circulating platelet count

(National Blood Transfusion Committee, 2012)

Transfusion Associated Acute Lung Injury (TRALI)

Platelets are requested from the Blood Transfusion laboratory by completing the Blood Transfusion


Donor ABO group

O A B Uniplas

O

A

B

AB

Group

Unknown



bone marrow failure caused by disease, cytotoxic


Crumlin, refer to shared care

Prevention and treatment of haemorrhage in patients with thrombocytopenia or platelet function

Induced

mmune Thrombocytopenia should not be transfused with

abnormal platelet function

/Aspirin/GP IIb/IIIa Inhibitors:

platelet therapy for one or two weeks prior to surgery.

e readily available in MRHM before surgery

vessel bleeding during or after

indicated in these settings regardless of the circulating platelet count

Platelets are requested from the Blood Transfusion laboratory by completing the Blood Transfusion


niplas

PATHOLOGY




sent, completion of FORM-

Transfusion laboratory to place your request is acceptable. Where the indication for

unclear, the medical scientist may advise the requesting doctor t

for guidance.

• Platelets are ordered by the BT lab from the Irish Blood Transfusion Service (IBTS) in Dublin when

requested. It is advisable to order

Platelet component to be transported by the IBTS and issued by the BT laboratory

Platelets for routine transfusion

delivery service and reduces costs.

• Platelets are stored on an agitator in the BT l

Issue and Prescription:

• A same day platelet count is recommended prior to ordering platelets. Platelets are either

apheresis (1 donor) or random pools (4

• Platelets are issued as ABO and RhD c

Blood Transfusion medical scientist advice). Refer to FORM

platelet selection.

• Platelets are ordered as ‘1 adult dose’. Standard treatment for an adult is ‘1 adu

For children < 20kg, the dose is 10

volume should not exceed 1 pool per transfusion.

• In the event of a massive transfusion, Platelets may need to be used before laboratory resu

available. However, it is important to take the FBC first as a baseline.

• A 30-60 minute Platelet check post infusion to assess the effectiveness of the treatment is

recommended, especially if the patient’s responsiveness to Platelet transfusions i

• One adult dose for prophylactic transfusion should raise the Platelet count by approximately

20 x 109/L but more may be required for active bleeding.

• Failure of the Platelet count to rise/above the target should be discussed wit

Haematologist.

Administration:

• A single dose of apheresis platelets contains an average of 230

320-340mL.

• Each dose of platelets should be transfused over a period of 30

Compatibility Groups for Platelets

Patient

Group 1ST

Choice

O O

A A

B B

AB AB

(preferably in additive

*Avoid the use of O Platelets in non





-M/BT/201 (See Section 19.5.4) with a telephone request to the Blood

Transfusion laboratory to place your request is acceptable. Where the indication for

unclear, the medical scientist may advise the requesting doctor to contact the Haematology team

Platelets are ordered by the BT lab from the Irish Blood Transfusion Service (IBTS) in Dublin when

requested. It is advisable to order Platelets early in the day to allow for the most appropriate

nent to be transported by the IBTS and issued by the BT laboratory

Platelets for routine transfusion by 8pm the day before transfusion optimises use of the daily

delivery service and reduces costs.

Platelets are stored on an agitator in the BT laboratory until infusion and are never refrigerated.

day platelet count is recommended prior to ordering platelets. Platelets are either

apheresis (1 donor) or random pools (4-5 donors).

Platelets are issued as ABO and RhD compatible when possible (seek Consultant Haematologist or

Blood Transfusion medical scientist advice). Refer to FORM-M/HV/23 for Compatibility table for

Platelets are ordered as ‘1 adult dose’. Standard treatment for an adult is ‘1 adu

For children < 20kg, the dose is 10-20 mL/kg, refer to OLCHC Shared Care Manual.

volume should not exceed 1 pool per transfusion.

In the event of a massive transfusion, Platelets may need to be used before laboratory resu

available. However, it is important to take the FBC first as a baseline.

60 minute Platelet check post infusion to assess the effectiveness of the treatment is

recommended, especially if the patient’s responsiveness to Platelet transfusions i

One adult dose for prophylactic transfusion should raise the Platelet count by approximately

/L but more may be required for active bleeding.

Failure of the Platelet count to rise/above the target should be discussed wit

A single dose of apheresis platelets contains an average of 230-300mL and pooled platelets contain

Each dose of platelets should be transfused over a period of 30-60 minutes (NBUG, 2004).

Compatibility Groups for Platelets

Donor ABO Group

2nd

Choice 3rd

Choice

B A

AB B


solution)

AB A


solution)

B or A


solution)

O


solution)*

Avoid the use of O Platelets in non-Group O children unless situation is critical



M/BT/201 (See Section 19.5.4) with a telephone request to the Blood

Transfusion laboratory to place your request is acceptable. Where the indication for Platelets is

o contact the Haematology team

Platelets are ordered by the BT lab from the Irish Blood Transfusion Service (IBTS) in Dublin when

latelets early in the day to allow for the most appropriate

nent to be transported by the IBTS and issued by the BT laboratory. Ordering

transfusion optimises use of the daily

aboratory until infusion and are never refrigerated.

day platelet count is recommended prior to ordering platelets. Platelets are either

ompatible when possible (seek Consultant Haematologist or

M/HV/23 for Compatibility table for

Platelets are ordered as ‘1 adult dose’. Standard treatment for an adult is ‘1 adult dose’ in 24 hours.

20 mL/kg, refer to OLCHC Shared Care Manual. Please note

In the event of a massive transfusion, Platelets may need to be used before laboratory results are

60 minute Platelet check post infusion to assess the effectiveness of the treatment is

recommended, especially if the patient’s responsiveness to Platelet transfusions is unknown.

One adult dose for prophylactic transfusion should raise the Platelet count by approximately

Failure of the Platelet count to rise/above the target should be discussed with the Consultant

300mL and pooled platelets contain

60 minutes (NBUG, 2004).

4th

Choice

-


O


solution) *


O


solution) *

-

PATHOLOGY




Platelet Selection:

• ABO Identical Platelets are ideal, but not essential. In an emergency, a different group to that

specified above can be given if the preferred group is not available. Check with Consultant

Haematologist, if in doubt. If the identical ABO type is not available

subsequent choices.

• Platelet components of patient’s own ABO/Rh

especially in children as due to the smaller blood volume of the recipients, there is a risk of inducing

a haemolytic reaction in the recipient from ABO antibodies in the donor plasma. This is especially

true when Group O Platelets are transfused to Group A, B or AB recipients and should only be

selected for non-group O patients if they are not labell

Transfusion of Group O platelets in children of Blood Groups A, B and AB should be avoided unless

the situation is critical.

• RhD negative Platelets are essential

cover is indicated for potentially child

transfused where RhD negative Platelets are unavailable. Check with Consultant Haematologist.

• Platelets like RCC must be CMV negative and gamma irradiated for patients as indicated.

(All Platelet Pools are currently irradiated)

• HLA matched, or HPA typed donations are selected specifically for each patient, and may not be

ABO/RhD or CMV compatible, as the requirement for HLA typing is considered more important in

these instances.

• When Patients with inherited Platelet function defects e.g. Glanzmann’s thrombasthenia or

Bernard Soulier Syndrome require Platelet transfusion

However if the patient is bleeding severely, transfusion with random donor Platelets need not be

withheld if there is a delay in obtaining HLA selected Platelets

Committee, 2012).

• In all cases of suspected and severe Neonatal Allo

Platelet Antigen (HPA) matched Platelets should be provided for transfusion. Transfusion of

random donor platelets is an appropriate strategy in the management of NAIT if comp

platelets are not available. (NBUG, 2004)

19.13.5 Albumin Albumin is a plasma protein circulating in the bloodstream where it maintains the oncotic pressure in th

vascular system. Human Albumin is prepared from large quantities of pooled donor plasma under

pharmaceutical manufacturing conditions. Albumin is also heat treated in accordance with international

guidelines with the aim of inactivating any known viruses.

Indications: There are no absolute indications for the use of Human Albumin Solution

Availability: 20% Human Albumin (100mL) and 5% Human Albumin (500mL) are available in MRHM.

Complications & Contraindications:

• Albumin is contraindicated in patients with a history of allerg

• Anaphylaxis-type reactions can occur and necessitate immediate discontinuation of the infusion

and the appropriate treatment instituted.

• Hypervolaemia may occur if the dosage and rate of administration are not adjusted

circulatory condition. Caution is advised in patients with low cardiac reserve or cardiac

insufficiency. Patients should be monitored carefully for evidence of circulatory overload.

• The risk of transmission of viral infection cannot be ex

use of human blood or blood products.

Prescription and Administration:

• Albumin is prescribed on the BTPRS.

• The batch number of the product is also recorded on this form on administration.

• Albumin is issued by the Blood Transfusion laboratory on a named patient basis.





Identical Platelets are ideal, but not essential. In an emergency, a different group to that


Haematologist, if in doubt. If the identical ABO type is not available refer to

ponents of patient’s own ABO/RhD group should be selected as far as possible


tion in the recipient from ABO antibodies in the donor plasma. This is especially


group O patients if they are not labelled as ‘High Titre Anti


D negative Platelets are essential for RhD negative females of childbearing potential. Anti D

cover is indicated for potentially child-bearing RhD negative females if Rh

D negative Platelets are unavailable. Check with Consultant Haematologist.

s like RCC must be CMV negative and gamma irradiated for patients as indicated.

(All Platelet Pools are currently irradiated)

HLA matched, or HPA typed donations are selected specifically for each patient, and may not be

D or CMV compatible, as the requirement for HLA typing is considered more important in

When Patients with inherited Platelet function defects e.g. Glanzmann’s thrombasthenia or

Bernard Soulier Syndrome require Platelet transfusion they should be HLA matched

f the patient is bleeding severely, transfusion with random donor Platelets need not be

withheld if there is a delay in obtaining HLA selected Platelets (Natio

ases of suspected and severe Neonatal Allo-Immune Thrombocytopenia (NAIT), Human


random donor platelets is an appropriate strategy in the management of NAIT if comp

platelets are not available. (NBUG, 2004)

Albumin is a plasma protein circulating in the bloodstream where it maintains the oncotic pressure in th

Albumin is prepared from large quantities of pooled donor plasma under


guidelines with the aim of inactivating any known viruses.

no absolute indications for the use of Human Albumin Solution

: 20% Human Albumin (100mL) and 5% Human Albumin (500mL) are available in MRHM.

:

Albumin is contraindicated in patients with a history of allergic reaction to albumin preparations.

type reactions can occur and necessitate immediate discontinuation of the infusion

and the appropriate treatment instituted.

Hypervolaemia may occur if the dosage and rate of administration are not adjusted



The risk of transmission of viral infection cannot be excluded with absolute certainty following the

use of human blood or blood products.

Albumin is prescribed on the BTPRS.

The batch number of the product is also recorded on this form on administration.

he Blood Transfusion laboratory on a named patient basis.



Identical Platelets are ideal, but not essential. In an emergency, a different group to that


refer to table above for

D group should be selected as far as possible


tion in the recipient from ABO antibodies in the donor plasma. This is especially


High Titre Anti-A/Anti-B Positive’.


D negative females of childbearing potential. Anti D

RhD positive Platelets are

D negative Platelets are unavailable. Check with Consultant Haematologist.

s like RCC must be CMV negative and gamma irradiated for patients as indicated.

HLA matched, or HPA typed donations are selected specifically for each patient, and may not be

D or CMV compatible, as the requirement for HLA typing is considered more important in

When Patients with inherited Platelet function defects e.g. Glanzmann’s thrombasthenia or

they should be HLA matched Platelets.

f the patient is bleeding severely, transfusion with random donor Platelets need not be

(National Blood Transfusion

Immune Thrombocytopenia (NAIT), Human


random donor platelets is an appropriate strategy in the management of NAIT if compatible

Albumin is a plasma protein circulating in the bloodstream where it maintains the oncotic pressure in the

Albumin is prepared from large quantities of pooled donor plasma under


no absolute indications for the use of Human Albumin Solution

: 20% Human Albumin (100mL) and 5% Human Albumin (500mL) are available in MRHM.

ic reaction to albumin preparations.

type reactions can occur and necessitate immediate discontinuation of the infusion

Hypervolaemia may occur if the dosage and rate of administration are not adjusted to the patient’s



cluded with absolute certainty following the

The batch number of the product is also recorded on this form on administration.

he Blood Transfusion laboratory on a named patient basis.

PATHOLOGY




• Human Albumin solutions are administered using a standard IV infusion set.

19.14 Anti-D Immunoglobulin and Kleihauer TestingRefer also to HVGL-M/HV/13 ‘Guideline for the

Testing’ current revision. Anti-D immunoglobulin is administered to RhD negative non

to prevent Haemolytic Disease of the Newborn.

19.14.1 Routine Antenatal AntiThis is the routine administration of 1500 IU Anti

women at 28/40 gestation. The rationale behind RAADP is to protect against sensitisation caused by ‘silent’

Foetal Maternal Haemorrhage and thus prevent

pregnancies.

19.14.2 Potentially Sensitising EventsAnti-D Immunoglobulin should be administered in pregnancy to RhD negative non

following circumstances:

Prior to 12 Weeks Gestation:

• Any medical/surgical methods to evacuate the products of conception

• Diagnosis of ectopic pregnancy

• Patients with heavy or repeated bleeding associated with abdominal pain particularly if

approaching 12 weeks gestation

After 12 Weeks Gestation:

• Antenatal patients who are bleeding and are not sensitised

• Miscarriage including threatened miscarriage

• Missed miscarriage that requires ERPC

• Medical/surgical evacuation of the products of conception

• Ectopic pregnancies

• Hydatidiform mole

• External Cephalic version

• Abdominal trauma (Kleihauer test recommended after 20 weeks gestation)

• Amniocentesis/Cordocentesis/Chorionic villus sampling

Post-natal:

• Non-sensitised RhD negative mothers wh

within 72 hours of delivery regardless of recent administration of Anti

irrespective of RAADP.

Anti-D is not indicated in the following situations:

• Women with threatened mis

12 weeks gestation.

• Uncomplicated miscarriage prior to 12 weeks gestation, as long as medical or surgical methods

have not been used to evacuate the products of conception (Clinical Pract

19.14.3 Anti-D ImmunoglobulinPrescription: The doctor interprets the results of the official laboratory report and when anti

it must be indicated in the patient’s medical records. An informed verbal consent is obtained from the

patient and an information leaflet is provided. Anti





Human Albumin solutions are administered using a standard IV infusion set.

D Immunoglobulin and Kleihauer Testing Guideline for the Administration of Anti-D Immunoglobulin & Kleihauer

D immunoglobulin is administered to RhD negative non

to prevent Haemolytic Disease of the Newborn.

Routine Antenatal Anti-D Prophylaxis (RAADP) This is the routine administration of 1500 IU Anti-D immunoglobulin to all non-sensitised RhD negative


Foetal Maternal Haemorrhage and thus prevent complications and potential morbidity in subsequent

Potentially Sensitising Events D Immunoglobulin should be administered in pregnancy to RhD negative non-sensitised women in the

Any medical/surgical methods to evacuate the products of conception

Diagnosis of ectopic pregnancy

Patients with heavy or repeated bleeding associated with abdominal pain particularly if

approaching 12 weeks gestation

patients who are bleeding and are not sensitised

Miscarriage including threatened miscarriage

Missed miscarriage that requires ERPC

Medical/surgical evacuation of the products of conception

dominal trauma (Kleihauer test recommended after 20 weeks gestation)

Amniocentesis/Cordocentesis/Chorionic villus sampling

sensitised RhD negative mothers who have delivered a RhD positive baby. This should be given

within 72 hours of delivery regardless of recent administration of Anti

indicated in the following situations:

Women with threatened miscarriage with a viable foetus where bleeding completely stops before

Uncomplicated miscarriage prior to 12 weeks gestation, as long as medical or surgical methods

have not been used to evacuate the products of conception (Clinical Practice Guideline, 2012)

D Immunoglobulin : The doctor interprets the results of the official laboratory report and when anti


patient and an information leaflet is provided. Anti-D immunoglobulin is prescribed by a doctor in the blood



Human Albumin solutions are administered using a standard IV infusion set.

Immunoglobulin & Kleihauer

D immunoglobulin is administered to RhD negative non-sensitised mothers

sensitised RhD negative


complications and potential morbidity in subsequent

sensitised women in the

Patients with heavy or repeated bleeding associated with abdominal pain particularly if

o have delivered a RhD positive baby. This should be given

within 72 hours of delivery regardless of recent administration of Anti-D Ig antenatally and

carriage with a viable foetus where bleeding completely stops before

Uncomplicated miscarriage prior to 12 weeks gestation, as long as medical or surgical methods

ice Guideline, 2012)

: The doctor interprets the results of the official laboratory report and when anti-D is required,


immunoglobulin is prescribed by a doctor in the blood

PATHOLOGY




& blood product section of the Drug Prescription Record Sheet. Anti

by completing FORM-M/BT/212 ‘Prophylactic Anti

Laboratory.

Dosage:

• Anti-D Immunoglobulin (Rhophylac) is presented in a prefilled syringe which contains 1500 IU of

human anti-D Ig in 2 mL. This standard dose is administered to antenatal and postnatal women as

indicated.

• Anti-D is administered with 72 hours of the potentially sensitising event. The deltoid muscle is the

preferred site to optimise absorption but it can be given in the gluteus muscle if required.

Rhophylac anti-D can be administered IV by doctors, refer to HVGL

Administration of Anti-D Immunoglobulin & Kleihauer Testing

• Anti-D prophylaxis should be given at 6

an additional sensitising event occurs in the setting of recu

treated as a separate event and anti

weeks gestation, FMH estimation performed

administered is required.

Contraindications:

• Known or suspected allergic response to anti

• Incomplete documentation or laboratory reports

• The intramuscular injection

other disorders of haemostasis. In these situations, it is administered IV.

Interactions: Active immunisation with live virus vaccines e.g. measles, mumps, rubella or varicella should

be postponed until 3 months after the last administration of anti

vaccine may be impaired.

19.14.4 Kleihauer TestingThe Kleihauer blood test detects foetal cells in the maternal circulation.

Haematology Laboratory in MRH, Portlaoise.

indicated if pre-formed immune anti

appropriate. Refer to HVGL-M/HV/13 ‘

Kleihauer Testing’ current revision.

Indications in RhD negative non-sensitised patients

� Ante Partum Haemorrhage (AP

� Following significant abdominal trauma after 20/40 gestation

� All RhD negative non sensitised women post delivery

� Cordocentesis

� External Cephalic version

� Following Intra Uterine death and still births (Note: indicated for both RhD Positive and Negative

women)

� In cases where a foeto-maternal bleed is suspected as a cause of anaemia in a newborn

indicated for both RhD Positive and Negative women

Sample Requirements:

• A blood sample for ABO & RhD Group of the mother is reserved at the same time as the FMH test.

