PATHOLOGY SERVICES HANDBOOK 2016
Pathology Services Handbook 2016
Pathology Services Handbook 2016 1
Introduction 3
Where to find us 3
Opening hours 4
Our commitment to you – Quality Policy 6
Information for patients 7
Where do I go for my blood tests? 7
Information about having a blood sample taken 7
Delivering a sample to Pathology 9
24 hour urine collection 9
Collecting a mid-stream urine (MSU) sample 11
Collecting stool samples for detection of occult blood 11
Semen samples 11
Fasting blood tests 11
Our anti-coagulant monitoring service 12
Glucose tolerance test 14
Information about post-mortem examinations 14
PALS 14
Information for Healthcare Professionals 15
Pathology results 15
Cerebrospinal fluid (CSF) collection 16
Submission and storage of specimens for Cellular Pathology 16
Collection and delivery of semen samples 16
Labelling of samples 16
Completion of request forms 17
Criteria for accepting and rejecting samples 19
Transport of diagnostic specimens 19
Guide to laboratory tests 21
Blood Sciences Key Contacts 22
Haematology Tests 23
Routine blood tests 23
Paediatric samples. 24
Coagulation Tests Available: 25
Blood Transfusion 26
Blood Transfusion - Sample Requirements: 26
Specimen Identification – Special Requirements for Transfusion 27
Group and Antibody Screen 27
Routine Cross match request 27
Urgent/Emergency Crossmatch requests 28
Unknown patients 28
MSBOS 28
Management of Blood Products outside the laboratory 28
Location of Blood Fridges 29
Investigation of Suspected Transfusion Reaction 29
Blood Products 30
Kleihauer Testing 31
Clinical Biochemistry and Point of Care testing 32
Routine Investigations 32
Sending Samples during normal laboratory hours: 33
Sending samples 'Out-of-hours' 33
Drug Screens 33
Endocrine Investigations 33
Turnaround time for Urgent Tests 34
Clinical chemistry tests performed in house 34
Urine tests: 41
Faeces Tests: 42
Clinical chemistry tests referred to reference laboratories: 44
Point of Care Testing (POCT) 53
Microbiology and Infection Control 54
Histology, Cytopathology and Mortuary Services 55
Key Contacts: 55
Cellular Pathology Hours: 55
Requests for Histology and Diagnostic Cytology 55
Cervical Cytology Samples: 56
Histopathology Laboratory - Routine Histology 56
Consent 56
High Risk Samples 57
Urgent Specimens 57
Frozen sections 57
Specimens that require bacteriological, in addition to histological examination 57
Turnaround time for histology samples. 57
Formaldehyde Safety 57
Cytology Laboratory 58
Request forms 58
Consent 58
Turnaround time for cervical LBC samples. 58
Turnaround time for non-gynae samples. 59
Gynaecological Cytology 59
Contact numbers for cervical cytology services. 59
Manufacturers’ instructions for the taking of Surepath LBC cytology samples 60
Endometrial cytology 61
Non-Gynaecological Cytology 61
Sputum for malignant cells, asbestos bodies, eosinophils, asthmatic stigmata. 61
Pleural / Ascitic / Pericardial fluids. 62
Fine Needle Aspiration (FNA) Cytology. 62
Bronchial washings/BAL 62
Bronchial brush biopsies. 62
EBUS-TBNA samples 62
Synovial fluids for polarised light microscopy (for crystals) 63
Cerebrospinal fluid (CSF) for malignant cells. 63
Instructions for the storage, handling and transport of Cytospin © collection fluid. 63
Instructions for the storage, handling and transport of CYTORICH® Red Preservative Fluid 63
Seminal Analysis 64
HIV Positive/HIV Risk Patients 64
Mortuary Services: 64
Deaths to be Reported to HM Coroner 64
Hospital Autopsies 65
“High Risk” cases 65
Immunology and Allergy Service 66
Requests for Immunology/Allergy testing 66
Principal Staff and contact details 66
General Specimen Requirements for Auto Immune Serology/Allergy testing 67
Send Away Tests 68
Specimen collection: 69
Transport of specimens to the laboratory: 69
Turnaround times: 70
Clinical advice on the use and interpretation of immunology laboratory tests: 70
Autoimmunity 70
Allergy 73
Suspected immunodeficiency 73
Special considerations affecting performance of the test and the interpretation of the results: 74
Time limits for requesting additional tests: 74
Feedback on our Pathology services and the Complaints procedure 74
Appendix One – List of referral laboratories 75
Appendix Two – User Survey Feedback 78
Introduction
This handbook is intended as a source of reference to all healthcare staff and patients using the Countess of Chester Hospital NHS Foundation Trust Pathology Services.
