Departments

Analytical Specialist Chemistry

About EPA Analytical Specialist Chemistry

The Analytical and Specialist Chemistry (ASC) department, formally the Toxicology & Endocrinology department, is a specialist area of the Laboratory. The department is split into four subsections; Toxicology, Endocrinology, Maternal Serum Screening (MSS) and the SAAS Bone Metabolism service.

Toxicology

The toxicology sub-section has been processing toxicology samples for Primary and Secondary care service users, as well as private companies and the Norfolk, and Suffolk Coroner’s services for approximately 30 years. This has involved the analysis of urine samples for the assessment of detectable drug compounds, as well as the analysis of blood samples for the biochemical markers such as ethanol and carboxyhaemoglobin.

The toxicology subsection has a track record for developing and innovating to keep at the ‘cutting edge’ of toxicology analysis. We have recently acquired and ‘gone-live’ with a new QToF-MS instrument to improve the service provided to our service users which includes the wider screening of toxicology compounds, and more specialist toxicology compound screens such as NPS/Legal high compounds. The Quadrupole time-of-flight mass spectrometry analyser (QToF-MS) is an accurate mass spectrometer and although used in research and pharmaceutical companies, these types of analysers are rarely found in NHS laboratories largely due to the cost and the specialist expertise required to operate these systems.

ASC has a long history of mass spectrometry expertise and as well as processing specialist toxicology workloads, the staff in the department run MS/MS (triple quad mass spectrometry) analysers for urine analysis to determine 5-HIAA (5-hydroxyindoleacetic acid) and metanephrines, these are used to diagnose and monitor progress of certain tumours.

The sub-section also runs one of a few specialist NHS trace elements services in the UK, analysing elements such as copper, zinc and selenium for nutrition and disease states, and chromium and cobalt to monitor joint replacement health. Again this service requires a mass spectrometry analyser, in this case an inductively coupled plasma mass spectrometry (ICP-MS), the analyser operates but super-heating argon to greater than 8000 oC, which is hotter than the surface of the sun!

Endocrinology

The Endocrinology subsection offers specialist tumour and endocrinology tests to both Primary and Secondary-care service users across the East of England.

The subsection analyses a variety of molecules e.g. steroid hormones, testosterone and oestradiol, peptide hormones such as PTH, and tumour markers such as CA 1-99, these are all used in the diagnosis and monitoring of specific cancers or other disease states.

The Endocrinology subsection is a semi-automated area and has a number of large immunoassay based analysers running in excess of 500 samples a day. The ASC department, in conjunction with Primary and Secondary-care, has provided access to the Faecal Immunochemical Testing (FIT) bowel screening service for in excess of 25,000 patients in Norfolk per year.

The ASC department also has an isoelectric focusing electrophoresis analyser used for the analysis of paired cerebrospinal fluid (CSF) and serum samples from patients for the detection of bands of immunoglobulins, called Oligoclonal bands. Oligoclonal bands are suggestive, but not pathognomonic of Multiple Sclerosis, as they can 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 subsection of ASC provides a first trimester MSS service for Down’s (trisomy 21), Edward’s (trisomy 18) and Patau’s (trisomy 13) syndromes for the three Trusts across Norfolk.

The first trimester MSS is a combined service 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 statistical calculation is performed using this data, and information provided by the parents, to estimate the chance of Down’s syndrome and a combined chance of Edward’s and Patau’s syndromes, from this the parents can be either reassured that the pregnancy has a low chance for an affected baby or the parents can be counselled and offered diagnostic testing if the result is high risk.

First Trimester screening for Down’s, Edward’s, and Patau’s is the test recommended by the UK National Screening Committee and may be performed within the gestational age range of 11 weeks + 1 day to 14 weeks + 1 day

SAAS Bone Metabolism Service

An increasing repertoire of laboratory tests are available for assessing the bone remodelling process. Although these tests have a role in a variety of disease states, their main role is in the management of osteoporosis.

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, could be related to fracture risk reduction. The choice of therapy could be influenced by knowledge of bone remodelling.

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-dihydroxyvitamin D (calcitriol), 24, 25-dihydroxyvitamin D and investigations related to phosphate metabolism (FGF23), are available.

For a full range of tests see further down this page

 

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

Paper Request Forms:

All Blood Science requests are made on EPA three-part request forms with specimen bags attached. Please ensure addressograph labels are attached to all three copies.

Green – Haematology and Biochemistry and Analytical Specialist Chemistry

Red – Blood Transfusion

White – Microbiology

Yellow – Cellular Pathology

HMR101/5 – Cervical Screening Samples (NB: full details are required)

Electronic Requests:

Electronic test requesting is currently not available within the JPUH.

Andrology requesting is booked through ICE via NNUH

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

Paper Request Forms

All Blood Science requests are made on EPA three-part request forms with specimen bags attached. Please ensure addressograph labels are attached to all three copies.

Green – Haematology and Biochemistry and Analytical Specialist Chemistry

Red – Blood Transfusion

White – Microbiology

HMR101/5 – Cervical Screening Samples (NB: full details are required)

Electronic Requests:

Electronic test requesting is currently not available within the QEH.

Andrology requesting is booked through ICE via NNUH

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.

Rejection of unacceptable specimens

Specimens and request forms are checked on receipt to confirm the patient identification (PID) information provided on the form and specimen agree. There are 4 PID data items; Surname, Forename, Date of Birth and ID Number (Hospital or NHS) which are required by the laboratory and these must match in order for the specimen to be accepted. It is good practice for us to have location and date & time of sample collection. If errors are found the laboratory may contact the requestor, explain the problem and request a repeat specimen.

For samples that are not easily repeated (such as CSF or paediatric samples) the problem will first be discussed with a BMS from the relevant section who will make a decision on whether testing may be allowed to proceed (usually after discussion with the clinician concerned). If the specimen is tested the report will clearly state the nature of the problem as a comment. Alternatively, the requesting clinician will be asked to send a repeat sample.

For further details regarding incompletely labelled samples or forms please contact the laboratory.

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

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

  • 1, 25 dihydroxy vitamin D
  • 24, 25 dihydroxy vitamin D
  • 25 hydroxy vitamin 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)
  • 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
Saturday09:00 - 12.30
SundayClosed

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