Cellular Pathology - University Hospitals Birmingham

Cellular Pathology is based across UHB sites at QE Hospital Birmingham,  nearby to the QE in the Robert Aitken Building, at Birmingham Heartlands Hospital, Solihull Hospital and at Good Hope Hospital.

The majority but not all of Cellular Pathology tests that are performed and equipment in use are accredited to internationally recognised standards for medical laboratories ISO 15189.  This is important for the Department and for service users as it provides assurance on quality and competence.   There is increasingly an integrated approach across the different UHB hospital sites where staff, equipment and testing may be shared to deliver the highest possible quality services to our service users. The full range and nature of accredited tests is detailed on the United Kingdom Accreditation Service website and the Department worked during 2022 to integrate all testing in to a single integrated UKAS accredited laboratory under UKAS lab ref. 10141 as below.

Please select the link below for the UKAS schedule of accreditation relating to UHB Cellular Pathology accredited testing. Please note UHB Cellular Pathology includes QE, Heartlands, Good Hope and Solihull sites and Musculoskeletal Lab Cellular Pathology testing. The Department has been assessed by UKAS as lab 10141 early in 2023 UKAS as a single accredited laboratory and so this testing schedule is subject to UKAS decisions to reflect updated repertoire and extensions to our testing scope.

https://www.ukas.com/wp-content/uploads/schedule_uploads/00007/10141-Medical-Single.pdf

At the QE site the laboratory has recently updated equipment H&E, special stains and immunohistochemistry staining platforms to support high quality diagnostic cellular pathology reporting and to ensure full traceability of samples within the laboratory.  Other new tests to meet clinical requirements are regularly added to the testing repertoire.  Consequently not all platforms, special stains and antibodies have been assessed by UKAS and so will not currently be covered by published UKAS Accreditation scope to ISO15189.   

The Department is currently supporting the Trust with significant increases in clinical activity.  For some specialties reporting times have fallen bellow targets and so the Department is working with service users to minimise the impact of this.  The Department is prioritising clinically urgent requests and patients on cancer pathways, recruiting and working additional sessions.  The Department is also outsourcing reporting of some requests to two external specialist UKAS Accredited suppliers that hold contracts with the Trust.

Specialist Services  within Cellular Pathology (by site) QE=Queen Elizabeth, BHH=Birmingham Heartlands, SH = Solihull MSK=Musculoskeletal Pathology, GH=Good Hope		UKAS Accredited Tests
MOHS (QE, SH)	Mohs, is microscopically controlled surgery used to treat common types of skin cancer. ......................................................................	Yes
Neuropathological Smears (QE)	The Department provides a rapid diagnostic service for intra-operative brain tissue specimens. ......................................................................	Yes
Cytopathology (BHH,QE)	The Department provides the diagnostic cytopathology services for the Trust including fine needle aspirations, endoscopic brushings and washings, EUS-FNAs , serous fluids urines and CSF.                                                                    .......................................................................	Yes
Muscle Biopsy Service (QE)	Muscle biopsies are performed as part of the investigation of a clinically suspected neuromuscular disorder when other less invasive tests have not provided a firm diagnosis.                                      .......................................................................	Yes
Electron Microscopy Service (QE)	The Electron Microscope Unit is used routinely at magnifications of between 1500 and 70,000 times to examine the ultrastructure of cells and their surroundings.                                                        .........................................................................	Yes
Andrology (GHH)	Diagnostic, Post Vasectomy and Retrograde  Semen analysis .                                                                .........................................................................	Yes
Direct Immunofluorescence (BHH)	Direct immunofluorescence is used for the detection of  tissue bound proteins such as antibodies and complement proteins. Two types of tissue, skin or renal, are processed, This method allows for the detection of tissue bound antibodies when there may be insufficient levels to detect in serum.                    .........................................................................	Yes
Mortuary (QE, BHH, SH, GH)	Body storage available on all sites with 10 freezer storage spaces available on the Solihull sites.  Post Mortems can be carried out on the Heartlands and QE sites.                                                                    ..........................................................................	Yes
Immunohistochemistry (QE,MSK, BHH)	This technique is carried out using different platforms and antibodies across the sites.  See attached UKAS scope for those antibodies accredited.  At present there are several antibodies that are not yet accredited but will be added to the scope in due course.                                               ..........................................................................	Yes

Minimum Dataset required for Cellular Pathology Requests

In order to process specimens it is essential that request forms are fully completed in a clear and legible format. The use of patient ID stickers is permitted however please ensure you use the full patient sticker NOT the smaller blood tube sticker. All specimens received into Cellular Pathology must meet the agreed laboratory minimum dataset; any specimens not meeting the criteria will be returned to the requesting department.  Please ensure that any important information (e.g. clinical history, bleep number etc.) is clearly indicated on the form and ensure that any priority or urgent cases are marked as such.

• Trust cases can be requested via a theatre book or by completing an internal UHB histopathology / cytopathology request form. 
• GP and dental practices should complete the external request form which can be supplied on request from the Department and for internal service users this link http://www.uhb.nhs.uk/gps/laboratory-information/ shows this request form together with specific request forms used within the Trust (QE site)  for liver and breast biopsy cases.

Specimen Labelling and Multi-Part Cases

If more than one specimen from the same patient attributed to a case is sent they should be clearly indicated as part 1, 2, 3 etc. with an note on the request form detailing the site of the specimen.

Hazardous Specimens

Specimens arising from patients with known or suspected transmissible diseases (e.g. tuberculosis, viral hepatitis, HIV) must be clearly labelled as such to prevent unnecessary risk to laboratory staff.

Specimen Containers 

When requesting stock a member of staff from the Cellular Pathology department will inform the requestor when they will be ready for collection by the portering staff. Consumables provided by the lab should be transported via the porters so please allow time for preparation and transport.  Please note specimens must be despatched to the Department within a secondary bag or secure transport box with sufficient absorbent material to absorb/contain any potential spillage.

Transportation of Specimens

Specimens are collected at regular intervals from theatres and all relevant departments via portering services. Urgent and unfixed (dry/not in formalin) specimens should NOT be left until the next routine collection – telephone portering services and arrange for a member of staff to bring the sample(s) to the laboratory without delay.

Urgent Reporting

Occasionally it may be necessary for a requesting clinician to highlight a specimen as clinically urgent. If an urgent report is required it should be clearly identified or indicated on the request form. Urgent requests should be sent to Cellular Pathology via the porters without delay.

To ensure that cases are not delayed within the laboratory please make sure that the request form is correctly completed and all sections are filled in properly. Once received urgent cases will be highlighted by the specimen reception and prioritised appropriately in the departmental workload.