Laboratory User Manual · LP-GEN-007, EDITION 04 Page 1 of 72 If this is printed on blue paper it...

St Columcille’s Hospital Pathology Laboratory

LABORATORY USER MANUAL

LP-GEN-007, EDITION 04

Page 1 of 72

If this is printed on blue paper it is controlled. All other copies only valid for date printed Date printed: 1/31/2013

Laboratory User Manual




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CONTENTS

1. INTRODUCTION..........................................................................................................................................5

2. CONTACT DETAILS....................................................................................................................................6

2.1 Directory .............................................................................................................................................6

2.2 Laboratory Fax ...................................................................................................................................6

2.3 Postal Address...................................................................................................................................6

2.4 email ....................................................................................................................................................6

3. LOCATION...................................................................................................................................................7

4. OPENING HOURS .......................................................................................................................................7

5. ON-CALL SERVICE.....................................................................................................................................7

6. LABORATORY SUPPLIES .........................................................................................................................9

6.1 Hospital...............................................................................................................................................9

6.2 General Practitioners ......................................................................................................................10

7. THE REQUEST FORM ..............................................................................................................................11

7.1 Completing the request form (Hospital requests)........................................................................11

7.2 Completing the request form (GP patients) ..................................................................................12

8. SPECIMEN LABELLING ...........................................................................................................................13

8.1 Hospital samples .............................................................................................................................13

8.2 GP samples ......................................................................................................................................14

9. SPECIMEN REJECTION ...........................................................................................................................14

10. PHLEBOTOMY SERVICES...................................................................................................................15

10.1 Wards ................................................................................................................................................15

10.2 Out patients ......................................................................................................................................15

11. INSTRUCTIONS FOR PHLEBOTOMY .................................................................................................16

12. ORDER OF DRAW, SAMPLE VOLUMES FOR BLOOD SAMPLES...................................................17

13. GUIDANCE ON NUMBER OF SAMPLES TO TAKE ...........................................................................18

13.1 Serum samples ................................................................................................................................18

13.2 Other samples ..................................................................................................................................18

14. DISPOSAL OF WASTE MATERIAL USED IN SPECIMEN COLLECTION.........................................19

15. PATIENT INSTRUCTIONS FOR COLLECTING MID-STREAM URINE (MSU)...................................19




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16. PATIENT INSTRUCTIONS FOR COLLECTING A FAECES/STOOL SAMPLE..................................20

17. PATIENT INSTRUCTIONS FOR COLLECTING A 24-HOUR URINE COLECTION ...........................21

18. PATIENT INFORMATION FOR ORAL GLUCOSE TOLERANCE TEST.............................................22

19. ADDITIONAL REQUESTS / SAMPLE RETENTION ............................................................................23

20. URGENT REQUESTS ...........................................................................................................................23

21. SAMPLE TRANSPORTATION..............................................................................................................23

21.1 Health and safety .............................................................................................................................23

21.2 Sample delivery within the hospital...............................................................................................24

21.3 Sample delivery from outside the hospital ...................................................................................24

21.3.1 Packaging of diagnostic specimens from GP surgeries ................................................................24

21.3.2 Samples for reporting to SVUH OPD ............................................................................................25

21.4 Storage of samples prior to transport to the laboratory .............................................................25

22. REPORTS & ENQUIRIES .....................................................................................................................26

22.1 Electronic access to reports...........................................................................................................26

22.2 Instructions for accessing reports electronically ........................................................................26

22.3 Hardcopy reports .............................................................................................................................30

22.3.1 Hospital hardcopy reports .............................................................................................................30

22.3.2 GP hardcopy reports .....................................................................................................................30

22.4 Phoning of critical results...............................................................................................................30

22.5 Faxing of results ..............................................................................................................................31

22.6 Telephone enquiries ........................................................................................................................32

23. TURNAROUND TIMES .........................................................................................................................33

24. ADVICE..................................................................................................................................................33

25. USER SATISFACTION & COMPLAINTS .............................................................................................34

26. BIOCHEMISTRY....................................................................................................................................35

26.1 Biochemistry test repertoire...........................................................................................................35

26.2 Endocrinology test repertoire ........................................................................................................36

26.3 Urine specimens / CSF specimens ................................................................................................37

26.4 Requests for additional tests / specimen retention .....................................................................37

26.5 Telephoning of results in the critical intervals .............................................................................37

26.6 Point of care testing ........................................................................................................................38

27. HAEMATOLOGY...................................................................................................................................39




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27.1 Haematology test repertoire ...........................................................................................................39

27.2 Coagulation test repertoire.............................................................................................................40


28. HISTOLOGY ..........................................................................................................................................42

28.1 Routine Surgical Pathology............................................................................................................42

28.2 Specimens requiring special handling..........................................................................................42

28.3 Cytology............................................................................................................................................42

28.4 Target turnaround times .................................................................................................................43

28.5 Telephoning of reports....................................................................................................................43

28.6 Conferences .....................................................................................................................................44

28.7 Autopsies..........................................................................................................................................44

29. MICROBIOLOGY...................................................................................................................................45

29.1 General guidelines for Microbiology samples..............................................................................45

29.2 Microbiology Turnaround Times....................................................................................................46

29.3 Microbiology test repertoire ...........................................................................................................47

29.3.1 Urine tract infection........................................................................................................................47

29.3.2 ENT infection .................................................................................................................................48

29.3.3 Respiratory tract infection..............................................................................................................48

29.3.4 Gastrointestinal infection ...............................................................................................................49

29.3.5 Genital infections ...........................................................................................................................49

29.3.6 Pus & Wound specimens ..............................................................................................................50

29.3.7 Fluids/aspirates from sites normally sterile ...................................................................................51

29.3.8 MRSA screens, VRE screens, environmental screens .................................................................51

29.3.9 Blood culture..................................................................................................................................51

29.3.10 CSF................................................................................................................................................52

29.3.11 Tissue specimens ..........................................................................................................................52

29.3.12 Intravascular cannulae ..................................................................................................................52

29.3.13 Fungal culture ................................................................................................................................53

29.4 Requests for additional tests / specimen retention .....................................................................53


30. REFERRAL LABORATORIES..............................................................................................................54

30.1 Referred tests...................................................................................................................................54

30.2 Contact details for referral laboratories ........................................................................................70

APPENDIX A. REVISION HISTORY .......................................................................................................71




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1. INTRODUCTION

This manual is designed to provide a guide to Biochemistry, Haematology, Histology and

Microbiology services provided by the Laboratory of St Columcille’s Hospital. Details of

Blood Transfusion services are provided in the Blood Transfusion User Manual (CM-HV-

0001).

The pathology department provides a diagnostic service for all clinical activity in St

Columcille’s Hospital. It also provides a diagnostic service to other healthcare institutions

and to the community of General Practitioners (GPs) supported by the hospital.

There are four departments in the laboratory: Biochemistry, Haematology & Blood

Transfusion, Histology and Microbiology. Most specimens are processed on site. Main

exceptions at present are most immunological tests, virology tests and most drug levels.

These tests are carried out in St. Vincent’s University Hospital, Beaumont Hospital, Biomnis

Laboratory, St. James’s Laboratory and The National Virus Reference Laboratory.

All laboratory activities are subject to continuous review through quality assurance and audit.

The laboratory participates in a number of external quality assessment schemes, all of which

are Clinical Pathology Association (CPA) accredited. A list of assays and relevant schemes

is available on request.

The laboratory is committed to performing its activities in accordance with the requirements

of the International Standard, ISO 15189 (Medical Laboratories – Particular Requirements for

Quality and Competence) and of the EU Directive 2002/98/EC.

An electronic copy (pdf) of this document is available in the PPPG folder on the SCH server.

Electronic (pdf) copies are issued to all General Practices and other healthcare institutions as

appropriate.




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2. CONTACT DETAILS

2.1 Directory

`

Prefix (01) 211 for direct access from outside

Section Telephone

Laboratory Office (all enquiries)* 5005 / 5006

Phlebotomy 5265

Emergency out of hours on call laboratory

service

9 (switchboard) – connects to mobile of

scientist on-call

Out of hours Consultant Haematologist (SVUH) (01) 269 4533

Out of hours Consultant Microbiologist (SVUH) (01) 269 4533

* Due to workflow and staffing restrictions, the laboratory office cannot receive calls for results enquiries

between 13:00 and 15:30.

2.2 Laboratory Fax

(01) 282 1134

2.3 Postal Address

Laboratory

St Columcille’s Hospital,

Loughlinstown,

Co Dublin.

2.4 email

Complaints: [email protected]

GP Supplies: [email protected]




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3. LOCATION

The Laboratory is located on the first floor of the hospital. External and internal doors are

controlled via keypad access.

4. OPENING HOURS

To facilitate efficient processing of requests, samples should be delivered to the laboratory

before 16:00.

Patients admitted for elective surgery should have their routine pre-operative bloods taken

before 16.00 hours on the day prior to surgery. The “On-call” service should not be used to

run routine bloods for elective cases.

5. ON-CALL SERVICE

An emergency out of hours service (on call) is in place for emergency work, i.e. non-

deferrable tests necessary for decisions regarding patient treatment, Mon-Fri 17:00-09:00,

24 hours Sat, Sun, Bank Holidays. During these hours, the laboratory is staffed by one

medical scientist on call. The scientist must be contacted when urgent samples are being

sent to the laboratory (via switch – dial ‘9’).

Department / Activity Opening Hours

Laboratory Office / Specimen Reception Mon – Fri 09:00 - 17:00

Routine Laboratory Diagnostic Service Mon – Fri 09:30 - 17:00

Emergency out of hours service (on call) Mon – Fri 17:00 – 09:00

Sat, Sun, Bank Holidays 24 hours




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The following tests are available on call:

Department On-call tests

Biochemistry � Renal profile

� Liver profile

� Cardiac profile

� Bone profile

� Glucose

� Amylase

� Magnesium

� Calcium

� Albumin

� CRP

� Paracetamol

� Salicylate

� Lithium1

� Digoxin2

Haematology � FBC

� PT/APTT

� D-Dimers

� Monospot

� ESR 3

� Malaria

screen1

� Malaria blood

film4

� WBC differential4

� Fibrinogen4

Blood

Transfusion

See Blood Transfusion User Manual CM-HV-0001

Microbiology � CSF

� Blood cultures

� Urine culture and microscopy1

� Fluid culture and microscopy2

1 Telephone requests only

2 Consultant approval required

3 Temporal arteritis only

4 Haematology team authorisation necessary (contact SVUH switch 269 4533)

For advice on any test not included in these lists, please contact the medical scientist on-call.

Blood gases can be analysed on either of the blood gas instruments located in ICU and A&E.

Lactate and Carboxyhaemoglobin are available on both of these instruments.




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6. LABORATORY SUPPLIES

6.1 Hospital

Order from Special instructions

Request forms Hospital Stores department

Blood tubes Hospital Stores department

BD red cap serum tubes As required from Laboratory

Specimen Reception

Required for Insulin

Growth Factor,

Theophylline

Greiner white cap serum

tubes

As required from Laboratory

Specimen Reception

Required for Coper, Zinc

24 hour urine container

(plain)

Laboratory Specimen Reception

24 hours urine container

(acid)

Laboratory Specimen Reception Supplied with 20 ml

Hydrochloric Acid.

Container marked with

hazard warning signs

Sterile MSU containers Hospital Stores department

Sterile transport swabs Hospital Stores department

CSF universal containers

tubes

Microbiology laboratory

Virology swabs Hospital Stores department

Sterile transport swabs Hospital Stores department

Histology formalin pots Histology laboratory/Specimen

reception




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6.2 General Practitioners

Requests for supplies should be sent to the laboratory via email on the laboratory requisition

form (available on request from the laboratory). Please email completed requisition forms to

[email protected] before 11am Friday.

