Pathology
Pathology at Lancashire Teaching Hospitals
Our pathology department has excellence at its core in service provision across the range of sub specialisms – cellular pathology, microbiology and molecular biology, immunology, clinical biochemistry, haematology and blood transfusion.
With more than 300 staff, and led by a high performing team of specialist consultants, clinical scientists, and managers, our philosophy is to achieve excellence through innovation, in all of our services which include cellular pathology, microbiology and molecular biology, immunology, clinical biochemistry, haematology and blood transfusion.
We host the regional and reference laboratories for immunology and virology, providing a wide range of UKAS accredited tests. We also have a large cellular pathology department serving the regional cancer centre which is based at Royal Preston Hospital.
We have always been early adopters of new technology including molecular technology, and we are a local delivery partner for the 100,000 genome project in Lancashire and South Cumbria. We have also invested in electron microscopy to support our regional renal service, and have plans to expand further.
Central Lancashire Pathology Services (CLPS) is a federated service consisting of 5 departments located on the Royal Preston Hospital site with satellite Haematology, Blood Transfusion and Clinical Biochemistry services at Chorley and South Ribble District General Hospital. They are part of Lancashire Teaching Hospitals NHS Foundation Trust.
The laboratories provide a range of analytical and advisory services for the Trust, both inpatients and outpatients, General Practitioners along with diagnostic services to a range of other health care providers. To ensure the highest standard of work we participate in internal
Departments
Each department provides a full range of services including specialist medical and scientific advice and further details can be found on this website.
Clinical Biochemistry UKAS Ref 8549
The service is a UKAS accredited Medical Laboratory No. 8549.
Click here to view our schedule of accreditation.
Haematology/ Blood Transfusion UKAS Ref 8548
The service is a UKAS accredited Medical Laboratory No. 8548.
Click here to view our schedule of accreditation.
Immunology UKAS Ref 8547
The service is a UKAS accredited Medical Laboratory No. 8547.
Click here to view our schedule of accreditation.
Microbiology UKAS Ref 8545
The service is a UKAS accredited Medical Laboratory No. 8545.
Click here to view our schedule of accreditation.
Cellular Pathology UKAS Ref 8544
The service is a UKAS accredited Medical Laboratory No. 8544.
Click here to view our schedule of accreditation.
- Directions to Pathology Laboratories
Royal Preston Hospital
Sharoe Green Lane
Fulwood
Preston
PR2 9HTTake junction 32 of the M6.
Turn left off the slip-road onto Garstang Road (A6), heading towards Preston.
At the second major set of traffic lights turn left into Sharoe Green Lane.
The main entrance to Royal Preston Hospital is 200 yards on the right.Sat Nav PR2 9HT
The closest visitors car park is car park A (on your right just inside the entrance, charge made on exit).
From the car park make your way to the entrance of the four storey building (Gordon Hesling Block).
Once inside the foyer go down the corridor to your left.
The Pathology entrance (double doors) is about 30 metres down on the left.
Report to the Reception desk situated inside almost facing you.
Chorley and South Ribble Hospital
Preston Road
Chorley
PR7 1PPTake junction 8 of the M61.
Follow signs towards Chorley (A6) along short dual carriageway.
At the first roundabout, turn left, continuing to head towards Chorley (A6).
At the second roundabout, take second turning onto Euxton Lane (B5252).
The main hospital entrance is 200 yards on the left at the traffic lights.Sat Nav PR7 1PP
Pathology is on level 3
Maps
You can find a map to Preston and Chorley Hospitals here
- Pathology Consultants
Consultants
Click on a consultant to see more information.
- Cellular Pathology
Our Cellular Pathology Service
We deliver a large and complex histopathology service with a wide repertoire of procedures provided for a broad range of clients. We provide diagnostic histopathology, immunocytochemistry, electron microscopy, neuropathology and nongynae cytology services. Additionally, we provide specialist tertiary cellular pathology services for renal, plastics and neurosciences, gynaeoncology, head and neck, as well as network coverage of herceptin testing for neighbouring NHS trusts.
Our histopathology lab is fully accredited by UKAS/ISO15189 and also participates in the N.E.Q.A.S. schemes for cellular pathology, neuropathology, muscles, cytopathology, renal pathology and immunocytochemistry.
- Cellular Pathology Careers
- Haematology
The Haematology Service diagnoses and treats both malignant (cancerous) and non-malignant blood disorders. The haematology team includes specialist consultants and clinical nurse specialists. Haematology outpatient clinics are held every week day.
The Haematology Service can be accessed via a referral from your GP.
