HAEMATOLOGY DEPARTMENT USER MANUAL - Norfolk and Norwich University Hospital
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Eastern Pathology Alliance Haematology NNUH User Manual Page 1 of 38
Dept/Site : Haematology NNUH Doc Ref: EBN-HQP-001 Author: A. Macartney
Revision: 7 Issued: 16/04/2021 Authorised by: R. Pipkin Review interval: Annual
Norfolk and Norwich University
Hospital
HAEMATOLOGY DEPARTMENT
USER MANUAL
April 2021
Eastern Pathology Alliance Haematology NNUH User Manual Page 2 of 38
Dept/Site : Haematology NNUH Doc Ref: EBN-HQP-001 Author: A. Macartney
Revision: 7 Issued: 16/04/2021 Authorised by: R. Pipkin Review interval: Annual
Version control sheet: HAEMATOLOGY DEPARTMENT – USER MANUAL
Version Date Author Status Comment
4 16.10.18 KS Active UKAS accreditation notes added to tests
4 08.11.18 MW Active UKAS schedule added as embedded document
5 18.04.19 KW Active Removal of UKAS schedule PDF and addition of hyperlink
5 18.04.19 KW Active Addition of information regarding which tests are sent to
referral laboratories
5 18.04.19 KW Active Statement regarding consent to share information
5 18.04.19 KW Active Complaints responsible person changed
5 18.04.19 KW Active Staff updates
5 18.04.19 KW Active Changes to analysers for FBC & Misc. Fluid Cell Count
5 18.04.19 KW Active Addition of reference to Massive blood loss in children doc
5 18.04.19 KW Active BT referral labs
6 04.02.20 KW Active CR7656 Contents page - says Molecular genetics is on p39,
should say p29; Section 5 refers to Trust Venepuncture Policy
v6, should say v7.
6 04.02.20 KW Active CR8123 Page 7, remove the Trust documents revision
numbers as the two quoted are out of date. Just use the
trust ID number
6 04.02.20 KW Active CR8395 harmonise telephone criteria to EPA-HAP-061
6 04.02.20 KW Active Add in reference to Introducing Pre-Labelling of Pathology
Samples Trust Doc ID 14472
6 04.02.20 KW Active Updated Trust draw order (Appendix 1)
7 17.03.21 DS Active Pg 4 Specific wording regarding laboratory accreditation
status changed
Pg 4 Clarification made regarding what is and is not included
within Accreditation schedule for UKAS.
Eastern Pathology Alliance Haematology NNUH User Manual Page 3 of 38
Dept/Site : Haematology NNUH Doc Ref: EBN-HQP-001 Author: A. Macartney
Revision: 7 Issued: 16/04/2021 Authorised by: R. Pipkin Review interval: Annual
Haematology User Manual
INDEX
Section Page
1 Introduction 4
2 Location 4
3 Contact names and numbers 5
4 Working hours 6
5 Phlebotomy 6
6 Samples 8
6.1 General guidelines 8
6.2 Rejection of unacceptable samples 9
6.3 Packaging and transport of samples 10
6.4 Sending samples via the pneumatic tube system 10
6.5 Transport to Microbiology NNUH 11
7 “High risk” samples 11
8 Tests and sample requirements 12
8.1 Routine Haematology tests 12
8.2 Routine Coagulation tests 14
9 Result enquiries/Telephoned results 15
10 Clinical Liaison 15
11 Complaints 16
12 Non-NHS samples 16
13 Haematology Reference Ranges / Turnaround times 17
14 Transfusion 25
14.1 Consultants and senior staff 25
14.2 Sample labelling and request forms 27
14.3 Component requesting 26
14.4 Collection and administration of blood components 27
14.5 Transfusion reactions 27
14.6 Massive blood loss protocol 27
14.7 Transfer/receipt of components with a patient between hospitals 28
14.8 Transfusion Referral Laboratories 28
15 Molecular Genetics 29
16 Referral Laboratories 30
17 Add-on Tests 31
18 Key factors known to affect test performance and result interpretation 32
Appendix 1: Advice on use of vacutainer tubes / Tube Guide
Appendix 2: Storage, retention and disposal of clinical samples
Appendix 3: Point Of Care Testing (POCT)
Appendix 4: Supply of specimen containers and request formsEastern Pathology Alliance Haematology NNUH User Manual Page 4 of 38
Dept/Site : Haematology NNUH Doc Ref: EBN-HQP-001 Author: A. Macartney
Revision: 7 Issued: 16/04/2021 Authorised by: R. Pipkin Review interval: Annual
1. Introduction
The Haematology Department based at the Norfolk and Norwich University Hospital (NNUH) is part
of the Eastern Pathology Alliance (EPA), a managed Pathology network involving NNUH, the James
Paget University Hospitals NHS Foundation Trust and the Queen Elizabeth Hospital Kings Lynn.
The Laboratory’s services include Automated Haematology and Coagulation, Specialised
Coagulation, Malaria, Morphology, Transfusion, Molecular Genetics and Andrology. In order to
maintain high standards of analysis this Department participates in national external quality
assessment schemes (EQA).
The Haematology Department is a UKAS accredited medical laboratory No. 10295. The defined
schedule of tests for which the laboratory is accredited can be found by clicking on the link below.
Haematology accreditation no. 10295
Please note that this schedule does not include Andrology, Molecular Genetics or Blood Transfusion
which are not UKAS accredited.
The Blood Transfusion section is compliant with the requirements of the Blood Safety and Quality
Regulations 2005 as assessed by the Medicines and Healthcare Products Regulatory Agency (MHRA).
This user manual provides information about how users can access our services, who to contact for
advice, which tests we perform, sample requirements, normal ranges and turnaround times.
The information within this manual is accurate at the time of issue and is reviewed and updated
regularly to incorporate new developments.
For patients using this manual, please note that any information provided should not be used for
self-diagnosis and should you have any concerns about your health please consult your GP.
If you find any errors within this document or would like to make any comments and/or suggestions
for improvement, please contact David Stokely, EPA Quality Manager on 01603 286900 or email
david.stokely@nnuh.nhs.uk
NOTE: All information held by the laboratory regarding patients and their results is in accordance
with the NNUH Trust policy on patient confidentiality: Confidentiality Protocol v5. Doc ID 8265.
2. Location
The Haematology Department is located on Level 1 in East Block at the Norfolk and Norwich
University Hospital. Directions to Pathology, where the department is located, can be sought from
the reception areas at the major entrances to the hospital.Eastern Pathology Alliance Haematology NNUH User Manual Page 5 of 38
Dept/Site : Haematology NNUH Doc Ref: EBN-HQP-001 Author: A. Macartney
Revision: 7 Issued: 16/04/2021 Authorised by: R. Pipkin Review interval: Annual
Phlebotomy – Level 3
Pathology – Level 1
3. Contact names and numbers
Consultants
Clinical Consultant Ext. 6744
Laboratory Consultant Bleep 0158
Specialist Registrar Bleep 0163
Medical Staff Secretary Ext. 6750, Fax 01603 286918
Dr. Hamish Lyall Clinical Lead, Haematology 01603 287865/Ext. 3865
Prof. Kris Bowles Consultant Haematologist 01603 289979/ Ext. 5979
Dr. Matt Lawes Consultant Haematologist 01603 289979/Ext. 3106
01603 289942/Ext.
