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Location of UHB Laboratories

Current Locations of Departments

Department Location
Central Specimen Reception

Clinical Laboratory Services, Level-1
Queen Elizabeth Hospital Birmingham Mindelsohn Way,
Edgbaston, Birmingham,
B15 2GW

Tel: 0121 627 2000

Clinical Biochemistry
Laboratory Haematology/Transfusion
Clinical Microbiology
Microbiology Specimen Reception
Infection Control Nurses
Cellular / Molecular Pathology 
Mortuary

Map to location

Management of the Menopause

The menopausal transition is best diagnosed on clinical grounds. Endocrine investigation may be helpful where the pattern of age, menstrual history and features of oestrogen deficiency are unusual.

Please indicate the woman’s date of birth, recent menstrual pattern and date of last menstrual period/day of cycle on which the blood sample was collected. A rise in follicle stimulating hormone (FSH) is the earliest sign of the approaching menopause. Measurement of serum FSH is the recommended first investigation if biochemical confirmation is necessary. The measurement of luteinising hormone (LH), oestradiol or progesterone is not appropriate. A serum FSH in the reference range for the follicular phase does not exclude the perimenopause.

Hormone Replacement Therapy

HRT when prescribed (orally or transdermally) for the relief of menopausal symptoms does not require endocrine monitoring. Where there is unexpected failure of treatment, for example due to non-compliance or malabsorption, investigation may be useful. Different formulations of HRT may or may not be detected by oestradiol assays. Please indicate on the request form the HRT preparation prescribed.

The main indication for measuring oestradiol in women on HRT is in those receiving implants containing oestradiol. Early replacement of the implant may result in accumulation of oestradiol. Monitoring of serum oestradiol before the implant is replaced has been recommended to avoid supraphysiological concentrations. Sometimes testosterone implants are used in HRT. Measurement of testosterone in an analogous fashion to oestradiol may help to assess whether a further implant may be necessary.

 

Massive Transfusion

During massive transfusion, i.e. a patient receiving 10 or more red cell bags within 24 hours, the patient’s total circulation is replaced with donor blood. Note that subsequent serum samples will contain very little of the patient’s original blood serological profile. Stored blood contains minimal plasma/ platelets, shock also disturbs blood coagulation. (note: all patients born after 1 January 1996 must be identified as they must be issued with non UK sourced plasma. This is a DOH directive.)

Monitoring glycaemic control in patients with diabetes

HbA1c is routinely measured for this purpose. The assay is run daily on weekdays and requires an EDTA plasma sample (purple top). Fructosamine can be used as an alternative when HbA1c is not appropriate. Fructosamine reflects blood glucose over two weeks rather than 2 to 3 months as it reflects glycation of albumin rather than haemoglobin. Fructosamine is performed on serum (yellow or red top) and run daily.

Non-Red Cell Components (General)

Components do not require a cross-match but the blood group of the patient must be known before compatible components can be issued. These always require a fresh blood administration set. If a blood group has not been performed then a transfusion sample must be sent. A request form is required. In emergency situations a telephone order can be made giving all the details required and a request form must be sent as soon as possible. Specific details of each blood components can be found in the Trust Blood Transfusion Policy. Blood Bank provides red cells, platelets, fresh frozen plasma (including virucidally inactivated) and cryoprecipitate.

NB – Octaplas is obtained from blood from Blood Bank at QEHB after consultation with Haematology consultants.

Opening Hours

Opening Hours

Weekdays

A full laboratory service is available from each department between 8.00 and 20.00 weekdays but each individual laboratory may have extended core service times; please consult each section for details. Specimens for routine analysis should be submitted as soon as possible to the individual laboratories.

Saturdays

A more limited laboratory service is available in the following laboratories.