- Microbiology
With more than 300 staff, and led by a high performing team of specialist consultants, clinical scientists, and managers, our philosophy is to achieve excellence through innovation, in all our services which include cellular pathology, microbiology and molecular biology, immunology clinical biochemistry, haematology and blood transfusion.We host the regional and reference laboratories for immunology and virology, providing a wide range of UKAS accredited tests, and our cellular pathology department provides an invaluable service to our regional cancer centre, based at Royal Preston Hospital.
We have always been early adopters of new technology including molecular technology, and we are a local delivery partner for the 100,000 genome project in Lancashire and South Cumbria. We have invested in electron microscopy to support our regional renal service, and have plans to expand further.
This is an exciting time for pathology services, and we have been developing a regional collaborative that will optimise opportunities for growth, innovation and research.
Our microbiology service
We deliver a large and complex microbiology service, with a wide repertoire of analytical procedures provided for a broad range of clients. In addition to clinical microbiology and infection control services to Lancashire Teaching Hospitals and the GP community, virology services are provided to hospitals throughout Lancashire and South Cumbria, and specialist viral and bacterial serology tests on a regional and national basis.
We work in collaboration with colleagues throughout the hospitals and in the community, to drive innovation, streamline pathways and improve care for patients.
Our OPAT service has won national awards for innovation and this best practice is being adopted by other hospitals around the country.
We have recently established a new molecular pathology department has been created and the range of molecular tests offered increased to include additional virology, haematology and oncology tests.
Our microbiology lab is within our pathology department, and is accredited by UKAS.
- Microbiology Leaflets
- Pathology Leaflets
- Relevant Leaflets/Documents/Links
- North West Blood Bikes
We are delighted to receive support from the North West Blood Bikes charity. North West Blood Bikes provides a voluntary out of hours transport for urgent and emergency blood, blood derivatives, samples, donor breast milk for premature babies, doctors notes, and theatre equipment, in fact anything that can be carried by motorcycle, between hospitals.
North West Blood Bikes provides this support through the night, at weekends and bank holidays, enabling hospital funding to be better spent on patient care.
The blood bikers work on a voluntary basis but fundraise to contribute towards feet maintenance and fuel costs.
- North West Blood Bikes and us - our 5th Anniversary
We are proud to be celebrating our five year relationship with North West Blood Bikes. We were the first trust to work with the North West Blood Bikes and the collaboration has gone from strength to strength.North West Blood Bikes provide a voluntary out of hours transport for urgent and emergency blood, blood derivatives, samples, donor breast milk for premature babies, doctor’s notes, and theatre equipment - in fact anything that can be carried by motorcycle, between hospitals.
We were the first trust to start working with the group back in 2012 and the volunteer service has continued to grow and expand ever since. Karen Partington, Chief Executive, said: “We made the innovative decision to combine the voluntary sector into our health delivery team and it has been incredibly successful. We are now working with other areas of the UK to share details of the way we work as many other NHS trusts want to follow in our footsteps.”
Maria Burn, Pre Analytics Manager for Pathology, said: “Back in 2012 we came up with the innovative idea to use volunteers to transport emergency items, it was something that had never been done before and it has been an incredible success. We were the first NHS trust to use this service and now it has been extended all across the North West, and other areas of the UK are looking to launch a similar service. The kind volunteers who give up their time free of charge are an extremely valuable part of our team and they make a real difference to the lives of our patients. This scheme ensures that our hospitals receive the supplies they need quickly and reliably and it means we have been able to save in excess of £30,000 by not having to pay for emergency out of hours transport.”
Paul Brooks, founder, chairman and trustee of North West Blood Bikes for Lancashire and the Lakes, said: “Once other hospitals heard about what we were doing for both Royal Preston Hospital and Chorley District Hospital, they contacted Maria to find out if what we said was true. We now cover 5 hospital trusts, covering 3,000 square miles, and it all started at Preston and Chorley. There is no doubt that what we do not only helps save costs but also, and more importantly helps save lives.”
We made the innovative decision to combine the voluntary sector into our health delivery team and it has been incredibly successful.
- Biochemistry
The Department of Clinical Biochemistry runs around 5,950,000 tests annually and runs a main hub laboratory at Royal Preston Hospital, alongside a spoke laboratory at Chorley and South Ribble District General Hospital. Both laboratories are staffed 24/7, providing a high quality, innovative clinical biochemistry service.
A wide range of clinical services are supported by pathology and the regional specialist services of oncology, renal, neuromedicine, neurosurgery, plastics, vascular, specialist mobility and rehabilitation, and trauma are delivered from the Preston site. We also provide an extensive and innovative Point of Care Testing Service across both hospital sites and throughout many GP practices across the region, with training provided by our Point of Care Academy.