Dr. Nimish Shah Consultant Haematologist
01603 286987/Ext. 2897
01603 286899/Ext.
Dr. Angela Collins Consultant Haematologist
01603 286984/Ext. 2894
Dr. Suzanne Docherty Consultant Haematologist 01603 286895
Dr. Cesar Gomez Consultant Haematologist 01603 287695/Ext. 2894
Dr Victoria Willimott Consultant Haematologist
Haematology Scientific staff
Dr. Gavin Willis Clinical Scientist, Molecular Genetics 01603 287068/Ext. 3068
Alistair Macartney Chief Biomedical Scientist 01603 286909/Ext. 2909
Carol Harvey Network Transfusion Manager 01603 287337/Ext. 3337
Diane Murley Network Transfusion Quality Lead 01603 287337/Ext. 3337
EPA Staff
Nigel Roberts EPA Service Operations Manager 01603 286936/Ext. 2936
Richard Pipkin EPA Network Blood Sciences Manager 01603 286901/Ext. 2901
David Stokely EPA Network Quality Manager 01603 286900/Ext. 2900
Ginny Marley EPA Network Assistant Quality Manager 01603 286903/Ext. 2900
Rebecca Cozens EPA Network Training Manager 01603 286963/Ext. 2963
Specialist Haematology Nurses – Ext. 6753
Amanda Hutchings – lead nurse
Christine Havers
Liz McClagish
Rhodora Manville
Catherine StephensonEastern Pathology Alliance Haematology NNUH User Manual Page 6 of 38
Dept/Site : Haematology NNUH Doc Ref: EBN-HQP-001 Author: A. Macartney
Revision: 7 Issued: 16/04/2021 Authorised by: R. Pipkin Review interval: Annual
Specialist Anticoagulant Nurses – Ext 3809
Specialist Transfusion Practitioners – Bleep 0852 or 0663
Alison Rudd
Kathy Ford
4. Working hours
The laboratory is open 24 hours a day, 7 days a week but operates core working hours of Monday to
Friday 08.00 - 20.00hrs and 09.30 - 12.30hrs at the weekend (except Molecular Genetics). During
these times we are routinely staffed and will be able to respond to most requests.
Outside these hours Haematology operates a shift system and qualified Biomedical Scientists are
available in the department to undertake emergency and certain routine tests. Special or unusual
tests may have to be analysed in batches and may not be available outside the core times.
The laboratory does not need to be contacted if urgent routine investigations are required.
5. Phlebotomy
The Phlebotomy Department is managed by Haematology. Our team of Phlebotomists is dedicated
to providing a service of the highest standard to the Norfolk and Norwich University Hospital
inpatients and outpatients.
The main out-patient department is based in East Block on Level 3, opposite the Elsie Bertram
Diabetes Centre. There is also a smaller clinic in the West OPD, also on level 3 next to the Early
Pregnancy Unit. For further details please refer to appropriate section below.
East Outpatients (located on level 3 East Block)
Walk-in and appointment clinic
Glucose Tolerance Tests (by appointment only)
Babies and children
To make an appointment please telephone 01603 286921
Normal opening times: Monday to Friday 08:30 - 16:55
Please note if there are more than 6 patients waiting for a blood test at 16:45 the door will be
closed.
Due to staff training the phlebotomy East OPD clinic will open at 9.05 am on the last Wednesday of
every month.
West Outpatients (located on level 3 West Block)
Walk-in clinic
Glucose Tolerance Tests (by appointment only)
Babies and children (depending on phlebotomist availability)
Normal opening times: Monday to Friday 08:30 - 16:55Eastern Pathology Alliance Haematology NNUH User Manual Page 7 of 38
Dept/Site : Haematology NNUH Doc Ref: EBN-HQP-001 Author: A. Macartney
Revision: 7 Issued: 16/04/2021 Authorised by: R. Pipkin Review interval: Annual
Please note if there are more than 6 patients waiting for a blood test at 16:45 the door will be
closed.
Due to staff training the phlebotomy West OPD clinic will open at 9.15 am on the last Wednesday of
every month.
Weekends and Public / Bank Holidays
The East and West OPD clinics are closed on weekends and public / bank holidays.
The phlebotomy ward round operates 365 days a year.
Ward Rounds
Daily Ward rounds are carried out at the following times 365 days a year:
Monday - Friday 07:30 - 12:30
Weekends and Public / Bank Holidays 07:15 - 10:45 (non- routine / essential bloods only)
All wards are covered except Buxton Ward.
The phlebotomy ward round service will be reduced to allow for staff training on the last Wednesday
of every month.
Request Forms
Forms must be requested on Web Ice by 06:00 for that day’s round.
Extra forms will not be accepted by the phlebotomists during the ward round.
Requests marked 'URGENT' WILL NOT be taken by the Phlebotomist - these must be done by the
requesting clinician.
Request forms which have the incorrect location on the request form will be sent to the correct
location (if identified) via the pneumatic air tube system. If the phlebotomist on the correct location
has already completed their ward round the request form will become the responsibility of the ward
staff to obtain blood sample collection for their patient.
If the phlebotomist is unable to obtain blood sample collection the request form will be returned to
the clinician.
Patient consent:
NOTE - All procedures carried out on a patient need the informed consent of the patient.
For most routine laboratory procedures, consent can be inferred when the patient presents
himself or herself at a laboratory, or other suitable area, within a primary or secondary care
setting, with a request form and willingly submits to the usual collecting procedure.
Patient preparation and all other procedures must be followed as detailed in the Trust phlebotomy
documents.
Venepuncture policy E3 Trust Doc ID 1114.
24 hour advance blood test request policy Trust Doc ID 5092.Eastern Pathology Alliance Haematology NNUH User Manual Page 8 of 38
Dept/Site : Haematology NNUH Doc Ref: EBN-HQP-001 Author: A. Macartney
Revision: 7 Issued: 16/04/2021 Authorised by: R. Pipkin Review interval: Annual
6. Samples
6.1 General guidelines
All requests for pathology investigations must be made by, or on behalf of, a registered medical
practitioner, a recognised nurse practitioner or similar, to whom the results will be sent (see below
for patient detail requirements). Requests signed by an authorised person (e.g. practice nurse) on
behalf of a practitioner are acceptable as long as the origin is stated clearly and the request is fully
completed (including relevant clinical details).
If possible requests should be made using ICE which limits errors in patient identification and speeds
up workflow in the laboratory. When making a request please ensure that all the relevant patient
identification, clinical details and locations are provided, including the name of the requesting
physician. Contact information must be supplied when an urgent request is made.