• An EDTA sample (FBC tube) for FMH estimation should be collected after a gap of 30

post-delivery/sensitising event, to allow for any FMH to be dispersed in the maternal circulation. If

a maternal sample is not taken within 2 hours, a sample should be taken ASAP. Addressograph

labels are not permitted on





& blood product section of the Drug Prescription Record Sheet. Anti-D if is ordered from the BT Laboratory

Prophylactic Anti-D Order Form’ current revision and sending it

D Immunoglobulin (Rhophylac) is presented in a prefilled syringe which contains 1500 IU of

D Ig in 2 mL. This standard dose is administered to antenatal and postnatal women as

d with 72 hours of the potentially sensitising event. The deltoid muscle is the


D can be administered IV by doctors, refer to HVGL-M/HV/13 ‘

D Immunoglobulin & Kleihauer Testing’ current revision.

D prophylaxis should be given at 6-weekly intervals as per indications if bleeding is recurrent.

an additional sensitising event occurs in the setting of recurrent antenatal bleeding

treated as a separate event and anti-D Ig should be administered. For recurrent bleeding after 20

FMH estimation performed at 2-weekly intervals and additional anti

Known or suspected allergic response to anti-D or to blood components or products

Incomplete documentation or laboratory reports

intramuscular injection route is contraindicated in persons with severe thrombocytopaenia or

of haemostasis. In these situations, it is administered IV.

: Active immunisation with live virus vaccines e.g. measles, mumps, rubella or varicella should

be postponed until 3 months after the last administration of anti-D immunoglobulin, as

The Kleihauer blood test detects foetal cells in the maternal circulation. This test is carried out in the

Haematology Laboratory in MRH, Portlaoise. Foetal Maternal Haemorrhage (FMH) estimation is not

formed immune anti-D is present in the mother’s plasma as prophylaxis is not

M/HV/13 ‘Guideline for the Administration of Anti

sensitised patients:

Ante Partum Haemorrhage (APH) after 20/40 weeks gestation

Following significant abdominal trauma after 20/40 gestation

All RhD negative non sensitised women post delivery

Following Intra Uterine death and still births (Note: indicated for both RhD Positive and Negative

maternal bleed is suspected as a cause of anaemia in a newborn

oth RhD Positive and Negative women)

A blood sample for ABO & RhD Group of the mother is reserved at the same time as the FMH test.

An EDTA sample (FBC tube) for FMH estimation should be collected after a gap of 30

delivery/sensitising event, to allow for any FMH to be dispersed in the maternal circulation. If


FMH samples.



D if is ordered from the BT Laboratory

and sending it to the BT

D Immunoglobulin (Rhophylac) is presented in a prefilled syringe which contains 1500 IU of

D Ig in 2 mL. This standard dose is administered to antenatal and postnatal women as

d with 72 hours of the potentially sensitising event. The deltoid muscle is the


M/HV/13 ‘Guideline for the

’ current revision.

weekly intervals as per indications if bleeding is recurrent. If

rrent antenatal bleeding, this should be

For recurrent bleeding after 20

weekly intervals and additional anti-D

D or to blood components or products

route is contraindicated in persons with severe thrombocytopaenia or

: Active immunisation with live virus vaccines e.g. measles, mumps, rubella or varicella should

D immunoglobulin, as the efficacy of the

This test is carried out in the

Foetal Maternal Haemorrhage (FMH) estimation is not

D is present in the mother’s plasma as prophylaxis is not

dministration of Anti-D Immunoglobulin &

Following Intra Uterine death and still births (Note: indicated for both RhD Positive and Negative

maternal bleed is suspected as a cause of anaemia in a newborn (Note:

A blood sample for ABO & RhD Group of the mother is reserved at the same time as the FMH test.

An EDTA sample (FBC tube) for FMH estimation should be collected after a gap of 30-45 minutes

delivery/sensitising event, to allow for any FMH to be dispersed in the maternal circulation. If


PATHOLOGY




• Complete a Blood Transfusion

testing and provide full clinical details including blood group and date of sensitising

event/trauma/delivery along with gestation details.

• Post-natal patients: Cord blood sample

and FMH sample from the mother are sent to the BT Lab as a bundle for processing.

Procedure When Additional Anti-D is Required

• If the Kleihauer is positive and shows a bleed >8 mL, a FMH estimation by f

performed by the Coombe Women & Infants University Hospital to quantify the volume of the

bleed. The result will be telephoned to the laboratory at MRHM and the laboratory staff will

a senior clinician i.e. (registrar/consultant in

• Contact the Consultant Haematologist or the IBTS Consultant Haematologist for management of a

patient requiring large doses of anti

administered as soon as possible

• The baby’s FBC should be monitored.

• Intravenous Anti-D is given as per manufacturer’s instructions.

• Following administration of additional anti

hours to ensure clearance (48 hours if the anti

• In the event of large bleeds (greater than 24 mL), the mother should be counselled about the

possibility of sensitisation and an antibody screen should be checked at 6 months post

19.15 Guidelines for the Use of Factor ConcentratesThe following factor concentrates are stored in the Blood Transfusion laboratory:

• Factor I (Fibrinogen) e.g. Riastap

• Factor VIII Recombinant e.g. Advate

• Factor IX Recombinant e.g. Benefix

• Human Prothrombin Complex e.g. Octaplex

• Activated Factor VII e.g. NovoSeven

• Factor VIII + vWF e.g. Wilate

• Factor VIII Inhibiting Bypass Activity e.g. FEIBA

Other coagulation factors may be stored in the Blood Transfusion laboratory by request on a named patient

basis only (e.g. patient with inhibitors). Please contact the Blood Transfusion laboratory if you have any

queries regarding the availability of specific coagulation factors.

To order these products the advice of the Consultant Haematologist must be sought. In c

coagulation disorders, such as DIC, liver disease or hyperfibrinolysis, alternative treatments such as plasma

may be recommended.

19.15.1 Fibrinogen Riastap is a purified concentrate of fibrinogen (Factor I) derived from human plasma. It is issue

transfusion laboratory on a named patient basis for immediate use. This product is stored at 4°C and is not

group specific.

Indications: Treatment of patients with congenital or acquired hypofibrinogenaemia. Acquired

hypofibrinogenaemia may be due to disseminated intravascular coagulation (DIC), severe blood loss, failure

of hepatic synthesis or bleeding post

Contraindications:

• Known hypersensitivity to constituents of the product

• Manifest thrombosis and myocardial infarction except in cases of potential fatal bleeding





Transfusion request form (See Section 6.2) for Kleihauer test

and provide full clinical details including blood group and date of sensitising

event/trauma/delivery along with gestation details.

Cord blood sample from the baby for ABO & RhD Group


D is Required:

If the Kleihauer is positive and shows a bleed >8 mL, a FMH estimation by f


bleed. The result will be telephoned to the laboratory at MRHM and the laboratory staff will

a senior clinician i.e. (registrar/consultant in Obstetrics Dept.) with the result

Contact the Consultant Haematologist or the IBTS Consultant Haematologist for management of a

patient requiring large doses of anti-D immunoglobulin. The additional anti

as possible after the sensitising event and preferably within 72 hours.

The baby’s FBC should be monitored.

D is given as per manufacturer’s instructions.

Following administration of additional anti-D immunoglobulin, repeat the Kleihauer test in

hours to ensure clearance (48 hours if the anti-D was given IV).

In the event of large bleeds (greater than 24 mL), the mother should be counselled about the

possibility of sensitisation and an antibody screen should be checked at 6 months post

Guidelines for the Use of Factor Concentrates The following factor concentrates are stored in the Blood Transfusion laboratory:

Factor I (Fibrinogen) e.g. Riastap

Factor VIII Recombinant e.g. Advate

Factor IX Recombinant e.g. Benefix

bin Complex e.g. Octaplex

Activated Factor VII e.g. NovoSeven

Factor VIII + vWF e.g. Wilate

Factor VIII Inhibiting Bypass Activity e.g. FEIBA

coagulation factors may be stored in the Blood Transfusion laboratory by request on a named patient

ly (e.g. patient with inhibitors). Please contact the Blood Transfusion laboratory if you have any

queries regarding the availability of specific coagulation factors.

To order these products the advice of the Consultant Haematologist must be sought. In c


Riastap is a purified concentrate of fibrinogen (Factor I) derived from human plasma. It is issue


: Treatment of patients with congenital or acquired hypofibrinogenaemia. Acquired

e to disseminated intravascular coagulation (DIC), severe blood loss, failure

of hepatic synthesis or bleeding post-fibrinolytic therapy i.e. treatment post-CVA and MI.

Known hypersensitivity to constituents of the product

ombosis and myocardial infarction except in cases of potential fatal bleeding



request form (See Section 6.2) for Kleihauer test and ABO & RhD

and provide full clinical details including blood group and date of sensitising

from the baby for ABO & RhD Group, ABO & RhD Group


If the Kleihauer is positive and shows a bleed >8 mL, a FMH estimation by flow cytometry is


bleed. The result will be telephoned to the laboratory at MRHM and the laboratory staff will notify

) with the result.

Contact the Consultant Haematologist or the IBTS Consultant Haematologist for management of a

D immunoglobulin. The additional anti-D should be

after the sensitising event and preferably within 72 hours.

D immunoglobulin, repeat the Kleihauer test in 48-72

In the event of large bleeds (greater than 24 mL), the mother should be counselled about the

possibility of sensitisation and an antibody screen should be checked at 6 months post-delivery.

coagulation factors may be stored in the Blood Transfusion laboratory by request on a named patient

ly (e.g. patient with inhibitors). Please contact the Blood Transfusion laboratory if you have any

To order these products the advice of the Consultant Haematologist must be sought. In cases of complex


Riastap is a purified concentrate of fibrinogen (Factor I) derived from human plasma. It is issued by the


: Treatment of patients with congenital or acquired hypofibrinogenaemia. Acquired

e to disseminated intravascular coagulation (DIC), severe blood loss, failure

CVA and MI.

ombosis and myocardial infarction except in cases of potential fatal bleeding

PATHOLOGY




Complications:

• Allergic/anaphylactic reactions

• Potential risk of thromboembolic episodes (including MI and PE)

Dosage: 1 g of fibrinogen concentrate will raise the plasma fibrinogen by 0.25 g/L. If plasma fibrinogen is

<1.5 g/L, the usual dose is 2-4 g. Subsequent infusion as required, see laboratory testing. The dose for

children is calculated according to body weight a

Laboratory Testing: Plasma fibrinogen sample should be reserved prior to requesting fibrinogen

concentrate. Plasma fibrinogen level should be repeated post

treatment has been effective.

Reconstitution:

1. Warm the concentrate to room temperature before aseptically adding water for injection, 50 mL

water for injection per 1 g Riastap.

2. Do not shake the solution to avoid formation of foam, swirl the bottle until powder is completely

reconstituted.

3. Do not use solutions which are cloudy or contain residues.

Administration: Fibrinogen should be prescribed on the BTPRS and must be fully traceable. It should not be

mixed with medicinal products, diluents or solvents. Administer once reconstituted by a d

separate infusion line. The rate of the infusion should not exceed 5 mL/minute. Do not withdraw syringe on

administration to ensure no blood enters syringes filled with product.

Observations: Observe patient for signs of immediate reaction o

Record vital signs. If reaction occurs, the rate of infusion should be decreased or stopped depending on

clinical condition of the patient. All reactions or events are reportable to the Consultant Haematologist,

TSO, Transfusion laboratory and clinical risk management.

19.15.2 Factor VIII and Factor IXThese are available for use in Haemophilia A and B patients respectively. All known haemophilia patients in

the region are registered either with the Haemophilia Departmen

Centre for Hereditary Coagulation Disorders

Haematologist /Haematology Registrar based in MRH, Tullamore must be contacted in the event of a

haemophilia patient attending MRHM in an emergency situation who will liaise with the haematology team

at OLCHC/NCHCD prior to advising the relevant dosage of factor concentrate for the patient. Alternatively,

the Haematology Registrar on-call may be contacted at either OLCHC o

provide details on the patient’s diagnosis and treatment of choice on a 24 hour basis.

delays in initiating treatment if these patients present to the hospital in order to optimise patient outcome.

19.15.3 Factor VIII + vWF This is indicated for patients with severe von Willebrand’s Disease (vWD) with major haemorrhage as per

haematology advice. Most patients with vWD can be managed with antifibrinolytic agents and/or

Desmopressin (DDAVP).

19.15.4 Human Prothrombin Comple

The human prothrombin complex currently in use is Octaplex and is a pooled plasma coagulation factor

concentration. Each vial contains factors II, VII, IX and X.

Indications: It is licensed in Ireland for the treatment of:

• Bleeding and peri-operative

coagulation factors such as deficiency caused by treatment with vitamin K antagonists, when rapid

correction of the deficiency is required

• Bleeding and peri-operative prophylaxis in congenital d

coagulation factors (II and X) when purified specific coagulation products are not available





Allergic/anaphylactic reactions

Potential risk of thromboembolic episodes (including MI and PE)

: 1 g of fibrinogen concentrate will raise the plasma fibrinogen by 0.25 g/L. If plasma fibrinogen is

4 g. Subsequent infusion as required, see laboratory testing. The dose for

children is calculated according to body weight and clinical need.

: Plasma fibrinogen sample should be reserved prior to requesting fibrinogen

concentrate. Plasma fibrinogen level should be repeated post-administration of this product to ensure the

Warm the concentrate to room temperature before aseptically adding water for injection, 50 mL

water for injection per 1 g Riastap.

Do not shake the solution to avoid formation of foam, swirl the bottle until powder is completely

Do not use solutions which are cloudy or contain residues.

: Fibrinogen should be prescribed on the BTPRS and must be fully traceable. It should not be

mixed with medicinal products, diluents or solvents. Administer once reconstituted by a d


administration to ensure no blood enters syringes filled with product.

: Observe patient for signs of immediate reaction or signs and symptoms of thrombosis or DIC.



SO, Transfusion laboratory and clinical risk management.

Factor VIII and Factor IX These are available for use in Haemophilia A and B patients respectively. All known haemophilia patients in

the region are registered either with the Haemophilia Department at OLCHC (children) or at the National

for Hereditary Coagulation Disorders (NCHCD), St James’s Hospital (adults). A Consultant


tending MRHM in an emergency situation who will liaise with the haematology team


call may be contacted at either OLCHC or NCHCD as required. They can

provide details on the patient’s diagnosis and treatment of choice on a 24 hour basis.


This is indicated for patients with severe von Willebrand’s Disease (vWD) with major haemorrhage as per


Human Prothrombin Complex


concentration. Each vial contains factors II, VII, IX and X.

It is licensed in Ireland for the treatment of:

operative prophylaxis in acquired deficiency of the prothrombin complex


correction of the deficiency is required

operative prophylaxis in congenital deficiency of any of the vitamin K dependent




: 1 g of fibrinogen concentrate will raise the plasma fibrinogen by 0.25 g/L. If plasma fibrinogen is

4 g. Subsequent infusion as required, see laboratory testing. The dose for

: Plasma fibrinogen sample should be reserved prior to requesting fibrinogen

administration of this product to ensure the

Warm the concentrate to room temperature before aseptically adding water for injection, 50 mL

Do not shake the solution to avoid formation of foam, swirl the bottle until powder is completely

: Fibrinogen should be prescribed on the BTPRS and must be fully traceable. It should not be

mixed with medicinal products, diluents or solvents. Administer once reconstituted by a doctor using a


r signs and symptoms of thrombosis or DIC.



These are available for use in Haemophilia A and B patients respectively. All known haemophilia patients in

t at OLCHC (children) or at the National

(NCHCD), St James’s Hospital (adults). A Consultant


tending MRHM in an emergency situation who will liaise with the haematology team


r NCHCD as required. They can

provide details on the patient’s diagnosis and treatment of choice on a 24 hour basis. There should be no


This is indicated for patients with severe von Willebrand’s Disease (vWD) with major haemorrhage as per



prophylaxis in acquired deficiency of the prothrombin complex


eficiency of any of the vitamin K dependent


PATHOLOGY




• For emergency reversal of warfarin in life

surgery (i.e. where there is no possibility of delaying surgery by >6 hours to allow vitamin K to take

effect). Note: for reversal of warfarin in non

and/or reduction/discontinuation of warfarin are sufficient. See table below for recommendations

for reversal of warfarin.

Recommendations for Reversal of Warfarin

SITUATION INR

Elevated

INR – No

Bleeding

Minor

Bleeding

3.0-6.0

6.0-8.0

>8

Elevated

INR -

Major

Bleeding

Irrespective of INR:

�� Intracranial bleed

�� Retroperitoneal

bleed

�� Muscle bleed with

compartment

syndrome,

�� GI Bleed,

�� Vital organ bleed

(e.g. eye)

�� Active bleed with

low BP or 2 g/dL

drop in Hb

Planned

Surgery





For emergency reversal of warfarin in life-threatening/major haemorrhage and/or emergency


effect). Note: for reversal of warfarin in non-emergency situations, administration of vitamin K



TREATMENT

� Reduce Warfarin dose or stop

� Dose reduce by 10-20%

� Restart when INR <5.0

� Aim for original INR target

�� Stop Warfarin

�� Restart when INR <5.0

�� Consider Vitamin K 0.5-1 mg PO if minor bleeding, age >70 or

history of bleeding complications

�� Stop Warfarin

�� Restart when INR <5.0

�� Consider Vitamin K 0.5-2mgs PO

�� Recheck INR between 6-12 hours

�� If INR remains elevated at 24 hours- repeat dose of Vitamin K.

Intracranial bleed

Muscle bleed with

Vital organ bleed

Active bleed with

�� Vitamin K 10 mgs IV

�� HPC is the treatment of choice:

Patient’s

INR

Recommended HPC Dose

2.0-3.9 25 IU/kg

4.0-6.0 35 IU/kg

>6.0 50 IU/kg

Note: The single dose should not

exceed 3000 IU of HPC

�� Recheck coagulation screen at 20-60 minutes

hourly post and daily thereafter

�� Rarely HPC may be contraindicated and Plasma may be

required.

�� Consult with Haematology team @ MRHT advice using HPC in

liver disease, DIC or mechanical valves.

�� For CNS bleed neurosurgical review is always required.

�� All patients should have their anticoagulation reviewed in

advance

�� Stop Warfarin 5 days in advance of surgery

�� Check INR day before surgery

�� If INR not fallen sufficiently consider Vitamin K 5mg

�� Risk of VTE with interruption of anticoagulation varies according

to indication and co-morbidities

�� All patients should be stratified according to

and risk for bleeding

�� If high risk of thrombosis, contact Haematologist for advice on

bridging anticoagulation

�� Inappropriate use of HPC for planned surgical procedures is

costly and may expose patients unnecessarily to blood products



threatening/major haemorrhage and/or emergency


ions, administration of vitamin K


1 mg PO if minor bleeding, age >70 or

repeat dose of Vitamin K.

Note: The single dose should not

minutes post HPC, 6

Rarely HPC may be contraindicated and Plasma may be

Consult with Haematology team @ MRHT advice using HPC in

For CNS bleed neurosurgical review is always required.