  • Clinical Biochemistry
  • Laboratory Haematology
  • Clinical Microbiology

Samples requiring analysis for daily monitoring purposes should reach the laboratory by 11.00 so that they can process by the staff available. Samples sent after this time for routine analysis will be processed in strict order and after dealing with true emergency samples. Some specialist biochemistry investigations can be performed by prior arrangement with the laboratory, and should reach the laboratory earlier in the day. A limited number of staff work in the laboratories on Saturday morning. Investigations should be restricted to those patients who require monitoring to alter or prescribe therapy for that day. The Specimen Delivery System is available for sending most specimens. There are limited collections by the portering staff. Ad hoc porters can be called to take urgent specimens to the laboratory specimen reception. Transport should be contacted directly if the specimen cannot wait. Tests requiring urgent analysis should be brought to the attention of the laboratory staff by a prior telephone call.

Sundays

Limited services are provided to UHB Trust on a Sunday and vary dependent on the laboratory. Investigations should be restricted to those patients who require monitoring to alter or prescribe therapy for that day. Specimens for this type of analysis must be in the departments by 11.00. The Specimen Delivery System is available for sending most specimens. There are limited collections by portering staff. Ad hoc porters can be called to take urgent specimens to the laboratory specimen reception. Transport should be contacted directly if the specimen cannot wait. Tests requiring urgent analysis should be brought to the attention of the laboratory staff by a prior telephone call.

Public Holidays

A limited service is available in the laboratories, and vary dependent on the laboratory.

Out-of-hours

An out-of-hours service is provided by the following departments:

  • Clinical Biochemistry
  • Laboratory Haematology
  • Clinical Microbiology

These services operate at all times when the laboratories are not open for 'routine' service. Out-of-hours you must make contact with the Duty Biomedical Scientist in each laboratory prior to dispatching any specimen. Investigations should only be requested out-of-hours when the results are required for immediate patient management. The out-of-hours Mortuary viewing service is provided by the Trust on-call manager.

All arrangements for specimen delivery to the departments must be made by the requesting doctor. Each department has a published repertoire of tests available out-of-hours and guidelines for requesting are available (see below). A senior member of the scientific or medical staff is available in each department for consultation at all times. If asked by the Duty Biomedical Scientist for your reasons for requesting a test, you should give the clinical indications; no reasonable request will be refused but the Biomedical Scientist will be at liberty to ask you to consult a senior member of the laboratory staff to discuss the necessity for the investigation.

Before any urgent specimens are sent to Biochemistry or Microbiology out-of-hours, you must make prior contact with the department concerned and discuss your requirements. You must complete the request form and include your contact point (telephone or bleep number).

All results are electronically transferred to the PICS and Browser systems. The results of urgent requests may be notified to the requesting source if there are abnormal results that exceed critical limits. You must be prepared to accept results and must not delegate this responsibility to anyone else unless you have made arrangements that are made clear to the department concerned.

NB Without prior notification requests for priority written on request forms (e.g. "urgent" or "please telephone") may be ignored by the laboratory 

Cellular Pathology Service Hours

In general terms the opening hours are as follows :

Cellular Pathology: 08:00 to 17:00 weekdays and 07:00-15:00 on Sundays

Mortuary : 08:00 to 16:00 weekdays.

On Call Service

There is currently no formal on call routine diagnostic Cellular Pathology service or on call consultant in Cellular Pathology.  On occasions a specialist pathologist may be approached out of hours by clinicians or transplant teams requesting out of hours urgent histology biopsy processing or frozen section reporting for clinically urgent cases.   In these cases where a consultant pathologist is available then the Department can support with technical biomedical scientist support and also for back up support for critical equipment downtime.  The on call biomedical scientist is available via switchboard.  There is also a Cell Path manager on call via switchboard for example to support with for example major incidents or mortuary capacity issues, or critical refrigerated equipment failures for Cellular Pathology and Mortuary.

Urgent Histopathology Biopsy Requests

Urgent histopathology biopsy requests e.g. renal transplant / renal biopsy / cardiac biopsy

For same day processing these must reach the Cellular Pathology Reception by 13:30 Mon-Fri. Such urgent requests received after this time will be processed for reporting on the next working day. on the same day.

Molecular Pathology

09:00 to 17:00 weekdays.