Orders are filled on Monday mornings and will be sent to the requesting practice with the

courier service.

GPs/Nursing Homes that are not served by the courier service must indicate on the request

form when they will collect the requested supplies.




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7. THE REQUEST FORM

7.1 Completing the request form (Hospital requests)

The appropriate request form must be used. The following request forms are in use:

Department(s) Request form colour Document Number

Biochemistry/Haematology Lilac LF-GEN-0027

Histology White/blue LF-HIST-0033

Microbiology Yellow LF-MICRO-0057

The following information should be documented in a legible manner on all sheets of the

request form

� Patient’s Hospital Number (where Hospital number is not available, patient

address and date of birth must be provided)*

� Patient’s full name (initials are not acceptable)*

� Patient’s date of birth*

� Patient’s gender

� Patient location (ward)

� Patient consultant

� Date and time of sample collection

� Sample type

� Specimen anatomical site (for Microbiology and Histology)

� Name and bleep number of the requesting clinician

� Name and bleep number of the person taking the sample

� Relevant clinical information appropriate to the test(s) requested

� Examination(s) required

* minimum requirements for acceptance of samples. Request forms not meeting minimum

requirements will be rejected (see section 9 for Laboratory policies on sample rejection).

Please note the following:

a) Clinical details and relevant treatment information are extremely useful to the

laboratory in interpreting results.




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b) The use of patient addressograph labels on request forms is recommended.

c) Please remember that inadequately completed request forms can cause delays in

issuing reports and in contacting clinicians in the case of urgent or unexpected

results.

7.2 Completing the request form (GP patients)

The appropriate request form must be used. The following request forms are in use:

Department(s) Request form colour Document Number

SCH laboratory form Multicoloured LF-GEN-0026

Referral tests for SVUH request form*

White/blue LF-GEN-0051

* Form and samples to be sent directly to SVUH laboratory. Please request only the tests

listed on the form

The following information should be documented in a legible manner on all sheets of the

request form

� Patient’s full name (initials are not acceptable)*

� Patient’s date of birth*

� Patient’s full address (not townland)*

� Patient’s gender

� Requesting GP

� GP Practice address

� Date and time of sample collection

� Sample type

� Specimen anatomical site (for Microbiology and Histology)

� Relevant clinical information appropriate to the test(s) requested

� Examination(s) required

* minimum requirements for acceptance of samples. Request forms not meeting minimum

requirements may be rejected (see section 9 for Laboratory policies on sample rejection).

Please note the following:




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a) Clinical details and relevant treatment information are extremely useful to the

laboratory in interpreting results.

b) Patient address is required for transmission of results to Healthlink

c) The use of patient addressograph labels on request forms is recommended.

d) Please remember that inadequately completed request forms can cause delays in

issuing reports and in contacting clinicians in the case of urgent or unexpected

results.

8. SPECIMEN LABELLING

8.1 Hospital samples

The following information must be written on the sample:

� Hospital number* or date of birth (please note that it is preferable to give the hospital

number)

� Full name*

� Date and time of specimen collection (for 24 hour collections include the date and

time commenced and the date and time finished)

� Specimen site (for Microbiology and Histology) samples

� Signature of the person collecting the sample.

* minimum requirements for acceptance of samples.

These criteria for sample acceptance are essential for patient safety. They are in place to

decrease the risk of potential harm caused by labeling errors. Samples not meeting

minimum requirements may be rejected (see section 9 for Laboratory policies on sample

rejection).

Specimen containers that are externally contaminated with body fluids should not be sent to

the laboratory.




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8.2 GP samples

The following information must be written on the sample:

� Full name *

� Date of birth *

� Date and time of specimen collection (for 24 hour collections include the date and

time commenced and the date and time finished)

� Specimen site (for Microbiology and Histology) samples

� Signature of the person collecting the sample.

* minimum requirements for acceptance of samples.

These criteria for sample acceptance are essential for patient safety. They are in place to

decrease the risk of potential harm caused by labeling errors. Samples not meeting

minimum requirements may be rejected (see section 9 for Laboratory policies on sample

rejection).

Specimen containers that are externally contaminated with body fluids should not be sent to

the laboratory.

9. SPECIMEN REJECTION

The laboratory reserves the right to reject specimens that are improperly labeled or are

accompanied by forms that are incompletely filled. Consistent practices for specimen

rejection are employed across the laboratory.

The following constitute improper labeling:

a) Minimum labeling requirements for request form and sample are not met (as defined

in sections 7 and 8 of this document);

b) Discrepancies between details on the sample and request form;

c) Use of correction fluid on sample or request form;

d) Alterations to sample labeling that are not initialed by the person taking the sample;

e) Patient details written on the sample by more than one person.




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The laboratory recognises that, in certain cases where the specimen is less common, involves an

invasive procedure, or could not otherwise be easily recollected, it may be acceptable to apply an

exception of specimen rejection. Exceptions are applied using strict and explicit criteria in

accordance with established procedures. The person who collected the specimen will be required to

come to the laboratory to identify the specimen and sign a waiver assuming responsibility for the

identification of the specimen.

Reports relating to such samples will carry a disclaimer.

If insufficient specimen is received for all tests requested and the specimen is easily re-

collectable (e.g. urine, stool, sputum, blood), a repeat collection will be requested. Test(s)

for which there is sufficient specimen will be performed.

If the specimen is not easily re-collectable (e.g. CSF, fluids), the ordering clinician will be

contacted to establish priority order of tests to be performed.

Specimens that are received and are unsuitable for the test(s) requested (e.g. saliva for

sputum test, urine for blood tests) or if the specimen has been in transit too long for a valid

result, the specimen will be rejected.

10. PHLEBOTOMY SERVICES

10.1 Wards

A service is provided by two phlebotomists on hospital wards Mon-Fri, 08:30 to 12:30 and on

Saturdays 8:00 to 12:00

Please note that on Saturdays only samples which are tested on call will be drawn by the

phlebotomist (see section 5).

10.2 Out patients

A phlebotomy service is available in the Out Patient Department




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This service is available for GPs by appointment, for difficult phlebotomy cases only.

Contact (01) 211 5265 for appointments

11. INSTRUCTIONS FOR PHLEBOTOMY

Please refer to the Phlebotomy Guidelines of the Phlebotomy Association of Ireland

http://www.pairl.ie/guidelines_2010_33.html

Or

to the SCH Phlebotomy procedure Blood Sampling in the Phlebotomy Department (CM-PHL-

0001). The phlebotomy SOP is available in the PPPG folder on the SCH server.




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12. ORDER OF DRAW, SAMPLE VOLUMES FOR BLOOD SAMPLES

The order of draw is important to minimize carry-over of anticoagulant. Note: Blood

cultures must be drawn first to avoid contamination.

Please note, it is preferable that blood tubes, especially those containing preservatives, are

filled to their stated capacity. This avoids the risk of insufficiency or interferences from excess

concentrations of preservative. This is mandatory for some tests (e.g. coagulation), where

an imbalance of preservative due to under-filling or over-filling would invalidate the test.

Order of draw

Colour closure

Spec vol

Tube content Example assays

Mixing instructions (after blood collection)

Special instructions

1

Blue & Purple

10ml Blood cultures Rotate gently to mix

2 Blue

3ml Trisodium citrate

PT, INR, APTT D-Dimers

Invert tube 4 times

FILL TO LINE ON BOTTLE. Under or overfilled tubes cannot be used

3 Yellow

5ml Separation gel, clot activator

General Biochemistry, Endocrinology

Invert tube 5-10 times

4

Green

4ml Lithium Heparin General Biochemistry, Endocrinology

Invert tube 5-10 times

For patients on heparin

5

Lilac

2.5ml EDTA

FBC, ESR Monospot DCT HBA1c

Invert 8-10 times

6

Pink

6ml EDTA Group and hold, Crossmatch

Invert 8-10 times

Handwritten details only, must be signed NO addressograph, NO exceptions Service not available to GP’s

7

Grey

4ml Sodium fluoride Glucose Invert 5-10 times

State time on sample and whether the sample is fasting or random.




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13. GUIDANCE ON NUMBER OF SAMPLES TO TAKE

13.1 Serum samples

Sample

No

Tests performed

in

Tests

1 SCH Renal profile Liver profile Bone profile Lipid profile Cardiac profile Amylase

Calcium CRP Digoxin Paracetamol Salicylate

Iron LDH Lithium Magnesium Uric acid

2 SCH TSH T3 fT4

Ferritin Folate Vit B12

PSA

3 National Virus

Reference

Laboratory

Hepatitis screens VDRL HIV

All viral serology

4 SVUH Tumour markers1

Specific hormone levels

Theophylline Immunoglobulins Electrophoresis

Endocrinology

5 SVUH Immunology Autoantibodies2

Rheumatoid factor Specific antibodies

6 SJH Methotrexate C1 Esterase Inhibitor

TRAB Ceruloplasmin Anti Phospholipid Ab Anti Reticulin Ab

7 Beaumont

Toxicology

Caramazepine Epilim Phenytoin Phenobarbitone

Drug Screen

8 Biomnis Laboratory Specialized antibody tests Specialized tests

Zinc etc

BNP Red Cell Folate

1 Please state the specific marker required, e.g. CEA, Ca199 etc as SVUH will not accept a

request for a “Tumour marker Screen”

2 Please indicate if thyroid, liver or rheumatology antibodies are required

13.2 Other samples

Please refer to the laboratory for advice where more than one test is required.




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14. DISPOSAL OF WASTE MATERIAL USED IN SPECIMEN

COLLECTION

All materials used in specimen collection should be treated as potentially hazardous and

discarded using sharps containers and other appropriately colour coded bags. Please refer

to the current hospital guidelines for Waste Management prepared by the Infection Control

Committee.

15. PATIENT INSTRUCTIONS FOR COLLECTING MID-STREAM URINE

(MSU)

Why do patients need to give a sample of urine (MSU) for testing?

To test for the presence of a urinary tract infection (UTI)

Tips before passing a sample of urine

• Do not empty your bladder for three hours if possible

• Label the container with your surname, first name, date of birth and date and time of

collection of sample

• Wash you hands and then wash your genital area with soap and water

Instructions for collection of a mid-stream urine sample

The objective is to get a sample of urine from the middle of the bladder. Urine is normally

sterile (no bacteria present). If bacteria are found in the sample, it means that the urine may

be infected. A ‘mid-stream’ sample is the best sample as the first part of the urine passed

may be contaminated with urine from the skin.

• Do not open the sterile container until you are ready to take the sample

• Specific instructions for females: Hold open your labia (entrance to the vagina)

apart while urine is passed. If you have a vaginal discharge or period, a tampon

should be inserted prior to collecting the sample.

• Specific instructions for uncircumcised males: retract the foreskin while the urine

is passed.

• Pass some urine into the toilet.




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• Without stopping the flow of urine, catch some urine in the sterile container (fill the

container approximately half full)

• Finish off passing urine into the toilet.

• Close the lid of the sample container tightly. Place the container into the sample bag

and close the bag.

• Wash hands thoroughly with soap and water.

• Check that the request form details the full name and date of birth the person

sampled and add the date and time the sample was taken.

• The sample should be brought to the laboratory within 2 hours.

A report will be sent to the requesting doctor, usually within 2-3 working days.

16. PATIENT INSTRUCTIONS FOR COLLECTING A FAECES/STOOL

SAMPLE

What is the purpose of faeces/stool testing in Microbiology?

To detect if a patient has a bowel infection

Instructions for sample collection

• Label the specimen container with your surname, forename, date of birth.

