Home Page - uhbpathology.com

Introduction

Written by Craig Webster on 05 April 2012.

Protection of Personal Information – Pathology Laboratories Services comply with the Trust Data Protection Policy and have procedures in place to allow the Directorate and it’s employees to comply with the Data Protection Act 1998 and associated best practice and guidance.

The laboratories at Queen Elizabeth Hospital, Heartlands Hospital, Good Hope Hospital and Solihull Hospital form part of the services provided by University Hospitals Birmingham and are UKAS (United Kingdom Accreditation Service) accredited to the ISO 15189:2022 standard. For a list of accredited tests and other information please visit the UKAS website using the following link: https://www.ukas.com/find-an-organisation/

Molecular Pathology is a UKAS accredited medical laboratory No. 8759
Biochemistry is a UKAS accredited medical laboratory No. 8910
Haematology and Transfusion is a UKAS accredited medical laboratory No. 8784
Clinical Microbiology is a UKAS accredited medical laboratory No. 8760
Cellular Pathology is a UKAS accredited medical laboratory No. 10141
Musculoskeletal laboratory is a UKAS accredited medical laboratory No. 9897
United Kingdom Health Security Agency laboratory is a UKAS accredited medical laboratory No.8213

Tests not appearing on the UKAS Schedule of Accreditation currently remain outside of our scope of accreditation. However, these tests have been validated to the same high standard as accredited tests and are performed by the same trained and competent staff.

For further test information, please visit the test database: http://www.heftpathology.com/frontpage/test-database.html.

For further information contact Louise Fallon, Quality Manager, 0121 371 5962/ 0121 424 1235

Created on 05 April 2012.
Last updated on 23 July 2025.

Department of Biochemistry and Immunology

Written by Craig Webster on 08 April 2025.

Department of Clinical Chemistry, Immunology and Toxicology

Department Profile

The Clinical Chemistry/Immunology and Toxicology department provides a wide range of analytical and advisory services, which are available to inpatients, outpatients, and the community at large. As you would expect from a large teaching hospital this service is backed up with training and research programmes designed to improve patient care. To ensure the highest standard of work we participate in extensive internal and external quality assurance schemes.

biochemistry, blood sciences, specialist testing, toxicology

Created on 08 April 2025.
Last updated on 23 July 2025.

Edoxaban Assay

Written by Mark Hill on 27 June 2019.

Edoxaban is one of the direct oral anticoagulants, exerting an anticoagulant effect by inhibiting activated factor X.

Changes in the prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT) may be observed in patients on therapeutic edoxaban doses. However, these changes tend to be small, unpredictable, and highly variable, so clinicians should not use these markers to monitor the anticoagulant effects or titrate the dose of edoxaban (Plitt A, Giugliano RP. Edoxaban: review of Pharmacology and key phase I to III clinical trials. J Cardiovasc Pharmacol Ther. 2014;19(5):409–416).

Urgent requests should be discussed with the laboratory prior to receiving the sample.

This test will be reviewed by UKAS for ISO 15189 accreditation at the next surveillance visit in October 2019

Created on 27 June 2019.
Last updated on 29 July 2019.

Haematinic Guidelines

Written by Craig Webster on 09 October 2015.

HEFT Pathology Guideline Investigation and Referral Pathways for Anaemia in Primary Care

Produced by:	Dr Sukhbir Kaur (Senior Clinical Biochemist)
Approved by:	Dr Kartsios Charalampos (Consultant Haematologist)
	Dr Marcus Mottershead (Consultant Gastroenterology)

This guidence covers the following areas

1. Anaemia Testing in Adults

2. Iron Deficiency Anaemia Testing in Adults

3. Iron Deficiency Anaemia Treatment and Monitoring Advice

4. Vitamin B12 Deficiency Testing, Treatment and Monitoring

5. Folate Deficiency Testing, Treatment and Monitoring Advice

6. Renal Anaemia Testing in Adults

biochemistry, haematology, haemainics

Clinical Decision Limits

Written by Craig Webster on 09 May 2014.