A request form must accompany all specimens sent to the laboratory. For high risk samples also
attach a yellow biohazard/Danger of Infection label.
All request forms should clearly state the following information:
Patient’s surname and forename
Patient’s address
Date of birth
NHS number
Gender
Location and Consultant where applicable
GP practice code where applicable
Requestor’s name and telephone/bleep number
Type of sample/specimen
Date and time sample/specimen taken and who collected it
Investigations/tests required
All relevant clinical details including any treatment (recent, current and intended) and
foreign travel
Risk status - if applicable
Date of onset and duration of illness
Useful epidemiological information, e.g. date of contact if relevant
Priority level
The best results are obtained when an appropriate, well taken sample, in the proper container, is
delivered to the laboratory promptly and relevant clinical information is provided on the request
form.
General guidelines on sample collection are:
Please fill all sample bottles with the correct volume of blood.
Samples must be transported promptly to the laboratory. Delays can render the samples
unusable.
Samples should be stored at room temperature until transported to the laboratory.
The laboratory does not check the expiry date of sample collection devices when the sample
is received for testing. It is the responsibility of the person collecting and sending the sample
to ensure that the device is in date when the sample is collected and with sufficient time
remaining for the sample to reach the laboratory for processing.Eastern Pathology Alliance Haematology NNUH User Manual Page 9 of 38
Dept/Site : Haematology NNUH Doc Ref: EBN-HQP-001 Author: A. Macartney
Revision: 7 Issued: 16/04/2021 Authorised by: R. Pipkin Review interval: Annual
Patient Preparation:
Verify the patient’s identity against the laboratory requisition, using a minimum of four
points of identification (surname, forename, date of birth and hospital or NHS number),
confirmed with the patient wristband if present and where possible with the patient
themselves verbally.
Review the clinician’s request and the patient’s written or verbal consent and that any
special requirements have been met.
Review the procedure with the patient. Inform him or her about the tests for which the
samples are being collected and allow the patient to ask questions.
Please contact the laboratory if there is any doubt about the best sample to take or concerning the
availability of a test.
NOTE: All procedures and investigations carried out on a patient need the informed
consent of the patient.
Please note that the laboratory infers informed consent has been obtained when samples are
received. It is the responsibility of the clinician requesting the test to ensure that informed consent
has been obtained.
This consent includes notification to third parties where required by law for example under
the Health Protection (Notification) Regulations 2010: we are required to notify any
infection of public health significance to local public health department as mandated by the
regulation. Please ensure your patient is aware of this before submission of samples for
testing.
6.2 Rejection of unacceptable samples
Samples may not be suitable for testing if they are so inadequately labelled that the patient's
identification is in doubt, or if they have leaked or been contaminated. If samples are rejected every
effort is made to inform the requesting doctor first.
Samples and request forms are checked on receipt to confirm the patient identification (PID)
information provided on the form and sample agree. A minimum of four points of PID, ie. Surname,
Forename, Date of Birth and ID Number (Hospital or NHS) are required by the laboratory and these
must match in order for the sample to be accepted. It is good practice for us to have location andEastern Pathology Alliance Haematology NNUH User Manual Page 10 of 38
Dept/Site : Haematology NNUH Doc Ref: EBN-HQP-001 Author: A. Macartney
Revision: 7 Issued: 16/04/2021 Authorised by: R. Pipkin Review interval: Annual
date and time of sample but is not absolutely necessary. If errors are found the laboratory will
contact the requestor, explain the problem and request a repeat sample.
For samples that are not easily repeated (such as CSF or paediatric samples) the problem will first be
discussed with a BMS from the relevant section who will make a decision on whether testing may be
allowed to proceed (usually after discussion with the clinician concerned). Usually the requestor will
be given the opportunity to come to Pathology and complete patient information on the sample or
request and sign a disclaimer. If the sample is tested the report will clearly state the nature of the
problem as a comment. Alternatively, the requesting clinician will be asked to send a repeat sample.
For full details regarding incompletely labelled samples or forms please contact the laboratory.
6.3 Packaging and Transport of Samples
Samples are a potential source of infection and should be treated accordingly. Please fill all sample
bottles with the correct volume of blood to ensure correct anticoagulation, and all containers must
be securely closed. Leaking samples with gross contamination of contents and containers are
discarded. Pocket bags are available for sample transport. Samples should be placed in the
appropriate container, which must be securely fastened. This must be placed in a clear plastic bag
and sealed. Samples accompanied by forms without specimen bags must be put into marsupial bags
with the request form being placed in the side pouch.
Refer to local Trust policies.
The transport of samples from GP surgeries or other primary care locations is carried out by the
Logistics service staff who will collect all samples from dedicated collection points. Samples from
within the hospital can be transported to Pathology either by the Pneumatic Tube System (PTS) if
suitable or by a porter. For urgent samples ward staff are required to arrange delivery to the
laboratory. Samples must first be placed in the plastic sample bags together with the completed
request form.
The safe transport of specimens to the laboratory is the responsibility of the requesting doctor or
carrier. Laboratory responsibility for the sample begins when it has arrived at the laboratory.
NOTE: Packaging, labelling and transportation of specimen’s policy Trust Doc ID 7808.
Transportation of specimen’s policy Trust Doc ID 7806.
Introducing Pre-Labelling of Pathology Samples Trust Doc ID 14472
6.4 Sending samples via the pneumatic tube system:
All items MUST be sent in the carriers provided.
Samples MUST not be placed directly into the carriers. ALL Pathology samples MUST be
placed in specimen bags and the lids of all items with the potential to leak (fluids etc.) tightly
secured BEFORE placing them in the carriers.
Do not cram samples/items into the carrier as this may lead to breakage/leakage and system
failure.
Only one carrier at a time should be placed in a delivery station.
Ensure that carriers are closed securely at both ends to avoid them jamming in the tube
network.
If any defect is noticed with the operation of the air-tube systems please notify the
laboratory at the earliest opportunity.Eastern Pathology Alliance Haematology NNUH User Manual Page 11 of 38
Dept/Site : Haematology NNUH Doc Ref: EBN-HQP-001 Author: A. Macartney
Revision: 7 Issued: 16/04/2021 Authorised by: R. Pipkin Review interval: Annual
The system must not be used for sending consumables and other “forbidden items” around
the hospital.
The air tube systems are for the transport of Blood Sciences specimens to the laboratories only.
The air-tube system should NOT to be used for:
Danger of Infection samples
Blood gases
Blood cultures
Unrepeatable samples
CSFs (for culture, protein, glucose or xanthochromia)
SEE INDIVIDUAL TRUST POLICIES.
6.5 Transport to Microbiology NNUH
During normal working hours:
Non-urgent specimens from NNUH should be taken/sent to Pathology Reception, East Block,
Level 1, Norfolk and Norwich University Hospital; these will be delivered by routine van runs to
the EPA Microbiology Department.
