Telephone the laboratory on 0121 424 2252 or 0121 424 1185 and inform staff that an urgent sample is on its way. Please include the patient’s NHS number, name, date of birth, where is sample is arriving from, which tests are required and indicate on the form that the sample is urgent. If possible also give an indication of when the sample will arrive
Staff in the laboratory will record this information in the “Urgent GP Request form” (document code) CIT.F010 located on a clipboard in the hot cell area of specimen reception
Book a courier to transfer the sample from the GP Practice to Heartlands Hospital, Biochemistry department. Urgent samples can be transported with the routine courier service however please be aware this may result in delay
If the urgent sample is transported alongside routine work, please ensure that it is easily identifiable ie in an envelope marked “Urgent”
Except those on renal wards or under renal consultants or from dialysis units
Creatinine
-
Adults: 354
Paediatrics: 200
umol/L
Except those on renal wards or under renal consultants or from dialysis units
eGFR
Adults: 15
-
ml/min
AKI
-
3
Do not phone on dialysis patients (often from dialysis units or renal wards – 3, 303, 305, HH5)
Do not phone in CKD 4 or 5
Glucose
2.5
Adults: 25
Paediatrics: 15
mmol/L
Calcium adjusted
1.8
3.5
mmol/L
Magnesium
0.4
-
mmol/L
Phosphate
0.3
-
mmol/L
AST
-
600
U/L
Except those on liver wards or under liver consultants
ALT
-
600
U/L
Except those on liver wards or under liver consultants
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 I
-
16 (female or unknown)
34 (male)
ng/L
GP only
Ammonia
-
100
umol/L
Paediatrics only
Ethanol
-
>10
mg/dL
Paediatrics only
Paracetamol
-
Paediatrics > 5
Adults > 50
mg/L
Salicylate
-
300
mg/L
Conj bilirubin (DBIL)
-
25
umol/L
Paediatrics only
Total bilirubin
-
225
umol/L
Paediatrics only
Carbamazepine
-
25
ug /mL
Iron
-
70
umol/L
ED only
Phenobarbitone
-
70
mg/L
CSF Glucose
3.3
-
mmol/L
Paediatrics only
CSF Protein
-
0.45
g/L
Paediatrics only
Lactate
-
2.3
mmol/L
CRP
-
300
mg/L
GP only
Total bile acids
-
20
umol/L
Obs/gynae only. Phoning protocol already agreed.
Urine protein:creatinine ratio
30
mg/mmol
Antenatal only, first raised result only
Methotrexate
Phone all
umol/L
Xanthochromia results phoned
Oxyhaemoglobin is present in sufficient concentration to impair the ability to detect haemoglobin. SAH not excluded.
Increased CSF bilirubin. Consistent with SAH (NB: this would be an unusual pattern within the first week after an event).
Increased CSF bilirubin. Consistent with SAH (NB: this would be an unusual pattern within the first week after an event).
Increased CSF bilirubin but probably totally accounted for by increase in serum bilirubin. Not supportive of SAH.
Bilirubin and oxyhaemoglobin increased. Consistent with SAH.
Increased CSF bilirubin. This finding may be consistent with: SAH; an increased bilirubin accompanying the increased CSF protein; or another source of CSF blood
Haematology
Haematology
Core hours**
Out of hours
All hours
Hb
<70g/L or >200g/L
<50g/L
Unexplained sudden drop in
Hb >30g/L within 24hrs
MCV
Plt
New unexplained <50 x 109/L or >1000 x 109/L
Platelet count <20 x 109/L
Wbc
New unexplained <2.0 x 109/L or >50 x 109/L
Neuts
New unexplained <0.5 x 109/L
Other general
rules
All newly presented Acute Leukaemia and CML
Known Acute Leukaemia’s with blasts present
Suspected relapse of Acute Leukaemia’s
Blood film suggestive of Thrombotic microangiopathic anaemia (e.g. TTP, MAHA, HUS, DIC)
Results that are not comparable to previous
All hours
Infectious Mononucleosis
All Positives
Malaria
All Positives
Sickle Screen
All Positives (inpatient’s only)
FMH
All FMH Quantitation’s
G6PD
= or < 6.4 IU/gHb
Clotting Studies
INR
>5.0 (>6.0 Anticoagulant clinic)
APTT
APTT >4.0
Fibrinogen
Fibrinogen <1.0g/L
D-Dimer
> 250 ng/mL (GP/ Outpatients)
Special Coagulation
(All results stipulated below will be telephoned to a Consultant Haematologist who will contact the requesting medical team)
ADAMTS13 Activity
< 10 IU/dL All new urgent or ? TTP
HIT screen
>1.0 IU/mL
First time Factor Assay
<10 u/dl
Positive Inhibitor
>0.6BU or any new patients
Urgent VWF
<15 IU/dL
All abnormal coagulation results must be telephoned regardless of previous results
Sickle screens should be phoned for all in-patients
Immunology
Autoimmunity
New positive GBM antibodies
New positive MPO antibodies*
New positive PR3 antibodies*
*Low positive / equivocal anti-MPO / PR3 antibody results should be interpreted in the clinical context and decision to communicate is based on whether features of small vessel vasculitis are present or likely.
New finding of positive LKM / SMA / SLA or LC-1 liver antibody in a child (<16 years) with very high ALT
Investigation of plasma cell dyscrasias (myeloma)
Serum IgG paraprotein >15 g/L
Serum IgA or IgM paraprotein >10 g/L
IgD or IgE paraproteins regardless of concentration
Light chain only kappa or lambda paraproteins with abnormal sFLCs ratio of >7 or <0.1 and involved light chain >100 mg/L.
Any paraprotein / abnormal sFLCs ratio with significant symptoms indicating an urgent problem (e.g. spinal cord compression, acute kidney injury)
Suspected immunodeficiency
Any result supporting a new finding of severe combined immunodeficiency (SCID) in a child should be communicated urgently to Paediatric Immunology.
New severe T-cell lymphopenia
Adults: CD4+ T-cell count <200 cells/uL
Child ≥6 years: CD4+ T-cell count <200 cells/uL
Child aged 1 year to <6 years: CD4+ T-cell count <500 cells/uL
To assess prednisolone metabolism in steroid dependent asthmatics
Justification:
Small group of asthmatics remain symptomatic despite long term treatment with oral corticosteroids “prednisolone”, with major implication in terms of steroid induced side effects. The cause of this lack of effect could be due to poor adherence, malabsorption, rapid metabolism or genetically mediated resistance to steroids. The aim of this test is to assess the cause of the apparent lack of responsiveness to steroids in a patient.