All patients should have their anticoagulation reviewed in

days in advance of surgery

If INR not fallen sufficiently consider Vitamin K 5mg

Risk of VTE with interruption of anticoagulation varies according

All patients should be stratified according to their risk for VTE

If high risk of thrombosis, contact Haematologist for advice on

Inappropriate use of HPC for planned surgical procedures is

costly and may expose patients unnecessarily to blood products

PATHOLOGY





SITUATION INR

Emergency

/Urgent

Surgery

Contraindications: HPC should not be used in patients with known hypersensitivity to:

• The active substance or any of the excipients (see product insert)

• Heparin or recent history of heparin induced thrombocytopaenia (<100 days)

Complications: HPC contains heparin. Therefore, a sudden allergy

may rarely be observed (thrombocytopaenia type II). In patients not previously hypersen

thrombocytopaenia may occur 6-14 days after the start of treatment. It is recommended to perform a full

blood count before the infusion of HPC and to repeat it on day 6 and day 14 post

previous heparin hypersensitivity, this reduction may happen within a few hours.

Dosage and Monitoring:

• Each vial of HPC contains 500 IU based on Factor IX content.

• Dosage and duration of therapy depends on the severity of the coagulation disorder, the location

and extent of bleeding and the clinical condition of the patient. An initial bolus dose of 25

body weight is recommended in cases of severe haemorrhag

3000 IU. Where calculation for a patient requires more than 3000 IU, contact the Haematologist

on-call for advice.

• Generally in adults the dose is rounded off to an appropriate number of whole vials.

• As a guideline, the recommended dose of HPC to provide complete reversal of warfarin is based on

the Factor IX content of HPC and the patient’s INR. See above table for recommended dose.

• It is recommended to administer vitamin K intravenously in addition to HPC.

Reconstitution: HPC is presented in powder form with 20 mL water for injection, only this supplied water

should be used and not any other solvent diluent.

Factor Concentrates’ current revision.

Administration:

• HPC must be administered intravenously by a doctor.

• It is acceptable to use a continuous infusion pump.

• The suggested rate of administration of Human Prothrombin Complex (Octaplex) is

o FOR THE FIRST TEN MINUTES

Volume to be infused in

o REMAINDER OF INFUSION

mL/minute).

• Do not withdraw blood into the product

leading to the administration of fibrin clots to the patient.

• The INR should be monitored regularly as the effect of warfarin may last longer than the effect of

the HPC due to the relative short half

• It is recommended that the INR is checked within one hour of administration of HPC and repeated

6 hours post administration.

• A further dose of HPC may be required if there is an insufficient response or duration of response.






TREATMENT

�� If surgery can be delayed (but necessary within 3 days) reverse

anticoagulation with Vitamin K 2–5mg IV or PO to reduce INR to

<1.5

�� If immediate surgery required, Vitamin K 5

Plasma may be required

�� Discuss with Haematology Team

�� Repeat Coagulation Screen pre surgical intervention (as per

guidelines)

: HPC should not be used in patients with known hypersensitivity to:

The active substance or any of the excipients (see product insert)

recent history of heparin induced thrombocytopaenia (<100 days)

: HPC contains heparin. Therefore, a sudden allergy-induced reduction of the platelet count

may rarely be observed (thrombocytopaenia type II). In patients not previously hypersen

14 days after the start of treatment. It is recommended to perform a full

blood count before the infusion of HPC and to repeat it on day 6 and day 14 post-infusion. In patients with

sitivity, this reduction may happen within a few hours.

Each vial of HPC contains 500 IU based on Factor IX content.

Dosage and duration of therapy depends on the severity of the coagulation disorder, the location

and extent of bleeding and the clinical condition of the patient. An initial bolus dose of 25

body weight is recommended in cases of severe haemorrhage. A single dose should not exceed


Generally in adults the dose is rounded off to an appropriate number of whole vials.

recommended dose of HPC to provide complete reversal of warfarin is based on


It is recommended to administer vitamin K intravenously in addition to HPC.

HPC is presented in powder form with 20 mL water for injection, only this supplied water

should be used and not any other solvent diluent. Refer to package insert and HVG/L

Factor Concentrates’ current revision.

PC must be administered intravenously by a doctor.

It is acceptable to use a continuous infusion pump.

The suggested rate of administration of Human Prothrombin Complex (Octaplex) is

FOR THE FIRST TEN MINUTES: Set RATE on Syringe Pump to 60mL

Volume to be infused in the first ten minutes is 10mL

REMAINDER OF INFUSION: Increase RATE on Syringe Pump to 120

Do not withdraw blood into the product-filled syringe due to the risk of the formation of fibrin clots

leading to the administration of fibrin clots to the patient.

itored regularly as the effect of warfarin may last longer than the effect of

the HPC due to the relative short half-life of Factor VII.

It is recommended that the INR is checked within one hour of administration of HPC and repeated

administration.

A further dose of HPC may be required if there is an insufficient response or duration of response.


No. Of Pg: 100 of 132

If surgery can be delayed (but necessary within 3 days) reverse

5mg IV or PO to reduce INR to

If immediate surgery required, Vitamin K 5 -10mg +/- HPC or

Repeat Coagulation Screen pre surgical intervention (as per

: HPC should not be used in patients with known hypersensitivity to:

recent history of heparin induced thrombocytopaenia (<100 days)

induced reduction of the platelet count

may rarely be observed (thrombocytopaenia type II). In patients not previously hypersensitive to heparin,

14 days after the start of treatment. It is recommended to perform a full

infusion. In patients with

Dosage and duration of therapy depends on the severity of the coagulation disorder, the location

and extent of bleeding and the clinical condition of the patient. An initial bolus dose of 25-50 IU/kg

e. A single dose should not exceed


Generally in adults the dose is rounded off to an appropriate number of whole vials.

recommended dose of HPC to provide complete reversal of warfarin is based on


It is recommended to administer vitamin K intravenously in addition to HPC.

HPC is presented in powder form with 20 mL water for injection, only this supplied water

Refer to package insert and HVG/L-M/HV/7 ‘The Use of

The suggested rate of administration of Human Prothrombin Complex (Octaplex) is:

per hour (1mL/minute).

120-180 mL per hour (2-3

filled syringe due to the risk of the formation of fibrin clots

itored regularly as the effect of warfarin may last longer than the effect of

It is recommended that the INR is checked within one hour of administration of HPC and repeated

A further dose of HPC may be required if there is an insufficient response or duration of response.

PATHOLOGY




19.15.5 FEIBA (Factor VIII FEIBA is an activated prothrombin complex concentrate made from human plasma. The active sub

per vial of FEIBA is 500 IU Factor VII

also contains factor II, IX and X in mainly non

currently available in 500 IU and 1

Concentrates’ current revision.

Indications:

• Treatment of bleeding in Haemophilia A patients with inhibitors

• Prophylaxis of bleeding in Haemophilia A patients with inhibitors

• Treatment of bleeding in non

Contact NCHCD in St James’s hospital for advice.

19.15.6 Activated Factor VII (Recombinant)Indications: This is licensed for use in the following very rare situations:

• Haemophilia with inhibitors

• Glanzmann’s Thrombasthenia

glycoprotein IIb/IIIa receptors on platelets

• Inherited Factor VII deficiency

Possible Off-licence Use:

• There is increased interest in the use

with severe bleeding where other treatments have failed e.g. multiple trauma or massive

haemorrhage patients who are bleeding severely.

• Any surgically correctable cause of bleeding must be correc

RCC, plasma, platelets and fibrinogen should be given if indicated as per massive transfusion

template, refer to Section

activated factor VII can be life

Dosage: Usual dose for active bleeds and haemophilia patients is 90 µg/kg. For factor deficiency, the usual

dose is 15-30 µg/kg.

Notes:

• As recombinant factor VII is not from blood donors, it may be acceptable to Jehovah’s Witnesses i

a variety of coagulopathies that would usually be treated with blood products.

• The use of activated Factor VII in reversal of warfarin overdose has been described but other than

in Jehovah’s Witnesses, HPC is recommended.

• Seek haematology advice for dosage of activated Factor VII and refer to package insert.

19.15.7 Direct Acting Oral AnticoagulantsThere are two types of direct acting

and Direct Factor Xa Inhibitors (e.g. Rivaroxaban).

Direct Factor Xa Inhibitors (e.g. Rivaroxaban).

interval for DTIs/ Direct Factor Xa Inhibitors, the increased

risk to the patient from delaying a necessary procedure. Senior clinicians should be involved in these

decisions and discussion with the Consultant Haematologist on

Factor Xa Inhibitors (e.g. Rivaroxaban) then HPC may be considered in the setting of severe/life

bleeds. Refer to HVG/L-M/HV/7 ‘The Use of Factor Concentrates’ current revision and Figure 19.1 below.

Idarucizumab is a specific reversal agent

Dabigatran when rapid reversal of its anticoagulant effects is required i

uncontrolled bleeding and for emergency surgery

recommended dose of Idarucizumab

now stock. The advice of a consultant haemato





Inhibiting Bypass Activity) FEIBA is an activated prothrombin complex concentrate made from human plasma. The active sub

per vial of FEIBA is 500 IU Factor VIII inhibiting bypass activity in 200-600 mg human plasma protein. FEIBA

also contains factor II, IX and X in mainly non-activated form as well as activated factor VII. FEIBA is

currently available in 500 IU and 1000 IU in MRHM. Refer also to HVG/L-M/HV/7 ‘The Use of Factor

Treatment of bleeding in Haemophilia A patients with inhibitors

Prophylaxis of bleeding in Haemophilia A patients with inhibitors

bleeding in non-haemophilia patients who have developed inhibitors to Factor VIII.

Contact NCHCD in St James’s hospital for advice.

Activated Factor VII (Recombinant) : This is licensed for use in the following very rare situations:

a with inhibitors

Glanzmann’s Thrombasthenia – a rare inherited platelet function disorder where there is lack of

glycoprotein IIb/IIIa receptors on platelets

Inherited Factor VII deficiency

There is increased interest in the use of activated Factor VII to correct coagulopathy associated


haemorrhage patients who are bleeding severely.

Any surgically correctable cause of bleeding must be corrected and all the usual products including


template, refer to Section 19.17. If, despite all these usual measures, a patient is still bleeding,

can be life-saving.

: Usual dose for active bleeds and haemophilia patients is 90 µg/kg. For factor deficiency, the usual

As recombinant factor VII is not from blood donors, it may be acceptable to Jehovah’s Witnesses i


The use of activated Factor VII in reversal of warfarin overdose has been described but other than

Jehovah’s Witnesses, HPC is recommended.

Seek haematology advice for dosage of activated Factor VII and refer to package insert.

Oral Anticoagulants direct acting oral anticoagulants, Direct Thrombin Inhibitors (DTIs) e

(e.g. Rivaroxaban). Currently, there is no current specific reversal agent for

Direct Factor Xa Inhibitors (e.g. Rivaroxaban). If a procedure or surgery cannot be delayed to allow an

interval for DTIs/ Direct Factor Xa Inhibitors, the increased risk of bleeding must be balanced against the


decisions and discussion with the Consultant Haematologist on-call is advised. If the patient is on Direct

Factor Xa Inhibitors (e.g. Rivaroxaban) then HPC may be considered in the setting of severe/life

M/HV/7 ‘The Use of Factor Concentrates’ current revision and Figure 19.1 below.

is a specific reversal agent for Dabigatran and is indicated in adult patients treated with

when rapid reversal of its anticoagulant effects is required i.e.

uncontrolled bleeding and for emergency surgery. This is a consultant prescribed only medicat

Idarucizumab is 5 g IV (2x2.5 g/50 mL) which the pharmacy dep

now stock. The advice of a consultant haematologist must be sought. Refer to Product Insert for


No. Of Pg: 101 of 132

FEIBA is an activated prothrombin complex concentrate made from human plasma. The active substance

600 mg human plasma protein. FEIBA

activated form as well as activated factor VII. FEIBA is

M/HV/7 ‘The Use of Factor

haemophilia patients who have developed inhibitors to Factor VIII.

a rare inherited platelet function disorder where there is lack of

of activated Factor VII to correct coagulopathy associated


ted and all the usual products including


. If, despite all these usual measures, a patient is still bleeding,

: Usual dose for active bleeds and haemophilia patients is 90 µg/kg. For factor deficiency, the usual

As recombinant factor VII is not from blood donors, it may be acceptable to Jehovah’s Witnesses in


The use of activated Factor VII in reversal of warfarin overdose has been described but other than

Seek haematology advice for dosage of activated Factor VII and refer to package insert.

oral anticoagulants, Direct Thrombin Inhibitors (DTIs) e.g. Dabigatran

here is no current specific reversal agent for

If a procedure or surgery cannot be delayed to allow an

risk of bleeding must be balanced against the


If the patient is on Direct

Factor Xa Inhibitors (e.g. Rivaroxaban) then HPC may be considered in the setting of severe/life-threatening

M/HV/7 ‘The Use of Factor Concentrates’ current revision and Figure 19.1 below.

and is indicated in adult patients treated with

in life-threatening or

his is a consultant prescribed only medication. The

which the pharmacy department at MRHM

Refer to Product Insert for

PATHOLOGY




administration. In the unlikely event that there is a

Haematologist regarding on-going management

Figure 19.1: Algorithm for Use in Acute Bleeding of Direct Thrombin Inhibitors (DTIs) or Direct Factor Xa

Inhibitors





In the unlikely event that there is a poor response from the Idarucizumab

management

: Algorithm for Use in Acute Bleeding of Direct Thrombin Inhibitors (DTIs) or Direct Factor Xa


No. Of Pg: 102 of 132

poor response from the Idarucizumab, discuss with

: Algorithm for Use in Acute Bleeding of Direct Thrombin Inhibitors (DTIs) or Direct Factor Xa

PATHOLOGY




19.15.8 Laboratory Tests for Monitoring Response to Blood Products

Product

Fibrinogen

(e.g. Riastap)

Human Prothrombin Complex

(e.g. Octaplex)

Activated Factor VII

(e.g. Novoseven)

Human Factor VIII

(e.g. Wilate)

Recombinant Factor VIII

(e.g. Advate)

Recombinant Factor IX

(e.g. Benefix)

Activated Prothrombin Complex

Concentrate (FEIBA)

19.16 Traceability EU Directive 2002/98/EC requires 100% traceability and fating of each blood product transfused. On

commencement of each blood transfusion, the traceability label (purple section) attached to the

compatibility label on each blood product must be:

1. Detached from the unit

2. Dated

3. Timed (24 hour)

4. Signed

5. Name printed

6. Returned to the Blood Transfusion laboratory, MRH Mullingar. (Red envelope provided)

Note: Fating is automatic when Electronic Blood Track Phase 3 is used for checking and administration of

RCC and Platelets so steps 1-6 listed above

19.17 Transporting Blood ProductsThere are strict regulations with regard to the transpo

a patient. Please contact the Blood Transfusion laboratory on extension 4329 or the Haem/BT medical

scientist on-call at *51836 to arrange for blood to packed in the appropriate transport cooler. Please

takes 10-15 minutes for blood to be packed correctly.





Laboratory Tests for Monitoring Response to Blood Products

Coagulation Test

Clauss fibrinogen 1g of fibrinogen concentrate will

raise plasma fibrinogen by 0.25

g/L. If plasma fibrinogen is

<1.5g/L, the usual dose is 2

PT 1 dose should correct INR of

patients on warfarin to near

normal. Should be checked at 1

hour and 6 hours post infusion

No specific measurement Monitor clinically and as per

massive blood loss i.e. PT/APTT/

Fib/Hb/Plt

VIIIc/vWF Ag/Ristocetin cofactor Coagulation sample can be sent

to St James’s Hospital

Factor VIII

APTT in an emergency

1 dose should correct to normal.

Coagulation sample can be sent

to St James’s Hospital for Factor

VIII levels

Factor IX

APTT in an emergency




IX levels

APTT for DTI inhibitors

PT for Xa inhibitors (note FEIBA generally not used as first line

treatment)

Seek haematologist‘s advice.

2002/98/EC requires 100% traceability and fating of each blood product transfused. On


compatibility label on each blood product must be:

Returned to the Blood Transfusion laboratory, MRH Mullingar. (Red envelope provided)


6 listed above will not be required.

Transporting Blood Products There are strict regulations with regard to the transport of blood, should blood need to be transferred with


call at *51836 to arrange for blood to packed in the appropriate transport cooler. Please

15 minutes for blood to be packed correctly.


No. Of Pg: 103 of 132

Comments

1g of fibrinogen concentrate will

raise plasma fibrinogen by 0.25

g/L. If plasma fibrinogen is

the usual dose is 2-4g.

1 dose should correct INR of

s on warfarin to near

normal. Should be checked at 1

hour and 6 hours post infusion

Monitor clinically and as per

massive blood loss i.e. PT/APTT/

Fib/Hb/Plt


to St James’s Hospital







PT for Xa inhibitors (note FEIBA generally not used as first line

2002/98/EC requires 100% traceability and fating of each blood product transfused. On


Returned to the Blood Transfusion laboratory, MRH Mullingar. (Red envelope provided)


rt of blood, should blood need to be transferred with


call at *51836 to arrange for blood to packed in the appropriate transport cooler. Please note it

PATHOLOGY




19.18 Transfusion Reactions

• A transfusion reaction can be acute (within 24 hours) or delayed (between 24 hours and 28 days of

a transfusion).

• Refer to Figure 19.2 for management of an acute tran

• In the event of a suspected transfusion reaction, it is the doctor’s responsibility to record any

reaction (suspected and confirmed)

• The reporting of Serious Adverse Reactions and Events is

They are reported to the National Haemovigilance Office by the TSO and are reported to clinical risk

management at the clinical level.

• Refer to HVG/L-M/HV/5 ‘Management of Adverse Transfusion Reactions and Events’

revision for the signs, symptoms, causes, management and investigations required for acute and

delayed transfusion reactions.

• Further information or clarification may be obtained from the Consultant

Haematologist/Haematology Registrar/Medical Scientist and/or TSO.

MRHT provides an on call service and can be contacted via switchboard for advice

management of suspected transfusion reactions

• Contact the Blood Transfusion medical scientist immediately if suspect a transfusion reaction due

to:

o Bacterial contamination of the blood component/product

o Viral, parasitic or other post

o Transfusion Related Acute Lung Injury (TRALI)

Rapid alert to the Irish Blood Transfusion Service is necessary.

notification should be taken following review with the Consultant Haematologist and/or the

patient’s primary clinician. The medical scientist and TSO should be informed if there is any

suspicion of the above.





A transfusion reaction can be acute (within 24 hours) or delayed (between 24 hours and 28 days of

Refer to Figure 19.2 for management of an acute transfusion reaction.

In the event of a suspected transfusion reaction, it is the doctor’s responsibility to record any

(suspected and confirmed) and management in the patient’s medical notes.

The reporting of Serious Adverse Reactions and Events is mandatory with EU Directive


management at the clinical level.



delayed transfusion reactions.

Further information or clarification may be obtained from the Consultant

Haematologist/Haematology Registrar/Medical Scientist and/or TSO. The haematology service @

MRHT provides an on call service and can be contacted via switchboard for advice

management of suspected transfusion reactions.

Contact the Blood Transfusion medical scientist immediately if suspect a transfusion reaction due

Bacterial contamination of the blood component/product

Viral, parasitic or other post-transfusion infection

Transfusion Related Acute Lung Injury (TRALI)

Rapid alert to the Irish Blood Transfusion Service is necessary. The decision to initiate a rapid alert


primary clinician. The medical scientist and TSO should be informed if there is any


No. Of Pg: 104 of 132

A transfusion reaction can be acute (within 24 hours) or delayed (between 24 hours and 28 days of

In the event of a suspected transfusion reaction, it is the doctor’s responsibility to record any

and management in the patient’s medical notes.