We offer a wide variety of specialist tests and are part of the NPEX network. See our full list of specialist tests here.
For a full list of our accredited tests, please visit the UKAS website by clicking the icon below.
8549
Accredited to
ISO 15189: 2012
Specialist tests
As part of our Clinical Biochemistry service, we offer a range of specialist tests that are available to order. These are:
- 5-Hydroxyindole Acetic Acid (5HIAA)
- AFP
- Aldosterone
- Angiotensin Converting Enzyme
- Beta Hydroxybutyrate
- Bile acids
- CA 125
- CA 19-9
- Caeruloplasmin
- Calprotectin
- CEA
- Copper
- Cyclosporin
- Digoxin
- Drugs of Abuse
- Ethanol
- Faecal Occult Blood
- Growth Hormone
- HbA1c
- IGF
- Lithium
- Metadrenalines
- Parathyroid Hormone
- Phenobarbitone
- Phenytoin
- Plasma Renin Concentration
- Tacrolymus
- Theophylline
- Vancomycin
- Vitamin D
- Zinc
If you would like more information on any of the above, please search for the relevant test on our A-Z list below:
- 5-HIAA
Alternative name 5-Hydroxy Indole Acetic Acid Sample tube 24hr urine container with HCI preservative Sample volume 24hr urine Special requirements (for sample collection) Protect collection from light using a black bag. Various dietary substances interfere with the measurement of 5-HIAA. Bananas, pineapples and walnuts can cause 5-HIAA levels to increase as they contain high amounts of serotonin. Therefore, ingestion of these substances should be avoided on the day of sample collection. A patient information sheet is available upon request. Special requirements Send frozen aliquot of acidified 24hr urine collection, protected from light, together with a note of the total urine volume collected. Turnaround time 2 weeks Reference range <50 μmol/24hr Clinical application Investigation of carcinoid tumours Comments Samples cannot be processed unless the total volume of urine collected is noted with the sample aliquot. - Angiotensin Converting Enzyme (serum)
Alternative Name ACE Sample tube Gel tube (Sarstedt brown top) Sample volume 1ml blood (0.5ml serum) Special requirements (for sample collection) None Special requirements Separate serum and send via first class post. Store separated serum at 2-4oC if not sending same day as collection. Turnaround time 1 week Reference range 15-55 U/L Clinical application Monitoring in patients with sarcoidosis Comments Suppressed in patients on ACE inhibitors. Method used: Kinetic spectrophotometric. - Anti-Mullerian Hormone
Alternative name AMH Sample tube Gel tube (Sarstedt brown top) Sample volume 1ml blood (0.5ml serum) Special requirements (for sample collection) None Special requirements Separate serum and send via first class post. If there will be >48 hours before sending, store the specimen at -20°C. Samples can be sent to us at ambient temperature. On arrival in Pathology reception Separate on day of collection. Store at -20°C in rack. Turnaround time 1 week Reference range 20-29 years 13.1-53.8 pmol/l
30-34 years 6.8-47.8 pmol/l
35-39 years 5.6-37.4 pmol/l
40-44 years 0.7-21.1 pmol/l
45-50 years 0.3-14.7 pmol/l
Clinical application In female infertility investigations, AMH correlates with ovarian reserve independently of LMP. High levels are associated with PCOS and granulosa cell tumours of the ovary. Comments Method used: ROCHE cobas electrochemiluminescent immunoassay - AFP (serum)
Alternative name Alpha feto protein Sample tube Gel tube (Sarstedt brown top) Sample volume 1ml (0.5ml serum) Special requirements (for sample collection) Separate serum and send via first class post. Special requirements None Turnaround time 2 working days Reference range <10 kU/L (for use as a tumour marker) Clinical application Tumour marker; can be useful in teratoma, hepatocellular cancer, neuroblastoma. May also be raised in other malignancies. Comments This test is not suitable for antenatal screening. Method used: ROCHE cobas electrochemiluminescent immunoassay. - Beta Hydroxybutyrate
Alternative name N/A Sample tube No preservative (serum) Sample volume 1ml blood (0.5ml serum) Special requirements (for sample collection) None Special requirements Separate serum and send via first class post. Turnaround time 1 day Reference range In the treatment of Diabetic Ketoacidosis (DKA), the target betahydroxybutyrate concentration is <0.3mmol/l. In hypoglycaemia, betahydroxybutyrate should be interpreted in the context of the clinical presentation & other test results. Clinical application Monitoring of patients with DKA and for paediatric hypoglycaemia screens. Comments Method used: Enzymatic spectrophotometric - Bile acids