Urgent specimens from NNUH should be taken to the Security desk at the West Atrium for
delivery to the EPA Microbiology Department. The EPA Microbiology Department must be
contacted to ensure that the specimen is dealt with immediately.
Outside normal working hours:
Non urgent specimens from NNUH should be taken/sent to Pathology Reception, East Block,
Level 1, Norfolk and Norwich University Hospital, for delivery the following day to the EPA
Microbiology Department.
Urgent specimens from NNUH should be sent to the Security desk at the West Atrium NOT
Pathology and instructions given to send the specimen to the Microbiology Laboratory.
Remember the Microbiology service is provided from the Norwich Research Park, Colney.
The specimen will be sent to the Microbiology Department via the most appropriate
available transport.
7. “High Risk” samples
Medical officers responsible for the care of patients have a duty of care towards other members of
staff - therefore all samples from patients who are known to have, or strongly suspected of having
the conditions noted below must be identified.
Creutzfeldt - Jakob disease
Viral haemorrhagic fever (VHF) of any type
Microorganisms, (biological agents) in Hazard Group 3 or 4.
Pyrexia of unknown origin (PUO) recently returned from Africa.
Medical staff should ensure that appropriate information, including relevant travel history, is
provided in order to alert laboratory staff of potential dangers. Clinical details supplied on sample
request forms must contain clear information regarding the nature of the test being requested and
sufficient detail to inform laboratory staff upon the safety precautions they need to take in order to
process the sample without risk of infection.
If, during patient intervention, further information becomes available that has implications for the
safety of laboratory staff this must be communicated immediately to the laboratory so thatEastern Pathology Alliance Haematology NNUH User Manual Page 12 of 38
Dept/Site : Haematology NNUH Doc Ref: EBN-HQP-001 Author: A. Macartney
Revision: 7 Issued: 16/04/2021 Authorised by: R. Pipkin Review interval: Annual
appropriate steps regarding containment can be taken.
NOTE: Patient suspected of having VHF (guidelines) v3. Doc ID 10584
Contact details for the Infection Protection and Control Nurses:
09:00 - 17:00 Mon-Fri Tel: 01603 289847 (Ext: 5847)
Email: IP&Cadministrator@nnuh.nhs.uk
Out of hours: First contact the relevant site practitioner.
See flow chart: Infection prevention and Control On-call Service Flow Chart IP&C guidelines and
policies can be found on the IP&C Manual on the Intranet or by using the “Hands” shortcut on the
desktop.
8. Tests and sample requirements
8.1 Routine Haematology Tests
Full Blood Count (FBC):
Abbott Alinity H analysers produce a complete automated blood count result with a differential and
platelet count - individual parameters need not be requested. Reticulocytes and Nucleated Red
Blood Cell Analysis can also be undertaken where appropriate.
Blood films are made and examined if requested or if the parameters suggest that a manual film
and/or differential will be helpful.
Sample Requirements: 3 ml ETDA or Paediatric EDTA.
Erythrocyte Sedimentation Rate (ESR) :
The ESR is an indirect measure of the degree of inflammation present in the body. It is a non-specific
test and has to be interpreted within the clinical context in which it is requested. It may be helpful in
diagnosing inflammatory disorders such as temporal arteritis/polymyalgia rheumatica and may also
be used to monitor disease activity and response to therapy in these and other inflammatory
disorders. It is affected by age, gender and anaemia.
Analysed on request.
Sample requirements: 3ml EDTA – can use the same sample as FBC.
Detection of Epstein Barr Virus (Paul Bunnell):
A test for the presence of heterophile antibodies in the serum produced in infectious
mononucleosis.
Sample requirements: 3 ml EDTA - can use the same sample as FBC.
Malarial Parasites:
Thick and thin blood films are stained with Giemsa stain and examined for the presence of malarial
parasites. A rapid immunological test is also performed as a complementary test to the standard
blood film examination.
Blood films for malarial parasites will be made on request if clinical indications suggest the patient is
at risk of malaria. Positive blood films are sent to the London School of Hygiene and Tropical
Medicine for confirmation.
Sample requirements: 3ml EDTA.
SAMPLE SHOULD ARRIVE IN THE LABORATORY NO LATER THAN 4 HOURS AFTER BEING TAKEN.Eastern Pathology Alliance Haematology NNUH User Manual Page 13 of 38 Dept/Site : Haematology NNUH Doc Ref: EBN-HQP-001 Author: A. Macartney Revision: 7 Issued: 16/04/2021 Authorised by: R. Pipkin Review interval: Annual Haemoglobinopathy Screening: Haemoglobinopathy screens can be requested for any patient who might be considered to be at risk of having a haemoglobin variant or thalassaemia. A haemoglobinopathy screen consists of a Full Blood Count and Hb HPLC analysis. If haemoglobin variants are detected by HPLC, confirmation will be performed by electrophoresis and the Sickle Solubility Test. Rare haemoglobin variants that cannot be identified by our laboratory are referred to the Special Haematology Laboratory at Guy’s Hospital (Viapath). These tests should be requested by the patient’s clinician with prior consent. The laboratory does not take telephone requests for add-on haemoglobinopathy screening unless made by a Consultant Haematologist. Sample requirements: 3ml EDTA – can use the same sample as FBC. Sickle Cell Solubility Screen: This is a rapid test to detect the presence of sickle haemoglobin, eg. HbS but in itself doesn’t distinguish between sickle cell trait and sickle cell disease. Positive screen results will be referred for further confirmatory tests. This test is performed when Hb HPLC indicates the presence of a haemoglobin variant or if a rapid result on sickle status is required. Sample requirements: 3ml EDTA – can use the same sample as FBC. Antenatal Sickle Cell and Thalassaemia screening: NNUH participates in the National Screening Programme as a “low prevalence area”. Screening is performed according to the National Screening Programme guidelines using FBC, family of origin questionnaire and, when indicated, HPLC. Sample requirements: 3ml EDTA – can use the same sample as FBC. Glucose-6-phosphate dehydrogenase (G-6-PD) Screening Test: G-6-PD deficiency is the most common inherited genetic enzyme deficiency. Most individuals are asymptomatic, but devastating haemolysis can occur when susceptible patients are exposed to oxidative drugs or infection. It is important to identify individuals at risk as certain drugs may then be avoided. The screening test is based on a qualitative visual fluorescence screening procedure. This test is not performed by the NNUH laboratory – Please note - samples are sent away. Sample requirements: 3ml EDTA – can use the same sample as FBC. Urinary Haemosiderin: Haemosiderin is a pigment formed during the breakdown of haemoglobin and indicates chronic intravascular haemolysis. The test may be used to evaluate and manage disorders involving the destruction of red blood cells. Centrifuged urine deposits can be stained and examined for the presence of urinary haemosiderin. The test is normally only performed at the request of Haematology clinicians. Sample requirement: Urine in Universal Container -not Boric Acid. Cerebrospinal Fluid (CSF) Analysis: CSF is centrifuged, the resulting preparation stained and a manual count made of any cells present. Usually only performed if requested by Haematology Registrar/Consultant if there is a suspicion of CNS involvement in haematological neoplasms. Any other reasons for cell counting should be referred to Microbiology or Cytology. Sample requirement: 1ml CSF. Bone Marrow Sample Analysis: Bone Marrow samples are only taken by a Haematology medical staff. All diagnostic samples (morphology, cytogenetics, molecular genetics) are sent to Addenbrookes Haematopathology and Oncology Diagnostic Service (HODS) for analysis. Depending on the clinical