EU Directive 2002/98/EC.


M/HV/5 ‘Management of Adverse Transfusion Reactions and Events’ current


The haematology service @

MRHT provides an on call service and can be contacted via switchboard for advice regarding the

Contact the Blood Transfusion medical scientist immediately if suspect a transfusion reaction due

The decision to initiate a rapid alert


primary clinician. The medical scientist and TSO should be informed if there is any

PATHOLOGY




Figure 19.1: Management of an Acute Transfusion Reaction





: Management of an Acute Transfusion Reaction


No. Of Pg: 105 of 132

PATHOLOGY




19.19 Emergency Blood Transfusion

19.19.1 Emergency O RhD Negative Red Cells

• Two units of O RhD Negative red cell concentrates are stocked for immediate use. These units are

available in an emergency

• There is also an emergency neonatal SAGM O RhD Negative unit of red cells suitable for neonatal

use for 5 days after date drawn. This is also s

no coagulation factors in the SAGM neonatal unit

coagulopathy in massive haemorrhage.

• In an emergency, the clinician in charge of the patient may decide that

transfusion is so urgent that there is no time to undertake full pre

responsibility of the clinician to request uncrossmatched RCC.

• The Blood Transfusion laboratory should be contacted as soon as possible

are required.

• Emergency O RhD Negative RCC should not be used for elective and/or non

red cell antibodies, as these units are not typed for all antigens for other non

groups.

• Where possible, a group and crossmatch sample must be taken from the patient prior to

transfusion of any emergency RCC.

• A confirmatory sample for b

group of the patient in the laboratory.

designated sample tube wil

• Group O RhD matched or

after receipt of the sample. This will be labelled as ‘

uncrossmatched’. The blood should be prescribed on the BTPRS.

• In order to ensure full traceability, the two administrators must complete the documentation and

patient details must be matched with unit details. The traceability labe

returned to the laboratory.

19.19.2 Massive Transfusion

• In the event of a massive transfusion, refer to HVG/L

Blood Components in the Management of a Massive Haemorrhage’ current revision. See also the

acute massive transfusion template in Table 19.1 below.

• A Massive Transfusion Protocol (MTP) is available for use in the ED, using FORM

activated by the team leader in the following circumstances:

o Major trauma with haemorrhage

o Major bleeding that cannot be controlled

o Bleeding haemodynamically unstable patient after initial resuscitation

o Anticipated requirement for >4 units of Red Cell Concentrate i

• To activate the MTP, the Blood Transfusion staff must be informed and it must also be documented

on the BT request form.

• For initial resuscitation, Order

• If further transfusion required, contact the BT lab &

Order MTP 2: 6 RCC, 6 Plasma, 2

Definition of massive haemorrhage:

a) An on-going transfusion requirement in an adult of > 150 mL/minute

b) Replacement of >50% of blood volume in

c) The loss or transfusion of one blood volume (~7% of body weight in adults) or ~10 units of RCC over

24 hours





Emergency Blood Transfusion

Emergency O RhD Negative Red Cells

of O RhD Negative red cell concentrates are stocked for immediate use. These units are

There is also an emergency neonatal SAGM O RhD Negative unit of red cells suitable for neonatal

use for 5 days after date drawn. This is also suitable for paediatric patients < 1 year old. There are

no coagulation factors in the SAGM neonatal unit – plasma may be required for treatment of

coagulopathy in massive haemorrhage.

In an emergency, the clinician in charge of the patient may decide that

transfusion is so urgent that there is no time to undertake full pre-transfusion testing. It is the

responsibility of the clinician to request uncrossmatched RCC.

The Blood Transfusion laboratory should be contacted as soon as possible

Emergency O RhD Negative RCC should not be used for elective and/or non

red cell antibodies, as these units are not typed for all antigens for other non

p and crossmatch sample must be taken from the patient prior to

transfusion of any emergency RCC.

for blood group is desirable prior to red cell transfusion if there is no historic

group of the patient in the laboratory. The 2 samples must be taken at separate times.

l be provided by the BT Lab.

or group-specific uncrossmatched blood will be available

after receipt of the sample. This will be labelled as ‘Group O RhD matched/

uncrossmatched’. The blood should be prescribed on the BTPRS.

In order to ensure full traceability, the two administrators must complete the documentation and

patient details must be matched with unit details. The traceability label must be completed and

returned to the laboratory. Note: Blood Track Tx cannot be used to check emergency RCC.

Massive Transfusion

In the event of a massive transfusion, refer to HVG/L-M/HV/14 ‘A Guideline for the Use of Blood &


acute massive transfusion template in Table 19.1 below.

A Massive Transfusion Protocol (MTP) is available for use in the ED, using FORM

y the team leader in the following circumstances:

Major trauma with haemorrhage

Major bleeding that cannot be controlled

Bleeding haemodynamically unstable patient after initial resuscitation

Anticipated requirement for >4 units of Red Cell Concentrate in < 4 hours

To activate the MTP, the Blood Transfusion staff must be informed and it must also be documented

Order MTP 1: 6 RCC, 3 Plasma, 1 Platelets

If further transfusion required, contact the BT lab & inform them that MTP 2 is required:

MTP 2: 6 RCC, 6 Plasma, 2 Platelets.

Definition of massive haemorrhage:

transfusion requirement in an adult of > 150 mL/minute

Replacement of >50% of blood volume in ≤ 3 hours

transfusion of one blood volume (~7% of body weight in adults) or ~10 units of RCC over


No. Of Pg: 106 of 132

of O RhD Negative red cell concentrates are stocked for immediate use. These units are

There is also an emergency neonatal SAGM O RhD Negative unit of red cells suitable for neonatal

uitable for paediatric patients < 1 year old. There are

plasma may be required for treatment of

In an emergency, the clinician in charge of the patient may decide that the need for blood

transfusion testing. It is the

The Blood Transfusion laboratory should be contacted as soon as possible if uncrossmatched RCC

Emergency O RhD Negative RCC should not be used for elective and/or non-critical patients with

red cell antibodies, as these units are not typed for all antigens for other non-ABO/Rh blood

p and crossmatch sample must be taken from the patient prior to

red cell transfusion if there is no historic

t be taken at separate times. A

blood will be available 15-45 minutes

matched/Group-specific,

In order to ensure full traceability, the two administrators must complete the documentation and

l must be completed and

Blood Track Tx cannot be used to check emergency RCC.

M/HV/14 ‘A Guideline for the Use of Blood &


A Massive Transfusion Protocol (MTP) is available for use in the ED, using FORM-M/HV/41. It is

Bleeding haemodynamically unstable patient after initial resuscitation

n < 4 hours

To activate the MTP, the Blood Transfusion staff must be informed and it must also be documented

inform them that MTP 2 is required:

transfusion of one blood volume (~7% of body weight in adults) or ~10 units of RCC over

PATHOLOGY




Table 19.1: Acute Massive Haemorrhage Template

GOAL

1. Contact Key

Personnel

DIRECT COMMUNICATION

IS VITAL. SEND FOR SENIOR

HELP EARLY

- Blood bank: Ext. 4329. For “

- Consultant in charge, Consultant Anaesthetist and Consultant

- Nursing Administration (Bleep 086)

- House Porter: - Bleep 050

2. Arrest Bleeding

- Control obvious bleeding (pressure, tourniquet, haemostatic dressings)

- Early surgical or obstetric intervention

- Upper Gastrointestinal Tract Procedures or Interventional radiology

3. Immediate Actions - Administer high level Oxygen

- IV access – largest bore possible

- Ensure ID band is on the patient

- Baseline bloods -FBC, Coag, Clauss Fibrinogen, Group & Crossmatch,

- Fluid resuscitation – in the massive haemorrhage, this means

- May need to give blood components/products before the FBC and coagulation results available

- Actively warm the patient and all transfused fluids

- If patient is conscious and talking and a peri

- Consider Tranexamic Acid. if Trauma

over 8 hr for adults.

- Aim to repeat FBC and PT, APTT, Fibrinogen hourly if b

4. Restore Circulating

Volume

- Aim to restore/maintain vital organ perfusion. Definitive measures to control bleeding should take priority over restoration

normal BP.

- Aim to maintain adequate BP and urine output >30 ml/ hour in

5. Blood Transfusion

Sampling

Order CMV negative

components for

antenatal women and

infants <1 year old

- Unconscious/Unidentifiable patient

Where Date of birth is unknown “01/01/1900” is used by BT lab to issue blood /blood products but this is not an identifier

- Conscious patient: 3 unique identifiers

-A confirmatory sample is required prior to RCC if there is no histor

times. (Use designated sample tube provided by the BT Lab).

- Use either a handwritten sample tube signed with date & time by sampler or label created

6. Red Cell Concentrate

(RCC)

-RCC needed immediately -

- RCC needed in 15-45 minutes

receipt of the sample. If the patient has a





PROCEDURE

For “On Call” phone *51836 to discuss the patient’s requirements and

Consultant in charge, Consultant Anaesthetist and Consultant Haematologist on call, via switch board

(Bleep 086)

Bleep 050. Emergency Department Porter:- Bleep 059/126

Control obvious bleeding (pressure, tourniquet, haemostatic dressings)

obstetric intervention

Tract Procedures or Interventional radiology

Administer high level Oxygen

largest bore possible

Ensure ID band is on the patient – preferably with 2D barcode containing patient demographics

FBC, Coag, Clauss Fibrinogen, Group & Crossmatch, Biochemistry profile and Blood Gases

in the massive haemorrhage, this means warmed blood components and products

blood components/products before the FBC and coagulation results available

Actively warm the patient and all transfused fluids - Use of blood warmer and/or rapid infusion device according to local guidelines

If patient is conscious and talking and a peripheral pulse is present, then the BP is adequate

Consider Tranexamic Acid. if Trauma -give Tranexamic acid 1g (in 100mls Nacl 0.9% or Glucose 5%) over 10 min,

Aim to repeat FBC and PT, APTT, Fibrinogen hourly if bleeding is on-going.

Aim to restore/maintain vital organ perfusion. Definitive measures to control bleeding should take priority over restoration

Aim to maintain adequate BP and urine output >30 ml/ hour in adults (or 0.5ml/kg/hour)

Unconscious/Unidentifiable patient: Minimum of 2 patient identifiers required (Gender, MRN)


unique identifiers (Name, DOB & MRN).

A confirmatory sample is required prior to RCC if there is no historic Group of the patient. The 2 samples must be taken at s

(Use designated sample tube provided by the BT Lab). ADRESSOGRAPH labels are NOT permitted.

Use either a handwritten sample tube signed with date & time by sampler or label created with BloodTrack Device

- use “Emergency stock” group O RhD negative –inform BT lab 4329 or “on call :*51836”

45 minutes: Group O RhD matched or group specific uncrossmatched RCC

receipt of the sample. If the patient has a historic blood group: Group specific RCC will be made available. Where the patient has


No. Of Pg: 107 of 132

*51836 to discuss the patient’s requirements and required timeframes

Haematologist on call, via switch board

demographics

Biochemistry profile and Blood Gases as early as possible.

blood components and products

blood components/products before the FBC and coagulation results available

Use of blood warmer and/or rapid infusion device according to local guidelines

give Tranexamic acid 1g (in 100mls Nacl 0.9% or Glucose 5%) over 10 min, then 1g (in 500ml)

Aim to restore/maintain vital organ perfusion. Definitive measures to control bleeding should take priority over restoration of

patient identifiers required (Gender, MRN).


ic Group of the patient. The 2 samples must be taken at separate

ADRESSOGRAPH labels are NOT permitted.

with BloodTrack Device

inform BT lab 4329 or “on call :*51836”

: Group O RhD matched or group specific uncrossmatched RCC will be available 15-45 minutes after

: Group specific RCC will be made available. Where the patient has no

PATHOLOGY




GOAL

historic blood group a confirmatory sample is requested but if this is not possible

tested Group O RhD matched RCC (uncrossmatched) will be supplied until the second sample is collected.

current Group & Screen with a negative antibody screen

- RCC needed in 60 minutes

antibody screen.

- Emergency use of RhD positive blood is acceptable for male or postmenopausal females but should be avoided in pre

RhD neg. women unless no option

- ABO Group identical blood can be issued without any further serological testing after replaceme

hours (10 RCC units approx.).

7. Platelets

- Target Platelet Count >50 x 10

situation.)

- For multiple/CNS trauma or if platelet

- Anticipate platelet count <50 x 10

Request Platelets - One adult therapeutic dose (1 bag)

centre (2-3 hours)

8. Request Plasma

- Dilutional coagulopathy should be prevented by early infusion of Plasma.

- Target PT: Aim for normal

- Dose 15mls/kg e.g. 70 Kg adult: 5

30mls/kg

- Allow 30 minutes for thawing and issue.

9. Request Fibrinogen

- Target Fibrinogen ≥1.5 g/L

Obstetric bleeds consider fibrinogen when levels are <2·0 g/l and there is on

Recheck level post administrati

- 1g Fibrinogen will raise Plasma Fibrinogen by 0.25g/L.

10. Suspect DIC

Mortality from DIC is high

- If DIC suspected take samples for PT, APTT, Fibrinogen, D

these results).

- Treat underlying cause if possible and continue replacement of appropriate blood components/products

11. Anticoagulants - In the context of a life threatening bleed/massive haemorrhage,

K (10mg IV) and HPC (Octaplex 25 to 50 IU/kg).

(Octaplex 25 to 50 IU/kg) is the first choice of treatment

Idarucizumab 5 g IV (2x2.5 g/50 mL

response to Idarucizumab





PROCEDURE

a confirmatory sample is requested but if this is not possible, inform BT MS. Once the first sample has been

tested Group O RhD matched RCC (uncrossmatched) will be supplied until the second sample is collected.

current Group & Screen with a negative antibody screen, fully crossmatched should be available within

60 minutes–ABO, RhD typing, antibody screen & CXM carried out, RCC will be available within

Emergency use of RhD positive blood is acceptable for male or postmenopausal females but should be avoided in pre

unless no option

ABO Group identical blood can be issued without any further serological testing after replaceme

hours (10 RCC units approx.).

>50 x 109 /L. Note: Anaesthetic Guidelines recommend Target Platelet count >75 x 10

For multiple/CNS trauma or if platelet function abnormal, target platelet count of >100 x 109/L may be desirable.

Anticipate platelet count <50 x 109 /L after 2 x blood volume replacement

One adult therapeutic dose (1 bag) or 10-20 mL/kg for a neonate/small child

Dilutional coagulopathy should be prevented by early infusion of Plasma.

Aim for normal (normal range is 11.5-16 seconds) & Target APTT: Aim for normal (normal range is

15mls/kg e.g. 70 Kg adult: 5-6 units. In patients with widespread microvascular oozing –

Allow 30 minutes for thawing and issue.

≥1.5 g/L. If Plasma Fibrinogen level is <1.5g/L administer 2-4g Fibrinogen as per Haematology advice.

Obstetric bleeds consider fibrinogen when levels are <2·0 g/l and there is on-going bleeding. Administer as per product insert.

Recheck level post administration.

1g Fibrinogen will raise Plasma Fibrinogen by 0.25g/L.

If DIC suspected take samples for PT, APTT, Fibrinogen, D-dimer and FBC (Diagnosis is based on clinical signs and overall pattern of

Treat underlying cause if possible and continue replacement of appropriate blood components/products

In the context of a life threatening bleed/massive haemorrhage, contact Haematologist for advice

IV) and HPC (Octaplex 25 to 50 IU/kg).● If the patient is on Direct Xa Inhibitor (e.g. Rivaroxaban or Apixaban)

(Octaplex 25 to 50 IU/kg) is the first choice of treatment ● If the patient is on Dabigatran (Direct Thrombin Inhibitor),

5 g IV (2x2.5 g/50 mL) is the specific reversal agent (Stocked in the Pharmacy Dept.).

Idarucizumab discuss with Haematologist regarding on-going management.


No. Of Pg: 108 of 132

, inform BT MS. Once the first sample has been

tested Group O RhD matched RCC (uncrossmatched) will be supplied until the second sample is collected. If the patient has a

available within 45 minutes of request.

ABO, RhD typing, antibody screen & CXM carried out, RCC will be available within 60 minutes if negative

Emergency use of RhD positive blood is acceptable for male or postmenopausal females but should be avoided in pre-menopausal

ABO Group identical blood can be issued without any further serological testing after replacement of 1 blood volume within 24

Anaesthetic Guidelines recommend Target Platelet count >75 x 109 /L. (Assess clinical

/L may be desirable.

/kg for a neonate/small child -Allow for delivery time from blood

(normal range is 25–36 seconds)

– plasma may need to be given up to

4g Fibrinogen as per Haematology advice. In

going bleeding. Administer as per product insert.

dimer and FBC (Diagnosis is based on clinical signs and overall pattern of

Treat underlying cause if possible and continue replacement of appropriate blood components/products

contact Haematologist for advice. ● Reverse Warfarin with Vitamin

Direct Xa Inhibitor (e.g. Rivaroxaban or Apixaban) then HPC

Direct Thrombin Inhibitor), then

is the specific reversal agent (Stocked in the Pharmacy Dept.). In an unlikely event of a poor

PATHOLOGY




19.20 References � Association of Anaesthetists of Great Britain and Ireland (AAGBI) (2010) Safety Guideline: Blood

Transfusion and the Anaesthetist

http://www.aagbi.org/sites/default/files/massive_haemorrhage_2010.pdf

� BCSH (2009) Guideline on the Administration of Blood Components.

http://www.bcshguidelines.com/documents/Admin_blood_components_bcsh_05012010.pdf

� BCSH (2012) Guidelines for Compatibility Procedures in Blood Transfusion Laborato

http://onlinelibrary.wiley.com/doi/10.1111/j.1365

� BCSH (2012) Guideline on the Administration of Blood Components. Addendum: Avoidance of

Transfusion Associated Circulatory Overload (TACO) and Problems Associated with Over

http://www.bcshguidelines.com/documents/BCSH_Blood_Admin_

� BCSH (2009) Guideline for the Estimation of Fetomaternal Haemorrhage.

http://www.bcshguidelines.com/documents/BCSH_FMH_bcsh_sept2009.pdf

� BCSH (2016) Transfusion for fetuses, neonates and older children

http://www.bcshguidelines.com/documents/2016

� RCPI (2012) Clinical Practice Guideline No. 13

of RhD Haemolytic Disease of the Newborn.

https://www.rcpi.ie/wp-content/uploads/2016/05/10.

Haemolytic-Disease-of-the-newborn.pdf

� DBL McClelland (2007) Handbook of Transfusion Medicine, 4

Office.