• Place plenty of toilet paper in a clean potty of in the toilet bowl.

• Make sure there is no trace of disinfectant or bleach present, as this will interfere

with the test.

• Faeces (a bowel movement) should then be passed onto the toilet paper.

• Open the specimen container. Place a sample of the faeces in the specimen

container. There is no need to fill the container. Screw the lid firmly back on the

container.

• Note: If you have severe diarrhea or a watery stool, a potty may be needed to collect

the initial sample.

• Place the container in the plastic bag attached to the form and seal the bag.

• Flush away the remaining paper and faeces.




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• Wash you hands thoroughly with soap and water.

• Check that the request form details the full name and date of birth of the person

providing the sample and add the date and time of the sample collection.

• The sample should be brought promptly to the laboratory for analysis.

A report will be sent to the requesting doctor, usually within 3 working days.

17. PATIENT INSTRUCTIONS FOR COLLECTING A 24-HOUR URINE

COLECTION

Important points

• It is very important that al urine passed in an exact 24 hour period is collected. Loss

of any urine or a collection made for either more or less than 24 hours will invalidate

the tests and might lead to an incorrect diagnosis

• Do not void urine directly into the 24-hour container, but into a suitable clean

detergent-free jug and then pour into the 24-hour container.

• If the container contains acid (used as a preservative) or has a warning label,

then care needs to be exercised when adding urine from the collection vessel.

Hydrochloric acid causes burns and is irritating to eyes, skin and respiratory

system. If it comes in contact with skin, wash the affected area immediately

with plenty of water and seek medical advice. Keep out of reach of children.

Not to be taken internally – would cause severe irritation and damage. The

laboratory provides an information leaflet when containers are provided. This

should be read carefully.

• Ensure that the container is labeled with patient’s full name and date of birth.

Instructions for sample collection

• Empty your bladder at 7am on rising (or at a more convenient time) and throw away

the sample. The collection is started after this sample has been passed. Write the

start time on the specimen container label.

• Collect all urine in the container provided on every occasion that it is passed during

the following 24 hours and store refrigerated if possible.




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• Empty your bladder at 7am on rising the next morning (or at the more convenient time

chosen) and add this sample to the collection.

• Write the finish time on the container label.

• Bring the container to the laboratory on the day of completion.

Incomplete collections

• If a sample is forgotten or lost down the toilet, then all the urine collected to this point

should be thrown away and the collection re-started the following morning.

• If the incomplete sample is an acid collection, the original container should be

returned to the laboratory and a new one requested.

18. PATIENT INFORMATION FOR ORAL GLUCOSE TOLERANCE TEST

Principle

The oral glucose tolerance test involves the taking of two blood samples: one when you

arrive (fasting 8-14 hours) and one 2 hours after a glucose drink.

Instructions

• Fast overnight (8-14 hours). Fasting blood sample will be taken.

• Take the glucose drink provided. After taking the drink, the following should be

observed until the second blood sample has been taken:

o No food

o No drink

o No smoking

o No exercise

• The second blood sample will be taken 2 hours after the glucose drink.




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19. ADDITIONAL REQUESTS / SAMPLE RETENTION

If further additional testing is required after the specimen has been sent to the laboratory,

please contact the relevant department to investigate the feasibility of using the initial

specimen for analysis.

20. URGENT REQUESTS

All Biochemistry and Haematology requests from A&E and ICU are treated as urgent and are

fast-tracked through the laboratory’s system. Once authorized, results are available for

viewing on the Ward Enquiry module of the Laboratory Information System (see section 14

for details on accessing results electronically).

All other urgent requests should be labeled as such AND the relevant laboratory phoned to

advise of the urgency.

Please note that during on-call times all requests should be phoned to the Medical

Scientist on call. See section 5 of this manual for further details.

21. SAMPLE TRANSPORTATION

21.1 Health and safety

It is the policy of the Laboratory to treat all samples as potentially infectious or high risk.

Therefore, we advise that universal precautions are taken in the collection process,

packaging, and delivery of specimens to the Laboratory for analysis.

Specimens should always be placed in the transport bag attached to the request form and

the bag should be sealed. Multiple specimens should be transported in rigid transport

containers and should not be carried by hand or in plastic bags.




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21.2 Sample delivery within the hospital

Samples may be sent to the Laboratory via the Pneumatic Tube System (PTS). The following

samples must never be sent in the PTS:

� Histology specimens

� CSFs

NOTE: The Laboratory is not responsible for the maintenance of the PTS. In the event of

system failure, please use the contact numbers posted on all PTS stations.

The laboratory provides a collection service from all wards areas at the following times:

09:00 – 09:30 and 15:00 – 15:30.

21.3 Sample delivery from outside the hospital

Courier service from Arklow arrives at approximately 13:00hrs to the laboratory.

Courier service from the rest of Wicklow area arrives at approximately 14.00hrs to the

laboratory.

Specimens may be brought directly to the laboratory Specimen Reception by GPs or

patients.

21.3.1 Packaging of diagnostic specimens from GP surgeries

It is the responsibility of all persons sending samples to the laboratory to adhere to national

and international regulations ensuring that specimens sent to the laboratory do not present a

risk to anyone coming in contact with them during transportation or on receipt in the

laboratory. Carriage of goods by road must comply with the European Agreement

Concerning the International Carriage of Dangerous Goods by Road regulations (2007). See

http://www.unece.org/trans/danger/publi/adr/adr2007/07ContentsE.html for details.




Page 25 of 72


Instructions:

1. The packaging must be of good quality, strong enough to withstand the shocks and

loadings normally encountered during carriage.

2. The packaging must consist of at least three components:

a. A leakproof primary receptacle e.g. blood collection tube, MSU container;

b. A secondary sealable package to enclose and protect the primary

container(s), e.g. plastic specimen bag.

3. Outer package: the secondary package is placed in an outer transport container with

suitable cushioning that protects it and its contents from external influences such as

physical damage and water while in transit. This must conform to P650 of ADR 2007.

4. For carriage, the outer packaging must be marked with UN 3373 and ‘Biological

substances, Category B’ marked adjacent to the diamond shaped mark.

BIOLOGICAL SUBSTANCE, CATEGORY B

Provided the correct packaging and labeling has been used, there are no further

requirements for special documentation or specially marked and equipped vehicles or

trained drivers for specimen transportation.

21.3.2 Samples for reporting to SVUH OPD

Requests sent on SVUH request forms where patients have follow-up outpatient

appointments at SVUH should be sent directly to SVUH laboratory.

21.4 Storage of samples prior to transport to the laboratory

Samples should be transported to the Laboratory as soon as possible after collection.

Samples should not be stored in ward areas or in GP practices overnight or over the




Page 26 of 72


weekend. Samples that are not transported in a timely manner to the laboratory may be

rejected if there is any doubt about the sample integrity.

22. REPORTS & ENQUIRIES

22.1 Electronic access to reports

As soon as reports are authorized, they may be viewed within the Ward Enquiry module of

the Laboratory Information System.

Upon authorisation, Biochemistry and Haematology reports for GP patients are released to

Healthlink (for all GPs registered with Healthlink).

Upon printing, Microbiology reports for GP patients are released to Healthlink (for all GPs

registered with Healthlink).

22.2 Instructions for accessing reports electronically

22.2.1 Authorised results from the following departments may be accessed as described below:

a) Biochemistry

b) Haematology

c) Histology

d) Microbiology

22.2.2 To log on to the Laboratory Information System (LIS), click on the Lab Results icon on the

PC desktop. Please contact the laboratory for advice re log on ID and password.

22.2.3 The following patient search screen is displayed after logging on to the Laboratory

Information System:




Page 27 of 72


22.2.4 If the patient Medical Record Number (MRN)/Hospital number is known:

a) Enter the patient hosptial number.

b) Confirm the patient surname by entering the first two letters of the surname

22.2.5 If the patient MRN/Hospital number is not known:

a) Enter ‘U’ in the Hospital number field

b) Enter the patient surname, forename and DOB (if DOB is unknown, enter NK)

c) The system returns patient(s) matching the search criteria entered. NOTE: The

system will perform a partial search based on information entered in the first two

fields – see screenshot below)

d) Select the appropriate patient from the list displayed:




Page 28 of 72


22.2.6 When the required patient details have been selected, the following screen is displayed:

22.2.7 Enter the earliest and latest dates to search as prompted (press <return> to accept the

system defaults of earliest and latest (or refine your search to specified dates as requried)).

The system will display a list of requests (in sample date order). Summary information

displayed includes:

a) the date of the request;

b) the laboratory department

BIO = Biochemistry

HAE = Haematology

HIS = Histology

MIC = Microbiology

c) patient clinician and location;

d) specimen type (for Histology specimens) or investigation (for Biochemstry,

Haematology and Microbiology specimens).

22.2.8 Select the report you wish to view. The system displays a soft copy report.

NOTE: Remember that the report may run over more than one page. Scroll down the page

(+) to view all the data in the report.

22.2.9 Type E or L to view earlier or later requests for the patient.

22.2.10Append S to view reports of the same specimen or investigation type.

22.2.11Apend D to view reports from the same laboratory.

NOTE: Only authorised reports are viewable at ward enquiry




Page 29 of 72


Appearance of Haematology and Biochemstry unauthorised reports:

Softcopy report is displayed with patient demographic details only:

Appearance of Microbiology unauthorised reports:

System message ‘Results are not yet available’.

Appearance of Histology unauthorised reports:

System message: ‘You are not permitted to see this report’.




Page 30 of 72


22.3 Hardcopy reports

22.3.1 Hospital hardcopy reports

To facilitate identification, hospital reports are colour-coded as follows:

Department Report colour

Biochemistry Green

Haematology Pink

Histology Blue

Microbiology Yellow

Hardcopy reports are delivered to ward areas every afternoon Mon-Fri. For all other areas

(OPD etc), reports may be collected from the laboratory.

22.3.2 GP hardcopy reports

For GPs receiving reports electronically via Healthlink, hardcopy reports are not printed for

Biochemistry or Haematology (except by special request). Where these are printed, they are

printed on white paper.

Microbiology reports are printed on yellow paper.

Reports are delivered via the courier service where this is available to a practice. All other

reports are posted to the requesting practice.

Any reports received in error should be returned to the laboratory.

22.4 Phoning of critical results

Abnormal results in defined critical limits will be telephoned to the requesting source. Critical

limits are defined in the department sections of this manual.

Critical results in Microbiology are telephoned to the Consultant Microbiologist and/or the

Infection Control Officer.




Page 31 of 72


Please note that it is laboratory policy to ask that results be repeated back when phoned to

ensure accurate transfer of information.

The following protocol applies when phoning abnormal results:

22.5 Faxing of results

The laboratory follows the HSE policy regarding faxing of patient information. This policy

advises that confidential and personal information should not be transmitted by fax.

However it is acceptable to transmit confidential and personal information by fax in the

following circumstances:

a) Informed consent: all persons identified in the fax message have fully understood the

risks and agreed;

b) No alternative: there are no other means available;

c) Harm: in a medical emergency where a delay would cause harm to a

patient/client/employee, or the potential risk to a patient/client/employee is greater

harm than the risk of disclosure of their personal information.

Ref: ED-IT-0083 (HSE) Electronic communications policy

Abnormal results in category for phoning

In patients

Out patients Mon-Fri 09:00 – 17:00

Out patients After 17:00

Phoned to ward / location of sampling or to the clinical

team

Phoned to Registrar on clinical team

SHO phoned if Registrar unavailable

Phoned to Medical or Surgical Registrar On-Call




Page 32 of 72


Before a fax may be sent, the laboratory must be satisfied that the destination fax is at a

secure location. A report may only be faxed to a destination for which LF-GEN-008

Confirmation of secure fax form has been completed.