There is no out of hours service

Patient Consent and Data Protection

The Trust has many policies and procedures which the Clinical Laboratory Services (CLS) complies with including a Data Protection and Confidentiality Policy which ensures that the Trust complies with the Data Protection Act 1998 (DPA), the Caldicott principles and the duty of confidentiality in relation to all personal data held.

The Trust is committed to protecting the rights and privacy of individuals (including staff, patients, contractors, members of the public and any other groups) in accordance with the DPA to which it is subject as a controller and processor of personal data (data controller).

A copy of the Data Protection and Confidentiality Policy is available through the Trust on request under the Freedom of Information Act 2000.

There is also a Trust policy and procedure for Consent to Examination or Treatment and these are also available through the Trust on request under the Freedom of Information Act 2000.

Patients with Allo-Antibodies

Patients with Allo-antibodies

Blood for transfusion is routinely typed for ABO and Rhesus (D) groups only. If a patient has produced an allo-antibody stimulated either by a previous transfusion or by pregnancy, it will be necessary to search for blood negative for the antigen. Some patients carry an antibody identification card, or such information is displayed in their notes. This information MUST be written on all cross-match request forms. Please try to give at least 24 hours notice of transfusion or expect a delay otherwise. When a new antibody is identified in a patient, Blood Bank will request a further 4 x EDTA of blood for investigation by the National Blood Service who will confirm the antibody and issue an antibody identification card which the patient must carry at all times. 

Point-of-Care Testing (POCT or Near Patient Testing, NPT)

The use of all point-of-care devices from simple dip-stick tests to blood gas analysis machines is governed by a comprehensive Trust policy and procedure. Please ensure that you are aware of the requirements of this policy before you embark on point-of-care testing. The POCT services managed by the team are rapidly expanding and include:

Blood Glucose Meters

Ward based glucose meters that measure blood glucose using a 'dry-chemistry' stick are used throughout the Trust. These meters must only be used by authorised staff that have received training via the scheme organised in conjunction with the meter manufacturer.

The working range of all glucose meters is limited and for accurate determination at the extremes of the range (2.5 - 20.0 mmol/L for the UHB meters), blood should be taken into a grey-top vacuette tube and sent to the laboratory. If the result is unexpected, send a sample to the laboratory or a sample can be processed on one of the blood gas analysers located throughout the Trust.

In hypoglycaemia, values below the working range must be confirmed by a laboratory glucose measurement. Consult the biochemist/consultant on duty prior to taking the blood so that appropriate samples can be collected for the investigation of insulinoma, should this be warranted.

Blood Gas Analysers (QEHB, Heritage Building, ROH, Moseley Hall)

The department has rationalised blood gas instrumentation in the Trust and identical instruments are sited throughout the Trust. All analysers measure pH, pCO2, pO2, sodium, potassium and ionised calcium. They provide full co-oximetry and derive values for base excess and bicarbonate. Glucose and lactate measurement is available on both sites, but not on all analysers.

The blood gas analysers are located throughout QEHB, Heritage Building and the POCT team also manage analysers at the Royal Orthopaedic Hospital and Moseley Hall Hospital.

Ward based operators and doctors are trained by staff of the POCT team. The laboratories do not have blood-gas analysers in the department and there is no in-house lactate measurement.

INR Measurement

Throughout the Trust the POCT team manage the INR devices used for rapid testing. These meters have been installed in areas where a clinical need has been identified and approved. Operators are trained by the members of the POCT team.

Ketone Measurement

To comply with the DKA guidelines and to support the diagnosis and management of patients with DKA the POCT team manage the ketone meter service within the Trust. Meters have been installed in areas where a clinical need has been identified and approved. Training and full service report is provided by the POCT team.

Other POCT Services

As well as these tests the POCT team are currently managing or are reviewing the following services:

DDimer testing, urine analysis including hCG testing (pregnancy testing) and dipsticks for screening, Haemostasis testing (ACT, APTT, ROTEM, TEG), Haematology clinics, Biochemistry one stop clinics and sexual Health testing.

If any clinical areas require advice or guidance on the installation or use of POCT systems please contact us to discuss further.

The POCT team can be contacted by: Telephone – extension 15976
Bleep - 1189
Email - This email address is being protected from spambots. You need JavaScript enabled to view it.