Alternative name N/A Sample tube Gel tube (Sarstedt brown top) Sample volume 1ml blood (0.5ml serum) Special requirements (for sample collection) None Special requirements Separate serum and send via first class post. Store separated serum at 2-4 oC if not sending same day as collection. Turnaround time 1 day Reference range <10 μmol/l Clinical application Investigation and monitoring of obstetric cholestasis - CA 125
Alternative name N/A Sample tube Gel tube (Sarstedt brown top) Sample volume 1ml (0.5ml serum) Special requirements (for sample collection) None Special requirements Separate serum and send via first class post. Store separated serum at 2-4oC if not sending same day as collection. Turnaround time <3 days Reference range <35 KU/L Clinical application Monitoring of patients with malignancy, most often ovarian in origin. Comments Note that ascites, whatever the cause, can result in a markedly elevated CA 125. - CA 19-9
Alternative name N/A Sample tube Gel tube (Sarstedt brown top) Sample volume 1ml blood (0.5ml serum) Special requirements (for sample collection) None Special requirements Separate serum and send via first class post. Store separated serum at 2-4oC if not sending same day as collection. Turnaround time <3 days Reference range <35 KU/L Clinical application Monitoring of patients with malignancy, most often pancreatic in origin. - Caeruloplasmin
Alternative name N/A Sample tube Gel tube (Sarstedt brown top) Sample volume 2ml Special requirements (for sample collection) None Special requirements Separate serum and send via first class post. Store separated serum at 2-4oC if not sending same day as collection. Turnaround time 1 day Reference range Caeruloplasmin (g/l)
0.08-0.23 (0-3 months)
0.12-.035 (4 months-11 months)
0.2-0.4 (1-9 years)
0.15-0.23 (10-12 years)
0.2-0.6 (13 years +)
Clinical application Investigation of Wilson's disease Comments Interpret with caution in acute illness. Caeruloplasmin shows a negative acute phase response. - Calprotectin
Alternative name N/A Sample tube Plain universal tube Sample volume Random stool sample (at least 1g) Special requirements (for sample collection) None Special requirements Send to laboratory within 48 hours of collection. Turnaround time 7 working days Reference range < 50µg/g Calprotectin not suggestive of intestinal inflammation. Results should be interpreted in line with clinical assessment.
< 50µg/g Elevated calprotectin indicates intestinal inflammation, suggest further information for inflammatory bowel disease (IBS). Note, calprotectin may also be raised in colorectal neoplasia, GI infections, GI bleeding more than 100ml and NSAID use. Results should be interpreted in line with clinical assessment.
Clinical application Investigation of inflammatory bowel disease Comments A definitive clinical diagnosis should not be based on the results of a single diagnostic method, but should only be made by the physician after all clinical and laboratory findings have been evaluated. - CEA
Alternative name Carcinoembryonic antigen Sample tube Gel tube (Sarstedt brown top) Sample volume 1ml blood (0.5ml plasma) Special requirements (for sample collection) None Special requirements Separate serum and send via first class post. Store separated serum at 2-4oC if not sending same day as collection. Turnaround time 1 day Reference range <7 µg/l Clinical application Used for monitoring malignancy, mostly in GI tract and colon, with a range of other primary sites - Copper (serum)
Alternative name None Sample tube Gel tube (Sarstedt brown top) or plain tube for paediatric samples Sample volume 3ml blood (1ml serum) Special requirements (for sample collection) None Special requirements Separate serum and send via first class post. Store separated serum at 2-4oC if not sending same day as collection. Turnaround time 1 week Reference range 13-24 μmol/l Clinical application Investigation of Wilson's disease and deficiency, or toxicity Comments Increases seen in pregnancy, oestrogen therapy, rheumatoid disease and other inflammatory conditions. Decreases seen in low serum protein states, also in valproate and steroid therapy. Measured by flame atomic absorption spectroscopy. - Cyclosporin A (whole blood)