Please note that Microbiology reports are never faxed.

22.6 Telephone enquiries

Telephone enquiries for reports should be directed to the laboratory office (211 5005,

2115006).

Due to workflow and staffing restrictions, the laboratory office cannot receive calls for

results enquiries between 13:00 and 15:30.

Please note that electronic reports are available on authorization as described in section

22.1 above.




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23. TURNAROUND TIMES

The Laboratory has set target turnaround times for all tests performed. Turnaround times

are subject to the daily cut-off times.

Turnaround times are determined from the date and time of receipt of the sample in the

laboratory to the date and time of authorization. Turnaround times for Microbiology and

Histology are based on working days (Mon-Fri).

Turnaround times are subject to regular audit.

24. ADVICE

Scientific and medical advice on issues within the laboratory’s range and competence is

available. Key contact staff are listed below. All staff are contactable through the laboratory

office (211 5005 / 211 5006) or through the hospital switch (282 5800).

Postion Name

Director and Consultant Histopathologist Dr Niamh Nolan

Consultant Haematologist Dr Gerard Connaghan

Consultant Microbiologist Dr Susan FitzGerald

Laboratory Manager Victor Shaw

Scientist Head of Biochemistry Maria Walsh

Scientist Head of Haematology & Blood Transfusion Cariosa Power

Scientist Head of Histology Nicole Dowdall

Scientist Head of Microbiology Bronagh O’Leary

Quality & IT Manager Denise O’Toole

Haemovigilance Officer Lubna Alaaraji

Mortuary Mary Henry

PM liaison officer Carol de Wilde




Page 34 of 72


25. USER SATISFACTION & COMPLAINTS

There are a number of channels by which comments and complaints may be identified to the

Laboratory. In all cases, it is department policy to respond in an open, positive and

professional manner to issues raised. Where necessary, adjustment to process may ensue.

The laboratory performs annual surveys of user satisfaction. Reports of the surveys are

returned to all survey participants.

Complaints should be referred to the Laboratory Manager: [email protected]




Page 35 of 72


26. BIOCHEMISTRY

26.1 Biochemistry test repertoire

Set /Test Sample type Assay

frequency

Target turnaround times

A&E Wards GP

Renal profile Sodium Potassium Chloride Urea Creatinine

Liver profile Albumin Total bilirubin Total Protein ALT ALP AST GGT

Cardiac profile AST CK CKMB (if CK > 300)

Bone profile* Albumin Calcium Phosphate ALP

Lipid profile* Cholesterol Trigylcerides

Fasting lipid profile* Cholesterol Triglycerides LDL – cholesterol HDL-cholesterol

Amylase

CKMB

CRP

Digoxin

Iron*

Lithium

Serum (yellow)

Lithium Heparin

(green)

Daily

Daily

Daily

Daily

Daily

Daily

Daily

Daily

Daily

Daily

Daily

Daily

2hrs

2hrs

2hrs

2hrs

2hrs

2hrs

2hrs

2hrs

2hrs

2hrs

2hrs

2hrs

4hrs

4hrs

4hrs

4hrs

4hrs

4hrs

4hrs

4hrs

4hrs

4hrs

4hrs

4hrs

24 hrs

24 hrs

24 hrs

24 hrs

24 hrs

24 hrs

24 hrs

24 hrs

24 hrs

24 hrs

24 hrs

24 hrs




Page 36 of 72


Set /Test Sample type Assay

frequency


A&E Wards GP

LDH*

Magnesium

Paracetamol

Salicylate

Uric Acid*

Serum (yellow)

Daily

Daily

Daily

Daily

Daily

2hrs

2hrs

2hrs

2hrs

2hrs

4hrs

4hrs

4hrs

4hrs

4hrs

24 hrs

24 hrs

24 hrs

24 hrs

24 hrs

Glucose Fluoride oxalate

(grey)

Daily 2hrs

4hrs 24hrs

* denotes tests not analysed out of hours

NOTE: All tests in this category may be performed on one serum sample

26.2 Endocrinology test repertoire

Test Sample type Assay

frequency


A&E Wards GP

TSH 36hrs 36hrs 72hrs

T3 36hrs 36hrs 72hrs

fT4 36hrs 36hrs 72hrs

TPSA 36hrs 36hrs 72hrs

Vitamin B12 36hrs 36hrs 72hrs

Folate 36hrs 36hrs 72hrs

Ferritin

Serum (yellow)

Daily

36hrs 36hrs 72hrs

HbA1c EDTA (lilac) 2.5ml

Daily 36hrs 36hrs 72hrs




Page 37 of 72


26.3 Urine specimens / CSF specimens

Test Sample

type

Assay

frequency


A&E Wards GP

CSF Protein CSF When requested 2hrs 2 hrs NA

CSF Glucose CSF When requested 2hrs 2 hrs NA

Urinary Electrolytes 24 hr/Spot Daily 2hrs 4hrs 24hrs

Urinary Creatinine 24 hr/Spot Daily 2hrs 4hrs 24hrs

Creatinine Clearance 24 hr/Spot Daily 2hrs 4hrs 24hrs

Urinary Protein 24 hr/Spot Daily 2hrs 4hrs 24hrs

26.4 Requests for additional tests / specimen retention

The Biochemistry laboratory retains serum samples for 5 days. Depending on the stability of

the analyte, further analysis may be possible. Please contact the laboratory for advice.

26.5 Telephoning of results in the critical intervals

Analyte Phone < Fax < Fax > Phone

>

Units Conditions

Sodium 120 128 150 155 mmol/L If new

Potassium 2.8 3.0 5.7 5.9 mmol/L If new

Glucose 2.6 3.0 15.0 22.0 mmol/L If new

Urea 28.0 mmol/L If new /significant increase Consider age

Creat 250 umol/L If new /significant increase

Albumin 16 g/L If new

Calcium 1.70* 1.90 2.90 3.00 mmol/L If new/ *with normal albumin levels

Bilirubin Tot. 100 150 µmol/L If new/external patient

Magnesium 0.40 1.70 mmol/L If new




Page 38 of 72


Analyte Phone < Fax < Fax > Phone

>

Units Conditions

Phosphate 0.40 mmol/L If new

ALP 500 IU/L If new/external patient

Amylase 350 IU/L If new

ALT/AST 200 300 IU/L If new/external patient

GGT 500 IU/L If new/external patient

CK 400 500 IU If new/external patient

Iron 35.0 mmol/L If new/external patient

Uric Acid 700 umol/L If new/external patient

Lithium 0.20 0.40 1.20 1.40 mmol/L If new

Digoxin 0.50 0.80 2.60 2.80 nmol/L If new/external patient

Paracetamol/

Salicylate

Phone all TOXIC results

NT ALL ‘not tested’ Biochemistry and Sendaway samples

CSF All CSF results are phoned

26.6 Point of care testing

GEM 4000: Arterial Blood Gas Analyser is available in A&E and ICU. The blood gas

analysers are maintained and quality controlled by Biochemistry laboratory staff.

The parameters available are:

Measured: pH, pCO2, pO2, Na+, K+, Cl-, Ca++, Hct, Glu, Lactate

Derived: TCO2, BEecf, tHb(c), BE(B), Ca++(7.4), AG, sO2(c), HCO3-(c), HCO3-std.




Page 39 of 72


27. HAEMATOLOGY

27.1 Haematology test repertoire

Test Sample

type

Special requirements Target turnaround time

A&E Wards GP

Full Blood Count

1 hr 2 hrs 24 hrs

Differential White

Cell Count

Processed routinely as

part of FBC during

routine hours only. Not

possible on samples

>24 hours old.

1 hr 3 hrs 24 hrs

Peripheral Blood

Film

Processed only on

abnormal FBC results

or relevant clinical

details.

2 hrs 3 hrs 24 hrs

Reticulocyte Count Samples must be

tested within 24 hours.

1 hr 2 hrs 24 hrs

ESR 6 hrs 6 hrs 24 hrs

Infectious

Mononucleosis

screen

1 hr 24hrs 24 hrs

Malaria screen

EDTA (lilac)

Relevant clinical details

must be supplied

before processing.

6 hrs 6 hrs 48 hrs




Page 40 of 72


27.2 Coagulation test repertoire

Test Sample

type

Special Requirements Turnaround time

A&E Wards GP

PT / INR

1 hr 2 hrs 3 hrs

APTT Sample must be less than 4

hours old

1 hr 2 hrs 3 hrs

D-Dimer Sample must be less than 4

hours old.

1 hr 2 hrs 3 hrs

Fibrinogen

Citrate

(Blue)

Only processed when

requested through

Haematology team. Sent to

SVUH for processing ‘on

call’.

3 hrs 3 hrs n/a




Page 41 of 72



Test Fax Phone Notify to

Haematology

team

WCC <2.0 NA < 1.0 (first time)

WCC >30 >30 (first time) >30 plus

Abnormal

morphology

Neutrophils <1.0 <1.0 (first time) <0.5 (first time)

Blasts Any

Hb <7.0 <7.0 (unexpected)

Platelets <50 <50 (first time) <20 (first time)

INR >4.5 >7.0

APTT NA >100

Fibrinogen NA <1.5 <1.5 (first time)

Malaria Pos Pos Notify Micro

IM Pos

Coag Clotted/Haemolysed/

Insufficient

Clotted/Haemolysed/

Insufficient

Urgent samples

FBC Urgent samples

Clotted/insufficient

Amended reports All amendments




Page 42 of 72


28. HISTOLOGY

28.1 Routine Surgical Pathology

All specimens should be sent in 10% formalin (see 17.4.2 below for exceptions). Proper and

timely fixation is a critical step in tissue preparation.

NOTE: Formalin is a potent eye and nasal irritant and can cause respiratory distress and

allergic dermatitis. Personnel involved in the use of formalin must be aware of this

risk and of the proper procedure for dealing with small or large formalin spills.

Contact the laboratory for further information (Ext 5253).

28.2 Specimens requiring special handling

The laboratory must always be notified at least 24 hours in advance when any of the

specimens below are to be sent.

Skins for direct immunofluorescence:

Wrap specimens in saline-moistened gauze and place in a dry container. Transport

immediately to the Histology Laboratory. These specimens are sent to St Vincent’s

University Hospital for analysis.

Muscle biopsies:

Wrap specimens in saline-moistened gauze and place in a dry container. Transport

immediately to the Histology lab. These specimens are sent to Beaumont Hospital

Neuropathology Laboratory for analysis.

28.3 Cytology

Specimens should be submitted in properly labeled 50ml Universal Containers. Please

ensure the lid of the specimen container is screwed tightly onto the body of the container.

Leaking specimens will not be accepted.

Fluids should be sent to the Laboratory as soon as possible to avoid degeneration. Cytology

specimens taken after 17:00 should be refrigerated overnight.




Page 43 of 72


The following special requirements apply:

Sample type Special requirements

Urine Freshly voided, collected from the first part of the stream, 3 hours

after the first early morning specimen

Bronchial brushings Using a pencil, label the frosted end of a slide with the patient

name and hospital number. Smear the brush on the slide. Spray

fix the slide with cyto-spray immediately. Place the slide in a

protective slide mailer. Cut the tip of the brush off and place in a

sterile 50ml Universal Container filled with saline.

(Cyto-fix and slide mailers are supplied by the laboratory)

Fine needle aspirates Contact the laboratory for assistance (5253)

Post vasectomy

semen samples

These specimens are processed by appointment only. Contact

the laboratory 5253.

28.4 Target turnaround times

The turnaround times for Histology vary according to the type of specimen, the optimum

fixation required, and the complexity of the case.