Prolactin and Macroprolactin

The laboratory will perform a screening test for immunoglobulin bound prolactin (macroprolactin) on samples with a prolactin greater than 600 mIU/L. Please contact the laboratory for further information.

Repeat Transfusions (sample interval)

One of the complications of blood transfusion is that the patient may develop a new red cell antibody. Red cell antibodies may cause a serious transfusion reaction if incompatible blood is given to the patient. If there is a gap between transfusions then a new sample is required to check whether a new antibody has developed.

For repeat transfusions the following applies:

Patients Transfused Within the Last 3 Months

Samples collected no more than 72 hours prior to the actual transfusion when the patient has been transfused or pregnant within the preceding 3 months.

ROH, QEHB and Pre Assessment Clinics

The samples from patients attending QEHB and ROH pre-op assessment clinic are stored for 4 weeks. It is important that pre-operative assessment clinic nursing staff inform patients that a condition of keeping the transfusion sample for 4 weeks is that patients must inform the ward upon admission that they have had a transfusion elsewhere or are or have been pregnant. In these cases, a new transfusion sample must be taken. Samples which contain antibodies require a FRESH sample for crossmatch.

Renal

If a patient attending the dialysis unit as an out-patient has a sample taken during the visit, providing no transfusion was given at the same visit, this sample can be used. If a transfusion was given then a fresh sample MUST be taken no more than 72 hours before the next transfusion episode.

Cardiac Clinic

The samples from patients attending cardiac pre-op assessment clinic are stored for 4 weeks during which time some patients may have received top up transfusions pre–op. As a precaution when the cardiac list arrives check each transfusion history.

Haematology Day Unit

The requests for cross-match from patients attending Haematology Clinics are for in-patient treatment during the next few days and providing the patient has not been transfused for 3 months prior the sample being taken then this sample is safe to use. If the patient has been transfused during the last 3 months then a fresh sample MUST be taken no more than 72 hours before the next transfusion episode unless the consultant concerned authorises the use of the sample.

Liver

Liver samples are kept for seven days in the specimen fridge. Treat as a routine group and save sample.

IF IN DOUBT IT IS SAFER TO REQUEST A FRESH SAMPLE

Reservation Period

Blood for Surgery

Cross-matched blood for patients undergoing surgery will be automatically de-reserved between 08.00 and 09.00 two days following the stated date required and the blood returned to bank stock. If the operation is delayed, or if you wish to transfuse after this time, then you must telephone the Blood Bank so that the blood will continue to be reserved for your patient. Platelets, Fresh Frozen Plasma and Cryoprecipitate will be automatically de-reserved between 08.00 and 09.00 on the day following the date required.

Blood for Anaemia

Cross-matched blood will be held for a maximum of 48 hours after the stated time required or first unit transfused. The patient may have formed antibodies during this time and it is therefore unsafe to transfuse the remainder of the cross-matched blood. If further transfusion is required, please send a fresh blood sample and transfusion request.

Return of Blood and Blood Components

All unused blood/components must be returned to Blood Bank with the form Authority For Return of Unused Blood/ Blood Components. Please complete all patient details on the form. Return Blood/FFP to drawer marked ‘returned blood’ in Issue Blood Bank fridge. If cryoprecipitate or platelets are to be returned, contact Blood Bank. If blood/FFP was not stored at 4o (+/- 2o) for longer than 30 minutes, the Blood Bank on 13297 or bleep 1376, must be contacted.

Serious Adverse Reactions and Events - SHOT and SABRE

It is mandatory that serious transfusion hazards and incidents must be recognised, managed and reported to either SHOT (Serious Hazards of Transfusion); and/or SABRE (Serious Adverse Blood Reactions and Events). All blood transfusion related incidents, including serious transfusion reactions, must be reported using the Trust Clinical Incident process. In addition Blood Bank must be notified immediately by telephone so that appropriate investigation can be undertaken which may include the immediate withdrawal of issued components. The Hospital Transfusion Team will generate a report for SHOT and SABRE, and the matter will be reported to the Hospital Transfusion Committee. All transfusion reactions will be investigated by the laboratory.