Eastern Pathology Alliance Haematology NNUH User Manual Page 14 of 38 Dept/Site : Haematology NNUH Doc Ref: EBN-HQP-001 Author: A. Macartney Revision: 7 Issued: 16/04/2021 Authorised by: R. Pipkin Review interval: Annual indication some bone marrow aspirate slides are also processed in duplicate at NNUH to allow for a provisional result and assist with patient management. Turn-around times depend on the assays required. Discuss with haematologist. Peripheral blood Leucocyte Immunophenotyping: Samples are sent to Addenbrookes HODS. See above Sample Requirements: 3mlEDTA Miscellaneous Fluid Cell Counts: Samples are assayed using the Abbott celldyn Ruby analysers and the total White Cell Count reported. Some samples may not be appropriate for analysis if they contain clots or other particulate matter. Sample requirements: Fluid preferably in an EDTA container. 8.2 Routine Coagulation Tests Coagulation Screening: Prothrombin Time/International Normalised Ratio (PT/INR) and Activated Partial Thromboplastin Time (APTT) are our standard coagulation tests. Prolonged clotting times are an indication of abnormal clotting which could lead to an increased risk of bleeding. Further coagulation investigations may be reflexed by the laboratory depending on the nature of the coagulation results and previous test results to aid interpretation. Clauss fibrinogen is reflex tested if the coagulation analyser indicates that the fibrinogen level is likely to be low (derived fibrinogen). Fibrinogen can also be requested by the requesting clinician. When requesting coagulation screening tests it is important to include relevant clinical information as to why the test was requested to enable laboratory staff to determine the best course of action in the event of an abnormal result. It is not appropriate to request a coagulation screen for patients receiving warfarin or heparin as the reference ranges will not be valid. If monitoring of anticoagulants required select the appropriate test on ICE (warfarin monitoring or heparin monitoring) Anticoagulant monitoring: Always ensure the request form contains details of any anticoagulants given, follow prompts on ICE and ensure accurate information is given regarding type of anticoagulant and correct tests are requested. All INR results >5.0 will be telephoned to the GP practice. No other INR results are routinely telephoned. Coagulation results are accessible on ICE For queries related to the anticoagulant monitoring service contact the anticoagulation service on 01603 646515. VTE (venous thromboembolism) screening: D-dimer is used to help venous thromboembolism. It is a restricted test and should only be used in conjunction with a clinical probability score e.g. Wells score and when the result will affect patient management (e.g. allow VTE to be excluded without radiology tests). D-dimer results are generally raised in in-patients and should not be requested. WebICE does not permit D-dimer requests from inpatient locations. D-dimer requests which are not permitted by webICE can only be made after discussion with the duty haematologist who can sanction adding on the request to a coagulation screen if indicated. Specimen Requirements:
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3ml Citrate bottle (ensure it is filled appropriately).
Specialist Coagulation Tests:
Discuss with a Consultant Haematologist.
9. Result enquiries/Telephoned results
Authorised results are available on the ICE system, which is updated regularly throughout the day.
If a result is needed urgently and/or cannot be found via the ICE system the laboratory may be
contacted 01603 286929/286931.
Results of urgent requests, if ICE access or electronic delivery is not available, and unexpected
results, which may aid immediate patient management, will be telephoned.
In the event that the laboratory is unable to deliver the required service due to equipment failure we
will endeavour to contact all relevant users.
Haematology telephone criteria:
It is the requestor’s responsibility to review laboratory results and act on any abnormal findings.
Users must not expect that they will be contacted directly by the laboratory to inform them of any
abnormal results. However, the laboratory will always telephone abnormal results if they satisfy the
criteria in the table below, unless it is clear to the laboratory scientist authorising the result that the
finding is to be expected (for example repeated samples showing the same abnormality).
Other abnormal results not fulfilling the criteria below may also be telephoned according to the local
laboratory telephone policy.
A copy of the laboratory telephone policy can be obtained on request.
Test EPA-wide criteria
Hb < 70 (any MCV)
Hb
No requirement to telephone high Hb/Hct
Hct >0.6
Hct
During working hours or next day
Inpatients:
ED/acute admissions area – telephone ifEastern Pathology Alliance Haematology NNUH User Manual Page 16 of 38
Dept/Site : Haematology NNUH Doc Ref: EBN-HQP-001 Author: A. Macartney
Revision: 7 Issued: 16/04/2021 Authorised by: R. Pipkin Review interval: Annual
Test EPA-wide criteria
unit
No requirement to telephone high platelets
Suspected acute leukaemia
TTP
1 presentation Platelet 100
st
1 presentation Haemolytic Anaemia Hb 5
Malaria screen Any positive
Sickle screen Not required
ESR Not required
Direct Coombs Not required
10. Clinical Liaison
Consultation about investigation and management of conditions is welcomed.
For advice on diagnosis and the interpretation of Haematology results or advice on treatment
contact a Consultant Haematologist.
Outside normal hours of service they may be contacted through the hospital switchboard.
11. Complaints
We strive to ensure a high quality service, but if you wish to make a comment or complaint please
contact:
Mr Nigel Roberts, EPA Service Operations Manager
Laboratory Medicine,
Norfolk and Norwich University Hospital,
Norwich. NR4 7UY
Tel: 01603 286936
Email: nigel.roberts@nnuh.nhs.uk
12. Non-NHS samples
Category 2 and private samples must be clearly indicated on the request form.Eastern Pathology Alliance Haematology NNUH User Manual Page 17 of 38 Dept/Site : Haematology NNUH Doc Ref: EBN-HQP-001 Author: A. Macartney Revision: 7 Issued: 16/04/2021 Authorised by: R. Pipkin Review interval: Annual All work on prospective students of universities or other institutions of further education (except rubella screening in females), is classified as Fee Paying Services and will therefore be charged at Category 2 rates. Testing will only be performed where it is indicated to whom the bill should be sent. Please ensure that your patients are aware that they will be charged for these tests before the sample is taken. Prices are available on request.