Alternative names Cyclosporine, ciclosporin, neoral Sample tube EDTA (Sarstedt grey top or red top) Sample volume 1ml Special requirements (for sample collection) Trough sample should be collected (pre-dose) Special requirements None Turnaround time < 4 days Analysis is performed on Monday, Wednesday and Friday Reference range 60-250 μg/l Clinical application Theraputic drug monitoring and assessment of toxicity Comments Analysed by tandem mass spectronomy. The therapeutic range varies on the individual requirement and is dependent on the length of time since the transplant was performed. - Digoxin
Alternative name N/A Sample tube Gel tube (Sarstedt brown top) Sample volume 1ml blood (0.5ml serum) Special requirements (for sample collection) Sample should be taken at least 6hrs post-dose Special requirements Separate serum and send via first class post. Store separated serum at 2-4oC if not sending same day as collection. Turnaround time 1 day Reference range 0.5-2.0 μg/l (target range in heart failure: 0.5-1.0 μg/l) Clinical application Therapeutic drug monitoring and toxicity Comments Toxicity exacerbated by hypokalaemia and renal impairment - Ethanol
Alternative name Alcohol Sample tube Fluoride EDTA (Sarstedt yellow top) Sample volume 1ml blood (0.5ml plasma) Special requirements (for sample collection) None Special requirements Separate plasma and send via first class post. Store separated plasma at 2-4oC if not sending same day as collection. Turnaround time 2 days Reference range 0mg/dl Comments 17.4mmol/l equivalent to 80mg/dl - Ethanol (urine)
Alternative name Alcohol Sample tube Fluoride EDTA (Sarstedt yellow top) or plain container Sample volume 1ml urine Special requirements (for sample collection) None Turnaround time 4 days Reference range 0mg/dl Comments 17.4mmol/l equivalent to 80mg/dl - Faecal Occult Blood
Alternative name FOB Sample tube Sampling kit- available from pathology reception upon request. Sample volume See sampling kit instructions Special requirements (for sample collection) Random sample should be collected on 3 consecutive days (instructions in the sampling kit should be followed). Special requirements None Turnaround time 1 week Reference range Reported negative or positive according to a cut off of 10μgHb/g faeces as recommended by NICE. Clinical application Screen for occult blood loss Comments Iron therapy can cause false positive results. Samples analysed by OC sensor FIT method. - Growth Hormone
Alternative name GH Sample tube Gel tube (Sarstedt brown top) Special requirements (for sample collection) None Special requirements Separate serum as soon as possible after collection and freeze at -20oC. Send samples frozen. Sample volume 2ml (1ml serum) Turnaround time 1 week Reference range N/A Clinical application Baseline GH levels cannot be used to exclude acromegaly, as elevated levels may be due to stress; normal levels are seen in up to 8% of patients subsequently failing to suppress during GTT. Comments Protocols for stimulatory or suppression testing available from the Clinical Biochemistry Department. Note that in isolation, a single GH test provides limited diagnostic information. Analysed by IDS iSYS human growth hormone immunoassay. - HbA1c
Alternative name Glycated haemoglobin Sample tube EDTA tube (Sarstedt grey top or red top) Sample volume 1ml blood Special requirements (for sample collection) None Special requirements None Turnaround time 2 days Reference range HbA1C > 48mmol/mol is diagnostic of diabetes mellitus. Clinical application Monitoring of diabetic control and diagnosis of diabetes mellitus. Comments Samples are analysed using Tosoh G11 ion exchange chromatography. - IGF 1
Alternative name Insuline-like growth factor 1 Sample tube Gel tube (Sarstedt brown top) Sample volume 2ml blood (1ml serum) Special requirements (for sample collection) None Special requirements Separate serum as soon as possible after collection and freeze at -20oC. Send samples frozen. Turnaround time 2 weeks Reference range Reference ranges are age related and will be provided with the report. Contact the duty biochemist for further information.