Therapeutic Drug Monitoring (TDM)

A TDM service is provided in the department of Clinical Biochemistry for some of the drugs requiring regular monitoring. Please check the time at which a sample should be collected as failure to collect the blood at the appropriate time will make it impossible to compare the measured concentration with an accepted therapeutic range. Assays are of little use under these conditions.

The monitoring of valproic acid is not recommended because of the poor correlation between plasma levels and therapeutic effect. The duty biochemist must be contacted to discuss its measurement for any other purpose.

Any request for urgent therapeutic drug analysis that is not provided by Clinical Biochemistry must be discussed with the Duty Biochemist, or when out-of-hours with the duty Biomedical Scientist who may ask you to discuss this with the Duty Consultant. In some circumstances additional discussion with a pharmacist is required. Some specimens requiring analysis out-of-hours may need to be sent to the Toxicology unit at City Hospital and if you organise this without consulting the Pharmacy department you will incur charges to the trust that will not be the responsibility of Clinical Biochemistry.

Overdoses/Drug Screens

Samples for a 'Drug Screen' are analysed at the Regional Toxicology Laboratory (RTL) at City Hospital. A request for a "drug screen" or ‘unknown drug’ requires:-

  • At least 10 mL of urine in plain tube (NOT containing boric acid).  A green top (Lithium heparin anticoagulant) tube filled with blood.  Detailed patient information.
  • Clinical condition e.g. coma grade, fitting etc.
  • Current known prescribed drugs.
  • Overdose drug(s) if known.
  • Urine specimen type e.g. voided or catheter.

Blood samples taken for a ‘Drug Screen’ are of little use unless there is prior knowledge of the agent ingested. Discuss whether a blood sample is of use with the duty biochemist or duty consultant (via the out-of-hours Biomedical Scientist). Paracetamol, salicylate and lithium measurements are available on a 24 hr basis. All requests for other ingested drugs must be discussed with the Poisons Unit and Regional Toxicology Laboratory and samples sent only by prior arrangement. Any samples requiring urgent analysis at the Regional Toxicology Laboratory will require direct dispatch to that laboratory and must not be sent to the Clinical Biochemistry department. Charges realised by these analysis will be forwarded to the relevant division.

Antibiotics

Amikacin, gentamycin, tobramycin and vancomycin are measured in Clinical Biochemistry but clinical advice is given from Microbiology. For patients with liver or renal impairment, advice on antibiotic dosage is available from Clinical Microbiology.

Assays for other antimicrobials including flucytosine, teicoplanin and streptomycin are available from Microbiology after prior consultation with the Clinical Microbiologist.

Thyroid Function Tests

TSH and free thyroxine (fT4) are provided as first-line tests. Since many drugs and treatments affect thyroid function tests, details of all drugs or other treatment must be provided in order that further tests can be initiated by the laboratory as appropriate. Please indicate on request form if patient is on thyroid hormone replacement.

Free T3 is analysed only according to an agreed protocol and full clinical details must be given on the request form.

Thyroid hormone measurements can be misleading in patients with acute and non-thyroid illness. Thyroid status should only be assessed after recovery from acute non-thyroidal illness. 'Screening' of patients in hospital for thyroid illness is not recommended.

Please see the UK Guidelines for the Use of Thyroid Function Tests at: http://www.british-thyroid-association.org/current-bta-guidelines-

Traceability

By law blood bank is required to document evidence of the fate of every blood component received by the Trust. If blood or blood components are administered to a patient, it is the clinical areas responsibility to record this evidence in PICS or the area’s blood registers/transfusion record. All blood components that are not transfused must be returned to blood bank as soon as possible with appropriate documentation (form WNP 0606; authority to collect/return blood or blood components). The law requires 100% traceability and Blood Bank audits, reports and monitors compliance on a continuous basis. Issues of non-compliance are reported to the Trust’s Hospital Transfusion Committee on a quarterly basis and to the MHRA in an annual return.

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Location of Laboratories

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