� National Haemovigilance Reports 2000

https://www.giveblood.ie/Clinical_Services/Haemovigilance/Publications

� National Blood Transfusion Committee (2012) Platelets Summary of Product Characteristics

http://www.hse.ie/eng/about/Who/archive/platelets.pdf

� HSE (2012) Platelet Transfusion in Clinical Practice

http://www.hse.ie/eng/about/Who/clinical/natclinprog/bloodtransfusionprogramme/bloodtransfusio

nprogramme.html

� National Blood Users Group (2007) Transfusion of Blood Components to I

Review and Guidelines.

http://archive.imj.ie/Archive/IMJ%20June%2007%20Supplement.pdf

� National Blood Users Group (2004) Guideline for the Administratio

https://www.giveblood.ie/Clinical_Services/Haemovigilance/Publications/

tration_of_Blood_and_Blood_Components.pdf

� Standing Advisory Committee on the Safety of Blood Tissues and Organs (SaBTO). Report of the

Cytomegalovirus Steering Group (2012)

https://www.gov.uk/government/publications/sabto





Association of Anaesthetists of Great Britain and Ireland (AAGBI) (2010) Safety Guideline: Blood

Transfusion and the Anaesthetist – Management of a Massive Haemorrhage.

http://www.aagbi.org/sites/default/files/massive_haemorrhage_2010.pdf

BCSH (2009) Guideline on the Administration of Blood Components.


BCSH (2012) Guidelines for Compatibility Procedures in Blood Transfusion Laborato

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-3148.2012.01199.x/pdf

BCSH (2012) Guideline on the Administration of Blood Components. Addendum: Avoidance of

sfusion Associated Circulatory Overload (TACO) and Problems Associated with Over

http://www.bcshguidelines.com/documents/BCSH_Blood_Admin_-_addendum_August_2012.pdf

BCSH (2009) Guideline for the Estimation of Fetomaternal Haemorrhage.

http://www.bcshguidelines.com/documents/BCSH_FMH_bcsh_sept2009.pdf

Transfusion for fetuses, neonates and older children

http://www.bcshguidelines.com/documents/2016-neonates-final.pdf

RCPI (2012) Clinical Practice Guideline No. 13 – The Use of Anti-D Immunoglobulin for the Prevention

of RhD Haemolytic Disease of the Newborn.

ent/uploads/2016/05/10.-Anti-D-Immunoglobin-for

newborn.pdf

DBL McClelland (2007) Handbook of Transfusion Medicine, 4th

Edition. United Kingdom, The Stationary

National Haemovigilance Reports 2000-2011

https://www.giveblood.ie/Clinical_Services/Haemovigilance/Publications

National Blood Transfusion Committee (2012) Platelets Summary of Product Characteristics

http://www.hse.ie/eng/about/Who/archive/platelets.pdf

HSE (2012) Platelet Transfusion in Clinical Practice – Professional Guidance Document


National Blood Users Group (2007) Transfusion of Blood Components to Infants Under Four Months:

http://archive.imj.ie/Archive/IMJ%20June%2007%20Supplement.pdf

National Blood Users Group (2004) Guideline for the Administration of Blood and Blood Components

https://www.giveblood.ie/Clinical_Services/Haemovigilance/Publications/Guidelines_for_the_Adminis

tration_of_Blood_and_Blood_Components.pdf

Standing Advisory Committee on the Safety of Blood Tissues and Organs (SaBTO). Report of the

Cytomegalovirus Steering Group (2012)

https://www.gov.uk/government/publications/sabto-report-of-the-cytomegalovirus


No. Of Pg: 109 of 132

Association of Anaesthetists of Great Britain and Ireland (AAGBI) (2010) Safety Guideline: Blood

Management of a Massive Haemorrhage.


BCSH (2012) Guidelines for Compatibility Procedures in Blood Transfusion Laboratories.

BCSH (2012) Guideline on the Administration of Blood Components. Addendum: Avoidance of

sfusion Associated Circulatory Overload (TACO) and Problems Associated with Over-Transfusion.

ndum_August_2012.pdf

D Immunoglobulin for the Prevention

for-prevention-of-RHD-

Edition. United Kingdom, The Stationary

National Blood Transfusion Committee (2012) Platelets Summary of Product Characteristics

Professional Guidance Document


nfants Under Four Months:

n of Blood and Blood Components

Guidelines_for_the_Adminis

Standing Advisory Committee on the Safety of Blood Tissues and Organs (SaBTO). Report of the

cytomegalovirus-steering-group

PATHOLOGY




20 HISTOPATHOLOGY Please note this service is provided b

Tullamore Pathology User Manual.

20.1 Histopathology Test Index

(For details of tests accredited to ISO: 15189, refer to the Irish National Accreditation Board (INAB) Website

scope of accreditation registration number 221MT)

Frozen Sections

Immunohistochemistry

Non Gynae Cytology

Post Mortem Histology

Routine Surgical Histology

Special Stains

Referral Tests: Immunofluorescence

Muscle Biopsies

Renal biopsies

20.2 Introduction The Histopathology Laboratory located at Midland Regional Hospital, Tullamore is the central

Histopathology Laboratory servicing the HSE Mid Leinster area. In addition, a referral service for more

specialised histopathology tests is provided. For reasons of pa

form labelling requirements as described in Section

20.3 Hours of Operation & Contact Details

Postal Address Hours of Operation

Histology Laboratory

MRHT

Tullamore

Co Offaly

Ireland

Mon - Fri 08:00

Routine service from

09:00 –

No on-

provided.

Histopathology

Personnel

Consultant

Histopathologist

Dr. Margaret Lynch

Consultant

Histopathologist

Dr. Nurul Nor

Consultant

Histopathologist

Dr Charles

d’Adhemar

Consultant

Histopathologist

Dr. Miriam Walsh

Chief Medical

Scientist

Ms. Margaret

Kelly

Senior Medical

Scientist

Ms. Brid Maher

Histopathology Office





Please note this service is provided by MRH Tullamore and the following section is taken from the MRH

Histopathology Test Index


on registration number 221MT)

Immunofluorescence

Histopathology Laboratory located at Midland Regional Hospital, Tullamore is the central


specialised histopathology tests is provided. For reasons of patient safety, compliance with sample and

form labelling requirements as described in Section 20.4 is strongly recommended.

Hours of Operation & Contact Details

Hours of Operation Phone

(internal EXT in bold)

Fri 08:00-18:00

Routine service from

17:00

-call service is

provided.

057-9358338 057

Name Contact Details

Dr. Margaret Lynch 057 9358383

(Consultant Histopathologist on call can be

contacted through switch 057 9321501)

Dr. Nurul Nor 057 9358279

Dr Charles

d’Adhemar

057 9359377

Dr. Miriam Walsh 057 9358278

Ms. Margaret 057 9358389

Ms. Brid Maher 057 9358338

General Enquires

057 9358342

057 9359393


No. Of Pg: 110 of 132

y MRH Tullamore and the following section is taken from the MRH


Histopathology Laboratory located at Midland Regional Hospital, Tullamore is the central


tient safety, compliance with sample and

Fax

057-9359394

Contact Details

(Consultant Histopathologist on call can be

contacted through switch 057 9321501)

PATHOLOGY




20.4 Pre-Testing Information

20.4.1 Handling and Transport of SamplesTo protect the safety of healthcare staff, the following precautions for the transportation of samples must

be followed:

1. Sample containers must be sealed correctly. Ensure that screw caps are fully closed. Formalin is a

chemical preservative that presents

chemical spill guidelines. If no guidelines are available

instructions.

2. Samples must be placed in a biohazard bag (where size allows) and the accompanying form

placed in the designated pouch.

3. Samples can be transported to the laboratory at room temperature.

20.4.2 Form and Sample Labelling Requirements

All parts of the Histopathology request form are to be completed in full. Failure to comply with this

requirement will result in sample processing being delayed while a member of the relevant team comes to

the laboratory to complete the request form.

All writing on the request form must be clearly legible (block capitals preferred) so that the information

provided is legible, thus ensuring proper identification of the patient and all tests requests. Writing should

be in ballpoint pen (not marker) to en

form.

Note: Computer generated labels may be used on the request form

the request form). Do not use the pre

have all of the information required for registration on the Laboratory Computer System.

Information Required on the Request Form:

a) Patient Surname and First Name/s (unabbreviated)

b) Patient date of birth.

c) Patient hospital ID (Chart Number)

d) Ward/GP Location.

e) Consultant/GP Name.

f) Patient Gender.

g) Date of Specimen.

h) Time of Specimen, if appropriate.

i) Specimen type and anatomical site of origin.

laboratory.

j) Patient full address. NB for GP samples especially

k) Clinical details/Medications.

l) Doctor’s signature and bleep number

Correct identification of the patient before collection of the sample is essential.

Samples are to be labelled using legible handwriting (ballpoint pen).

Note: A computer generated label is only to be used on the sample if it can be applied without overlap to

the specimen container. Current Hospital Addressograph labels are acceptable

Information Required On the Specimen

a) Patient Surname and First Name/s (unabbreviated).

b) Patient date of birth.

c) Patient hospital ID (Chart Number)





Handling and Transport of Samples To protect the safety of healthcare staff, the following precautions for the transportation of samples must

Sample containers must be sealed correctly. Ensure that screw caps are fully closed. Formalin is a

chemical preservative that presents a number of hazards. In case of a spillage

chemical spill guidelines. If no guidelines are available, please contact the laboratory for

Samples must be placed in a biohazard bag (where size allows) and the accompanying form

laced in the designated pouch.

Samples can be transported to the laboratory at room temperature.

Form and Sample Labelling Requirements



the laboratory to complete the request form.



be in ballpoint pen (not marker) to ensure the information is copied through to each sheet of the request

Computer generated labels may be used on the request form (one label required on each sheet of

Do not use the pre-printed specimen/tube label for the reques


Information Required on the Request Form:

Patient Surname and First Name/s (unabbreviated)

Number) for patient in hospital, if available.

Time of Specimen, if appropriate.

Specimen type and anatomical site of origin. Required for all specimens sent to the Histopatholog

Patient full address. NB for GP samples especially

Clinical details/Medications.

Doctor’s signature and bleep number

Correct identification of the patient before collection of the sample is essential.

are to be labelled using legible handwriting (ballpoint pen).

A computer generated label is only to be used on the sample if it can be applied without overlap to

the specimen container. Current Hospital Addressograph labels are acceptable

Information Required On the Specimen:

Patient Surname and First Name/s (unabbreviated).

Patient hospital ID (Chart Number) for patient in hospital, if available.


No. Of Pg: 111 of 132

To protect the safety of healthcare staff, the following precautions for the transportation of samples must

Sample containers must be sealed correctly. Ensure that screw caps are fully closed. Formalin is a

a number of hazards. In case of a spillage, please follow

please contact the laboratory for

Samples must be placed in a biohazard bag (where size allows) and the accompanying form





sure the information is copied through to each sheet of the request

one label required on each sheet of

printed specimen/tube label for the request form as this does not


Required for all specimens sent to the Histopathology

A computer generated label is only to be used on the sample if it can be applied without overlap to

PATHOLOGY




d) Ward/GP Location.

e) Consultant/GP Name.

f) Patient Gender.

g) Date of Specimen.

h) Time of Specimen, if appropriate.

20.4.3 Sample Requirements for Histology TestsFROZEN SECTIONS

• Frozen sections must be pre

directly at 05793 58338.

• The technical staff answering the call will ask specific questions relating to the sample and will

check that a Histopathologist is available at the stated time before confirming the booking.

• Please contact the Histopathology Laboratory again on the day o

frozen section is going ahead.

Sample Requirements

• Samples must be sent in a dry container (no fixative) via a porter to the Histopathology laboratory

and handed to technical staff.

• Please write a contact number on the

Turnaround Time

• Frozen Sections are regarded as critical samples and normal turnaround time for frozen sections is

30 min after arrival in the laboratory. Occasionally samples where interpretation is difficult may

take longer. Where multiple samples are received the turnaround time will be a multiple of this

time as only one frozen section can be handled at any one time

Cancellation or postponement

• It is important to contact the Histopathology laboratory if the

is being postponed or is delayed, as laboratory staff will be on hold waiting for its arrival.

ROUTINE HISTOLOGY

Specimen Requirements

• Samples for routine Histopathology (with the exception of Bone Marrow Trephines)

in formalin

• Bone marrow trephines must be fixed in Bouin’s Fixative

• Pre-filled pots are available from the laboratory for smaller biopsies

• Large specimens and organs should be sent in large containers with added 10% formalin

• For very large containers, contact the Laboratory directly and larger containers will be provided.

• Ensure that the containers used for larger samples are sufficient for the sample and have twice the

volume of formalin to sample

• Samples should be clearly labelled with

• For larger containers this information should be on both the lid and the side of the container.

Please note it is not sufficient to attach the request form to the specimen bucket

Urgent Samples

• Urgent samples should be cl

• A telephone call to the laboratory alerting staff to the urgency of the sample is appreciated.





Time of Specimen, if appropriate.

Sample Requirements for Histology Tests

Frozen sections must be pre-booked with the Histopathology Laboratory.

The technical staff answering the call will ask specific questions relating to the sample and will


Please contact the Histopathology Laboratory again on the day of the surgery to confirm that the

frozen section is going ahead.

Samples must be sent in a dry container (no fixative) via a porter to the Histopathology laboratory

and handed to technical staff.

Please write a contact number on the request form for telephoned report.

Frozen Sections are regarded as critical samples and normal turnaround time for frozen sections is


ke longer. Where multiple samples are received the turnaround time will be a multiple of this

time as only one frozen section can be handled at any one time.

It is important to contact the Histopathology laboratory if the frozen section is no longer required,


Samples for routine Histopathology (with the exception of Bone Marrow Trephines)

Bone marrow trephines must be fixed in Bouin’s Fixative

filled pots are available from the laboratory for smaller biopsies

Large specimens and organs should be sent in large containers with added 10% formalin

e containers, contact the Laboratory directly and larger containers will be provided.

Ensure that the containers used for larger samples are sufficient for the sample and have twice the

volume of formalin to sample

Samples should be clearly labelled with patient and specimen details.

For larger containers this information should be on both the lid and the side of the container.


Urgent samples should be clearly marked on the request form

A telephone call to the laboratory alerting staff to the urgency of the sample is appreciated.


No. Of Pg: 112 of 132

booked with the Histopathology Laboratory. Contact the laboratory



f the surgery to confirm that the

Samples must be sent in a dry container (no fixative) via a porter to the Histopathology laboratory

Frozen Sections are regarded as critical samples and normal turnaround time for frozen sections is


ke longer. Where multiple samples are received the turnaround time will be a multiple of this

frozen section is no longer required,


Samples for routine Histopathology (with the exception of Bone Marrow Trephines) must be fixed

Large specimens and organs should be sent in large containers with added 10% formalin

e containers, contact the Laboratory directly and larger containers will be provided.

Ensure that the containers used for larger samples are sufficient for the sample and have twice the

For larger containers this information should be on both the lid and the side of the container.


A telephone call to the laboratory alerting staff to the urgency of the sample is appreciated.

PATHOLOGY




Turnaround Time

Urgent samples:

• Turnaround time for urgent processing is 3 working days after sample receipt but is dependent on

the complexity of the case. A preliminary report is usually telephoned within 2 days.

Non urgent samples:

• Average turnaround time for routine processing of b

• Average turnaround time for larger samples is on average 6

• Some sample types take longer to report (

• Samples requiring immunohistochemistry or special stains on average require 10 working da

• Occasionally a case may require referral for second opinion in which case further time will be

needed

• Should the report take longer than the normal routine turnaround time the reporting

Histopathologist will be happy to discuss the progress of the rep

histopathology laboratory Ext 8338 to determine which Histopathologist is dealing with the case

Specimen Type Turnaround times

The following is the average turnaround time in days for specific histology samples:

Biopsies

Liver biopsies – tumour

Liver biopsies – medical

Gynae biopsies – Currettings

Prostate needle biopsies

Endoscopy biopsies

Lung Biopsies

FRESH LYMPH NODES (PLEASE PRE-

• Lymph Nodes must be pre

directly at 05793 58338.

• The technical staff answering the call will ask specific questions relating to the sample and will

check that a Histopathologist is available at the stated time before confirming the booking

• Contact the laboratory again when sending down the sample.

• For samples from Portlaoise and Mullingar the samples must be sent directly to the laboratory

without delay to prevent sample deterioration.

� This service only applies in routine working hours

of hours, bisect it and

histology samples.

� NB: Suspected TB/HIV samples

laboratory if it is likely to be infectious e

HIV positive. If this patient status is known or suspected, then bisect the lymph node

and place it in 10% formalin. Write the relevant clinical details on the form and send the

sample to the histology lab.


• The specimen must be sent to the laboratory in a dry container (no fixative)

• The lymph node will be examined, described and impression smears made before the specimen is

processed for routine Histopathology.

Turnaround Time

• A preliminary report may be telephoned to the





Turnaround time for urgent processing is 3 working days after sample receipt but is dependent on


Average turnaround time for routine processing of biopsy samples is 5 working days

Average turnaround time for larger samples is on average 6-7 working days

e types take longer to report (see chart below)

Samples requiring immunohistochemistry or special stains on average require 10 working da

Occasionally a case may require referral for second opinion in which case further time will be

Should the report take longer than the normal routine turnaround time the reporting

istopathologist will be happy to discuss the progress of the report at any stage. Call the

histopathology laboratory Ext 8338 to determine which Histopathologist is dealing with the case

The following is the average turnaround time in days for specific histology samples:

Biopsies Larger Samples

5 Appendix/ Gallbladder

12 Products of conception

Currettings 6 Skin

9 Gynae

4 GI resections

7 Placenta

-BOOK)

Lymph Nodes must be pre-booked with the Histopathology Laboratory.



Contact the laboratory again when sending down the sample.

For samples from Portlaoise and Mullingar the samples must be sent directly to the laboratory

without delay to prevent sample deterioration.

This service only applies in routine working hours. If the lymph node tissue is taken out

of hours, bisect it and place it in 10% formalin and send it to the lab as with all other

histology samples.

NB: Suspected TB/HIV samples: Fresh lymph node is not acceptable in the histology

laboratory if it is likely to be infectious e.g. if taken from a patient who is probably



sample to the histology lab.

be sent to the laboratory in a dry container (no fixative)

The lymph node will be examined, described and impression smears made before the specimen is

processed for routine Histopathology.

A preliminary report may be telephoned to the clinical team on the day of biopsy


No. Of Pg: 113 of 132

Turnaround time for urgent processing is 3 working days after sample receipt but is dependent on


iopsy samples is 5 working days

7 working days

Samples requiring immunohistochemistry or special stains on average require 10 working days


Should the report take longer than the normal routine turnaround time the reporting

ort at any stage. Call the

histopathology laboratory Ext 8338 to determine which Histopathologist is dealing with the case.

Larger Samples

6

6

8

10

15

21

Contact the laboratory



For samples from Portlaoise and Mullingar the samples must be sent directly to the laboratory

. If the lymph node tissue is taken out

place it in 10% formalin and send it to the lab as with all other

Fresh lymph node is not acceptable in the histology

if taken from a patient who is probably TB or



be sent to the laboratory in a dry container (no fixative)

The lymph node will be examined, described and impression smears made before the specimen is

clinical team on the day of biopsy

PATHOLOGY




• The turnaround time for full report on lymph node is the same as routine biopsy

FLUID CYTOLOGY INCLUDING TBNA, SPUTA AND BRUSHINGS


• Fluid Cytology samples should be sent to the laboratory without

• Separate samples must be submitted if Biochemistry and Microbiology is also required.

• Large aspirates must be aliquoted into representative samples comprising not more than 2

universal containers

• Outside of normal laboratory working hours samples should left in the laboratory fridge

Turnaround Time

• Turnaround time for cytology varies with sample.