Clinical application Investigation of growth hormone deficiency and acromegaly - Lithium
Alternative name N/A Sample tube Gel tube (Sarstedt brown top) Sample volume 1ml blood Special requirements (for sample collection) Sample should be taken 12 hours post-dose. Special requirements Separate serum and send via first class post. Store separated serum at 2-4oC if not sending same day as collection. Turnaround time 4 days Reference range 0.4-1.0mmol/l Clinical application Therapeutic drug monitoring Comments Concern level 1.4mmol/l. Severe toxicity likely at >2.0mmol/l. - Metadrenalines (urine)
Alternative names Normetadrenaline, metadrenaline, METS, NMA, VMA Sample tube 24hr urine container with strong acid Sample volume 24hr urine Special requirements (for sample collection) Ideally, collection should be made during a period in which the patient is symptomatic. There are no special delivery requirements. Special requirements None Turnaround time 2 weeks (a batch will be analysed every fortnight) Reference range Metadrenaline <2.0μmol/24hr
Normetadrenaline M <5.3μmol/24hr
F <4.3μmol/24hr
Clinical application Investigation of phaeochromocytoma - PTH
Alternative name Parathyroid hormone Sample tube EDTA (Sarstedt red top) Sample volume 1ml blood (0.5ml plasma) Special requirements (for sample collection) Sample to arrive in the laboratory within 6 hours. Special requirements Separate serum immediately and freeze if unable to send within 6 hours of collection. Send frozen. Turnaround time 2 days Reference range 1.6-6.8pmol/l Clinical application Investigation of causes of hyper and hypocalcaemia. Monitoring in renal disease. Comments Interpretation should be made in relation to accompanying serum calcium. - Phenobarbitone
Alternative names Primidone, phenobarbital Sample tube Gel tube (Sarstedt brown top) Sample volume 2ml Special requirements (for sample collection) Pre-dose samples preferred Special requirements Separate serum and send via first class post. Store separated serum at 2-4oC if not sending same day as collection. Turnaround time 1 day Reference range 10-30mg/l Clinical application Therapeutic drug monitoring. Target range ill-defined due to 'tolerance'. Comments Concern level 70mg/l. Conversion factor = μmol/l x 0.232 = mg/l. - Phenytoin
Alternative name N/A Sample tube Gel tube (Sarstedt brown top) Sample volume 2ml Special requirements (for sample collection) Pre-dose sample preferred or at least 1 hour post-dose Special requirements None Turnaround time Same day Reference range 8-15mg/l Clinical application Therapeutic drug monitoring. Severe toxicity likely if level >40.0mg/l. Concern level 25mg/l. Comments Note that drug is usually protein bound; those patients with very low serum albumin levels may have high free phenytoin relative to total levels. μmol/L x 0.252 = mg/l. - Renin
Alternative name Plasma renin concentration Sample tube EDTA (Sarstedt red top) Sample volume 2ml blood (1ml plasma) Special requirements (for sample collection) Stop therapy with spironolactone 4 weeks and β-blockers 2 weeks prior to test. Ensure potassium is within reference range at time of assessment. Please list any other medications. Sample must arrive in pathology reception within 15 minutes of collection.
SAMPLES MUST NOT BE TRANSPORTED TO THE LABORATORY ON ICE.Special requirements Centrifuge sample, aliquot and freeze plasma immediately on arrival. Send frozen plasma aliquot on dry ice. Turnaround time 2 weeks Reference range Adults: upright = 5.3-9.9mlu/l Clinical application Investigation of Conn’s syndrome (primary hyperaldosteronism). Generally combined with assessment of aldosterone to give an aldosterone : renin concentration ratio. Comments Plasma renin concentration is measured using the IDS iSYS immunoassay. - Tacrolimus
Alternative name FK506 Sample tube EDTA (Sarstedt grey top or red top). Grey top is the preferred sample type. Sample volume 1ml whole blood Special requirements (for sample collection) Pre-dose sample Special requirements None Turnaround time < 4 days. Analysis is performed on Monday, Wednesday and Friday. Reference range 3-15μg/l Clinical application Therapeutic drug monitoring of immunosuppressant treatment. Comments Concern level 25μg/l. Measured by LC-MS/MS. - Theophylline
Alternative name Aminophylline Sample tube Gel tube (Sarstedt brown top) Sample volume 1ml blood (0.5ml serum) Special requirements (for sample collection) Pre-dose sample preferred. Otherwise, at least 2 hours post-dose. Special requirements None Turnaround time 2 days Reference range 10-20mg/l Clinical application Therapeutic drug monitoring, compliance and toxicity. Comments Concern level 20 mg/L
Lower levels > 5.0 mg/L may be effective.
Concern level 14.0 mg/L if age < 3 months.
Severe toxicity likely if level > 60.0 mg/L. - Vancomycin
Alternative name N/A Sample tube Gel tube (Sarstedt brown top) Sample volume 1ml (0.5ml serum) Special requirements (for sample collection) Record time of sample and know how long it is since the last dose was given. Special requirements None Turnaround time 1 day Reference range Use drug level monitoring chart.
Levels > 4 mg/L will be phoned.
Interpretation depends on the timing of the sample in relation to the last dose. Refer any queries to the microbiologist.
Clinical application Therapeutic drug monitoring; interpretation depends on the timing of the sample and the time of the last dose.