Phoning limits for biochemistry tests are as follows:

Decision limits for phoning

Analyte	Phone results below or equal to:	Phone results above or equal to:	Units	Notes
Sodium	120	150	mmol/L
Potassium	2.5	6.5	mmol/L
Urea	-	Adults: 30 Paediatrics: 10	mmol/L	Except those on renal wards or under renal consultants.
Creatinine	-	Paediatrics: 200	umol/L
eGFR	Adults: 15	-	ml/min
AKI	-	2		Not CKD patients (AKI 2 discretionary)
Glucose	2.5	25	mmol/L
Calcium adjusted	1.8	3.5	mmol/L
Magnesium	0.4	-	mmol/L
Phosphate	0.3	-	mmol/L
AST	-	600	U/L
ALT	-	600	U/L
Total CK	-	5000	U/L
Amylase	-	500	U/L
Digoxin	-	2.5	ng/mL
Theophylline	-	25	mg/L
Phenytoin	-	25	mg/L
Lithium	-	1.5	mmol/L
Troponin T	-	GP only: >14	ng/L	GP only
Ammonia	-	100	umol/L
Ethanol	-	Paediatrics only: any detectable	mg/L	Paediatrics only
Paracetamol	-	10	mg/L	Not ED patients
Salicylate	-	300	mg/L	Not ED patients
Conj bilirubin (DBIL)	-	Paediatrics only: 25	umol/L	Paediatrics only
Total bilirubin	-	Paediatrics only: 225	umol/L	Paediatrics only
Carbamazepine	-	25	ug /mL
Iron	-	ED only: 70	umol/L	ED only
Phenobarbitone	-	70	mg/L
CSF Gluc	3.3	-	mmol/L
CSF Prot	-	0.45	g/L
Lactate	-	2.3
CRP	-	300
Total bile acids	-	20
Methotrexate	Phone all		umol/L

Immunology results to be telephoned:

CD4 count <200 cells/cumm or <10% on new patients (paediatric levels are different, but agreed with Paed consultants)
Lymphocyte subsets in infants <2yo: Any T cell subset below age-related normal range, any other abnormality suggesting SCID (e.g. MHC class II deficiency). (Note this is not exclusive: any abnormality may be discussed with requesting clinician)
New positive GBM antibodiest
New positive MPO antibodies
New positive PR3 antibodies
New paraprotein IgG , A or M > 20g/L
- IgD or IgE (any size)
- serum monoclonal free light chains (any size, whether or not with intact paraprotein)

Abnormal Laboratory Test Results – Triggers for Telephoning Results Haematology

Haemoglobin	White Blood Cell Count
<8.0 g/dl normochromic and normocytic	Low result – neutropenia <0.5 x 10 9/L
<7.0 g/dl microcytic and hypochromic	High result – White cell count >40 x 10 9/L
<7.0 g/dl macrocytic	or Lymph count > 20 x 10 9/L
<5.0 g/dl renal patients	Any presence of blast cells

Platelets	Clotting Studies
Lower limit - <70 x 10 9/L	INR - >5.0
Upper limit - >1000 x 10 9/L	PTT - >180 seconds
	Fibrinogen < 1.0g/l

All Positive Malaria Screens
All Anti FXa results >1.20 iu/ml
If the patient is known to the department and has had a similar result within the previous 7 days then the urgent contact is not necessary.

HPA Microbiology – List of abnormal results telephoned to clinical staff

Bacteriology

Gram stain results of positive blood culture on Day 1
Positive CSF results
Positive sterile site results
Significant in-patient results from enteric bench
Multi resistant gram negative and gram positive isolates including mupirocin resistant MRSA
Group B streptococcal isolates from neonates
Group A in patient isolates
Positive Legionella urinary antigen and Pneumococcal urine antigen results
Smear and culture positive Mycobacteria
Antibiotic assay results outside normal ranges
Any other significant results at the discretion of Medical Microbiologists

Virology

Serological evidence of acute infection with Hep A, Hep B and in pregnant patients CMV, Parvovirus and Rubella
New diagnoses of HIV
VZV IgG negative from exposed patients at risk of severe VZV infection
New diagnosis of Hep B, Hep C and HIV in haemodialysis patients
Evidence of Hep B/Hep C and HIV in needle stick injury source patients
Clinically important positive respiratory PCR results i.e.: influenza, RSV in immunocompromised patients
Positive PCR results in outbreaks
Positive blood PCR for CMV and Adenovirus
Negative blood results for CMV PCR
Significant blood PCR results for EBV and Polyomavirus
All positive PCR results on CSF specimens
All positive Chlamydia PCR results on eye swabs
All positive PCR results from neonatal unit

Created on 09 May 2014.
Last updated on 24 October 2019.