If the information you require cannot be found here please contact the appropriate department. Calls from outside the hospital should be prefixed with 36.
We are registered withClinical Pathology Accreditation (UK)
http://www.ukas.com/services/CPA/Clinical_Pathology_Accreditation_CPA.asp
whereyou can checkthe current accreditation status of our individual laboratories.
Where to find us
Postal Address
Pathology Laboratory
Countess of Chester NHS Foundation Trust
Liverpool Road
Chester
CH2 1UL
Click here for Countess of Chester Hospital NHS Foundation Trust web-site
Click here for information for patients
Any problems with access to handbook links or queries regarding content – contact our Directorate Administrator, Ms Maureen Delorey, on 01244 365031 or email
Location of Laboratory Services
The Cellular Pathology, Blood Sciences (Chemical Pathology, Haematology and Blood Transfusion) and Immunology Departments are located at the rear of the main hospital on the first floor in the ORANGE ZONE F12 . Follow the signs for F12 Pathology / Orange Zone and go to Pathology Reception which is just inside the main entrance door to the pathology area opposite CCU.
The Microbiology department is not located within the Countess Health Park.
Microbiology services are provided by:
Micropath, 11 Bassendale Road, Bromborough, CH62 3QL
Main Telephone Number: 01244 362500
There are hourly transport runs between the Countess and the Micropath laboratory.
Please refer to the separate Microbiology handbook on the Trust Intranet for advice on tests, specimen types etc. The Micropath handbook can also be accessed by clicking on this link to the WUTH website here.
Opening hours
BLOOD SCIENCES – Chemical Pathology/Haematology/Blood Transfusion
The Blood Sciences laboratories maintain a 24 hour 7 day a week continuous process pattern for hospital work. The core working hours are 09:00 – 17:30 Monday to Friday.
Outside these core working hours the laboratory will be served by 2 duty Biomedical Scientist (BMS), one covering Biochemistry and the other covering Haematology and Blood Transfusion. During this period it will not be necessary to contact the BMS regarding routine work sent to the laboratory. Requests should be delivered to the laboratory and left in the red basket in the laboratory entrance; those departments/wards with an air tube system can continue to send samples through this mechanism.
These samples will be dealt with routinely and authorised results can be accessed via Meditech. Only results that are grossly abnormal will be phoned.
The duty BMS must be contacted by bleep (2552 Chemistry, 2553 Haematology/Transfusion) or switchboard for:-
ALL urgent requests, in order that work can be prioritised
ALL requests for blood gases and cross-matching of blood after 17:30 hours.
Histopathology & Diagnostic Cytology:
Monday - Friday: / 8.30am – 5.00 pmSaturday / Closed
Sunday / Closed
NB No out of hour’s service is available for Histology / Diagnostic Cytology. Histology specimens must be received by the lab before 11am for processing that day. Diagnostic cytology samples must be received by the lab before 4.00 pm in order to be processed that day.
Immunology:
Monday – Friday / 9.00am – 5.30pmOutside the above core working hours contact the out-of-hours Biomedical Scientist via hospital switchboard, who will forward information or contact the Consultant Immunologist as required.
Phlebotomy Service:
Contacts
Mr Martin Langan / Blood Sciences Manager / 01244 365659Rose Edwards / Phlebotomy manager / 01244 366537
Bleep 3388
Suzanne Broadhurst / Phlebotomy supervisor / 01244 363711
Bleep 2572
Our commitment to you – Quality Policy
Information for patients
Where do I go for my blood tests?
Your GP may provide phlebotomy services in your own surgery. If not, drop-in sessions are available at the Countess and Ellesmere Port hospital sites (see out-patient services below).
In-patients:
All COCH Wards / 07.30 - 12.00 every day (NB: Ward 31 and TAL not covered at weekends)1.15 – 16.00 Monday to Friday
EPH wards / 08.30 – 11.00 Mon Tues Fri
09.45 – 12.30 Wed Thursday
CWP NHS Trust Wards (Bowmere) / 10.30 -12.00 noon Mon-Wed-Fri
Out-patients:
Countess of Chester Hospital(NHS Foundation Trust) / 07.30 - 17.55 Monday - Friday
Ellesmere Port Hospital / 13.30 - 15.45 Monday
08.30 - 12.00 noon Tuesday and Friday
You can book your appointment to have your bloods taken in Outpatients 3 at the Countess of Chester Hospital. There is a walk-in facility at CoCH which is open Monday to Friday 7.30am – 5.50pm.