The following are target turnaround times and are subject to the factors outlined above:

Specimen type Target turnaround time

Biopsies (e.g. GI biopsies, skin punches) 4 working days

Small surgical resection specimens (e.g.

appendix, gall bladder, skin lesions)

4 working days

Large surgical resections (e.g. bowel

resections)

4 working days

Cytology specimens 4 working days

28.5 Telephoning of reports

Request forms marked as urgent should include the name and contact phone number of the

clinician to whom the report should be phoned.




Page 44 of 72


28.6 Conferences

Clinical Pathological Conferences are held with the medical and surgical teams. The

pathology medical staff are available to assist in presenting clinical cases. Contact Dr. Nolan

(Ext. 5100) or the Registrar (Ext. 5198).

28.7 Autopsies

Autopsies are carried out on house (request) cases and coroner cases Monday to Friday.

Saturday autopsies are performed if required on Bank Holiday weekends. Tissues from

these examinations are processed and slides prepared in the histopathology laboratory.

Tissue samples for culture are sent to the microbiology department. In all coroner cases

toxicology samples are referred to Beaumont Hospital.

Death certificates are issued by the clinical team in the case of a house case. The coroner

issues the death certificate in a coroner’s case.

Reports are issued to the requesting source i.e. the relevant coroner or clinical team. Copies

of the Post Mortem report may be obtained via the clinical team (in the case of house Post

Mortem)

GPs may obtain a copy of a coroner’s post mortem following finalization of the cause.

A separate Post Mortem information folder is available on every ward and contains details

regarding the organisation of an autopsy, relevant forms and an information leaflet for

relatives.

The hospital Post Mortem Liaison Officer, Carol de WIlde, is available to provide information

and support to the families concerning all aspects of the post mortem. Mary can be

contacted at 2115179.




Page 45 of 72


29. MICROBIOLOGY

29.1 General guidelines for Microbiology samples

Microbiology results depend critically on the type and quality of the material received.

Therefore this material should be both representative and fresh. All container lids should be

securely tightened prior to transportation to ensure safe arrival in the laboratory.

The specimen itself must be labelled with sufficient information to allow correct processing

without reference to the request form, i.e. specimen type and anatomical site if appropriate.

The request form should also include all relevant clinical details.

Should there be any delay in the transport of any sample to the Microbiology Laboratory, the

following storage is required:

Sample type Storage conditions

Mycology

Blood cultures

Wound swabs (for recovery of anaerobes)

Pus (for recovery of anaerobes)

Room temperature

Urine

Faeces

Swabs

Sputa

Fluids

Refrigerate at 4°C




Page 46 of 72


29.2 Microbiology Turnaround Times

Turnaround times are based on routine specimens. They are approximate and apply to

working days only (i.e. Mon-Fri: no routine work is performed at weekends or public

holidays). Further times may also be required for culture of resistant or unusual organisms.

In some cases, additional testing and/or referral to other laboratories may be required. This

will also extend turnaround times.

SPECIMEN TYPE TURNAROUND TIME

BAL, bronchial aspirates/brushings 2-4 days

Blood cultures Culture negative Culture positive

1-5 days (21 days for SBE) 5 days Phoned on day of detection

CSF Microscopy C&S

1 hour 2-4 days

Faeces 2-4 days

Fluid culture 2-4 days

Fungal culture Microscopy Negative culture Positive culture

7 days 14 days 21-28 days

Intravascular cannulae 2-3 days

Joint aspirate 2-4 days

MRSA screen 1-2 days

Nasopharyngeal aspirate 2-4 days

Sinus secretions 2-4 days

Sputum 2-4 days

Swabs – mouth, nasal, throat 1-2 days

Swabs - other 2-4 days

Tissue C&S 1-5 days

Urine 1-3 days




Page 47 of 72


29.3 Microbiology test repertoire

The following pages contain guidance on the taking and submission of samples for the most

frequently requested bacteriological investigations. In addition, advice is always available

from medical and/or scientific staff of the department, both regarding tests described and

others which may occasionally be required.

29.3.1 Urine tract infection

Test Sample type Sample

volume

Special Note

Urine microcopy

culture and

sensitivity

� MSU

� CSU

� Suprapubic

aspirate

� EMU

� Bag urine

� Pad urine

� Clean catch

urine

� Ileal conduit

� Cystoscopy

urine

� Nephrostomy

urine

� Ureteric urine

At least

1mL

� The patient should be instructed to cleanse the genitalia

before micturition for a mid-stream urine

� For processing of urgent urine specimens outside routine

hours (Mon-Fri 17:00-09:00, Sat, Sun, Bank Holidays),

please contact the medical scientist on call (via switch)

� Store at 2-8°C if processing delayed > 4 hours




Page 48 of 72


29.3.2 ENT infection


volume

Special Note

� Mouth swab

� Eye swab

� Nasal swab

� Throat swab

Transport

swab

ENT

culture and

sensitivity

� Ear swab

� A nasal swab is not useful for the investigation of sinusitis

� Antral lavage or pus from sinus should be sent if acute

maxillary sinusitis is suspected

� Nasal swabs are useful for the investigation of carriage for

Staphylococcus aureus and MRSA

� Store at 2-8°C if processing delayed > 4 hours

29.3.3 Respiratory tract infection


volume

Special Note

� Sputum

1ml � Salivary samples accepted only from ICU

� Store at 2-8°C if processing is delayed > 4 hours.

� Refrigeration may affect viability of some pathogens and allow

overgrowth of colonising bacteria.

Sputum

culture

and

sensitivity

� Broncho-

alveolar lavage

� Bronchial

aspirate

� Bronchial

brushes

� Sinus

secretions

� Nasopharyngeal

aspirate

Total

sample

� Purulent or mucopurulent samples should be collected before

anti-microbial therapy

� Ideally specimens should be processed within 30 mins of

sampling. Delays of >4 hours will compromise the recovery of

anaerobes




Page 49 of 72


29.3.4 Gastrointestinal infection

Test Sample type Sample volume Special Note

Faeces

culture and

sensitivity

� Faeces

� Faecal fluid

� 1-2 g

� 1-2 mL

� Store at 2-8°C if processing is delayed >4 hours

Clostridium

difficile

toxin

detection

� Faeces � Representative

sample <1ml

� Non diarrhoeal stools are unsuitable for C. difficile

toxin test

� Store at 4°C immediately: specimens >96 hours old are

unsuitable for C.difficile toxin test

� The assay is not a test of cure: if a patient has had a

positive C.difficile test in the last 4 weeks, the specimen

will not be processed.

� Negative specimens will not be re-tested for 7 days

29.3.5 Genital infections


volume

Special Note

Genital

tract

culture and

sensitivity

� High vaginal

swab (HVS)

� Low vaginal

swab

� Endocervical

swab

� Cervical swab

� Vaginal swab

� Penile swab

� Urethral swab

� Intrauterine

contraceptive

device (IUCD)

� Fluids and pus

� Tissue and

biopsies

� STI service unavailable due to the poor viability of N.

gonnorhoeae and T. vaginalis.

� HVS is suitable for candida and trichomonas detection

� For the investigation of PID, please send a cervical swab

� Non-STI specimens: store at 2-8°C if processing is

delayed > 4hours




Page 50 of 72


29.3.6 Pus & Wound specimens

Test Sample

type

Sample

volume

Special Note

Wound

swabs

culture &

sensitivity

Wound

swabs

Transport

swab

� Wound samples are screened for all likely bacterial pathogens.

Significant isolates are reported, with susceptibility results if

appropriate. The inclusion of relevant clinical information on the

request form assists in deciding the relevance of some bacteria

isolated.

� Ideally all specimens should be processed within 30 min of


anaerobes.

Pus

culture &

sensitivity

Pus > 1 ml pus � Pus samples are screened for all likely bacterial pathogens.

Significant isolates are reported, with susceptibility results if

appropriate. The inclusion of relevant clinical information on the

request form assists in deciding the relevance of some bacterial

isolated.

� Ideally all specimens should be processed within 30 min of


anaerobes.

Fluids

culture &

sensitivity

(Non-

sterile

sites)

Fluids –

wound/

abscess/

drain

At least 1ml � Ideally all specimens should be processed within 30 min of


anaerobes.




Page 51 of 72


29.3.7 Fluids/aspirates from sites normally sterile


volume

Special Note

Fluid

culture &

sensitivity

� Pleural fluid

� Ascitic fluid

� Joint aspirate

At least 1

ml

� Ideally all specimens should be processed within 30 min

of sampling. Delays of >4 hours will compromise the

recovery of anaerobes

29.3.8 MRSA screens, VRE screens, environmental screens


volume

Special Note

MRSA

screen

culture

Nasal & groin swabs

CSU (previously

positive patients)

Sputum (previously

positive patients)

� Store at 2-8°C if processing is delayed > 4 hours

� Samples received by 10am Mon-Fri are tested that

day

VRE

screen

culture &

sensitivity

� Faeces

� Rectal swab

1-2 g

faeces

� Store at 2-8°C if processing is delayed > 4 hours

29.3.9 Blood culture


volume

Special Note

Blood

culture

� Aerobic blood

culture bottle

� Anaerobic blood

culture bottle

5-10 ml

blood

� Optimal time of specimen collection

- Before antimicrobial therapy where possible.

- As soon as possible after a spike of fever, except in

endocarditis where timing is less important.

� Store at room temperature if specimen transportation to

the laboratory is delayed




Page 52 of 72


29.3.10 CSF


volume

Special Note

CSF

culture &

sensitivity

CSF 1-2 ml in 3

sterile

universal

containers,

sequentially

marked

1,2,3

� Transport immediately to the laboratory. PTS should

not be used. Specimens should be processed within 10

mins and not longer than 2 hours of sampling.

29.3.11 Tissue specimens


volume

Special Note

Tissue

culture &

sensitivity

Tissue (fresh) Representative

sample

� Ideally all specimens should be processed within 30

min of sampling. Delays of >4 hours will compromise

the recovery of anaerobes

29.3.12 Intravascular cannulae


volume

Special Note

Culture &

sensitivity

Cannulae/Lines/Tips 4 cm of the

tip into a

sterile

container

Store at 2-8°C if processing is delayed > 4hours




Page 53 of 72


29.3.13 Fungal culture


volume

Special Note

Culture � Nail clippings

� Skin scrapings

� Minimum 7

pieces of

nail

� As many

skin flakes

as possible

Store at room temperature until processing

29.4 Requests for additional tests / specimen retention

Additional tests will be performed where possible, where specimen volume and specimen

quality allow. Specimen quality deteriorates over time, especially where specimens are stored

at room temperature.

After processing, Microbiology specimens are retained in the laboratory as follows:

Specimen Type Retention Time Storage Conditions

Urines Overnight 2-8°C

CSF specimens 1 month 2-8°C

Fungal specimens 1 month Room temperature

All other specimens – swabs, , sputa

& respiratory specimens, faeces,

tissue, fluids other than CSF,

One week Room temperature


Notifiable isolates, results with Infection Control implications and other results requiring

immediate clinical attention are telephoned to the consultant microbiologist and/or Infection

Control officer.




Page 54 of 72


30. REFERRAL LABORATORIES

Tests that are not performed in the SCH laboratory are referred to other competent

laboratories as appropriate. SCH has service level agreements with these laboratories and

ensures that the referral laboratories are accredited and/or participate in external quality

assurance programmes.

The laboratory operates a tracking system for all tests referred out. When reports are

returned from the referral laboratory, SCH records that the report has been returned, records

the referral laboratory specimen number, and dispatches the original report to the requester.

Please note that results are not retained in SCH laboratory. Please also note that

results from the National Virus Reference Laboratory (NVRL) are returned directly to

requesting GPs.

