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.
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!
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.
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.
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 any assay or sample queries not answered on the website, please contact our lab at SAASBoneMetabolism@nnuh.nhs.uk
For a full range of tests available, see below.
Some specialist or low volume tests are referred to external laboratories for analysis; these may take up to four 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:
For more information, please visit: https://www.sas-centre.org/centres/bone-markers/norwich
For any assay or sample queries not answered on the website, please contact our lab at SAASBoneMetabolism@nnuh.nhs.uk
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 27/03/23 (3)