Trough levels are usually measured: 12 to 24 hours after the last dose. - Vitamin D
Alternative names Calcidol, 25OH vitamin D, 25OH cholecalciferol, 25 hydroxy vitamin D. Sample tube Gel tube (Sarstedt brown top) Sample volume 2ml blood (1ml serum) Special requirements (for sample collection) None Special requirements Separate serum and send via first class post. Store separated serum at 2 – 4 oC if not sending same day as collection. Turnaround time 1 working day Reference range 50 – 150nmol/L (adequate vitamin D status) Clinical application Assessment of vitamin D deficiency/excess, investigation of hypo/hypercalcaemia in symptomatic patients. Comments Assay currently in use measures ‘total’ vitamin D. Seasonal variation seen due to sunlight exposure (D3). D2 reflects dietary or supplement origin. - Zinc
Alternative name N/A Sample tube Gel tube (Sarstedt brown top) Sample volume 2ml blood (1ml serum) Special requirements (for sample collection) None Special requirements Separate serum and send via first class post. Store separated serum at 2 – 4 oC if not sending same day as collection. Turnaround time 1 week Reference range 10-21μmol/l Clinical application Assessment of nutritional deficiency Comments Note, zinc is highly albumin bound and a negative acute phase reactant, interpret with caution.
Measured by atomic absorption spectrometry.
Human Biochemical Genetics
- Factor V Leiden
Alternative name FVL Sample tube EDTA whole blood (Sarstedt red top) Sample volume 2ml (7.5ml tube) Special requirements (for sample collection) None Special requirements None Turnaround time 2 weeks Reference range N/A Clinical application Genetic test for the R506Q mutation in the factor v gene. (OMIM 227400) used to identify individuals at increased risk of venous thrombosis.
Heterozygotes have a 4-8 fold increase in risk of thrombosis, homozygotes for the mutation have a 80-100 fold increase in risk.
Other factors may further increase the risk.Comments Analysed using LightCyclerTM fluorescence hybridisation. We can also measure the prothrombin gene variant on the same sample. - Prothrombin Gene Variant II
Alternative names PGV, PGV II Sample tube EDTA whole blood (Sarstedt red top) Sample volume 2ml (7.5ml tube) Special requirements (for sample collection) None Special requirements None Turnaround time 2-3 weeks Reference range <2.0μmol/l Clinical application Detection of mutation in the factor II (prothrombin) gene, causing increased risk of thrombosis (OMIM 176930).
Heterozygotes have a 3-fold increase in risk for thrombosis, that for homozygotes has not been established but may be higher.
Other factors may further increase the risk.Comments Can be analysed together with Factor V Leiden. Analysed using LightCyclerTM fluorescence hybridisation.
- Genetic Tests - Useful Links
UK Genetic Testing Network
Download the Molecular Testing Export Request Form:
Immunology
We specialise in the diagnosis and treatment of immunodeficiency and allergy.
Our nursing staff provide care and support to the patients who require immunoglobulin replacement therapy.
We provide a wide range of routine and specialised services to hospitals and practitioners within Lancashire and South Cumbria, and to other hospitals within the North West. We support regional clinical specialist services including oncology, nephrology, paediatrics, rheumatology and neurology.
We undertake protein immunology (immunoglobulins, myeloma screening and typing, complement determination, acute phase proteins and other specific protein assays), allergy and autoimmunity testing, and immunophenotyping by flow cytometry.
- Immunology Contact Details
Immunology team
Consultant Clinical Scientist
Dr Anthony RowbottomConsultant Immunologist
Dr VijayaduraiConsultant Immunologist
Dr Ariharan AnantharachaganMedical Secretary
Rebecca BrierleyLaboratory opening hours
Monday to Friday 9am – 5pm
Address
Immunology Laboratory
Pathology
Royal Preston Hospital
Lancashire Teaching Hospitals NHS Foundation Trust
Sharoe Green Lane
Fulwood
Preston
PR2 9HTContact numbers
General enquiries 01772 522134
Results hotline 01772 522134
Clinical interpretation (office hours) 01772 522130
Out of hours clinical advice 01772 716565
- Quality assurance
To ensure the high quality of service, we participate in all relevant External Quality Assurance Schemes and make strenuous efforts to have vigorous internal quality control checks.
In order to ensure that the needs and requirements of users are met, we will:
- Operate a quality management system to integrate the organisation, procedures, processes and resources.
- Set quality objectives and plans in order to implement this quality policy.
- Ensure that all personnel are familiar with this quality policy to ensure user satisfaction.
- Commit to the health, safety and welfare of its entire staff. Visitors to the department will be treated with respect and due consideration will be given to their safety while on site.
- Uphold professional values and is committed to good professional practice and conduct.
The department complies with ISO 15189:2012 standard.
- Staff recruitment, training, development and retention at all levels to provide a full and effective service to its users.
- The proper procurement and maintenance of such equipment and other resources are needed for the provision of the service.
- The collection, transport and handling of all specimens in such a way as to ensure the correct performance of laboratory examinations.
- Compliance with relevant environmental legislation.
- The use of examination procedures that will ensure the highest achievable quality of all tests performed.
