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.
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!
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.
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
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
General Sample Guidelines can be downloaded here.
Sample Acceptance/Rejection Criteria can be downloaded here
NOTE: All procedures and investigations 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.
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.
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.
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.
The full range of tests currently offered by the SAAS lab at NNUH are:
For more information please visit: https://www.sas-centre.org/centres/bone-markers/norwich
Please click here to download standard information for referring laboratories.
NNUH only
The laboratory can be found in East Block Level 1 sign posted ‘Pathology’
EWS-D-001 Last updated 23/09/22 (2)