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Laboratory Medicine (Pathology)

Haematology at Alder HeyThe Haematology laboratory processes approximately 90000 samples per year, acting as a regional diagnostic centre covering the North West, North Wales and The Isle of Man. Our aim is to provide a friendly and accessible routine and emergency service, with minimal test turnaround time together with a full clinical service to which clinicians and their patients have ready access.

The Haematology department is staffed by a team of medical, technical and support staff who provide an interactive clinical and analytical service. The majority of the staff are members of professional associations which have an important role in the setting of professional standards and standards of analytical performance.

Continuing Medical Education and Continuing Professional Development is supported by membership of professional bodies and learned societies including the Royal College of Pathologists and the Institute of Biomedical Science which assist staff in maintaining an up to date clinical knowledge for the department. All qualified members of laboratory staff are registered with the Health Care Professions Council.

The clinical service is led by 3 Consultant Haematologists and includes the Regional Leukaemia and Oncology Unit, the Regional Paediatric Haemophilia Comprehensive Care Centre and General Haematology.

The department undertakes all aspects of paediatric haematology and acts as a regional referral centre for haemophilia, leukaemia and oncology. The department also provides analytical and clinical support to the regional Neonatal Intensive Care Unit located at the Liverpool Women’s Hospital.

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Opening Hours

 


A laboratory service is provided 24 hours per day, seven days per week. The service is however, divided into periods where the full repertoire of tests is available (normal working hours service), and periods where a restricted range of tests are available.

Normal working hours are Monday to Friday, 9.00 am to 5.30 pm (with the exception of public holidays):

A team of Biomedical Scientists and assistants are available to handle the main workflow for the laboratory.

Outside normal working hours (All day Saturday, Sunday and Bank Holidays, and all night duties – 17:30 – 09:00hrs):

A Single Biomedical Scientist is available to provide the Haematology and Blood Transfusion service, as a result a restricted service is available. Requests should limited to those where there is a reasonable likelihood that the results of the laboratory investigations will affect the immediate management of the patient, or where regular monitoring is required for unstable patients. Delays in service provision during this time are likely and are dependent on current workload. “Urgent request for Blood Products” will be prioritised.

Where to find us

The Haematology departments are situated on the First Floor of the clinical support block of the new hospital building; staff can access the laboratory from the first floor of the main hospital crossing the bridge at the tree house end of the building.

Visitors to the laboratory should phone in advance to arrange a meeting point.

Making requests

All URGENT requests should be preceded by a telephone call to the haematology department on 0151-252-5490              (internal extension 2490 for Haematology, 2942 for Transfusion)

Requests for services should be made using the Trust’s Meditech System (paper request forms are available during times when Meditech is not available).

Requests from GP surgeries should be printed or hand written using the specific Alder Hey Pathology request forms, ensuring that details entered on the request form are legible. It is important that the information provided includes:

  • Full name of patient
  • Date of Birth
  • NHS Number/Hospital number /Address
  • Location of patient
  • Date of sample
  • Type of specimen
  • Name and contact details of requesting doctor
  • Name of consultant
  • Tests required
  • Clinical details including any medication

Clinical information and the patient’s date of birth are particularly important in paediatric requesting, so that the laboratory staff may:

  • Understand the reason for the request and consider the need for further investigation.
  • Interpret the results against an appropriate age specific reference range.

The Department reserves the right to decline to analyse samples with incomplete information, particularly if there is doubt about the identity of the patient or sample. The results may also be misleading in the absence of relevant clinical details.

Special requirements for the Blood Transfusion Laboratory

Request/Sample identification

Any mistakes or omissions in the labelling of samples and request cards can lead to deleterious effects on the patient. In order to avoid any such possibility, users of the laboratory are urged to comply with the following safety check procedures.