• Reporting of routine samples takes up to 5 working days.

• Reporting may take additional time (up to

stains are required.


needed

• Should the report take longer than the routine turnaround time the reporting Hi

be happy to discuss the progress of the report at any stage

FINE NEEDLE ASPIRATION (FNA) CYTOLOGY

Fine needle aspiration is a form of diagnostic biopsy that uses fine needles to obtain cellular samples. Upon

examination of the patient in the clinic and identification of a lesion, the ENT Consultant will phone the

laboratory to request a Medical Scientist to attend for FNA.


• It's important that the correct needle size is used, preferably 23 to 25 gauge (no larger

and movement back and forth within the lesion, preferably with a 10 ml syringe, with release of

negative pressure prior to exiting the lesion. It is advisable to do three separate passes.

• At the clinic, the Consultant should inform the Medi

sampled

• The lesion is aspirated two to three times depending on the cell yield from each pass

• The Consultant passes the syringe to the Medical Scientist

• The Medical Scientist is responsible for preparing the sl

sampled

• If the cell yield is low, the medical scientist will request that the lesion is sampled again until there

is adequate material for diagnosis

• A new needle is used for each pass

Turnaround time

• For urgent samples at least a provisional verbal report is available on the day following receipt

provided that the sample is received prior to 3

approximately 5 working days.

• Reporting may take additional time (up to 7 working

stains are required.


needed

• Should the report take longer than the routine turnaround time the reporting Histopatholo






The turnaround time for full report on lymph node is the same as routine biopsy

FLUID CYTOLOGY INCLUDING TBNA, SPUTA AND BRUSHINGS

Fluid Cytology samples should be sent to the laboratory without any fixative being added

Separate samples must be submitted if Biochemistry and Microbiology is also required.

Large aspirates must be aliquoted into representative samples comprising not more than 2

Outside of normal laboratory working hours samples should left in the laboratory fridge

Turnaround time for cytology varies with sample.

Reporting of routine samples takes up to 5 working days.

Reporting may take additional time (up to 7 working days) if immunohistochemistry or special


Should the report take longer than the routine turnaround time the reporting Hi


FINE NEEDLE ASPIRATION (FNA) CYTOLOGY


in the clinic and identification of a lesion, the ENT Consultant will phone the

laboratory to request a Medical Scientist to attend for FNA.

It's important that the correct needle size is used, preferably 23 to 25 gauge (no larger



At the clinic, the Consultant should inform the Medical Scientist of the number of sites to be

The lesion is aspirated two to three times depending on the cell yield from each pass

The Consultant passes the syringe to the Medical Scientist

The Medical Scientist is responsible for preparing the slides at the clinic once the site has been

If the cell yield is low, the medical scientist will request that the lesion is sampled again until there

is adequate material for diagnosis

A new needle is used for each pass

samples at least a provisional verbal report is available on the day following receipt

e sample is received prior to 3pm. Reporting of routine samples takes

approximately 5 working days.

Reporting may take additional time (up to 7 working days) if immunohistochemistry or special


Should the report take longer than the routine turnaround time the reporting Histopatholo



No. Of Pg: 114 of 132

The turnaround time for full report on lymph node is the same as routine biopsy

any fixative being added

Separate samples must be submitted if Biochemistry and Microbiology is also required.

Large aspirates must be aliquoted into representative samples comprising not more than 2

Outside of normal laboratory working hours samples should left in the laboratory fridge

7 working days) if immunohistochemistry or special


Should the report take longer than the routine turnaround time the reporting Histopathologist will


in the clinic and identification of a lesion, the ENT Consultant will phone the

It's important that the correct needle size is used, preferably 23 to 25 gauge (no larger) with suction



cal Scientist of the number of sites to be

The lesion is aspirated two to three times depending on the cell yield from each pass

ides at the clinic once the site has been

If the cell yield is low, the medical scientist will request that the lesion is sampled again until there

samples at least a provisional verbal report is available on the day following receipt

eporting of routine samples takes

days) if immunohistochemistry or special


Should the report take longer than the routine turnaround time the reporting Histopathologist will

PATHOLOGY




GYNAECOLOGICAL CYTOLOGY

Gynaecological cytology samples are referred to the laboratory in the Rotunda Hospital. The samples are

referred as follows depending on the hospital from which

• MRH @ Tullamore: Samples are sent by the wards involved to the referral laboratory (Rotunda

Hospital) and are not sent to the Tullamore laboratory for dispatch.

• MRH @ Mullingar: Samples are sent to the Mullingar laboratory. The details are recorded and the

samples forwarded to the Rotunda Hospital for reporting. Reports are issued directly from the

Rotunda Hospital to the requesting clinician. No reports are available from the pa

MRH @ Mullingar. For copies of reports please contact the cytology laboratory in the Rotunda

Hospital directly.

• MRH @ Portlaoise: Samples are sent to the Portlaoise Laboratory. The details are recorded and the

samples forwarded to the R

Rotunda Hospital to the requesting clinician. No reports are available from the pathology laboratory

MRH @ Portlaoise. For copies of reports please contact the cytology laboratory in the R

Hospital directly


Cervical Smears- Obtain an adequate sample from the cervix using ThinPrep kit provided. Kits and

instructions for sampling are available on the relevant wards. If specimens are to be posted follow the

guidelines given on the kit.

Turnaround Times

• 2-4 weeks depending whether the smear is routine, is based on suspicious clinical findings or if the

patient has previous positive history.

• Turnaround time for routine smears is shorter, while turnaround time for

GP samples:

Gynaecological cytology samples from women aged 25

centre in Dublin. Information on the referral address is available in the cytology pack received by the GP on

registering with Quest. Samples from women outside this age group and who are not previously registered

with the Cervical Screening Program should be referred directly to the Rotunda Hospital in the postal

packaging provided.

MUSCLE BIOPSIES (PLEASE PRE-BOOK)


• As this is a referral test requiring special transport, the Histopathology Laboratory (05793 58338)

must be contacted to book the muscle biopsy at least 24 hours in advance.

• The person contacting the laboratory must give their

name, date of birth and the name of the consultant.

• The biopsy must be arranged in time to allow the sample to get to the laboratory before 11:00

hours. This is necessary to meet transport requirements.

• The biopsy must be placed on saline

not use too much saline).

• Never squeeze a biopsy into a tight or narrow necked specimen container

• Please contact the laboratory promptly if the procedure has been cancel

Reports

• Muscle biopsies are referred to the Neuropathology Laboratory, Beaumont Hospital, Dublin.






referred as follows depending on the hospital from which they originate.

Samples are sent by the wards involved to the referral laboratory (Rotunda

Hospital) and are not sent to the Tullamore laboratory for dispatch.

Samples are sent to the Mullingar laboratory. The details are recorded and the


Rotunda Hospital to the requesting clinician. No reports are available from the pa


Samples are sent to the Portlaoise Laboratory. The details are recorded and the



MRH @ Portlaoise. For copies of reports please contact the cytology laboratory in the R

Obtain an adequate sample from the cervix using ThinPrep kit provided. Kits and


4 weeks depending whether the smear is routine, is based on suspicious clinical findings or if the

patient has previous positive history.

Turnaround time for routine smears is shorter, while turnaround time for other smears is longer.

Gynaecological cytology samples from women aged 25-60 should be sent directly to the agreed referral




OOK)

As this is a referral test requiring special transport, the Histopathology Laboratory (05793 58338)


The person contacting the laboratory must give their own name and bleep number, the patient

name, date of birth and the name of the consultant.

The biopsy must be arranged in time to allow the sample to get to the laboratory before 11:00

hours. This is necessary to meet transport requirements.

must be placed on saline-moistened gauze and placed in a dry universal container (Do

Never squeeze a biopsy into a tight or narrow necked specimen container

Please contact the laboratory promptly if the procedure has been cancelled.

Muscle biopsies are referred to the Neuropathology Laboratory, Beaumont Hospital, Dublin.


No. Of Pg: 115 of 132


Samples are sent by the wards involved to the referral laboratory (Rotunda

Samples are sent to the Mullingar laboratory. The details are recorded and the




Samples are sent to the Portlaoise Laboratory. The details are recorded and the

otunda Hospital for reporting. Reports are issued directly from the


MRH @ Portlaoise. For copies of reports please contact the cytology laboratory in the Rotunda

Obtain an adequate sample from the cervix using ThinPrep kit provided. Kits and


4 weeks depending whether the smear is routine, is based on suspicious clinical findings or if the

other smears is longer.

60 should be sent directly to the agreed referral






own name and bleep number, the patient

The biopsy must be arranged in time to allow the sample to get to the laboratory before 11:00

moistened gauze and placed in a dry universal container (Do

led.

Muscle biopsies are referred to the Neuropathology Laboratory, Beaumont Hospital, Dublin.

PATHOLOGY




• Reports when issued by the referral laboratory are sent to the MRHT laboratory office. Reports are

then forwarded to the referring Consultant’s secretary.

• Additional copies of reports are available from the referral laboratory only (01

Turnaround Times

• Turnaround time for muscle biopsies is 8

RENAL BIOPSIES (PLEASE PRE-BOOK)


• As this is a referral test requiring special transport, the Histopathology Laboratory (05793 58338)

must be contacted to book the renal biopsy at least 24 hours in advance

• The person contacting the lab must give

date of birth and the name of the consultant

• Biopsies must be scheduled as early as possible preferably in the morning to allow sufficient time

for the sample to be sent by courier to the referral laboratory in the afternoon.

• 3 cores of tissue should be taken to ensure that there are sufficient numbers of glomeruli for

examination- not less than 10 for light microscopy and immunofluorescence. This applies to nati

and allograft kidneys.

• Place one core into the pots in the following order:

� 1 biopsy into the Zeus pot supplied

� The other two biopsies into the Formalin pot supplied.

• The biopsies must be put into the containers in the above order to prevent contamin

Zeus solution by the forceps

• Make sure the cap is fastened tightly on the containers.

• The container must be labelled with patient name, DOB, Chart number (if available), and nature of

specimen.

• It must be accompanied by a histology form wit

Address, Consultant Name, Ward, and sample date) and including comprehensive clinical details.

Make a note on the form of the time the specimen was taken.

• The form and specimen must be sent immediately to the h

Reports

• Renal Biopsies are referred to the Histopathology Laboratory, Beaumont Hospital


then forwarded to the referring consultant’s

• Additional copies of reports are available from the refer

Turnaround Times:

• Turnaround time for renal biopsies varies depending on the complexity of the investigations

required. The minimum reporting time i

take up to 6 weeks. (Information provided by Beaumont Hospital)

SKIN BIOPSIES FOR IF (PLEASE PRE-


• As this is a referral request, the Histopathology Laboratory (05793 58338) must be contacted to

book the test at least 24 hours in advance

• The biopsy must be arranged in time to allow the sample to get to the laboratory before 11:00. This

is necessary to meet transport requirements.

• Take two 4mm skin biopsies from normal skin adjacent to the lesion

• Place one in 10% formalin for routine Histopathology





Reports when issued by the referral laboratory are sent to the MRHT laboratory office. Reports are

hen forwarded to the referring Consultant’s secretary.

Additional copies of reports are available from the referral laboratory only (01

Turnaround time for muscle biopsies is 8-10 days (Information provided by Beaumont Hospita

BOOK)


must be contacted to book the renal biopsy at least 24 hours in advance

The person contacting the lab must give their own name and bleep number

date of birth and the name of the consultant

Biopsies must be scheduled as early as possible preferably in the morning to allow sufficient time

be sent by courier to the referral laboratory in the afternoon.

3 cores of tissue should be taken to ensure that there are sufficient numbers of glomeruli for

not less than 10 for light microscopy and immunofluorescence. This applies to nati

the pots in the following order:

1 biopsy into the Zeus pot supplied

The other two biopsies into the Formalin pot supplied.

The biopsies must be put into the containers in the above order to prevent contamin

Zeus solution by the forceps

Make sure the cap is fastened tightly on the containers.

The container must be labelled with patient name, DOB, Chart number (if available), and nature of

It must be accompanied by a histology form with full patient details (Full name, DOB, MRN,


Make a note on the form of the time the specimen was taken.

and specimen must be sent immediately to the histology laboratory.

Renal Biopsies are referred to the Histopathology Laboratory, Beaumont Hospital


then forwarded to the referring consultant’s secretary.

Additional copies of reports are available from the referral laboratory only 01

Turnaround time for renal biopsies varies depending on the complexity of the investigations

required. The minimum reporting time is 2-3 weeks but reports requiring electron microscopy may

(Information provided by Beaumont Hospital)

-BOOK)

As this is a referral request, the Histopathology Laboratory (05793 58338) must be contacted to

book the test at least 24 hours in advance

The biopsy must be arranged in time to allow the sample to get to the laboratory before 11:00. This

meet transport requirements.

Take two 4mm skin biopsies from normal skin adjacent to the lesion

Place one in 10% formalin for routine Histopathology


No. Of Pg: 116 of 132


Additional copies of reports are available from the referral laboratory only (01-8093134)

(Information provided by Beaumont Hospital)


their own name and bleep number, the patient name and

Biopsies must be scheduled as early as possible preferably in the morning to allow sufficient time

be sent by courier to the referral laboratory in the afternoon.

3 cores of tissue should be taken to ensure that there are sufficient numbers of glomeruli for

not less than 10 for light microscopy and immunofluorescence. This applies to native

The biopsies must be put into the containers in the above order to prevent contamination of the

The container must be labelled with patient name, DOB, Chart number (if available), and nature of

h full patient details (Full name, DOB, MRN,


istology laboratory.

Renal Biopsies are referred to the Histopathology Laboratory, Beaumont Hospital


ral laboratory only 01-8092630/2008

Turnaround time for renal biopsies varies depending on the complexity of the investigations

3 weeks but reports requiring electron microscopy may

As this is a referral request, the Histopathology Laboratory (05793 58338) must be contacted to

The biopsy must be arranged in time to allow the sample to get to the laboratory before 11:00. This

PATHOLOGY




• Place the other on saline moistened gauze and place this in a dry universal container for

immunofluorescence

• Please ensure that the cap is securely tightened

• Both containers must be labelled with the patient name, DOB and nature of specimen.

• They must be accompanied by a Histopathology form with full patient details including

comprehensive clinical detail

• The specimen must be sent directly to the laboratory by porter

• Please contact the laboratory promptly if the procedure is cancelled.

Reports

• Skin biopsies for IF are referred to the Immunology Laboratory, St James’



• Additional copies of reports are available from the referral laboratory only (01

Turnaround Times

• Turnaround time for Immunofluorescence is 3 weeks approximately.

James Hospital)

CYTOGENETICS/CHROMOSOMAL ANALYSIS

Tissue for cytogenetic/chromosomal analysis is

are procedures in place in the Maternity Units at MRH Mullingar and MRH Portlaoise for transport of these

samples directly to the relevant referral centre. Please not

for cytogenetics.

AUTOPSY/POST MORTEM FROM TULLAMORE


Patient BID:

• If the patient dies before reaching the hospital contact nursing administration on 057 9358489/

8490

• Nursing administration will arrange transport to the mortuary and will contact the coroner and the

Histopathologist on call

Patient dies in Hospital and requires coroners post mortem

• It is the responsibility of the doctor in charge to contact the coroner

• The team should then contact nursing administration: 057 9358489/8490 to arrange transport to

the mortuary

• Nursing administration will also contact the Histopatholo

The clinician requires an in-house post mortem:

• All non-coroner and non-forensic

• The consent form is available from nursing administration 057 9358489/8490

• It is the responsibility of the relevant clinical team to contact the next of kin and arrange for the

form to be signed

• A next of kin information leaflet on the autopsy process is also available from nursing

administration

• Contact nursing administration also to arrange transport to the mortuary

• It is the responsibility of nursing administration to contact the Histopatholo

autopsy





Place the other on saline moistened gauze and place this in a dry universal container for

Please ensure that the cap is securely tightened

Both containers must be labelled with the patient name, DOB and nature of specimen.

They must be accompanied by a Histopathology form with full patient details including

omprehensive clinical details and the time the specimen was taken.

The specimen must be sent directly to the laboratory by porter

Please contact the laboratory promptly if the procedure is cancelled.

Skin biopsies for IF are referred to the Immunology Laboratory, St James’ Hospital, Dublin.



reports are available from the referral laboratory only (01

Turnaround time for Immunofluorescence is 3 weeks approximately. (Information provided by St

CYTOGENETICS/CHROMOSOMAL ANALYSIS

/chromosomal analysis is NOT processed by the Histopathology Department. There


samples directly to the relevant referral centre. Please note that formalin fixed samples are

Y/POST MORTEM FROM TULLAMORE

If the patient dies before reaching the hospital contact nursing administration on 057 9358489/

tration will arrange transport to the mortuary and will contact the coroner and the

Patient dies in Hospital and requires coroners post mortem:

It is the responsibility of the doctor in charge to contact the coroner

ould then contact nursing administration: 057 9358489/8490 to arrange transport to

Nursing administration will also contact the Histopathologist on call to arrange autopsy

house post mortem:

forensic reports require next of kin consent

The consent form is available from nursing administration 057 9358489/8490

It is the responsibility of the relevant clinical team to contact the next of kin and arrange for the

A next of kin information leaflet on the autopsy process is also available from nursing

Contact nursing administration also to arrange transport to the mortuary

It is the responsibility of nursing administration to contact the Histopatholo


No. Of Pg: 117 of 132

Place the other on saline moistened gauze and place this in a dry universal container for

Both containers must be labelled with the patient name, DOB and nature of specimen.

They must be accompanied by a Histopathology form with full patient details including

Hospital, Dublin.


reports are available from the referral laboratory only (01-4162928)

(Information provided by St

processed by the Histopathology Department. There


e that formalin fixed samples are NOT suitable

If the patient dies before reaching the hospital contact nursing administration on 057 9358489/

tration will arrange transport to the mortuary and will contact the coroner and the

ould then contact nursing administration: 057 9358489/8490 to arrange transport to

gist on call to arrange autopsy

The consent form is available from nursing administration 057 9358489/8490

It is the responsibility of the relevant clinical team to contact the next of kin and arrange for the

A next of kin information leaflet on the autopsy process is also available from nursing

It is the responsibility of nursing administration to contact the Histopathologist on call to arrange

PATHOLOGY




AUTOPSY/POST MORTEM FROM LONGFORD WESTMEATH

The notifications and paperwork required for the autopsy are performed by nursing administration in MRH

Mullingar.

NB: Longford patients and Westmeath patients requiring autopsy must first be transferred to the

mortuary in MRH Mullingar where nursing administration will process the paperwork before transfer to

Tullamore.

Coroners Autopsies

Once it has been decided that the deceased person is to be transported to the Mortuary of the MRHT for

autopsy, Nursing Administration staff MRHM contact the Undertaker appointed by the relevant Coroner to

inform them that transportation of the remains between MRHM and the Mortuary

In most Coroners’ cases it will be preferable for the identifying Garda to travel to MRHT to do the

subsequent identification and to supply a copy of the C71 form to mortuary staff. On a case by case basis

and in order to facilitate families in so far as is possible, the process of identification of remains to

may be carried out on site at the MRHM in the presence of the Mortuary Attendant prior to transfer of

remains to the mortuary MRHT. The Mortuary Attendant can then subseq

Consultant Histopathologist who will be performing the autopsy if the identifying Garda is subsequently

unable to attend MRHT.