Histology reports are incorporated into the original or supplementary St Columcille’s hospital

reports and the originals filed in the Consultant Pathologists office.

30.1 Referred tests

Test Specimen Referral laboratory Special instructions

Acethyl Choline-Receptor Ab

Serum Biomnis Separate & freeze within 1 hr.

ACTH EDTA SVUH Nuclear Medicine Separate & freeze immediately

Adenocorticophic Hormone

EDTA Biomnis Separate & freeze immediately

Adenovirus serology Serum NVRL

Adenovirus culture Faeces Other fluids

NVRL

Adrenal Ab Serum Biomnis

Adrenaline

24 hr Urine Biomnis 20 mls acid added before collection. Check acidity before sending out

AFB See TB culture / AFB stain

Albumin Excretion Rate Urine SVUH Metabolism

Alcohol

Glucose Beaumont TDM

Specimen must be filled to full capacity

Aldolase Serum Biomnis

Aldosterone Serum SVUH Endocrinology




Page 55 of 72



Aldosterone/Renin Ratio Serum x 1 EDTA x 2

SVUH Endocrinology Separate & freeze EDTA specimen

Allergy testing (RAST) Serum SJH Immunology Allergen specific IgE should be requested to a limited number of allergens guided by the history. Requests for ‘Allergy testing’ or ‘RAST’ will not be accepted. Please refer to the SJH Immunoloy GP information page for advice (follow the link below) http://www.stjames.ie/Departments/DepartmentsA-Z/I/Immunology/GPInformation Please follow the link below for a list of tests carried out in SJH Immunology http://search.stjames.ie/sjhservlet/Search.jsp?nlt=&dp=Immunology&Search=Search

Alpha 1 Antitrypsin Serum SVUH Immunology

Alpha 1 Antitrypsin phenotype

Serum Beaumont

Alpha feto protein Serum SVUH Nuclear Medicine

ALP Isoenzymes Serum Biomnis

Alpha Lipoprotein A1 Serum Biomnis

Alpha Lipoprotein B Serum Biomnis

Amikacin (Antibiotic) Serum Microbiology AMNCH Tallaght

Notify laboratory before 15:30 Mon-Fri. If testing required at weekend/ Bhol samples must arrive in Tallaght before 11am. Provide cotact numbers for results to be phone back to SCH; Microbiologist during routine hours, On-Call Scientist during On Call hrs.

Amiodarone Serum EDTA

Biomnis Separate & freeze <1hour

Ammonia EDTA (Patient x 1 & Healthy person x 1)

Temple St Biochemistry

Must pre-arrange with lab. Put on ice immediately after taking, separate and freeze within 30 mins

Androsteindione Serum SVUH Endocrinology

Angiotensin (ACE) Converting Enzyme

Serum SVUH Biochemistry

Anti B2 glycoprotein1 IgM antibody

Serum Biomnis

Antibiotics are now listed alphabetically

Anticardiolipin Ab Serum SVUH




Page 56 of 72



Anti Centromere Ab Serum SVUH Immunology

Anti Diuretic Hormone (ADH)

EDTA x 2 or Li Heparin

Biomnis Separate & freeze < 4 hrs

Anti DNA Serum SVUH Immunology

Anti ds-DNA Titre Serum SVUH Immunology

Anti GAD Ab (Glutamic Acid Decarboxylase)

Serum Biomnis Separate & freeze < 4 hrs

Anti GM 1&2 Ab (IgM Ab to GM 1&2 Ganglioside for Guillian Barre)

Serum CSF

Biomnis Package CSF in separate tertiary container with its own Biomnis transportation slip. Record S number and tests requested on slip

Anti Gliadin Ab (Endomysial Ab)

Serum Biomnis

Anti Glomerular Basement Membrane Ab

Serum SVUH Immunology

Anti Intestinal Peptide Serum Biomnis

Anti Insulin Ab

Serum or EDTA

Biomnis Separate & freeze <1 hr

Anti Islet Cell Ab Serum Biomnis

Anti Liver/Kidney Ab Serum SVUH Immunology

Anti-LKM Ab Serum SVUH Immunology

Anti-Mag (Myelin associated glycoprotein)

Serum Biomnis

Anti Mitochondrial Ab (Anti M2)

Serum Biomnis

Anti Mullerian Hormone Serum / EDTA

Biomnis Separate and freeze < 4 hours

Anti Myeloperoxidase Antibodies

Serum Biomnis

Anti MuSK Serum Biomnis

Anti Neuronal Ab (Hu, Yo, Ri, Ma, Tr)

Serum Biomnis Markers for paraneoplastic neurological syndromes

Anti Neutrophil Ab

Serum Bristol Haematology team request only. Special form to be completed

Anti Neutrophil Cytoplasmic Ab

Serum SVUH Immunology Samples are screened by indirect immunofluorescence for ANCA. If positive anti-PR3 and anti-MPO tests follow

Anti Ovary Ab Serum Biomnis

Anti Parietal Cell Ab Serum SVUH Immunology

Anti Phospholipid Ab Serum SJH Immunology Red top tube

Anti Proteinase 3 Antibodies

Serum Biomnis

Anti Platelet Ab Serum IBTS Not appropriate for suspected ITP

Anti Reticulin Ab Serum SJH Immunology

Anti Ribonuclear Protein see ENA

Anti Ribosomal Ab Serum Biomnis

Anti-SCL-70Ab




Page 57 of 72



See ENA screen

Anti Soluble Liver Ag Ab Serum Biomnis

Anti Streptolysin O titre (ASOT)

Serum Biomnis

Anti Striated Muscle Ab Serum Biomnis

Anti Thyroglobulin Ab Serum Biomnis

Anti TSH Ab Serum Biomnis

Anti Nuclear Ab Serum SVUH Immunology

Anti Smooth Muscle Ab Serum SVUH Immunology

Anti Voltage gated K Channel Ab

Serum Biomnis

Anti-Xa Citrate x 3 SVUH Coagulation Must state time of Clexane/inohep Must state time of sample Must be sent within 30 min of sampling.

Aripiprazole Serum Biomnis Separate and freeze within 4 hours

Arsenic Serum Beaumont TDM

ASOT

Serum Biomnis

Aspergillus Serum Biomnis

Atypical pneumonia antigen

Urine Biomnis

Atypical pneumonia serology

Serum NVRL

Autoantibodies Serum SVUH Immunology

Bartonella Serum/ EDTA

Biomnis

B2 Microglobulin Serum SVUH Biochemistry

Bence Jones Protein

Spot Urine SVUH Biochemistry Urine should be fresh & free from blood contamination

Benzodiazepine Serum Beaumont Toxicology

Beta 2 GP1 Serum SJH

BCR-ABL EDTA x2 OLHSC Genetics CMD lab SJH

One sample to each laboratory, samples must be <24 hours old

BHCG Serum SVUH Immunology

Bicarbonate see CO2

Bile Acids Serum Biomnis

Bilirubin Direct Serum SVUH Biochemistry Protect from light. Total Bilirubin must be > 21 µmol/L

Biperidine Serum Biomnis

Bone Marrow Aspirate

Bone Marrow SVUH Haematology By appointment only

Bordetella pertussis culture / PCR

1. Nasopharyngeal aspirate

2. Perinasal swab

3. Sputum 4. Nasal swab

OLHSC Should reach OLHSC asap. Must be refrigerated overnight if delay. GP should sent direct to OLHSC




Page 58 of 72



Bordetella pertussis serology

Serum Biomnis

Borrelia burgdorferi (Lyme Disease)

Serum CSF

NVRL Package CSF in separate tertiary container with its own Biomnis transportation slip. Record S number and tests requested on slip

Brain Nat.Peptide EDTA Biomnis Separate & freeze < 4 hr

Brucella - brucellosis Serum Biomnis

Bullous Periphgoid Ab Serum SJH

C1 Esterase Inhibitor Serum SJH Biochemistry

CA125 - Ovarian Serum SVUH Nuclear Medicine

CA153 - Breast Serum SVUH Nuclear Medicine.

CA199 - Pancreatic Serum SVUH Nuclear Medicine

CA50 Carbohydrate Ag Serum Biomnis

Cadmium Li Heparin Biomnis

Calcitonin Serum Biomnis Separate & freeze < 4 hr

Cannabis Serum Urine

Beaumont Toxicology

Carbamazepine (Tegretol)

Serum Beaumont TDM

Carotene

Serum Biomnis Separate & freeze < 1 hr Protect from light

Catecholamines

24 hr Urine Plasma LiH

Biomnis 20 mls acid added to Urine Container before collection. Check acidity before sending out

CEA

Serum SVUH Nuclear Medicine.

Ceruloplasmin Serum SJH Immunology

Chicken pox See Varicella zoster

Chlamydia PCR Urine, swab NVRL Special collection devices required – available from NVRL

Chlamydia Psittaci IgG/IgM

Serum Biomnis

Chlamydia serology

Serum NVRL

Cholinesterase - serum Serum Li Heparin

Biomnis

Cholinesterase - erythrocyte

EDTA Biomnis

Chlorpromazine

Serum Biomnis Separate and freeze within 4 hours

Chromium Li Heparin Biomnis

Chromoganin A Whole blood/ no gel tubes

Separate and freeze within 4 hours. Haemolysed samples unsuitable.

Chromosome testing Li Heparin Genetics Dept, Trinity or OLHSC, Crumlin

Do not spin

CJD See Prion disease

CK isoenzymes Serum Biomnis

CLO See Helicobacter pylori

Clopixol (Zuclopenthixol) Serum Biomnis Separate and freeze within 4 hours




Page 59 of 72



Clozapine Serum Plasma

Biomnis Separate and freeze within 4 hours

CO2/Bicarb Serum or Li Heparin

Biomnis

Cobalt Li Heparin Biomnis

Complement C3 & C4 EDTA SVUH Biochemistry Send same day

Complement function assay

EDTA SJH Haematology Send same day

Copper

Serum (White Cap)

Biomnis Do NOT use gel tubes

Cortisol Serum SVUH Nuclear Medicine

Cotinine Spot Urine Biomnis

Coxsackie virus culture Throat swab CSF Faeces


Coxsackie virus serology

Serum Biomnis

C-Peptide Serum or Li Heparin

Biomnis Separate & freeze < 4 hr

Cryglobulin Serum SVUH Immunology Keep specimen @ RT

Cryptococcus antigen CSF SVUH Package CSF in separate tertiary container with its own Biomnis transportation slip. Record S number and tests requested on slip

Cryptosporidium Faeces COH

Cyclic Citrullinated Peptide

Serum SJH Biochemistry

Cyclosporine EDTA SVUH Immunology Keep specimen @ RT

Cystic Fibrosis Genetic Studies

EDTA x 2 OLHSC Genetics Lab May be stored overnight @ 4ºC

Cytogenetics/karyotype Lithium heparin

OLHSC Crumlin Do not spin and do not refrigerate Not processed for GPs

Cytomegalovirus (CMV) serology

Serum NVRL

Dengue fever serology Serum NVRL

11 Deoxycortisol Serum SVUH Endocrinology

Dexamethasone Serum Biomnis

Dexamethasone Suppression Test

Serum SVUH SEE Cortisol

DHEA Serum SVUH Endocrinology

Diazepam (Valium) Serum Biomnis Separate & freeze < 4 hr

Drug Screen: Blood Serum Beaumont Toxicology

Drug Screen: Urine Spot Urine Beaumont Toxicology

Epstein Barr virus (EBV) serology

Serum VRL

Echinococcus - cysts Faeces Other fluids

COH

Echinococcus serology Serum Biomnis Store at 4°C




Page 60 of 72



Echo virus culture CSF Faeces


eGFR LiHeparin with gel seperator

SVUH Biochemistry If no gel separator, separate and state spec type on tube

Faecal Elastase Faeces Biomnis

Electron microscopy Faeces Tissue

NVRL

ENA Serum SVUH Immunology

ENA Screen Serum SVUH Immunology

Enterovirus RNA see PCRH

Epanutin (Phenytoin) Serum Beaumont TDM

Epidermal growth factor receptor2 (Human)

Serum Biomnis Separate & freeze < 4 hr

Epilim (Valproate) Serum Beaumont TDM

Erythropoietin Serum SJH Haematology

Ethosuximide Serum Biomnis

Factor assay Sodium citrate (coag) x 4

SVUH Requested through Haematology team only. Send immediately in a.m.

