Haematology

These ranges are age and sex related. Please note that uncertainty of measurement data (UOM) is available on request.

Royal Stoke University Hospital samples should be sent via the air tube system (or via portering staff in the event of system unavailability). GP samples are usually transported to Pathology via the courier driver system (scheduled collections – to discuss contact Specimen Reception on (6)74881) although there is also a specimen drop off point at the reception desk in the Main Building which is open 24 hours a day.

County samples should be sent via the air tube system (or via portering staff in the event of system unavailability). Samples can be dropped off at the Specimen Reception hatch during routine opening hours (weekdays 09:00 until 17:00). If the access door to Specimen Reception is locked then samples should be placed in the fridge provided for the purpose. This is located in the Blood Issue / Point of Care Room situated on the right hand side of the corridor, before Specimen Reception is reached. In this instance the duty BMS must be contacted via bleep 4751. Between 23:15 and 06:30 when the laboratory is not open to accept samples, samples which require urgent attention must be taken to CH Switchboard where appropriate transportation to RSUH will be organised.

RSUH

The laboratory is routinely open from 09.00 to 18.00 on weekdays. Outside these hours an out of hours service, available for contact via the bleep details below, is in operation. All specimens received in Pathology specimen reception will be prioritised and only those influencing immediate patient care will be tested immediately. The contact details for the out of hours staff is as follows:

RSUH Haematology / Blood Transfusion Biomedical Scientists – Bleep (78) 390

CH

The laboratory is open routinely from 09:00 to 17:00 on weekdays, but operates an extended day service, including weekends and Bank Holidays. Samples are accepted from 06:30 until 23:15. Samples from CH which require testing outside of these hours can be taken to Switchboard for transportation to RSUH. There is also a limited point of care service available.

CH Haematology / Blood Transfusion Biomedical Scientist – Bleep (88) 4751

The following requests will be analysed and results reported via iCM (RSUH) / ICE (CH) within a few hours provided that request cards are filled in correctly and the source of the request can be identified:

• FBC
• White blood cell differential
• Reticulocyte count
• INR
• APTT
• D-Dimer
• Fibrinogen

The department will endeavour to contact the requesting source by phone in the instances listed below:

• The BMS performing the test has agreed to phone.
• Results alert the BMS to the possibility that the patient may need immediate attention.
• They are urgent and ward reporting is unavailable

However, in the event that we are unsuccessful in making contact, the results will be available electronically via the ward reporting system. Alternatively the BMS can be contacted via the bleep for urgent results which are not available electronically.

Do not bleep the BMS unless the results are very urgent and need to be telephoned.

Urgent requests requiring prior discussion with BMS staff:

• Malarial parasites
• Sickle cell screen in appropriate patients requiring urgent general anaesthesia

Royal Stoke University Hospital:

Medical advice on Haematological, Blood Transfusion or related issues can be obtained at all times;

• By contacting the duty clinician on bleep 723 between 09:00 and 17:30 on weekdays.
• Outside these hours, by contacting switchboard (Internal 0, External 01782 715444), and asking for the Medical Haematologist on call.

County Hospital:

Medical advice on Haematological, Blood Transfusion or related issues can be obtained at all times;

• In the first instance, by contacting the duty Specialty Doctor on bleep 4500 between 09:00 and 17:00 on weekdays.
• If there is no reply, by contacting switchboard (internal 0, external 01785 257731 or 01782 715444) and asking for the duty clinician on bleep 723.
• Outside these hours, by contacting switchboard (internal 0, external 01785 257731 or 01782 715444), and asking for the Medical Haematologist on call.

Overview

All results produced by the laboratory are dependent upon the quality of the specimens received and accompanying information. Samples should be taken into the correct bottles, which should be correctly filled (this particularly applies to coagulation tests performed from a citrate tube).

The laboratory can only safely process adequately labelled specimens and request cards. Incompletely labelled specimens and requests will not be processed.

When raising a request in iCM the patient demographics are automatically populated and the mandatory fields on the form identify the additional information required for the particular test / referral.