  1. Positive patient identification must be made either by direct questioning, reference to a patient’s hospital identity bracelet or, for unconscious patients, the use of a unique numbering system.
  2. Requests for group and/or cross-match must be in a special blood transfusion tube which is then clearly labelled by hand with all available patient identification, the minimum acceptable PID on the specimen tube is Full Name, date of birth and hospital number (or NHS Number or Address), Location of patient, Date of sample and signature of the person taking the sample. PRE-PRINTED IDENTIFICATION LABELS WILL NOT BE ACCEPTED. Sample tubes must not be labelled in advance.
  3. The accompanying request MUST BE completed ON Meditech by a doctor or trained Nurse Practitioner.
  4. Clear instructions as to when, where and why blood grouping or cross-matching is being requested must be included in the spaces indicated on the request form.

NB – Incorrectly or incompletely labelled samples/request forms will not be accepted by the Transfusion Laboratory. FULL IDENTIFICATION IS ABSOLUTELY NECESSARY.

Requesting

  1. Full Group and Antibody Screen Requests Samples are ABO and Rhesus (D) grouped and screened for atypical antibodies.TIMING OF SAMPLES FOR PRE-TRANSFUSION TESTINGTransfusion or pregnancy may stimulate the production of unexpected antibodies against red cell antigens through either a primary or secondary immune response. The timing of samples selected for cross-matching or antibody screening should take account of this, as it is not possible to predict when or whether such antibodies will appear. It is also important to note that all cellular blood components contain residual red cells and may elicit an immune response.To ensure that the specimen used for compatibility testing is representative of a patient’s current immune status, serological studies (Antibody Screen and Crossmatching) should be performed using blood collected no more than 3 days in advance of the actual transfusion when the patient has been transfused or pregnant within the preceding 3months, or when such information is uncertain or unavailable. The 3 days includes the dereservation period, e.g. if the sample was 1-day old, the blood would have to be transfused within 2 days.Where there has been no transfusion or pregnancy within the preceding 3months, the sample is valid for up to 7 days.
  2. Requests for ADULT RBC or PAED RBC will have ABO and Rhesus (D) compatible donor units selected and cross-matched for named patients and held for that patient until 9.00 am on the day after the date for which the request was made. If your patient has been transfused, a fresh sample for further cross-matching will be required after 3 days. Please give as much time as possible for the lab to complete grouping, antibody screening and/or cross-matching, in case atypical antibodies are encountered which could cause a delay in the provision of compatible products. The hospital operates a Maximum Surgical Blood Ordering Schedule . Under normal circumstances, the Transfusion Laboratory will cross-match according to the MSBOS, unless clear reasons for doing otherwise are provided by the requesting clinician. For further details, please contact the laboratory.
  3. Accident and Emergency Samples An A/E number is only acceptable for identification purposes on requests for cross-matching of blood for IMMEDIATE transfusion, not for group and save serum samples.

Seeking Advice

 

Enquiring about sample types and amounts

See link for test repertoire or contact the laboratory on 0151 252 5490          (internal extension 2490). The sample volumes indicated are the minimum required but it is helpful if larger volumes can be supplied to enable repeat testing if required. If inadequate sample volumes are provided, it may be necessary to delete those tests from the profile that require large amounts of sample. If there are clinical reasons for giving preference to specific analytes please indicate this clearly on the request and/or telephone the department to discuss your requirement.

Additional investigations

If additional investigations are required on specimens already sent to the laboratory, please contact the laboratory to establish if sufficient sample remains and it is suitable for analysis.

Key contacts

Haematology Medical Staff

  • Consultant Haematologist (Head of Department): Dr Mark Caswell – Secretary Ext 3680 Via switchboard 0151 282 4811
  • Consultant Haematologist: Dr Russell Keenan Secretary – Ext 3680 Via switchboard 0151 282 4811
  • Consultant Haematologist: Dr Helen Campbell – Secretary Ext 3680 Via switchboard 0151 282 4811

Haematology Biomedical Scientists (BMS)

  • Laboratory Manager/Lead BMS: Mr Ray Billington Ext 2263 0151 252 5229
  • Senior BMS Coagulation: Janice Wilkinson Ext 2260 0151 252 5490
  • Senior BMS Routine Haematology: Mr Dennis Fath Ext 2490 0151 252 5490
  • Senior BMS Special Haematology: Mr Paul Walsh Ext 2559 0151 252 5490
  • Senior BMS Blood Transfusion: Mrs Michelle Wood Ext 2492 0151 252 5492
  • Transfusion Practitioner: Mrs Tracey Shackleton Ext 2006 0151 252 5006

Clinical Advice

Clinical advice on the planning and interpretation of haematological investigations is available at all times. The laboratory can be contacted at any time for technical advice on 0151 252 5940          (internal extension 2490) and the duty Consultant Haematologist can be contacted for clinical advice and result interpretation via the hospital switchboard (0151 228 4811).