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13. Haematology Reference Ranges / Turnaround times
Ideal sample age for
Turnaround Time (TAT)
Test (A) indicates that test Reference Comments/ accurate results / Maximum
Units Sample From arrival in lab to result
is UKAS Accredited range Precautions acceptable sample age (at
available on WebICE
the time of analysis)
Activated partial thromboplastin
time: (A)
Infant (full term - 15 days) 35-53
Infant (15 days to 28 days) 27.6 - 45.6 Urgent: 1hr
Routine
Infant (1 month to 5 months) 24.8-40.7 Sodium Inpatient routine: 4hrs
seconds coagulation Within 8 hours / 24 hours
Infant (6 months-11 months) 25.1-40.7 Citrate GP/OPD routine: 8hrs
test
Child (1 to 5 years) 24-39.2
Child (6 to 10 years) 26.9-38.7
Child (11-17 years) 24.6-38.4
Adult (17 + years 24.1-38
Prothrombin time: (A)
Infant (full term - 15 days) 12.0-23.5
Infant (15 days to 28 days) 9.5-12.6
Urgent: 1hr
Infant (1 month to 5 months) 9.7-12.8 Routine
Sodium Inpatient routine: 4hrs
Infant (6 months-11 months) 9.8-13.0 seconds coagulation Within 8 hours / 24 hours
Citrate GP/OPD routine: 8hrs
Child (1 to 5 years) 9.9-13.4 test
Child (6 to 10 years) 10.0-14.6
Child (11-17 years) 10.0-14.1
Adult (17 + years 9.8-13.1Eastern Pathology Alliance Haematology NNUH User Manual Page 19 of 38
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Ideal sample age for
Turnaround Time (TAT)
Test (A) indicates that test Reference Comments/ accurate results / Maximum
Units Sample From arrival in lab to result
is UKAS Accredited range Precautions acceptable sample age (at
available on WebICE
the time of analysis)
Fibrinogen: (A)
Infant (full term - 15 days) 0.95-2.45
Infant (15 days to 28 days) 1.36-3.00
1.41-4.37 Urgent: 1hr
Infant (1 month to 5 months) Routine
1.48-3.67 Sodium Inpatient routine: 4hrs
Infant (6 months-11 months) g/L coagulation Within 8 hours / 24 hours
1.64-4.97 Citrate GP/OPD routine: 8hrs
Child (1 to 5 years) test
Child (6 to 10 years) 1.71-5.37
Child (11-17 years) 1.68-5.29
Adult (17 + years 2.00-3.93
Routine Urgent: 1hr
Sodium
D Dimer (A)Eastern Pathology Alliance Haematology NNUH User Manual Page 20 of 38
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Ideal sample age for
Turnaround Time (TAT)
Test (A) indicates that test Reference Comments/ accurate results / Maximum
Units Sample From arrival in lab to result
is UKAS Accredited range Precautions acceptable sample age (at
available on WebICE
the time of analysis)
4 - 6 days 0.45 – 0.67 GP/OPD routine: 8hrs
7 - 13 days 0.42 – 0.66
14d – 1m 0.39 – 0.63
1m – 2m 0.33 – 0.53
2m – 3m 0.28 – 0.42
3m – 1yr 0.30 – 0.40
1 year 0.30 – 0.38
2 – 5 yr 0.34 – 0.40
5 – 11yr 0.35 – 0.45
12+ yr (Male) 0.40 – 0.50
12+ yr (Female) 0.36 – 0.46
Haemoglobin
0-3 days 140 – 220
4-6 days 150 – 210
7-13 days 135 – 215
14d – 1m 125 – 205 Urgent: 1hr
1m – 2m 115 – 165 Inpatient routine: 4hrs
g/L EDTA FBC Within 8 hours / 24 hours
2m – 3m 94 – 130 GP/OPD routine: 8hrs
3m – 1yr 111 – 141
2 – 5yr 110 – 140
6 – 11yr 115 – 155
12+ yr (Male) 130 – 170
12+ yr (Female) 120 - 150
MCH Urgent: 1hr
0d – 1m 31-37 pg EDTA FBC Inpatient routine: 4hrs Within 8 hours / 24 hours
1 – 2m 30-36 GP/OPD routine: 8hrsEastern Pathology Alliance Haematology NNUH User Manual Page 21 of 38
Dept/Site : Haematology NNUH Doc Ref: EBN-HQP-001 Author: A. Macartney
Revision: 7 Issued: 16/04/2021 Authorised by: R. Pipkin Review interval: Annual
Ideal sample age for
Turnaround Time (TAT)
Test (A) indicates that test Reference Comments/ accurate results / Maximum
Units Sample From arrival in lab to result
is UKAS Accredited range Precautions acceptable sample age (at
available on WebICE
the time of analysis)
2 – 3m 27-33
3m – 1yr 24-30
1year 25-29
2 – 5yr 24-30
6 – 12 yr 25-33
12+ yr M/F 27-32
MCHC
0-3 days 300 – 360
4-6 days 290 – 370
7-13 days 280 - 380
14d – 1m 280 - 380 Urgent: 1hr
1m – 2m 290 - 370 Inpatient routine: 4hrs
g/L EDTA FBC Within 8 hours / 24 hours
2m – 3m 285 - 355 GP/OPD routine: 8hrs
3m – 1yr 300 - 360
1year 320 - 360
2 – 5yr 310 - 370
6 – 11yr 310 - 370
12+ yr M/F 315 - 345
MCV
0-3 days 100 – 120
4-6 days 92 – 118 Urgent: 1hr
7-13 days 88 – 126 Inpatient routine: 4hrs
fl EDTA FBC Within 8 hours / 24 hours
14d – 1m 86 – 124 GP/OPD routine: 8hrs
1m – 2m 92 – 116
2m – 3m 87 – 103
3m – 1yr 68 – 84Eastern Pathology Alliance Haematology NNUH User Manual Page 22 of 38
Dept/Site : Haematology NNUH Doc Ref: EBN-HQP-001 Author: A. Macartney
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Ideal sample age for
Turnaround Time (TAT)
Test (A) indicates that test Reference Comments/ accurate results / Maximum
Units Sample From arrival in lab to result
is UKAS Accredited range Precautions acceptable sample age (at
available on WebICE
the time of analysis)
1year 72 – 84
2 – 5yr 75 – 87
6 – 11yr 77 – 95
12+ yr M/F 83 – 101
Platelets:
0-3 days 100 – 450
4-6 days 210 – 500
7-13 days 160 – 500
Urgent: 1hr
14d – 1m 170 – 500
9 Inpatient routine: 4hrs
1m – 2m 200 – 500 10 /L EDTA FBC Within 8 hours / 24 hours
GP/OPD routine: 8hrs
2m – 3m 210 – 650
3m – 1yr 200 – 550
2 – 5yr 200 – 490
6 – 11yr 170 – 450
12 = yr M/F 150 – 410
Red blood count (RBC)
0-3 days 5.0 – 7.0
4-6 days 4.0 – 6.6
7-13 days 3.9 – 6.3
Urgent: 1hr