House Autopsies (Non Coroner autopsies)

For non-coroner autopsies Hospital

Nursing Administration MRHM check that a consent form signed by the next

medical record prior to sending the medical case notes to MRHT. If no consent form is in the Medical case

notes Nursing Administration will contact the relevant Medical team to request that they organise signed

consent by the next of kin prior to the autopsy

For all autopsies

Nursing Administration MRHM also contact their Nursing Administration Colleagues

the Anatomic Pathology Technician (APT) / Multitask Attendant (MTA) is available. This ensures that the

APT / MTA is on site at the mortuary MRHT to receive the remains.

Where possible all transfers of remains should be done during

the Pathologist must be informed by telephone. Patient notes are transferred in a sealed envelope from

MRHM to the mortuary of the MRHT. This can be done by utilising the existing inter

by having the Mortuary assistant transport them directly when travelling from the MRHM or alternatively

by giving them to the undertaker accompanying the body. The Histopathologist is notified of how the notes

are being transported

The Consultant Histopathologist will be responsible for returning the medical chart to Medical Records

MRHM.

Return of the Remains

Depending on individual family requests and arrangements, the remains may be transferred by the relevant

undertaker to the Mortuary of the MRHM f

directly to the funeral home of the appointed undertaker. The mortuary attendant will contact the

undertaker to arrange transport

FOR ALL AUTOPSIES

Turnaround time

• Uncomplicated Post Mortem reports may take up to 6 months

• More complicated cases may take up to 12 months depending on testing required.

• Coroner’s post mortem results are available from the relevant coroner’s office only





AUTOPSY/POST MORTEM FROM LONGFORD WESTMEATH




hat the deceased person is to be transported to the Mortuary of the MRHT for


inform them that transportation of the remains between MRHM and the Mortuary of MRHT is required.

cases it will be preferable for the identifying Garda to travel to MRHT to do the


families in so far as is possible, the process of identification of remains to


remains to the mortuary MRHT. The Mortuary Attendant can then subsequently identify the body to


House Autopsies (Non Coroner autopsies)

autopsies Hospital medical staff are responsible for obtaining consent from next

Nursing Administration MRHM check that a consent form signed by the next-of-kin is contained in the



consent by the next of kin prior to the autopsy

Nursing Administration MRHM also contact their Nursing Administration Colleagues


APT / MTA is on site at the mortuary MRHT to receive the remains.

Where possible all transfers of remains should be done during normal working hours. If a delay occurs then


MRHM to the mortuary of the MRHT. This can be done by utilising the existing inter



hologist will be responsible for returning the medical chart to Medical Records


undertaker to the Mortuary of the MRHM for viewing prior to the funeral taking place or may be taken


Uncomplicated Post Mortem reports may take up to 6 months

More complicated cases may take up to 12 months depending on testing required.

Coroner’s post mortem results are available from the relevant coroner’s office only


No. Of Pg: 118 of 132




hat the deceased person is to be transported to the Mortuary of the MRHT for


of MRHT is required.

cases it will be preferable for the identifying Garda to travel to MRHT to do the


families in so far as is possible, the process of identification of remains to Gardaí


uently identify the body to the


esponsible for obtaining consent from next-of-kin.

kin is contained in the



Nursing Administration MRHM also contact their Nursing Administration Colleagues in MRHT to ensure that


normal working hours. If a delay occurs then


-laboratory taxi service,



hologist will be responsible for returning the medical chart to Medical Records


or viewing prior to the funeral taking place or may be taken


More complicated cases may take up to 12 months depending on testing required.

Coroner’s post mortem results are available from the relevant coroner’s office only

PATHOLOGY




• Non-coroners post mortem results

mortem examination.

• The reporting Histopathologist is available to answer any questions next of kin may have relating to

the report at any time

FORENSIC POST MORTEM

All forensic Post Mortems are carried out by the State pathologist or the Assistant State Pathologist.

Reports for these cases are neither generated by nor available from the Midland Regional Pathology

service.

REFERRALS FOR MULTIDISCIPLINARY TEAM REVIEW (MDT)/ TUMOUR BOARD

Surgical Teams /Oncology Team

• Each surgical team generates a list of patients who need to be discussed at MDT

• The surgical team brings the list to the oncology CNS who is the gatekeeper for the tumour board

meetings

• The oncology CNS adds the cases to the oncolog

Oncology CNS

• The amalgamated list is forwarded to the oncology secretary who in turn forwards it to the

Histopathology Team

• The request should be received in the laboratory before 4 pm on Monday to allow the

finalised, the slides and blocks to be retrieved and the case to be reviewed by the presenting

Histopathologist

GI MDT

MRH Tullamore:

• The GI MDT is held once per month

• All requests of GI MDT review are forwarded by Dr Geraldine McCormack to Dr Nurul Nor,

Consultant Histopathologist.

• The GI MDT List should be received in the laboratory before 4 pm on the Friday before the meeting

to allow the reports to be finalised,

reviewed by the presenting Histopathologist

MRH Mullingar:

• The Mullingar GI MDT is held every second Tuesday

• The list is generated by Dr Kirca’s registrar/

Dr Miriam Walsh Consultant Histopathologist

• The GI MDT List should be received in the laboratory before 4 pm on the Monday of the week

before the meeting to allow the reports to be finalised,

the case to be reviewed by the presenting Histopathologist

20.5 Sample Rejection Laboratory staff are only authorised to accept samples which meet the requ

Section 20.4 for further information. Adherence to specimen labelling requirements

importance for Histopathology specimens as in general, it is not possible to obtain a repeat specimen.

Specimens and forms with discrepancies may be corrected by

will be requested to attend the labo

of the specimen will not proceed until the correction has taken place.





coroners post mortem results are available from the consultant who requested the post

The reporting Histopathologist is available to answer any questions next of kin may have relating to

carried out by the State pathologist or the Assistant State Pathologist.


REFERRALS FOR MULTIDISCIPLINARY TEAM REVIEW (MDT)/ TUMOUR BOARD

Each surgical team generates a list of patients who need to be discussed at MDT

The surgical team brings the list to the oncology CNS who is the gatekeeper for the tumour board

The oncology CNS adds the cases to the oncology list which has already been generated by the

The amalgamated list is forwarded to the oncology secretary who in turn forwards it to the

The request should be received in the laboratory before 4 pm on Monday to allow the

the slides and blocks to be retrieved and the case to be reviewed by the presenting

The GI MDT is held once per month

All requests of GI MDT review are forwarded by Dr Geraldine McCormack to Dr Nurul Nor,

Consultant Histopathologist.

The GI MDT List should be received in the laboratory before 4 pm on the Friday before the meeting

to allow the reports to be finalised, the slides and blocks to be retrieved and the case to be

reviewed by the presenting Histopathologist

T is held every second Tuesday

The list is generated by Dr Kirca’s registrar/secretary who forwards it to Dr Charles d’Ad

Dr Miriam Walsh Consultant Histopathologist

The GI MDT List should be received in the laboratory before 4 pm on the Monday of the week

before the meeting to allow the reports to be finalised, the slides and blocks to be retrieved and

be reviewed by the presenting Histopathologist

Laboratory staff are only authorised to accept samples which meet the required standard. Please refer to

for further information. Adherence to specimen labelling requirements


Specimens and forms with discrepancies may be corrected by the person who took the sample.

will be requested to attend the laboratory to correct the error and sign and date the correction. Processing

of the specimen will not proceed until the correction has taken place.


No. Of Pg: 119 of 132

are available from the consultant who requested the post

The reporting Histopathologist is available to answer any questions next of kin may have relating to

carried out by the State pathologist or the Assistant State Pathologist.


Each surgical team generates a list of patients who need to be discussed at MDT

The surgical team brings the list to the oncology CNS who is the gatekeeper for the tumour board

y list which has already been generated by the

The amalgamated list is forwarded to the oncology secretary who in turn forwards it to the

The request should be received in the laboratory before 4 pm on Monday to allow the report to be

the slides and blocks to be retrieved and the case to be reviewed by the presenting

All requests of GI MDT review are forwarded by Dr Geraldine McCormack to Dr Nurul Nor,

The GI MDT List should be received in the laboratory before 4 pm on the Friday before the meeting

slides and blocks to be retrieved and the case to be

secretary who forwards it to Dr Charles d’Adhemar and

The GI MDT List should be received in the laboratory before 4 pm on the Monday of the week

the slides and blocks to be retrieved and

ired standard. Please refer to

for further information. Adherence to specimen labelling requirements is of particular


the person who took the sample. He/She

ratory to correct the error and sign and date the correction. Processing

PATHOLOGY




Rejected specimens from locations external to the hospital will be returned to that location for correction

by the person who took the sample.

clinical impact on the sample quality or on the patient, the Medical team involved may be allowed to clarify

discrepancies using an ‘Acceptance of Respon

Discrepancy and correction will be recorded. The final report of the patient’s test result(s) will contain

details of the correction made.

Where a dispute arises in relation to a sample, the final

Consultant Histopathologist or Chief Medical Scientist.

20.6 Sample Retention

Sample

Routine Histopathology Specimens

Cytology Specimens

Autopsy/Post Mortem Samples

Some samples may be retained for longer periods at the request of the reporting Histopathologist and with

the consent of the patient/next of kin where required.

20.7 Quality Assurance The Histology Laboratory participates in the following Quality Assurance Programmes:

Distributor

UK National External Quality

Assessment Service (UKNEQAS)

NordiQC External Quality

Assessment Service

RCPA QAP

Dept. Histopathology, Leicester

Royal Infirmary, Leicester LE1 5WW

UK GI EQA Scheme

IEQAS

Non-Gynae Cytology EQA Scheme

Secretary

Countess of Chester Hospital

The Histology Laboratory also participates in voluntary Inter

and Immunohistochemistry.






the person who took the sample. In exceptional cases where the delay in processing will have a direct


discrepancies using an ‘Acceptance of Responsibility Form’ while the specimen remains in quarantine.


Where a dispute arises in relation to a sample, the final decision on suitability for testing will lie with the

Consultant Histopathologist or Chief Medical Scientist.

Retention Time

Routine Histopathology Specimens 5 Weeks (a minimum of 2 weeks

after reporting)

4 Weeks

Autopsy/Post Mortem Samples 1 year


the consent of the patient/next of kin where required.

pates in the following Quality Assurance Programmes:

Distributor QA Programme

UK National External Quality

Assessment Service (UKNEQAS)

1. Cellular Pathology

2. Immunohistochemistry

Immunohistochemistry

Non-Gynae Cytopathology diagnostic

Module

Dept. Histopathology, Leicester

Royal Infirmary, Leicester LE1 5WW

National Specialist Dermatopathology

External Quality Assurance Scheme UK and

ROI

GI Pathology EQA Scheme

Irish EQA Scheme in General

Histopathology

Gynae Cytology EQA Scheme

Countess of Chester Hospital

Non-Gynae Cytology EQA Scheme

The Histology Laboratory also participates in voluntary Inter-Laboratory assessment for some special stain


No. Of Pg: 120 of 132


In exceptional cases where the delay in processing will have a direct


sibility Form’ while the specimen remains in quarantine.


decision on suitability for testing will lie with the

Retention Time

5 Weeks (a minimum of 2 weeks


pates in the following Quality Assurance Programmes:

QA Programme

Gynae Cytopathology diagnostic

National Specialist Dermatopathology

External Quality Assurance Scheme UK and

Irish EQA Scheme in General

Gynae Cytology EQA Scheme

Laboratory assessment for some special stains

PATHOLOGY




21 REFERENCE RANGES & UNCERTAINTY OF

21.1 Uncertainty of MeasurementUncertainty of Measurement is defined as quantification of the doubt about the measurement result. It is

the policy of the laboratory at MRH, Mullingar to determine the uncertainty for all examination methods

used to report measured quantity values on pati

current uncertainties calculated for each test. These are available to all service users upon request.

21.2 Reference Ranges The following pages list the reference ranges attributed to tests performed

of these are provided by the manufacturer of the test method used. Others are produced by the Pathology

Harmonisation Group. Please contact the appropriate department if you have any queries on the basis of a

stated reference range.

21.2.1 Clinical Chemistry – Serum Ranges

Test Age/Gender/Cycle Time

ALT <2 years

Male >2 years

Female > 2 years

Albumin <1 year

1-16 years

>16 years

ALP <1 month

1 month-1 year

1-9 years

9-15 years

>15 years

Amylase

AST <1 month

1 month-1 year

Male >1 year

Female >1 year

Bilirubin – Total Newborn

2-5 days

>6 days

Bilirubin – Direct

Calcium

(& Corrected Calcium)

<2 years

>2 years

Carbamazepine Therapeutic

Chloride <1 year

>1 year

Cholesterol

CK <3 days

3-10 days

10 days-15 years

Male >15 years

Female > 15

Cortisol AM Sample

PM Sample





NCERTAINTY OF MEASUREMENT

Uncertainty of Measurement Uncertainty of Measurement is defined as quantification of the doubt about the measurement result. It is


used to report measured quantity values on patient’s samples. Each department has a document listing the


The following pages list the reference ranges attributed to tests performed in the laboratory. The majority



Serum Ranges

Age/Gender/Cycle Time Reference Range

1-45

Male >2 years 1-50

Female > 2 years 1-35

30-45

30-50

35-50

45-315

1 year 60-550

45-400

50-350

40-120

28-100

1-75

1 year 1-65

Male >1 year 1-50

Female >1 year 1-35

24-149

26-205

0.4-21

0-3.4

2.15-2.65

2.2-2.6

Therapeutic Range 4-12

98-110

95-108

0.07-5.18

30-900

30-485

15 years 30-220

years 40-320

15 years 25-200

AM Sample 185-624

PM Sample <276


No. Of Pg: 121 of 132

Uncertainty of Measurement is defined as quantification of the doubt about the measurement result. It is


ent’s samples. Each department has a document listing the


in the laboratory. The majority



Units

U/L

U/L

U/L

g/L

g/L

g/L

U/L

U/L

U/L

U/L

U/L

U/L

U/L

U/L

U/L

U/L

µmol/L

µmol/L

µmol/L

µmol/L

mmol/L

mmol/L

mg/L

mmol/L

mmol/L

mmol/L

U/L

U/L

U/L

U/L

U/L

nmol/L

nmol/L

PATHOLOGY





Creatinine (Jaffe) <7 days

8 days-1 month

1 month-1 year

1-17 years

Male >17 years

Female > 17

Creatinine (Enzymatic) <1 month

1 month-1 year

1-16 years

Male >16 years

Female >16

CRP

Digoxin Therapeutic

Ethanol

Free T3 0-1 year

1-15 years

15-19 years

>19 years

Free T4 0-1 year

1-3 years

3-12 years

12-14 years

15-19 years

>19 years

Ferritin Male

Female

Folate

FSH Male

Female: - Follicular

- - -

Gentamicin Trough

Peak

GGT <1 month

1-2 months

2-4 months

4-7 months

7 months-12 years

Male 12-18 years

Female 12-

Male >18 years

Female >18

HDL Cholesterol

Iron <1 month

1 month-1 year

1-16 years






3.15-100

1 month 10-70

1 year 14-34

23-68

years 59-104

17 years 45-84

22-90

1 year 11-34

21-65

years 64-104

Female >16 years 49-90

0.1-5

Therapeutic Range 0.5-1.0

N/A

4.31-6.85

3.98-6.10

19 years 3.47-5.31

3.8-6.0

9.65-19.17

9.52-16.21

8.36-13.64

14 years 7.21-12.74

19 years 7.85-13.25

8.4-19.3

23.9-336.2

11-306.8

3.1-19.9

1.27-19.26

Follicular 3.85-8.78

Mid-cycle 4.54-22.51

Luteal 1.79-5.12

Menopause 16.74-114

1-2

5-8

1-150

2 months 1-114

4 months 1-81

7 months 1-34

12 years 1-24

18 years 1-42

-18 years 1-24

years 1-55


0.01-1.55

17.9-44.8

1 year 7.2-17.9

9.0-21.5


No. Of Pg: 122 of 132

Units

µmol/L

µmol/L

µmol/L

µmol/L

µmol/L

µmol/L

µmol/L

µmol/L

µmol/L

µmol/L

µmol/L

mg/L

μg/L

mg/dL

pmol/L

pmol/L

pmol/L

pmol/L

pmol/L

pmol/L

pmol/L

pmol/L

pmol/L

pmol/L

μg/L

μg/L

μg/L

IU/L

IU/L

IU/L

IU/L

IU/L

mg/L

mg/L

U/L

U/L

U/L

U/L

U/L

U/L

U/L

U/L

U/L

mmol/L

µmol/L

µmol/L

µmol/L

PATHOLOGY





Male >16 years

Female >16

LDH <1 month

1-6 months

6 months-1 year

1-2 years

2-16 years

>16 years

LDL Cholesterol

Lithium Therapeutic

LH Male


- - -

Magnesium <1 month

>1 month

Oestradiol Male


- - -

Paracetamol

Phenobarbitone Therapeutic

Phenytoin Therapeutic

Phosphate <2 months

2 months-1

14-16 years

>16 years

Potassium <1 year

>1 year

Potassium – Direct <1 month

1 month-16 years

>16 years

Progesterone Male


- - - - -

Prolactin Male

Female: - Pre

- PSA Male: - 40-

- 50

- 60






years 12.5-32.2

Female >16 years 10.7-32.2

365-1450

6 months 310-790

1 year 325-670

200-565

200-600

258-459

0.1-2.6

Therapeutic Range 0.4-1.0

1.24-8.62


Mid-cycle 19.18-103.03

Luteal 1.20-12.86

Menopause 10.87-58.64

0.6-1.0

0.7-1.0

<173.0

Follicular 392-510

Mid-cycle 1387-1816

Luteal 917-1240

Menopause 121-176

No range quoted



s 1.5-2.55

14 years 1.2-2.0

16 years 0.6-1.4

0.8-1.5

3.5-5.5

3.5-5.3

4.1-5.3

16 years 3.4-4.7

3.5-5.1

0.23-4.40


Mid-cycle 12.08-49.46

Luteal 0.16-1.51

Menopause 10.98-149.35

1st Trimester 51.90-131.83

2nd Trimester 0.23-4.40

43-375

Pre-menopausal 70.81-566.5

Post-menopausal 58.1-416.4

-49 years 0.0-2.5

50-59 years 0.0-3.5

60-69 years 0.0-4.5


No. Of Pg: 123 of 132

Units

µmol/L

µmol/L

U/L

U/L

U/L

U/L

U/L

U/L

mmol/L

mmol/L

IU/L

IU/L

IU/L

IU/L

IU/L

mmol/L

mmol/L

pmol/L

pmol/L

pmol/L

pmol/L

pmol/L

mg/L

mg/L

mg/L

mmol/L

mmol/L

mmol/L

mmol/L

mmol/L

mmol/L

mmol/L

mmol/L

mmol/L

IU/L

IU/L

IU/L

IU/L

IU/L

IU/L

IU/L

mIU/L

mIU/L

mIU/L

μg/L

μg/L

μg/L

PATHOLOGY





- >70 years

PTH (Intact)