Routine Haematology


This section provides approximately 60000 full blood counts per year including visual white cell differential counts, ESR, Glandular fever screening tests and Sickle screens. The section also assists in the collection, preparation and staining of bone marrow samples. Our aim here is to provide:

  • A timely and accurate screening service.
  • Diagnosis of anaemias and other cytopenias.
  • The diagnosis of primary haematological disorders.
  • Some help for the clinician in highlighting where significant non-haematological disease is present and manifest in either an abnormal blood count or ESR.
  • Monitoring of treatment particularly in areas where the blood count may be affected, such as chemotherapy.
  • Biomedical scientists regularly review blood films as an aid to diagnosis of disease, including leukaemia, sepsis anaemia and malaria.

Coagulation Section


Approximately 12000 coagulation screens and 700 specific clotting factor assays are performed annually. The following services are provided:

  • Routine Coagulation screens as part of pre and post-op assessment, and investigation of patients suspected of having an increased tendency to bruise or bleed.
  • Monitoring Warfarin treatment using the INR (Near Patient testing is available in the trust please discuss this with a consultant haematologist).
  • Monitoring Heparin therapy using the APTT or specific Heparin assay for patients receiving Low Molecular Weight Heparin (LMWH).
  • The diagnosis and management of congenital or acquired bleeding disorders; the former includes haemophilia, the latter the bleeding problems in the critically ill.
  • Platelet function tests including platelet aggregometry are available following discussion with the Consultant Haematologist and Senior BMS in Coagulation.
  • Thrombophilia screen, including the lupus anticoagulant, anti-thrombin III, protein S, protein C, resistance to activated protein C, anti-cardiolipin antibody, factor V Leiden and factor II mutations are referred to a local referral laboratory for analysis. (These tests cannot be fully performed if the patient is either on Heparin or Warfarin.

Other than in the acute situation (i.e. prior to commencement of heparin) the Consultant Haematologist must be contacted prior to requesting Thrombophilia screens to ensure that the correct investigations are carried out.

Transfusion Section


This section offers the following services:

  • Routine blood grouping and antibody screen with identification of antibodies. Any atypical antibodies identified are referred to the Regional Blood Transfusion Service for confirmation.
  • Provision of compatible Red Blood Cells, for routine and emergency cases, for surgery, bleeding patients and some cases of anaemia.
  • Provision of compatible Blood Products including Platelets, Fresh Frozen Plasma and Cryoprecipitate as required for the appropriate treatment of bleeding disorders, congenital or acquired. The laboratory holds a stock of standard blood products, if there are “special requirements” for blood products including fresh RBC’s and Irradiated Products additional time should be given when ordering the products to allow the laboratory to source the products from the National Blood Service.
    N.B. Always inform the laboratory of Urgent or Emergency cross-match and Blood product requests by telephone 0151-252-5492        (internal extension 2492/2490)
  • Direct and indirect antiglobulin test.
  • Kleihauer test to guide appropriate administration of anti-D during or following pregnancy to both general practice and hospital departments.
  • The investigation of cold agglutinins.

Special Tests Section


Immunosuppressant drug monitoring is performed in support of the renal unit and bone marrow transplantation.
The regional leukaemia and oncology unit is supported with a rapid diagnostic service comprising of immunophenotyping. The service provided also includes:

  • Provision of the Regional Neonatal Sickle Cell Screening service, haemoglobin studies such as sickle tests, haemoglobin electrophoresis and thalassaemia screen. If a haemoglobinopathy is diagnosed, follow up clinical support is provided by the Consultant Haematologist and clinical team.
  • Cell surface markers in the investigation and diagnosis of leukaemia and immune disorders.
  • Other special investigations include special stains for haematological malignancies, Ham’s test.
  • Assays for anti-rejection drugs including Cyclosporin and Tacrolimus.