14d – 1m 3.6 – 6.2
Inpatient routine: 4hrs
1m – 2m 3.0 – 5.4 1012/L EDTA FBC Within 8 hours / 24 hours
GP/OPD routine: 8hrs
2m – 3m 3.1 – 4.3
3m – 1yr 4.1 – 5.3
1 year 3.9 – 5.1
2 – 11 yr 4.0 – 5.2
12+ yr (Male) 4.5 – 5.5Eastern Pathology Alliance Haematology NNUH User Manual Page 23 of 38
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Ideal sample age for
Turnaround Time (TAT)
Test (A) indicates that test Reference Comments/ accurate results / Maximum
Units Sample From arrival in lab to result
is UKAS Accredited range Precautions acceptable sample age (at
available on WebICE
the time of analysis)
12+ yr (Female) 3.8 – 4.8
Reticulocytes
0 - 3 days 120 – 400
4 - 6 days 50 – 350
Urgent: 1hr
7d – 1m 50 – 100
Inpatient routine: 4hrs
1m – 2m 20 – 60 % EDTA FBC Within 8 hours / 24 hours
GP/OPD routine: 8hrs
2m – 3m 30 – 50
3m – 1yr 40 – 100
1 -11 yr 30 – 100
12+ yr M/F 50 – 100
White blood count (WBC)
0-3 days 10 – 26
4-6 days 7 – 23
7d – 1m 6 – 22
Urgent: 1hr
1m – 2m 5 – 15
Inpatient routine: 4hrs
2m – 3m 5 – 19 109/L EDTA FBC Within 8 hours / 24 hours
GP/OPD routine: 8hrs
3m – 1yr 6 – 18
1 year 6 – 16
2 – 5yr 5 - 15
6 – 11yr 5 - 13
12+ yr M/F 4 - 10
Detection of Epstein Barr Virus (Paul
N/A - EDTA One working day 24 hours / 24 hours
Bunnell) (A)
Malaria parasites (A) Processed on ASAP, within 1 hour /
N/A - EDTA Within 2 hours
arrival 4 hoursEastern Pathology Alliance Haematology NNUH User Manual Page 24 of 38
Dept/Site : Haematology NNUH Doc Ref: EBN-HQP-001 Author: A. Macartney
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Ideal sample age for
Turnaround Time (TAT)
Test (A) indicates that test Reference Comments/ accurate results / Maximum
Units Sample From arrival in lab to result
is UKAS Accredited range Precautions acceptable sample age (at
available on WebICE
the time of analysis)
Urinary haemosiderin URINE –
N/A - NOT in Same day Within 8 hours / 24 hours
boric acid
CSF analysis N/A - CSF Same day Within 4 hours / 8 hours
Leucocyte immunophenotyping Verbal report available within one day.
N/A - EDTA Within 8 hours / 24 hours
Requests send to Addenbrookes, Cambridge.
Miscellaneous fluid cell counts N/A - Method not validated Same day Within 4 hours / 8 hours
Haemoglobinopathy screen Haemoglobinopathy Screen: 1 working day Within 8 hours / 24 hours
HbFEastern Pathology Alliance Haematology NNUH User Manual Page 25 of 38
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White Cell Differential
Turnaround Time (TAT)
Comments / From arrival in lab to result
Precautions available on WebICE
Neutrophils Lymphocytes Monocytes Eosinophils Basophils
0 - 3 days 4.0 -14.0 3.0 – 8.0 0.5 – 2.0 0.1 – 1.0 0.0 – 0.1
4 - 6 days 1.5 – 6.9 2.0 – 8.0 0.5 – 1.0 0.1 – 2.0 0.0 – 0.1
7 - 13 days 1.5 -6.9 3.0 – 9.0 0.1 – 1.7 0.1 – 0.8 0.0 – 0.1
14 days – 1
1.5 – 6.9 3.0 – 9.0 0.1 – 1.7 0.1 – 0.9 0.0 – 0.1
month
1-2 Urgent: 1hr
1.5 – 6.9 3.0 – 16.0 0.3 – 1.0 0.2 – 1.0 0.0 – 0.1
months Inpatient routine: 4hrs
X 109/l
2–3 GP/OPD routine: 8hrs
1.0 – 5.0 4.0 – 10.0 0.4 – 1.2 0.1 – 1.0 0.0 – 0.1
months
3 months –
1.0 – 6.0 4.0 – 12.0 0.2 – 1.2 0.1 – 1.0 0.0 – 0.1
1 year
1 year 1.0 – 7.0 3.5 – 11.0 0.2 - 1.0 0.1 – 1.0 0.0 – 0.1
2 - 5 years 1.5 – 8.0 1.8 – 8.5 0.2 - 1.0 0.1 – 1.0 0.0 – 0.1
6-11 years 2.0 – 8.0 1.0 - 5.0 0.2 – 1.0 0.1 – 1.0 0.0 – 0.1
12+ years 2.0 – 7.0 1.0 – 3.0 0.2 – 1.0 0.02 – 0.5 0.0 – 0.1Eastern Pathology Alliance Haematology NNUH User Manual Page 26 of 38
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Revision: 3 Issued: Authorised by: R. Pipkin Review interval: Annual
14. Transfusion
The Transfusion Laboratory within Eastern Pathology Alliance (EPA) at the Norfolk and Norwich
University Hospital provides blood components for transfusion at the Norfolk and Norwich
University Hospital, Cromer Hospital, Priscilla Bacon Lodge (NCHC) and Spire Norwich.
They are also responsible for the supply of routine and prophylactic Anti-D, Prothrombin Complex
Concentrate (Beriplex) and clotting factors.
The Transfusion Lab is available 24 hours a day and can be contacted on Ext 2905/2906.
The lab is located in East Block on level one.
The turnaround time for blood groups and the sample requirements for Blood Transfusion are stated
on ICE in the test requesting screen.
All samples should be taken to the specimen reception hatch located on the main corridor or sent
through the pneumatic tube system (Numbers 302, 402, 502 & 602).
14.1 Consultants and senior staff
To contact the on call haematologist please contact the NNUH hospital switchboard.
Dr Suzanne Docherty Consultant Haematologist – (Secretary) Ext. 3866
Lead Consultant for Transfusion
Transfusion Practitioners:
Kathy Ford Transfusion Specialist Nurse Ext. 3863
Janet Pring Transfusion Practitioner Or
Alison Rudd Transfusion Specialist Nurse Bleep 0852/0663
Blood Transfusion Lab staff:
Carol Harvey EPA Network Transfusion Manager
Sandy Ellis Senior Biomedical Scientist in Transfusion Transfusion lab
Tracey McConnell Senior Biomedical Scientist in Transfusion Ext. 2905/2906
Rosie Lynskey Transfusion IT Lead
The Hospital Transfusion Committee (HTC) is a multi-disciplinary team which meets 4 times a year
and is made up of a variety of specialities with an interest in transfusion.