SPECIMEN ACCEPTANCE CRITERIA

Minimum data set for requests

1. Patient identifiable data (minimum of three unique identifiers for a patient):

• The unequivocal identity of the patient and/or specimens using the full name of the patient, correctly spelt.  A code identifier e.g. for GUM patients or unknown A&E patients is acceptable in place of the patient’s name.
• NHS number, hospital unit number or equivalent.
• Date of birth.

2. Requestor details:

• The source of the request and the destination for results.
• The identity (and authority) of the referrer. (When using the ordering on behalf of a referrer option in iCM (RSUH), the referrers name must be recorded as part of the order process).
• The identity of the person completing the request/ referral and, where applicable, obtaining the sample/s. (With electronic requests and referrals made on iCM the identity of the person logged onto iCM will be recorded as the person completing the request/ referral).
• The identity of the consultant in charge of the patient (this must be completed on all paper request cards and the appropriate field completed in iCM where required). Please note, the full surname and initials should be supplied.

1. Investigation clinical details

• The investigation required to be performed.
• Sufficient clinical details to demonstrate that the request is relevant and any other information relevant to the investigation requested that is essential for the correct interpretation of the request, including relevant past medical history, in particular, previous cancer and its treatment.
• When requesting using iCM the minimum data set also includes any mandatory fields

Any request or referral submitted on a paper request card should be completed in ink and must be legible. Any paper request / referral form should be signed by an individual authorised to request the investigation.

1. The minimum requirements for a pathology specimen are:

• Specimens relating to the request are attached to the request label / card or other supporting documentation.
• The specimen type is suitable for the request made.
• The specimen container is appropriate for the investigation and is transported as defined in Policy IC20 (11).
• The specimen is correctly stored.
• The specimen or request label/card must be labelled with the date and time of sample collection.
• The specimen is completed with the minimum data set (see above).
• The specimen label matches the request label/ card with respect to the minimum data set.

In instances where a specimen label is electronically produced as part of ordering an investigation on iCM the label produced will link the specimen to the bar-coded request label produced and must be applied to the correct specimen container at the earliest opportunity.

The laboratory will not return samples for re-labelling or amendment.

PRE-ANALYTICAL VARIABLES

A number of non-pathological factors may adversely affect the results obtained from blood samples.

• Correct sample from correct patient. Labelling of samples must take place immediately, and include positive identification of the patient.

• Labelling - Sample & request form must be correctly filled in; the information on both should match. Incorrect or inadequate information may result in the rejection of specimens and delay results.

• Prolonged venous stasis or poor phlebotomy technique may affect the sample integrity. This could cause full or partial coagulation of the sample which would affect both FBC and coagulation test results.

• Haemolysis may be caused by expelling blood into the sample tube via the needle or over-vigorous mixing. This will render the sample unsuitable for FBC (cellular components will be broken down), and coagulation testing (activation of the clotting system may shorten clotting times).

• Correct dilution - Coagulation samples tubes must be filled to the frosted line on the tube. Under or over dilution will give inaccurate results.

• Inappropriate sample – The correct anticoagulant must be used: EDTA (purple top) for FBCs and trisodium citrate (blue top) for coagulation testing.

• Transport and Storage - Full blood counts and coagulation samples should be tested as soon as possible after collection. Delays and incorrect storage (too hot or cold) will adversely affect results. Degenerative changes are retarded but not abolished at 4˚C.  Coagulation samples at room temperature should ideally be tested within 3 - 6 hours; INRs are stable at 4˚C for up to 24 hours and APTTs for 9 -12 hours. ESRs should be processed within 8-12 hours of collection and should not be requested as an add-on request after that time.
   
• For information regarding venepuncture please click here, then select 'Nursing Workbooks' and read 'The Venepuncture Workbook'

• Other sampling problems which may affect results:

Vigorous exercise

Certain drug treatments

Direct sunlight on the samples

Patient having blood taken from an arm with a drip in situ

Lipaemia

• Leaking or broken samples will not be processed.