Rheumatoid Factor

Salicylate

Sodium <16 years

>16 year

Sodium – Direct <1 month

1 month-16 years

>16 years

Testosterone Male

ThCG Female: - Non

- - - - - - - -

Theophylline Therapeutic

Total Protein

Transferrin <4 days

10 days-10 years

>10 years

Transferrin Saturation

Triglyceride

TSH

1st

Trimester

2nd

& 3rd

Trimesters

Urea <1 year

1-16 years

>16 years

Uric Acid <16 years

Male >16 years

Female >16

Valporate Therapeutic

Vitamin B12

Vitamin D

21.2.2 Clinical Chemistry – Plasma Ranges

Test Gender/Comment

Albumin <1 year

1-16 years

>16 years

ALT <2 years

Male >2 years






>70 years 0.0-6.5

11.1-79.5

1-14

No range quoted

133-144

133-146

139-146

16 years 138-145

136-145

6.07-27.10

Non-pregnant <5.0

1 week gestation 5-50

1-2 weeks 62.5-625

2-3 weeks 125-6250

3-4 weeks 625-12500

4-5 weeks 1250-62500

5-6 weeks 12500-125000

6-8 weeks 18750-250000

8-12 weeks 12500-125000


60-80

1.3-2.75

10 years 2.03-3.6

2.0-3.6

16-45

0.01-1.7

0.38-5.33

Trimester 0.1-2.5

Trimesters 0.2-3.0

1.0-6.0

2.0-6.0

2.5-7.8

120-320

years 200-430



122-626

> 50

Plasma Ranges

Gender/Comment Reference Range

30-45

30-50

35-50

1-45

Male >2 years 1-50


No. Of Pg: 124 of 132

Units

μg/L

ng/L

U/mL

mg/L

mmol/L

mmol/L

mmol/L

mmol/L

mmol/L

nmol /L

IU/L

IU/L

IU/L

IU/L

IU/L

IU/L

IU/L

IU/L

IU/L

mg/L

g/L

g/L

g/L

g/L

%

mmol/L

mIU/L

mIU/L

mIU/L

mmol/L

mmol/L

mmol/L

µmol/L

µmol/L

µmol/L

mg/L

ng/L

nmol/L

Units

g/L

g/L

g/L

U/L

U/L

PATHOLOGY




Test Gender/Comment

Female > 2 years

ALP <1 month

1 month-1 year

1-9 years

9-15 years

>15 years

Amylase

AST <1 month

1 month-1 year

Male >1 year

Female >1

Ammonia <1 month

1 month-16 years

>16 years

Bilirubin – Total Newborn

2-5 days

>6 days

Bilirubin – Direct

BNP

Calcium

(& Corrected Calcium)

<2 years

>2 years

Chloride <1 year

>1 year

Cholesterol

CK <3 days

3-10 days

10 days-1 month

1 month -15 years

Male >15 years

Female > 15

Creatinine (Jaffe) <7 days

8 days-1 month

1 month-1 year

1-17 years

Male >17 years

Female > 17

Creatinine (Enzymatic) <1 month

1 month-1 year

1-16 years

Male >16 years

Female >16

CRP

Ethanol

Gentamicin Trough

Peak

GGT <1 month

1-2 months






Female > 2 years 1-35

45-315

1 year 60-550

45-400

50-350

40-120

28-100

1-75

1 year 1-65

Male >1 year 1-50

Female >1 year 1-35

0.2-95

16 years 0.2-65

16-53

24-149

26-205

0.4-21

0-3.4

1-100

2.15-2.65

2.2-2.6

98-110

95-108

0.07-5.18

30-900

30-485

1 month 30-250

15 years 30-220

years 40-320

15 years 25-200

3.15-100

1 month 10-70

1 year 14-34

23-68

years 59-104

17 years 45-84

22-90

1 year 11-34

21-65

years 64-104


0.1-5

N/A

1-2

5-8

1-150

2 months 1-114


No. Of Pg: 125 of 132

Units

U/L

U/L

U/L

U/L

U/L

U/L

U/L

U/L

U/L

U/L

U/L

µmol/L

µmol/L

µmol/L

µmol/L

µmol/L

µmol/L

µmol/L

pg/mL

mmol/L

mmol/L

mmol/L

mmol/L

mmol/L

U/L

U/L

U/L

U/L

U/L

U/L

µmol/L

µmol/L

µmol/L

µmol/L

µmol/L

µmol/L

µmol/L

µmol/L

µmol/L

µmol/L

µmol/L

mg/L

mg/dL

mg/L

mg/L

U/L

U/L

PATHOLOGY




Test Gender/Comment

2-4 months

4-7 months

7 months-12 years

Male 12-18 years

Female 12-

Male >18 years

Female >18

Glucose <16 years Random

>16 years Random

<16 years Fasting

>16 years Fasting

1 hour PP

1 hour PP

Gestational Fasting

Gestational 1 hour

Gestational 2 hour

HbA1c Normal non

Diabetic Goal

HDL Cholesterol

Lactate

LDL Cholesterol

Magnesium <1 month

>1 month

Phosphate <2 months

2 months-1

14-16 years

>16 years

Potassium <7 days

7 days-1 year

1-16 years

>16 years

Sodium <16 years

>16 year

Total Protein

Triglyceride

Troponin I Normal

Cut-off for AMI

Urea <1 year

1-16 years

>16 years

Uric Acid <16 years

Male >16 years

Female >16






4 months 1-81

7 months 1-34

12 years 1-24

18 years 1-42

-18 years 1-24

years 1-55


16 years Random 3.3-5.6

>16 years Random 4.1-5.9

<16 years Fasting 3.3-5.6

16 years Fasting 3.3-7.0

3.5-7.8

3.5-6.7

Gestational Fasting 3.5-5.09

Gestational 1 hour 3.5-9.99

Gestational 2 hour 3.5-8.49

Normal non-diabetic range 20-42

Diabetic Goal <53

0.01-1.55

0.5-2.2

0.1-2.6

0.6-1.0

0.7-1.0

s 1.5-2.55

14 years 1.2-2.0

16 years 0.6-1.4

0.8-1.5

3.4-6.0

1 year 3.5-5.7

3.5-5.0

3.5-5.3

133-144

133-146

60-80

0.01-1.7

<0.04

off for AMI >0.04

1.0-6.0

2.0-6.0

2.5-7.8

120-320

years 200-430



No. Of Pg: 126 of 132

Units

U/L

U/L

U/L

U/L

U/L

U/L

U/L

mmol/L

mmol/L

mmol/L

mmol/L

mmol/L

mmol/L

mmol/L

mmol/L

mmol/L

mmol/mol

mmol/mol

mmol/L

mmol/L

mmol/L

mmol/L

mmol/L

mmol/L

mmol/L

mmol/L

mmol/L

mmol/L

mmol/L

mmol/L

mmol/L

mmol/L

mmol/L

g/L

mmol/L

μg/L

μg/L

mmol/L

mmol/L

mmol/L

µmol/L

µmol/L

µmol/L

PATHOLOGY




21.2.3 Clinical Chemistry – Urine Ranges

Test Gender/Comment

Urinary Albumin –

Random

Male

Female

Urinary Albumin – 24

hour

Urinary Amylase –

Random

Male

Female

Urinary Calcium

Urinary Chloride

Urinary Creatinine –

24 hour

Male

Female

Creatinine Clearance

Urinary Magnesium

Urinary Phosphate

Urinary Potassium

Urinary Protein

Urinary Sodium

Urinary Urea

Urinary Uric Acid

Albumin/Creatinine

Ratio

Male Normal

Female Normal

Microalbuminuria

Proteinuria

Protein/Creatinine

Ratio

Normal

Normal Pregnancy

Moderate Proteinuria

Clinical Proteinuria

21.2.4 Clinical Chemistry – CSF Ranges

Test

CSF Glucose

CSF Protein <1 month

>1 month

CSF Lactate <3 days

3-10 days

10 days-18 years

>18 years





Urine Ranges


0.0-25.0

7.0-19.0

0-30

2-490

2-450

2.5-7.5

110-250

1.24-2.30

0.97-1.77

85-125

2.4-6.5

12.9-42.0

25-125

0.05-0.08

133-146

250-570

1500-4500

Male Normal <2.5

Female Normal <3.5

Microalbuminuria 2.5-25

Proteinuria >25

<15

Normal Pregnancy <30

Moderate Proteinuria 15-45

Clinical Proteinuria >45

CSF Ranges

Age Reference Range

60% plasma value

0.15-1.30

0.15-0.45

1.1-6.7

1.1-4.4

18 years 1.1-2.8

1.1-2.4


No. Of Pg: 127 of 132

Units

mg/L

mg/L

mg/24 hours

U/L

U/L

mmol/24 hours

mmol/24 hours

mmol/24 hours

mmol/24 hours

mL/minute

mmol/24 hours

mmol/24 hours

mmol/24 hours

g/24 hours

mmol/24 hours

mmol/24 hours

µmol/24 hours

mg/mmol

mg/mmol

mg/mmol

mg/mmol

mg/mmol

mg/mmol

mg/mmol

mg/mmol

Units

mmol/L

g/L

g/L

mmol/L

mmol/L

mmol/L

mmol/L

PATHOLOGY




21.2.5 Immunology

Test Age/Clinical Significance

IgG <14 days

<1 month

<6 months

<1 year

<3 years

<6 years

<9 years

<12 years

Adult

IgA <14 days

<1 month

<6 months

<1 year

<3 years

<6 years

<9 years

<12 years

Adult

IgM <14 days

<1 month

<6 months

<1 year

<3 years

<6 years

<9 years

<12 years

Adult

IgE – Total 0-1 year

<3 years

<6 years

<10 years

>10 years

IgE – Specific Absent/Undetectable/

Negative (Normal)

For special use only: clinical

relevance undetermined

Low level of allergy,

indicative of

sensitisation

Moderate level of allergy,

indicative of high level

sensitisation

High level of allergy,


sensitisation

Very high level of allergy,





Age/Clinical Significance Reference Range

6.50-12.10

1.62-7.32

<6 months 2.96-10.06

3.00-9.16

4.28-11.53

5.54-11.98

6.43-11.31

6.58-12.86

6.80-15.30

0.07-0.49

0.08-0.80

<6 months 0.29-1.37

0.29-1.37

0.37-1.11

0.68-1.80

0.90-1.66

0.90-2.69

0.68-3.75

0.07-0.23

0.17-0.80

<6 months 0.24-0.70

0.48-1.07

0.31-1.27

0.37-1.53

0.37-1.53

0.47-1.53

0.40-2.30

0-13

0-32

0-56

0-85

0-100

Absent/Undetectable/

Negative (Normal)

<0.10

For special use only: clinical

relevance undetermined

0.10-0.35

Low level of allergy,

indicative of on-going

sensitisation

0.35-0.70

Moderate level of allergy,


sensitisation

0.70-3.5

High level of allergy,


sensitisation

3.5-17.5

Very high level of allergy, >17.5


No. Of Pg: 128 of 132

Units

g/L

g/L

g/L

g/L

g/L

g/L

g/L

g/L

g/L

g/L

g/L

g/L

g/L

g/L

g/L

g/L

g/L

g/L

g/L

g/L

g/L

g/L

g/L

g/L

g/L

g/L

g/L

kU/L

kU/L

kU/L

kU/L

kU/L

kAU/L

kAU/L

kAU/L

kAU/L

kAU/L

kAU/L

PATHOLOGY




Test Age/Clinical Significance

indicative of very high level

sensitisation

Alpha-1 Antitrypsin

Ceruloplasmin

Haptoglobin

Complement C3

Complement C4

Beta-2 Microglobulin

TPO Antibodies Negative

Equivocal

Positive

tTG Antibodies Negative

Equivocal

Positive

21.2.6 Haematology - FBC

Test Age/Gender

WBC Birth

1-3 days

<1 month

<2 months

2-6 months

6 months-1 year

1-6 years

6-12 years

>12 years

RBC Birth

1-3 days

<1 week

<2 weeks

<1 month

<2 months

2-6 months

6 months-6 years

6-12 years

12-18 years Male

12-18 years Female

Adult Male

Adult Female

Hb Birth

1-3 days

<1 week

<2 weeks

<1 month

<2 months

2 months-6 years





Age/Clinical Significance Reference Range

indicative of very high level

sensitisation

0.90-2.00

22.0-60.0

0.30-2.00

0.90-1.80

0.10-0.40

0.70-1.80

<60

60-100

>100

0-7

7-10

>10

Age/Gender Reference Range

10.0-26.0

7.0-23.0

5.0-19.0

<2 months 5.0-15.0

6 months 6.0-18.0

1 year 6.0-16.0

5.0-15.0

5.0-13.0

4.0-11.0

5.0-7.0

4.0-6.6

4.0-6.3

3.6-6.2

3.0-5.4

<2 months 3.0-4.3

6 months 4.0-5.3

6 years 4.0-5.0

4.0-5.2

18 years Male 4.5-5.5

18 years Female 3.8-4.8

Adult Male 4.5-5.5

Adult Female 3.8-4.8

14.0-22.0

14.5-22.5

13.5-21.5

12.5-20.5

11.5-16.5

<2 months 9.4-13.0

6 years 11.0-14.0


No. Of Pg: 129 of 132

Units

g/L

mg/dL

g/L

g/L

g/L

mg/L

IU/mL

IU/mL

IU/mL

IU/mL

IU/mL

IU/mL

Units

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x1012

/L

x1012

/L

x1012

/L

x1012

/L

x1012

/L

x1012

/L

x1012

/L

x1012

/L

x1012

/L

x1012

/L

x1012

/L

x1012

/L

x1012

/L

g/dL

g/dL

g/dL

g/dL

g/dL

g/dL

g/dL

PATHOLOGY




Test Age/Gender

6-12 years

12-18 years Male

12-18 years Female

Adult Male

Adult Female

Hct Birth

1-3 days

4 days-1 month

<2 months

2 months-6 years

6-12 years

12-18 years Male

12-18 years Female

Adult Male

Adult Female

MCV Birth

1 day-2 weeks

2 weeks-1 month

1-2 months

2 months-2 years

2-6 years

6-12 years

12-18 years

Adult

MCH

MCHC

RDW

Platelets Birth

1 day-1 month

1-2 months

2 months-1 year

1-6 years

6-12 years

>12 years

Neutrophils Birth

1-3 days

<1 month

<2 months

2-6 months

6 months-1 year

1-6 years

6-12 years

>12 years

Lymphocytes Birth

1-3 days

<1 month

<2 months






11.5-15.5

18 years Male 13.0-16.0


Adult Male 13.5-17.5


0.45-0.75

0.45-0.65

1 month 0.33-0.53

<2 months 0.30-0.42

6 years 0.30-0.40

0.35-0.45

18 years Male 0.40-0.50


Adult Male 0.4-0.5


100.0-120.0

2 weeks 92.0-118.0

1 month 92.0-116.0

2 months 87.0-103.0

2 years 68.0-84.0

75.0-87.0

77.0-95.0

18 years 80.0-99.0

79.0-99.0

27.0-32.0

31.5-34.5

11.5-14.5

150-450

1 month 210-500

2 months 210-650

1 year 200-550

200-450

180-400

140-450

4.0-14.0

3.0-5.0

3.0-9.0

<2 months 1.0-5.0

6 months 1.0-6.0

1 year 1.0-7.0

1.5-8.0

2.0-8.0

2.0-7.0

3.0-8.0

2.0-8.0

3.0-16.0

<2 months 4.0-10.0


No. Of Pg: 130 of 132

Units

g/dL

g/dL

g/dL

g/dL

g/dL

L/L

L/L

L/L

L/L

L/L

L/L

L/L

L/L

L/L

L/L

fL

fL

fL

fL

fL

fL

fL

fL

fL

pg

g/dL

%

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

PATHOLOGY




Test Age/Gender

2-6 months

6 months-1 year

1-6 years

6-12 years

>12 years

Monocytes Birth

1-3 days

<1 month

<2 months

2-6 months

6 months-12 years

>12 years

Eosinophils Birth

1-3 days

<1 month

1 month-12 years

>12 years

Basophils

LUC

% Neutrophils

% Lymphocytes

% Monocytes

% Eosinophils

% Basophils

% LUC

Reticulocytes Birth

1-3 days

<1 month

<2 months

2-6 months

6 months-12 years

>12 years

ESR Male

Female

21.2.7 Haematology - Coagulation

Test Comment

PT

INR

APTT

Fibrinogen

D-dimer Value <500 ng/mL suggests

acute venous

thromboembolism is unlikely






6 months 4.0-12.0

1 year 3.5-11.0

6.0-9.0

1.0-5.0

1.0-4.0

0.5-2.0

0.5-1.0

0.3-1.0

<2 months 0.4-1.2

6 months 0.2-1.2

12 years 0.2-1.0

0.1-1.0

0.1-1.0

0.1-2.0

0.2-1.0

12 years 0.1-1.0

0.02-0.50

0.02-0.1

0.00-0.40

40.0-74.0

19.0-48.0

3.4-9.0

0.0-7.0

0.0-1.5

0.0-4.0

120-400

50-350

20-60

<2 months 30-50

6 months 40-100

12 years 30-100

50-100

0-10

0-20

Coagulation

Comment Reference Range

11.5-16.0

0.8-1.2

25-36

2.0-4.0

Value <500 ng/mL suggests

venous

thromboembolism is unlikely

<500


No. Of Pg: 131 of 132

Units

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

%

%

%

%

%

%

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

x109/L

mm/hour

mm/hour

Units

Seconds

ng/mL

g/L

ng/mL

PATHOLOGY




22 INDICATION OF COST OF VARIOUS

Tests Performed at MRHM

Glucose

Urea

Amylase

PSA

Digoxin

CRP

SPE

Immunofixation

HbA1c

Free T4

TSH

Ferritin

Vitamin B12 & Folate

AED (per drug)

Troponin

BNP

Vitamin D

PTH

Blood Culture (per bottle)

FBC

Retic

PT/INR

APTT

D-dimer

tTG

Mixed Allergy Screen

Individual Allergen





ARIOUS TESTS & BLOOD PRODUCTS

Cost (€) Blood Products

0.30 Unit of Blood (RCC)

0.30 Octaplas

0.71 Platelet Concentrate

1.68 Anti-D

1.13 Novoseven 2.4mg

1.31 Novoseven 4.8mg

11.90 Benefix

52.80 Advate

3.00

0.63

0.63 Tests Sent to External Laboratories

0.99 Chromosome Analysis

2.63 ANCA

3.15 Cardiolipin Antibodies

0.86 Sickle Cell

23.00 Thrombophilia Screen

15.00 Testosterone Female

5.65 Lamictal

4.70 Aspergillus Antibodies

0.47 Intrinsic Factor

4.04 CCP

0.67 Hepatitis A

0.95 Hepatitis B

11.00

6.00

16.00

12.00


No. Of Pg: 132 of 132

Cost (€)

248.71

128.15

825.76

64.00

2,314.49

4,628.96

1,350.00

465.00

Tests Sent to External Laboratories Cost (€)

237.00

15.00

45.00

101.58

156.00

19.00

34.00

30.92

31.74

15.00

11.00

11.00

Date post:	18-May-2018
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Laboratory User Manual Longford Road, Mullingar, Co Westmeath Tel: 044 9394330 Doc. No: MANUAL-M/L/2...

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