The Hospital Transfusion Team (HTT) meets more frequently and is comprised of representatives
from the Medical staff, BMS staff and the Transfusion Practitioner team. The HTT is a subcommittee
of the HTC and issues can be feedback to the full committee when required.
If you have a matter you would like discussed please contact the Transfusion Practitioners at
TransfusionPractitionerTeam@nnuh.nhs.uk who will ensure that it is taken to the appropriate group.Eastern Pathology Alliance Haematology NNUH User Manual Page 27 of 38
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14.2 Sample labelling and request forms
Accurate patient identification and sample labelling is critical and the lab operates a zero tolerance
policy for samples that are incorrectly labelled or are missing the minimum patient identifiers.
The minimum information required on a sample is the patient’s full name, date of birth and hospital
number. These details must be the same on documentation used at any stage of the transfusion
(Wristband, sample, and prescription). The sample should be signed, dated and timed.
It is the responsibility of the person taking the blood sample to label it correctly at the patient’s side.
Incorrect or missing information can lead to the sample being rejected and therefore there will be a
delay in blood components being available.
All samples must be accompanied by an appropriate request form generated via the ICE system. If
the blood components are required in an emergency due to active bleeding then please phone the
lab to discuss the patient’s requirements.
For further information regarding requesting via ICE please see the Blood Transfusion ICE Requesting
User Guide (Trust Docs ID: 13770)
14.3 Component requesting
In order to issue blood components for a patient the laboratory must have a valid sample for the
patient. A sample is suitable for issuing components for up to 7 days after the sample was taken
unless the patient has received a transfusion within the previous 3 months when a sample must be
taken and sent for testing within 72 hours of the planned transfusion.
The check group: in line with national guidelines a check group sample may be required. If the
patient has no previous transfusion records at the NNUH then a second sample will be needed to
confirm that the correct patient has been bled. If this sample is required then it should be taken by a
different person to the initial sample and must be taken from a separate venepuncture.
Requests for red cells must be made through ICE which has been designed to guide appropriate
requesting. All urgent requests must be phoned to the laboratory. Once a unit of red cells is issued
for a patient it will be available for 24 hours after the date and time required.
If platelets are required then these may need to be requested from NHSBT specifically for the
patient. In order to allow for delivery on the routine transport please contact the transfusion lab
before the order cut off time.
Order cut-off time Expected time of delivery
08.00 11.00
13.00 17.00
Out of hours deliveries are only available for emergency/urgent requests as there may be additional
costs associated with ad hoc deliveries.
Platelets will be returned to stock 8 hours after the date and time requested has passed.
If you require blood components for a patient with a known special requirement it is important to
ensure that the transfusion lab is aware of that patient’s needs. If the requirement is new or if theEastern Pathology Alliance Haematology NNUH User Manual Page 28 of 38 Dept/Site : Haematology NNUH Doc Ref: EBN-HQP-001 Author: A. Macartney Revision: 7 Issued: 16/04/2021 Authorised by: R. Pipkin Review interval: Annual patient has not been treated at the hospital before then the appropriate special requirements request form must be completed and sent to the lab to allow an alert to be created for previous attendances (Trust Docs ID: 1286). 14.4 Collection and administration of blood components To collect blood components from the transfusion lab an EBTS pick up slip must be used. This should be taken to the transfusion issue hatch (East Block, Level One) and given to the Lab staff who will issue the required components. For areas that have a satellite blood fridge only staff who have been appropriately trained can put units in or remove them as per the Trust Guideline for the Storage of Blood Components in and Maintenance of Satellite Blood Fridges ( Trust Docs ID: 1074) For further information on collection and administering blood components please see Trust Policy for the Collection and Return of Blood Components/Products from the Norfolk and Norwich University Hospital Transfusion Laboratory (Trust docs id 1077) Trust Clinical Policy for Checking Blood Components/Products prior to Administration (Trust docs ID No: 1094) 14.5 Transfusion reactions If you suspect a transfusion reaction stop the infusion and assess the patient. If a transfusion reaction is suspected then Appendix 1: Investigation/reporting of transfusion reaction form should be completed and the transfusion lab informed. For full advice on the management of a transfusion reaction please see the Trust Guideline for the Management of Reactions to Blood and Blood Products (Trust docs ID 1281). 14.6 Massive blood loss protocol Massive blood loss is defined as ≥40% loss of total blood volume, blood loss of 4000mls within a 24hr period, blood loss of 2000mls in a 3hr period, or blood loss at a rate of >150mls/min. In recent years a more practical approach is that patients suspected of bleeding (especially if it is internal) will demonstrate a pulse of >110 bpm and a systolic blood pressure of < 90 mmHg. The NNUH uses the treatment algorithm developed by the East of England Trauma Network and agreed by the East of England Transfusion Committee. To activate the protocol phone the transfusion lab on ext. 2905/2906 and state “I want to trigger the massive blood loss protocol”. All subsequent communications between the clinical area and the lab staff should be started with “This call relates to the massive blood loss protocol”. A specific member of the clinical team should be nominated to co-ordinate communication with the transfusion lab. Full details can be found in the Guideline for the Management of: Massive Blood Loss in Adults (MBL) (Trust Docs ID: 1175) and Massive blood loss in children (Document ID 9960 and Flow chart ID 10828)
Eastern Pathology Alliance Haematology NNUH User Manual Page 29 of 38 Dept/Site : Haematology NNUH Doc Ref: EBN-HQP-001 Author: A. Macartney Revision: 7 Issued: 16/04/2021 Authorised by: R. Pipkin Review interval: Annual 14.7 Transfer/receipt of components with a patient between hospitals Blood components should only be transferred between hospitals if it is felt that there is likely to be a need to administer them during the transfer or if they have been requested for the individual patient due to antibodies and that the receiving hospital will not have appropriate units available. Any units being transferred must be packed in a suitable transfer box by the Lab and the necessary documentation completed. All transfer boxes will be sealed by the lab staff. This seal must not be broken unless units are being administered. If receiving a transfer box from another hospital the box should be taken to the transfusion lab with the seal intact to allow the blood units to be correctly stored and recorded. 14.8 Referral Laboratories The transfusion laboratory uses the reference laboratories of NHS Blood and Transplant for investigations and consultancy. Red cell immunohaematology: red cell antibody investigations that cannot be resolved in the NNUH laboratory are sent to Colindale, North London. Histocompatiblity and Immunogenetics: e.g. Investigation of platelet refractoriness, TRALI, are also sent to Colindale, North London Platelet immunology: e.g. HIT and NAIT cases are sent to Filton, Bristol Cell-free fetal DNA (cffDNA) - A 6ml EDTA sample is required. A small amount of the unborn baby’s DNA is present in the mother’s blood. By detecting the baby’s DNA in the mother’s blood it is possible to determine the unborn baby’s D group. This test is known as the fetal RHD screening test and is used to guide antenatal anti-D prophylaxis. These tests are sent to the International Blood Group Reference Laboratory (IBGRL), Bristol.
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