To book an appointment please follows http://www.coch.nhs.uk/blood-test-booking.aspx
To book an appointment for a patient under the age of 16 please contact Paediatric Outpatients on 01244 365082
Fasting patients – please review guidelines when booking.
Glucose Tolerance Tests:
GTTs are performed by GP surgeries. Reports and interpretations are sent electronically. A protocol is available on SharePoint for use in the hospital.
Information about having a blood sample taken
A blood test is taking a sample of blood for testing in a laboratory. Blood tests have a wide range of uses and are one of the most common types of medical test.
For example, a blood test can be used to:
· assess your general state of health
· confirm the presence of a bacterial or viral infection
· see how well certain organs, such as the liver and kidneys, are functioning
· screen for certain genetic conditions suchas cystic fibrosisor spinal muscular atrophy
Most blood tests only take a few minutes to complete and are carried out at your GP surgery or local hospital.
Preparing for a blood test
The healthcare professional who arranges your blood test will tell you whether there are any specific instructions you need to follow before your test.
For example, depending on the type of blood test, you may be asked to:
· avoid eating or drinking anything, apart from water(fasting)
· stop taking a certain medication
What happens during a blood test?
A blood test usually involves taking a blood sample from a blood vessel in your arm.
The arm is a convenient part of the body to use because it can be easily uncovered. The usual place for a sample to be taken from is the inside of the elbow or wrist, where the veins are relatively close to the surface.
Blood samples from children are usually taken from the back of the hand. The child's hand will be anaesthetised (numbed) with a special cream before the sample is taken.
A tight band (tourniquet) is usually put around your upper arm. This squeezes the arm, temporarily slowing down the flow of blood out of the arm, and causing the vein to swell with blood. This makes it easier for a blood sample to be taken.
Before taking the sample, the doctor or nurse may need to clean the area with an antiseptic wipe.
A needle attached to a syringe or to a special blood-collecting container is pushed into the vein. The syringe is used to draw out a sample of your blood. You may feel a slight pricking sensation as the needle goes in, but it should not be painful. If you do not like needles and injections, tell the person who is taking the sample so they can make you more comfortable. If you feel faint, lie down.
When the sample has been taken, the needle will be removed. Pressure is applied to the tiny break in the skin for a few minutes using a cotton-wool pad to stop the bleeding and to prevent bruising. A plaster may then be put on the small wound to keep it clean and prevent infection.
After the test
Only a small amount of blood is taken during the test so you shouldn't feel any significant after-effects.
However,some people do feel dizzy and faint during and after the test. If this happens to you, tell the person carrying out the test so they can help you feel more comfortable.
After a blood test, you may have a small bruised area on your skin where the needle went in. Occasionally, a larger area of bruising may appear. This can be because there was a lack of pressure at the site of the jab or the blood vessel was damaged by the needle.
Bruises can be painful but are usually harmless. However, tell your GP if you frequently get bruises after having a blood test.
Results
After the blood sample has been taken, it will be put into a bottle and labelled with your name. It will then be sent to a laboratory where it will be examined under a microscope or tested with chemicals, depending on what's being checked. The results are sent back to the hospital or to your GP, and you will be told when and how you will be given them.
Sometimes, receiving results can be stressful and upsetting. If you are worried about the outcome of a test, you may choose to take a trusted friend or relative with you. For some tests, such as HIV, you will be offered specialist counselling to help you deal with your results.
Information about laboratory tests can be found at the following website: http://labtestsonline.org.uk/
Delivering a sample to Pathology
The Countess Pathology Department is located at the rear of the main hospital on the first floor in the Orange zone. Follow the signs for Pathology F12 and go to Pathology Reception which is just inside the main entrance door to the pathology area opposite CCU. The reception is open from 8:30 am to 5pm. Samples are also collected from GP surgeries by our dedicated courier service. Samples for Microbiology may also be sent or delivered here at the Countess for onward transport to the Micropath site. NB: Semen samples must be delivered to the Fertility Unit in the Women and Children’s building.
24 hour urine collection
What is a 24 hour urine sample?
A 24 hour urine sample is a collection of all the urine you pass over a period of 24 hours.
What are the benefits of a 24 hour urine sample?
The benefit of a 24 hours urine sample is that it can help your doctor to diagnose your condition or monitor treatment you are having. Because the urine we produce varies throughout the day and night, the differences are ‘averaged out’ by collecting all urine over 24 hours, so we can get a more reliable result than a single urine sample for some tests.
What are the risks of a 24 hour urine sample?
There are no risks to collecting a 24 hour urine sample but in a few cases the test may need to be repeated. This could be due to technical reasons, or because the results are not clear or the instructions have not been followed carefully.