Factor V Leiden Genotype

EDTA x 1 Sodium citrate (coag) x 2

SVUH Performed only when APCR screen indicates. Relevant clinical history. Must be received in SVUH in morning. GP samples only sent of taken by appointment with Phlebotomy SCH before 10am

Fibrinogen (outside routine hours)

Sodium citrate x 1

SVUH Routine hours processed in house. On call, sent to SVUH only when requested by haematology team.

FK506/Prograf EDTA Whole blood

SVUH Immunology Can be stored in fridge overnight

Flecainide Serum Biomnis Separate & freeze < 4 hr

Flow cytometry BM & EDTA SVUH Prior notification necessary. Send immediately

Free PSA Serum SVUH Nuclear Medicine

Fructosamine Serum EDTA

Biomnis

FSH Serum SVUH Endocrinology

Gabapentin Serum Biomnis Separate & freeze < 4 hr

Ganglioside Abs Serum Biomnis

Gastrin

Serum SVH NUC.MED.

BD SSTII Advance tube. Separate within 1 hour and send immediately




Page 61 of 72



Gentamicin (antibiotic) Serum SVUH Microbiology Notify laboratory before 15:00 Friday if testing required at weekend. Weekend samples must arrive in SVUH before 11am

Gonorrhoea PCR Urine Swab

NVRL Special collection devices required – available from NVRL

Growth Hormone Serum

SVUH Nuclear Medicine

H1N1 see influenza H1N1

Haemachromatosis EDTA SVUH Biochemistry

Haptoglobins Serum SVUH

HBE, see HE1

Hb electrophoresis Thalassaemia

EDTA x 2 Serum x 1

SJH Must include recent FBC (MCH) result with request

HCG Serum SVUH Nuclear Medicine

Helicobacter pylori antigen

Test no longer available via SCH laboratory – see memo from consultant microbiologist 27/05/09

Hepatitis A Serum NVRL

Hepatitis B Serum NVRL

Hepatitis B Titre Serum NVRL

Hepatitis C Serum NVRL

Hepatitis C PCR Serum NVRL Separate and freeze within 6 hrs. Transport frozen

Herpes simplex virus (HSV) culture

CSF Swab Tissue


Herpes simplex virus (HSV) PCR

CSF

NVRL Separate and freeze within 6 hrs. Transport frozen Package CSF in separate tertiary container with its own Biomnis transportation slip. Record S number and tests requested on slip

Herpes simplex virus (HSV) serology

Serum NVRL

HIV Serum NVRL NVRL risk group form must be sent

5HIAA


HIT screen (Heparin induced thrombocytopenia)

Sodium citrate (coag) x 1 Serum x 1 Li Hep x 1

SJH

Prior arrangement with SJH. Send immediately in am only

High Sens. CRP Serum Plasma

SVUH

HLA antibodies Serum x 1

IBTS Separate and send immediately if <24hrs Or store at 4° or -50° to -80°C if <48 hours




Page 62 of 72



HLA B27 EDTA IBTS

HLA tissue typing EDTA IBTS

Homocysteine

EDTA x 2 SVH Biochemistry Separate & freeze within 30 mins

Huntingtons Chorea EDTA x 2 OLHSC, Crumlin Consent form required. Contact laboratory for form

Hydatid cysts See Echinococcus

17 Hydroxyprogesterone Serum SVUH Endocrinology

Hydroxyproline

Li Heparin 24 hr Urine

Biomnis Separate & freeze < 1 hr No preservative

IgE Serum SVUH Biochemistry

IGF binding protein 3 Serum Biomnis

Immunofixation Spot Urine SVUH Immunology

Immunoglobulins Serum SVUH Biochemistry

Indirect Bilirubin

Serum SVUH Biochemistry Total Bilirubin must be >30. Protect from light

Influenza virus H1N1 (Swine flu)

Nasopharyngeal swab or aspirate, BAL, nose/throat swab Use pink-topped or green-topped viral swabs

Specimens must arrive to NVRL by 11am to be processed that day Urgent specimens should be sent directly to the NVRL from the requesting department (drop box for specimens is on the right hand side of the main door of the hospital).

Influenza virus serology (seasonal flu)

Swab Other fluid Use pink-topped or green-topped viral swabs

NVRL Urgent specimens should be sent directly to the NVRL from the requesting department (drop box for specimens is on the right hand side of the main door of the hospital).

Insulin Serum SVUH Endocrinology No

Insulin Growth Factor 1 Serum (BD Red Cap)

SVUH Endocrinology Do NOT use gel tube

Intestinal polypeptide (VIP)

EDTA Biomnis Separate & freeze within 30 mins

Intrinsic Factor Ab Serum SJH Haematology

Ionised Calcium Serum SVUH Metabolic lab Do not expose to air

JAK2 BM or EDTA x 2

SJH (CMD LAB) Requested through haematology team. (Dr Connaghan)

Kappa/Lambda Ratio Serum SJH

Karyotype See Cytogenetics

Keppra Serum Biomnis

Lactate Contact Calymon

Biomnis Hospital – use ABG analyser in A&E

Lamictal Serum Biomnis Separate & freeze <4 hr

Lamotrigine Serum Biomnis Separate & freeze <4 hr

LC-1 Serum Biomnis




Page 63 of 72



Lead

Lithium Heparin

Biomnis Do NOT centrifuge Childhood poisoning- form must be completed. Form on Biomnis website

Legionella antigen Urine Biomnis

Legionella titre / serology Serum Biomnis

Leptospirosis Serum NVRL

LH Serum SVUH Endocrinology

Lignocaine/Lidocaine Serum Biomnis Separate & freeze <4 hr

Lipase Serum Biomnis

Lipoprotein Electrophoresis

Serum Biomnis

Lupus anticoagulant Sodium citrate (coag) x 3 Serum x 1

SVUH ASAP in am. Include information on coagulation therapy and any other relevant information. Full relevant history. Patient must be off heparin and stabilised on warfarin. GP samples sent only if taken by appointment with Phlebotomy SCH before 10am.

Lyme Disease See Borrelia burgdorferi

Manganese Li Heparin Biomnis

Measles culture Swab Tissue

NVRL

Measles serology Serum NVRL

Mercury

EDTA Li Heparin

Biomnis Transfer to special glass tube obtained from Biomnis

Meth Haemoglobulin EDTA x1 + Normal Control x 1

SJH Haematology Must reach SJH within 1 hr.

Metanephrines 24 Hor Urine Biomnis 20 mls acid added before collection. Check acidity before sending out

Methotrexate Serum SJH Biochemistry

Methyl Malonic Acid Li Heparin 24 hr Urine

Biomnis Separate & freeze <4 hr. Freeze < 4hr

Microbiological VB12 Serum SJH Haematology

Mumps culture Swab Tissue

NVRL

Mumps serology Serum NVRL

Mycoplasma antigen No test available. Please send serum for serology

Mycoplasma serology (Patient < 20 years)

Serum NVRL

Mycoplasma serology (Patient > 20 years)

Serum Biomnis

Myoglobin

Serum or EDTA Plasma

Biomnis Total CK recommended as better indicator of Rhabdomyolysis

Mysoline

Serum Biomnis Separate & freeze <4 hr Phenobarb must be assayed in parallel

Nerone Spec Enolase Serum Biomnis Separate & freeze <4 hr




Page 64 of 72



Netilmicin Serum Biomnis

Nickel Serum Biomnis

NMO antibodies Serum Biomnis

Noradrenaline


Norovirus/ SRSV Faeces Biomnis or NVRL SCH samples to Biomnis GP samples to NVRL

Oestradiol/Oestrogen Serum SVUH Endocrinology

Olanzapine Serum Biomnis Separate & freeze <4 hr

Oligoclonal bands CSF 1.5 ml Blood 7 ml

SJH Send serum sample (RED TOP) taken at same time for baseline Package CSF in separate tertiary container with its own Biomnis transportation slip. Record S number and tests requested on slip

Osmolality (Serum & Urine)

Serum /Urine

SVUH Metabolic lab

Osmotic fragility Lithium heparin x 2

SVUH By prior arrangement with SVUH only

Ova, cysts and parasites Faeces Urine

COH

In-patients will only tested by request of Infection Control or consultant microbiologist. GP samples sent out when requested

Oxycarbazepine Serum Biomnis Separate & freeze <1hr

Paraprotein Serum SVUH Biochemistry

Parathyroid Hormone Serum SVUH Metabolic lab Send whole specimen same day or separate & freeze for next day

Paraquat (serum) Serum EDTA

Biommis Separate & freeze <4 hr

Paraquat (urine) Urine (20 mL) Biomnis

Parvovirus Serum NVRL

PCR: Meningococcal Pneumococcal

CSF EDTA

IMMRL IMMRL form must be filled in (available from Microbiology lab SCH) Package CSF in separate tertiary container with its own Biomnis transportation slip. Record S number and tests requested on slip

PCR: Herpes group (HSV, EBV, CMV, VZV) Includes enterovirus RNA

CSF Serum

NRVL Package CSF in separate tertiary container with its own Biomnis transportation slip. Record S number and tests requested on slip

Penicillin allergy Serum Biomnis

Phenobarbitone Serum Beaumont TDM

Phenytoin (Epanutin) Serum Beaumont TDM

Plasma free metanephrines

EDTA LiH

Biomnis Separate & freeze < 1hr




Page 65 of 72



Plasma viscosity EDTA x 2 SVUH Samples must not be stored in the fridge

Pneumococcal antigen Urine Biomnis

Porphyrin Screen (Serum)

24 hr Urine Faeces Li Hep x 1 EDTA x 2

SJH Biochemistry

Protect all specimens from light. Place in black bags

Porphyrin Screen (Faecal)

Faeces SJH Biochemistry Protect all specimens from light. Place in black bags

Porphyrin Screen (Random)

Spot urine post acute attack

SJH Biochemistry

Pregnanetriol 24 hr Urine Biomnis

Primidone (Mysoline) Serum Biomnis Separate & freeze <4 hr

Prion disease CSF Beaumont Must be sanctioned by consultant microbiologist. Doctor must complete Beaumont questionnaire. See Beaumont LI-NCJD-CSF (Lab Spec Rec) Package CSF in separate tertiary container with its own Biomnis transportation slip. Record S number and tests requested on slip

Procallagen III Serum Biomnis Freeze < 4hr

Progesterone Serum SVUH Endocrinology

Progesterone Receptor Serum SVUH Endocrinology

Prograf EDTA Whole Blood

SVUH Immunology Can be stored in fridge overnight

Proinsulin

Serum Biomnis Separate & freeze <4 hr

Prolactin Serum SVUH Endocrinology

Protein C See thrombophilia screen

Protein Electrophoresis Serum SVUH Biochemistry

Prothrombin gene mutation

EDTA SJH Requested through haematology team

PSA/FreePSA ratio Serum SVUH Nuclear Medicine

Q Fever Serum NVRL

Quindine Serum Biomnis Separate & freeze <4 hr

RAST See Allergy testing

Red Cell Folate EDTA Biomnis

Red Cell Porphyrins

Heparin Whole Blood

Biomnis

Red Cell Transketolase Not Available Test is obsolete

Reducing Substances Faeces Biomnis

Renin (See Aldosterone/Rennin)

EDTA x 2 SVUH Endocrinology Separate & freeze.




