Departments

Analytical Specialist Chemistry

About EPA Analytical Specialist Chemistry

The Analytical and Specialist Chemistry (ASC) section, formerly the Toxicology & Endocrinology section, is a specialist area of the laboratory. The section is split into four sub-sections: Toxicology, Endocrinology, Maternal Serum Screening (MSS), and the Supra-Regional Assay and Advice Service (SAAS) for Calcium and Bone Metabolism.

Toxicology

The Toxicology sub-section has been processing toxicology samples for its service users for approximately 30 years. Users include primary and secondary care NHS organisations, the Norfolk and Suffolk Coroners’ Services, and a number of private users. This primarily involves the analysis of urine samples in the detection of drug compounds, both therapeutic and illicit, but also of post mortem blood samples for biochemical markers such as ethanol and carboxyhaemoglobin. The Toxicology sub-section has a track record of innovation and development in order to keep up with the progression of toxicology analysis. We have recently acquired and implemented a new quadrupole time-of-flight mass spectrometer (QToF–MS) to improve the service, which as well as general screening for ‘classic’ drugs of abuse, enables more specialist toxicology, such as detection of novel psychoactive substances (NPS, ‘legal highs’). The QToF–MS is a high-resolution, accurate-mass analyser, and although widely used in academic and industrial laboratories, these types of analysers are found in relatively few NHS laboratories, largely due to the cost and expertise required to operate such systems.

Mass spectrometry was adopted by what is now ASC nearly fifteen years ago, and as well as processing toxicology work, the staff in the section also use tandem mass spectrometry (MS/MS) analysers in a variety of assays, including the measurement of urinary 5‑hydroxyindoleacetic acid (5-HIAA) and urinary metadrenalines, used in the investigation and monitoring of certain tumours. The sub-section also houses one of a small number of specialist NHS trace elements services in the UK using inductively-coupled plasma mass spectrometry (ICP–MS). This service offers the measurement of trace elements, such as copper, zinc, and selenium, used in nutritional assessments and in the investigation of various disease states, and chromium & cobalt, used to monitor potential soft tissue reactions to metal-on-metal hip replacements. This service also utilises mass spectrometry, in this case an ICP–MS, which employs an argon plasma operating at more than 8,000°C, hotter than the surface of the sun!

Endocrinology

The Endocrinology sub-section offers specialist endocrinology tests and tumour markers to both primary and secondary care service users across the East of England. This includes a variety of analytes, including steroid hormones, such as testosterone and oestradiol, peptide hormones, such as PTH and IGF-1, and tumour markers, such as CA 19-9. The Endocrinology sub-section is a semi-automated area, in which a number of large immunoassay-based analysers are located, running in excess of 500 samples a day. The ASC section also provides the Faecal Immunochemical Testing (FIT) service for Norfolk, in both primary and secondary care, with a workload of approximately 50,000 samples per year.

The ASC section also uses isoelectric focusing electrophoresis for the analysis of paired cerebrospinal fluid (CSF) and serum samples from patients for the detection of a pattern of immunoglobulins called oligoclonal bands. Oligoclonal bands are suggestive of, but not pathognomonic of, multiple sclerosis (MS), as they may also be found in infective and inflammatory diseases of the CNS, such as viral encephalitis, bacterial meningitis, sarcoid, and lupus.

Maternal Serum Screening (MSS)

The MSS sub-section of ASC provides first trimester MSS service for Down’s (trisomy 21), Edwards’ (trisomy 18), and Patau’s (trisomy 13) syndromes for the three acute hospital Trusts across Norfolk. The trisomy screening service is provided in combination with other departments in the hospital, and involves ultrasound measurement of nuchal translucency (NT) and laboratory measurement of maternal serum biochemical markers, PAPP-A and free beta-hCG. A calculation is performed using these data, and information provided by the mother, to estimate the chance of Down’s syndrome, and a combined chance of Edwards’ and Patau’s syndromes. From this, the parents can either be reassured that the pregnancy has a low chance of an affected pregnancy, or be referred for counselling and diagnostic testing, if a high chance is received. First trimester screening for Down’s, Edwards’, and Patau’s syndromes is the test recommended by the UK National Screening Committee and may be performed within the gestational age range of 11 weeks + 2 days to 14 weeks + 1 day.