These special tests are probably best discussed with laboratory staff before samples are sent.

Results and reports


The results of most routine FBC and Clotting Screens will be available on Meditech within 4 hours. We aim to provide results for “urgent Blood Counts and Clotting Screens within 30 minutes of receiving the sample – depending on current workload and staff availability. Significantly abnormal results that require clinical action are telephoned to the requesting doctor.

All incoming work is classified as routine unless the requesting clinician contacts a member of laboratory staff to inform them that the specimen requires “urgent “ analysis and provides a valid reason.

Typical turnaround times are dependent on the complexity of the requested test, current workload and staff availability. Some tests are referred to external laboratories, and the turnaround time for such tests is largely out of our control. Additional time has to be allowed for appropriate transport of specimens. Please contact the Haematology laboratory for more detailed information.

Reference Ranges

It is important to understand that reference ranges are age (and in some instances sex) related and appertain to particular methodology. The reference ranges quoted in these pages and with printed and electronic results therefore are only applicable to analyses performed at the Haematology Department of Alder Hey Children’s NHS Foundation Trust. Reference ranges are displayed with all results on both computer screen and printed reports. For further clinical interpretation of laboratory results please contact the duty Consultant Haematologist. To view the reference ranges follow the link ranges.

Quality Control

The quality of results is controlled by internal quality control procedures and monitored by external quality assessment. The Haematology department participates in external quality assurance and proficiency schemes from the UK (UKNEQAS).

Common interferences

Users should be aware that samples collected by capillary puncture from children are more prone to interference than samples collected by venepuncture in adults. The most common interferences are haemolysis, lipaemia and jaundice. All our samples are routinely checked for the common interferences and the affected tests are indicated on the final report. Heparin and other contaminating fluids from venous line samples will interfere with coagulation test results (especially APTT, TT and Factor assays) and many other analytes.

Delays of more than a few hours in sample transport to the laboratory can also result in erroneous results for some analytes, e.g. PT, APTT. Laboratory users are encouraged to send samples to the laboratory as quickly as possible to minimise the effects of storage on the results produced and to help streamline workflow through the department. For more detailed information on interferences please contact the Haematology laboratory ext 2490.

Test repertoire and sample requirements

Turnaround times


The department classifies its work as routine or urgent . All incoming work is classified as routine unless the requesting clinician contacts a member of staff in the department to inform them that work is to be undertaken urgently. The processing of the different categories of work is described below.

Routine Work

Routine requests within each work section are processed on a depending on clinical details and first in, first out basis.

Urgent Work

The turnaround time given under the ‘urgent’ category is the minimum time needed to analyse a sample if we change the order of work on our work list. Requests for urgent work should be made only if the patient is unstable and results are needed to decide on the immediate clinical management.

Work will be prioritised according to clinical urgency.

Out of Hours Work

The department provides a continuous 24 hour service with a restricted repertoire of tests available outside normal working hours. Outside normal working hours one member of the Haematology BMS staff provides cover for all Haematology and Blood Transfusion requests and can be contacted on extension 2490 or bleep via switchboard.

The turnaround times quoted below are measured from the time of the receipt of the specimen in the laboratory to reporting of the result. The department operates a programme for regular review of turnaround times.

Provision of blood products

Turn around time for the provision of blood products are approximate and are timed from the receipt of a correctly labelled specimen in the appropriate container with sufficient blood volume. If there are special requirements eg irradiated products, or there are complicating factors eg red cell antibodies there may be a delay in provision of appropriate blood products.

Haematology reference ranges

For more specialist tests please contact the Haematology department or Consultant Haematologists for advice.

Referral laboratories

 

Version 4.0 16 March 2016
Review date 16 March 2018

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