- Reporting results of examinations in ways which are timely, confidential, accurate and clinically useful.
- The assessment of user satisfaction, in addition to internal audit and external quality assessment, in order to produce continual quality improvement.
- Test requests
When completing request forms please provide:
- Patient’s full name
- Date of birth
- NHS number (except Emergency Department)
- Date and time of collection
- Patient’s Consultant/GP code
- Test requirements
- Valid signature
- Location
- Identify URGENT requests clearly
Approximate test turnaround times
Test Turnaround Times Test
Usual test
Frequency
Turnaround times (excl. transport & postal time)
Specimen Container
Immunoglobulins
Daily
5 days
Gel tube
Complement C3, C4 (immunochemical)
Daily
5 days
Gel tube
Acute Phase Proteins
Daily
3 days
Gel tube
Serum electrophoresis
Daily
16 days
Gel tube
Urine electrophoresis
Weekly
13 days
Random or 24 hour
Immunofixation
Twice weekly
10 days
Gel tube
Serum Free Light Chains
Twice weekly
7 days
Gel tube
Complement C1 Inhibitor
Weekly
10 days
Gel tube
Beta-2-microglobulin
Weekly
7 days
Gel tube
IgG subclasses
Weekly
11 days
Gel tube
Functional Antibodies
Weekly
8 days
Gel tube
CSF investigations
Weekly
12 days
Universal (CSF) + Gel Tube (Serum)
Cryoglobulins
Weekly
10 days
Gel tube *
Total IgE
Twice weekly
6 days
Gel tube
Specific IgE
Twice weekly
7 days
Gel tube
Connective Tissue Disease Screen
Daily
7 Days
Gel tube
Tissue Autoantibody screen
Daily
9 days
Gel tube
Anti-Nuclear Antibodies
Daily
7 days
Gel tube
Rheumatoid Screen
Daily
5 days
Gel tube
Rheumatoid RAPA
Weekly
8 days
Gel tube
Mast Cell Tryptase
Weekly
7 days
Gel tube
DNA antibodies
Weekly
10 days
Gel tube
ENA screen
Twice weekly
5 days
Gel tube
Aspergillus precipitins
Weekly
10 days
Gel tube
Candida precipitins
Weekly
9 days
Gel tube
Farmers lung precipitins
Weekly
9 days
Gel tube
Avian precipitins
Weekly
9 days
Gel tube
ANCA screen
Daily
4 days
Gel tube
ANCA Quantitation
Daily
4 days
Gel tube
CSF immunophenotyping
As required
2 days
Universal
Lymphocyte proliferation
As required
2 weeks
Lithium Heparin+
GBM quantitation
Daily
4 days
Gel tube
Phospholipid antibodies
Weekly
11 days
Gel tube
Thyroid TPO antibodies
Weekly
9 days
Gel tube
Thyroid receptor antibodies
Fortnightly
15 days
Gel tube
Acetylcholine receptor antibodies
Fortnightly
15 days
Gel tube
Intrinsic Factor antibodies
Weekly
11 days
Gel tube
Neuronal/Purkinje Cell antibodies
Weekly
8 days
Gel tube
Organ-specific antibodies (e.g. Adrenal, ovary, etc)
Weekly
8 days
Gel tube
Skin and Kidney Biopsies
As Required
11 days
On ice in a Universal tube
Coeliac screen
Twice weekly
9 days
Gel tube
Lymphocyte subsets
Daily
5 days
EDTA X 1 **
Leukaemia immunophenotyping
Daily
10 days
EDTA X 2 **
CSF/Pleural fluid immunophenotyping
On request
3 days
Universal ***
Dihydrorhodamine test DHR
On request
1 day
Lithium heparin tube***
Synovial Fluid Examination
Daily
4 days
Universal
* Please refer to correct procedure for cryoglobulin sample handling
** Do not refrigerate. Specimens must be kept at room temperature
*** Please contact the Laboratory prior to sending sample
The above turnaround times reflect the expected time to carry out and report an immunology test. These times refer to negative/normal results. Specimens with positive/abnormal results are often referred for further tests, which may significantly add to the turnaround time, e.g. a positive Rheumatoid Screen test (tested daily) will be referred for a Rheumatoid RAPA test (tested weekly). Some tests have long processing times, which significantly affect the turnaround time. Urgently requested ANCA and anti-GBM antibody tests will be given priority.
GP specimens and reports
A daily van service is available for all GPs served by the laboratory for the collection of specimens and delivery of reports. For further information on this service, please contact Gillian Crankshaw, Associate General Manager on 01772 522068.