SAAS for Calcium and Bone Metabolism

An increasing repertoire of laboratory tests is available for assessing the bone remodelling process. Although these tests have a role in a variety of disease states, their main roles are in the management of osteoporosis, investigation of vitamin D metabolism, and in the diagnosis of tumour-induced osteomalacia (TIO). Markers of bone remodelling can be measured in serum, plasma, or urine, and have a number of potential roles in the management of fracture risk, including targeting therapy. Changes in bone remodelling, through targeted therapy are related to fracture risk reduction, with the choice of therapy influenced by knowledge of bone remodelling in that patient. Biochemical therapeutic monitoring may improve patient understanding and therapeutic adherence. Markers of bone remodelling are also useful in a variety of other conditions involving the skeleton, such as Paget’s disease of bone, bone disease in malignancy, disorders of growth, and renal bone disease. Other specialised investigations, such as 1,25-dihydroxy vitamin D (calcitriol), 24,25‑dihydroxy vitamin D, and investigations related to phosphate metabolism (FGF23), are also available.

For a full range of tests available, see below.

Test Samples

General Sample Guidelines can be downloaded here.

Sample Acceptance/Rejection Criteria can be downloaded here

Informed Consent

 NOTE: All procedures and investigations carried out on a patient need the informed consent
of the patient.

Patient consent:
  • NOTE – All procedures carried out on a patient need the informed consent of the patient.

For most routine laboratory procedures, consent can be inferred when the patient presents himself or herself at a laboratory, or other suitable area, within a primary or secondary care setting, with a request form and willingly submits to the usual collecting procedure.

The laboratory infers informed consent has been obtained when samples are received. It is the responsibility of the clinician requesting the test to ensure that informed
consent has been obtained.

This consent includes notification to third parties where required by law for example under
the Health Protection (Notification) Regulations 2010: we are required to notify any infection
of public health significance to local public health department as mandated by the regulation.
Please ensure your patient is aware of this before submission of samples for testing.

 

Packaging and Transport of Samples

Samples are a potential source of infection and should be treated accordingly. Please fill all sample bottles with the correct volume of blood to ensure correct anticoagulation, and all containers must be securely closed. Leaking samples with gross contamination of contents and containers are discarded. Pocket bags are available for sample transport. Samples should be placed in the appropriate container, which must be securely fastened. This must be placed in a clear plastic bag and sealed. Samples accompanied by forms without specimen bags must be put into marsupial bags with the request form being placed in the side pouch.

Refer to local Trust policies.

Sending Samples

The transport of samples from GP surgeries or other primary care locations is carried out by the Logistics service staff who will collect all samples from dedicated collection points. Samples from within the hospital can be transported to Pathology either by the Pneumatic Tube System (PTS) if suitable or by a porter.  For urgent samples ward staff are required to arrange delivery to the laboratory. Samples must first be placed in the plastic sample bags together with the completed request form.

The safe transport of specimens to the laboratory is the responsibility of the requesting doctor or carrier. Laboratory responsibility for the sample begins when it has arrived at the laboratory. 

Sending sample via the pneumatic tube system

  • All items MUST be sent in the carriers provided. 
  • Samples MUST not be placed directly into the carriers. ALL Pathology samples MUST be placed in specimen bags and the lids of all items with the potential to leak (fluids etc.) tightly secured BEFORE placing them in the carriers.
  • Do not cram samples/items into the carrier as this may lead to breakage/leakage and system failure.
  • Only one carrier at a time should be placed in a delivery station.
  • Ensure that carriers are closed securely at both ends to avoid them jamming in the tube network.
  • If any defect is noticed with the operation of the air-tube systems please notify the laboratory at the earliest opportunity.
  • The system must not be used for sending consumables and other “forbidden items” around the hospital.

The air tube systems are for the transport of Blood Sciences specimens to the laboratories only.

The air-tube system should NOT to be used for:

  • Danger of Infection samples
  • Blood gases
  • Blood cultures
  • Unrepeatable samples
  • CSFs (for culture, protein, glucose or xanthochromia)

The air tube systems are for the transport of Blood Sciences specimens to the laboratories only.

The air-tube system should NOT to be used for:

  • Danger of Infection samples
  • Blood gases
  • Blood cultures
  • Unrepeatable samples
  • CSFs (for culture, protein, glucose or xanthochromia)

SEE INDIVIDUAL TRUST POLICIES.

JPUH

Forms can now be requested on Web ICE

NNUH

Request Forms

Forms must be requested on Web ICE by 06:00 for that day’s round.

Extra forms will not be accepted by the phlebotomists during the ward round.

Requests marked ‘URGENT’ WILL NOT be taken by the Phlebotomist – these must be taken by the requesting clinician.

Request forms which have the incorrect location on the request form will be sent to the correct location (if identified) via the pneumatic air tube system. If the phlebotomist on the correct location has already completed their ward round the request form will become the responsibility of the ward staff to obtain blood sample collection for their patient.

 If the phlebotomist is unable to obtain blood sample collection the request form will be returned to the clinician.