Page 66 of 72



Respiratory simplex virus (RSV)

Swab Sputum Nasal secretions

NVRL

Reverse T3 Serum Biomnis Separate & freeze <4 hr

Rheumatoid Factor Serum SVUH Immunology

Rifampicin (antibiotic) Serum SVUH Microbiology Notify laboratory before 15:00 Friday if testing required at weekend. Weekend samples must arrive in SVUH before 11am

Risperidone Serum Biomnis Separate & freeze <4 hr

Rubella antibodies Serum NVRL

Selenium Serum-RED

cap Li Heparin

Biomnis Do NOT use gel tube

Serotonin Li Heparin Biomnis Separate & freeze <1 hr

SFLC-Serum Free Light Chains

Serum- needs its own tube

SVUH

Sickle cell EDTA SJH Send MCH with request.

Spot Urinary Amylase Spot Urine SVUH Biochemistry

SRSV see Norovirus

Stone Analysis STONE Biomnis

Strep pneumoniae antigen

Urine SVUH

Surmontil/ Trimipramine Serum Biomnis

Synacthen test Cortisol: pre & post synacthen stimulation

Syphillis serology Serum CSF


Tacrolimus (FK506/Prograf)

EDTA SVUH Immunology Store in fridge overnight

TB culture / AFB stain Sputum Bronchial aspirate Other fluids Tissue

SVUH Seal sample container using parafilm.

TB culture only Early morning urine (EMU) Swab

SVUH EMU for TB must be sanctioned by consultant microbiologist

TB Blood Culture Special Blood Culture bottles

SVUH

T cell subsets (CD4 count)

EDTA SJH Must be sent within 24 hrs of taking. Do not refrigerate

Tegretol (Carbamazepine)

Serum Beaumont TDM

Teicoplanin (antibiotic) Serum Biomnis




Page 67 of 72



Temazapam Serum Biomnis Separate & freeze < 4hrs

Testosterone (& SHBG) Serum SVUH Endocrinology

Thalassaemia, see HE1

Theophylline

Serum (BD Red Cap)

SVUH Biochemistry

Thiopurine methyltransferase

EDTA x 2 SVUH Biochemistry

Thread worms Faeces Cherry Orchard Hospital

Thyroid Peroxidase Ab (TPO)

Serum Biomnis

Thrombophilia screen: Protein S Protein C Factor V Leiden AT111 Anti-cardiolipin

Sodium citrate (coag) x 5 Serum x 1 EDTA x 1

SVUH Full relevant history. Patient must be unanticoagulated or off heparin and stabilised on warfarin. Send in morning ASAP. GP samples sent only if taken by appointment with Phlebotomy SCH before 10am.

Thyroxine Binding Globulin (TBG)

Serum EDTA Li Heparin

Biomnis Separate & freeze< 4 hr

Thyroglobulin Serum SVUH Endocrinology

Tocainamide Serum Biomnis

Topiramate Serum Biomnis Separate & freeze <4 hr

Total CO2 Li Heparin SVUH Biochemistry Fill tube to full capacity

Total Insulin Ab

Serum EDTA

Biomnis Separate & freeze <1 hr

Toxoplasma Serum NVRL

TPHA See Syphillis serology

TPMT EDTA x 2 SVUH

TRAB Thyroid Receptor Antibody

Serum SJH Endocrinology

Transferrin Serum Biomnis

Trimipramine/surmontil Serum Biomnis

Trinucleotide EDTA OLHSC Crumlin

Tryptase Serum Biomnis

Tryptophan Li Heparin Temple St

tTG Serum Biomnis

Typhus (Rickettsia) serology

Serum Biomnis

Tyrosine Li Hep Biomnis Separate & freeze <1 hr

Urinary Albumin 24 hr Urine SVUH Metabolic lab

Urinary Albumin:Creatinine Ratio

Spot Urine SVUH Metabolic lab

Urinary Aldosterone 24 hr Urine Biomnis See Biomnis manual, phone Biomnis

Urinary Amylase 24 hr Urine SVUH Biochemistry

Urinary Amylase (Spot) Spot Urine SVUH Biochemistry

Urinary bicarb Spot Urine SVUH

Urinary Calcium 24 hr Urine Biomnis

Urinary Cl Spot Urine SVUH




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Urinary Citric Acid 24 hr Urine SVUH Metabolic lab 20 mls acid added before collection. Check acidity before sending out

Urinary Copper 24 hr Urine Biomnis

Urinary Cortisol 24 hr Urine Biomnis

Urinary HCG

Spot Urine SVUH Immunology Include clinical details & age

Urinary Magnesium 24 hr Urine SVUH Biochemistry

Urinary Mercury Spot Urine Biomnis

Urinary Myoglobin 24 Hr Urine Spot Urine

Biomnis

Urinary Osmolality Spot Urine SVUH Metabolic lab Send out same day

Urinary Oxalate 24 hr Urine SVUH Metabolic lab 20 mls acid added before collection. Check acidity before sending out

Urinary pH Urine SVUH

Urinary Phosphorus 24 hr Urine Biomnis

Urinary Protein:Creatinine Ratio

Spot Urine SVUH Biochemistry

Urinary Protein Electrophoresis

Spot Urine SVUH Biochemistry

Urinary Urate 24 hr Urine SVUH Biochemistry

Urinary Urea 24 hr Urine SVUH Biochemistry Send entire collection

Valproate (Epilim) Serum Beaumont TDM

Vancomycin Serum SVUH Microbiology Notify laboratory before 15:00 Friday if testing required at weekend. Weekend samples must arrive in SVUH before 11am

Varicella zoster culture Swab Tissue CSF


Varicella zoster serology Serum NVRL

Vasculitis Screen Serum SVUH Immunology

Vaso Active Intestinal Polypeptide (VIP)

EDTA Biomnis Separate & freeze within 30 mins

VDRL See Syphillis serology

Viral culture Swab CSF Tissue Other fluids

NVRL

Package CSF in separate tertiary container with its own Biomnis transportation slip. Record S number and tests requested on slip

Viral pneumonia See Atypical Pneumonia

Viral screen serology Serum NVRL

Request specific tests or provide sufficient clinical details

Viscosity EDTA x 2 SVUH Samples must not be stored in the fridge

Vitamin A (Retinol)

Serum Biomnis Keep away from light Separate & freeze < 1 hr

Vitamin B1 (Thiamine) EDTA Biomnis Whole blood frozen within 4 hrs Li Heparin not frozen Protect from light

Vitamin B2 (Riboflavin) Li Heparin Biomnis Protect from light (wrap in tinfoil)




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Vitamin B6(Pyridoxal Phosphate/PLP)

EDTA Biomnis Freeze whole blood < 4 hours (Protect from light as above)

Vitamin B12 Micro Assay Serum SJH No

Vitamin D

Serum SVUH Metabolic lab Send whole specimen same day or separate & freeze for next day

Vitamin E (Tocophenol) Serum Biomnis Separate & freeze < 4 hr

Vitamin K Serum Biomnis Separate & freeze < 1 hr

VLDL Serum Biomnis Must be fasting at least 12 hours

VMA


Vanilylmandelic Acid 24 hr Urine Biomnis 20 mls acid added before collection. Check acidity before sending out

Von Willebrands screen Sodium citrate (coag) x 4

SJH Coagulation Phone lab before sending samples. Samples must be received in SCH lab before 10am. GP samples sent for testing only if taken by Phlebotomy SCH before 10am.

Water: cleaning machine Water COH Specimens must be sent according to protocol of Infection Control Officer

West Nile Virus (IgG/IgM)

Serum NVRL

Whooping cough / croup See Bordetella pertussis

Xanthochromia CSF Routine hours only- By request of Microbiologist only. Refer to LF-MICRO-0017 for specimen storage and referral details. Package CSF in separate tertiary container with its own Biomnis transportation slip. Record S number and tests requested on slip

Yersinia Serum Biomnis

Zinc

Serum (White cap) Li Heparin

Biomnis Separate ASAP into dry plastic tube. Do NOT use gel tube

ZN See TB culture / AFB stain

Zonegran Serum Biomnis

Zucopentizol (Clopixol) Serum Biomnis Separate & freeze <4 hrs. See Biomnis User Manual for details




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30.2 Contact details for referral laboratories

Laboratory Telephone

Biomnis 01 295 8545

National Virus Reference Laboratory (NVRL) 01 716 1323

SVUH Biochemistry laboratory 01 209 4550

SVUH Immunology laboratory 01 209 4598

SVUH Metabolic laboratory 01 209 4513

SVUH Microbiology Laboratory 01 209 4470

SVUH Histology Laboratory 01 209 4613

Beaumont Toxicology Laboratory 01 809 2673

Beaumont TDM Laboratory 01 809 2671

Beaumont Neuropathology Laboratory 01 809 2633

SJH Laboratory 01 416 2062

PHLS Cherry Orchard Hospital 01 620 6175

National Salmonella Reference Laboratory, UCHG 091 544 628

National MRSA Reference Laboratory 01 410 3662

Irish Meningococcal and Meningitis Reference Laboratory,

Children’s Hospital, Temple St.

01 878 4432




Page 71 of 72


APPENDIX A. REVISION HISTORY

Document No:

LP-GEN-007

Previous edition:

03

Document Title:

Laboratory User Manual

New edition:

04

Date:

17/01/2013

Change No.

Section Change details

1 1 Paragraph deleted (re sendaway samples): All samples should be sent to the St. Columcille’s Hospital laboratory and will be dispatched from there.

2 5 Malaria blood film requires authorisation by Haematology team Bone profile added to call repertoire

3 6.2 GP orders should be faxed to the laboratory before 11am Friday

4 7.2 New form referenced (LF-GEN-0051 Referral tests for SVUH request form)

5 8 Hospital and GP sample labelling requirements split over 2 sections: MRN required on hospital samples, DOB required on GP samples

6 9 New paragraph: The following constitute improper labeling:

a) Minimum labeling requirements for request form and sample are not met (as defined in sections 7 and 8 of this document);

b) Discrepancies between details on the sample and request form; c) Use of correction fluid on sample or request form; d) Alterations to sample labeling that are not initialed by the person

taking the sample; e) Patient details written on the sample by more than one person.

7 22.3 Hospital and GP hardcopy reports split over 2 sections. GPs on Healthlink are not sent hardcopy Biochemistry or Haematology reports. When these are printed, they are printed on white paper.

8 24 Lubna Alaaraji is the Haemovigilance Officer

9 26.5 Biochemistry critical results updated

10 27.3 INR phoned results corrected to >4.5

11 28.5 New section: Phoning of (Histology) reports Request forms marked as urgent should include the name and contact phone number of the clinician to whom the report should be phoned.

12 28.7 PM liaison is Carol de Wilde

13 29.2 Microbiology turnaround times amended

14 29.3.4 New special note for C Diff: Negative specimens will not be re-tested for 7 days

15 29.3.9 New special note for Blood Cultures � Optimal time of specimen collection

- Before antimicrobial therapy where possible.




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Change No.

Section Change details

- As soon as possible after a spike of fever, except in endocarditis where timing is less important.

16 30.1 Referral test table updated - Please note important changes re requesting of allergy tests (RAST) - Haemochromatosis testing now performed in SVUH – no need for cheque or

consent form

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