QEH

Forms can now be requested on Web ICE

Outside normal working hours

  • Non urgent specimens from NNUH should be taken/sent to Pathology Reception, East Block, Level 1, Norfolk and Norwich University Hospital, for delivery the following day to the EPA Microbiology Department.
  • Urgent specimens from NNUH should be sent to the Security desk at the West Atrium NOT Pathology and instructions given to send the specimen to the Microbiology Laboratory.  Remember the Microbiology service is provided from the Norwich Research Park, Colney.  The specimen will be sent to the Microbiology Department via the most appropriate available transport.

“High Risk” samples

Medical officers responsible for the care of patients have a duty of care towards other members of staff – therefore all samples from patients who are known to have, or strongly suspected of having the conditions noted below must be identified.

  • Creutzfeldt – Jakob disease
  • Viral haemorrhagic fever (VHF) of any type
  • Microorganisms, (biological agents) in Hazard Group 3 or 4.
  • Pyrexia of unknown origin (PUO) recently returned from Africa.

Medical staff should ensure that appropriate information, including relevant travel history, is provided in order to alert laboratory staff of potential dangers. Clinical details supplied on sample request forms must contain clear information regarding the nature of the test being requested and sufficient detail to inform laboratory staff upon the safety precautions they need to take in order to process the sample without risk of infection.

If, during patient intervention, further information becomes available that has implications for the safety of laboratory staff this must be communicated immediately to the laboratory so that appropriate steps regarding containment can be taken.

NOTE: Patient suspected of having VHF (guidelines) v3. Doc ID 10584

Contact details for the Infection Protection and Control Nurses:

Mon-Fri 09:00 – 17:00
Tel 01603 289847 (Ext: 5847)

Email: IP&Cadministrator@nnuh.nhs.uk

Out of hours: First contact the relevant site practitioner. 

Referred Tests

Some specialised or low volume assays are referred to external laboratories for analysis; these may take up to 4 weeks for a result to become available. Please contact the laboratory if there is any urgency for these investigations. Information regarding specimen type for referred tests can be obtained by contacting the laboratory.

In line with accreditation requirements we endeavour to use accredited laboratories whenever possible. Further information on the reference laboratories we use can be obtained from the Individual Head of Section or from the Quality Manager if required.

SAAS Bone Metabolism Service

SAAS Bone Metabolism Service

The full range of tests currently offered by the SAAS lab at NNUH are:

  • 1, 25 dihydroxyvitamin D
  • 24, 25 dihydroxyvitamin D
  • 25 hydroxyvitamin D
  • CTX (C-terminal telopeptides of type 1 collagen)
  • P1NP (Procollagen Type 1 N-terminal propeptide)
  • Osteocalcin
  • Bone-specific alkaline phosphatase
  • Fibroblast growth factor 23 (FGF23) (Both C-terminal and intact FGF23)
  • PTHrP (SERVICE CURRENTLY SUSPENDED)
  • PIIINP (Procollagen Type 3 N-terminal propeptide)
  • Urine NTX (urine N-terminal telepeptides of type 1 collagen)
  • Urine Deoxypyridinoline (DPD) and pyridinoline (PYD)
  • TRAP5b
  • Osteoprotegerin, and associated antibodies
  • PTH(1-34)
  • Vitamin D binding protein
  • Sclerostin
  • Cathepsin K
  • Urine and plasma cAMP

For more information, please visit: https://www.sas-centre.org/centres/bone-markers/norwich

Please click here to download standard information for referring laboratories

Results

Result enquiries / Telephoned results

Authorised results are available on the ICE system, which is updated in real time throughout the day. If a result is needed urgently and/or cannot be found via the ICE system the laboratory may be contacted on 01603 287430 (Ext ).

Results of urgent requests if ICE access or electronic delivery is not available and unexpected results, which may aid the immediate patient management, will be telephoned.

In the event that the laboratory is unable to deliver the required service due to equipment failure we will endeavour to contact all relevant users.

Clinical Liaison

Consultation about investigation and management of conditions is welcomed. 

For advice on diagnosis and the interpretation of Clinical Biochemistry results or advice on treatment during normal working hours (Monday – Friday, 09:00 – 17:30) contact the duty Biochemist on 01603 646685. 

Outside normal hours of service they can be contacted through the hospital switchboard. Tel: 01603 286286.

Due to IG compliance requirements, results cannot be communicated directly to patients. 

Guidance

For information about key factors that are known to affect test performance and result interpretation click here.

Opening Times

NNUH only

The laboratory can be found in East Block Level 1 sign posted ‘Pathology’

Monday09:00 - 17:30
Tuesday09:00 - 17:30
Wednesday09:00 - 17:30
Thursday09:00 - 17:30
Friday09:00 - 17:30
SaturdayClosed
SundayClosed

EWS-D-001 Last updated 23/09/22 (2)