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 Endocrinology laboratory at NNUH is accredited by the United Kingdom Accreditation Service (UKAS) to ISO 15189:2012. The defined schedule of tests for which the laboratory is accredited can be found by clicking on the following link: schedule no. 10295.
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 [email protected]
The ASC laboratory at NNUH is accredited by the United Kingdom Accreditation Service (UKAS) to ISO 15189:2022. The defined schedule of tests for which the laboratory is accredited can be found by clicking on the following link: schedule no. 10295
If you find any errors within this information or would like to make any comments and/or suggestions for improvement, please contact Fiona Butcher, EPA Quality Manager on 01603 286900 or email [email protected]
For a full range of tests available, see below.
Poster: Supra-Regional Assay and Advice Service (SAAS) for Calcium and Bone Metabolism
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 themselves at a phlebotomy clinic, 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.
Samples are a potential source of infection and should be treated accordingly. Samples must be placed into the appropriate container and be securely fastened; leaking samples with gross contamination of contents and containers are discarded. Samples should be placed into a marsupial bag (a clear, re-sealable plastic bag with a pocket), and be accompanied by a request form placed in the side pouch.
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.
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.
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 286929 (or internal ext. 2929).
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.
Clinicians
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 or email [email protected]..
Outside normal hours of service they can be contacted through the hospital switchboard. Tel: 01603 286286.
Patients
Due to information governance compliance requirements, results or clinical advice cannot be communicated directly to patients.
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 or email [email protected].
Outside normal hours of service they can be contacted through the hospital switchboard. Tel: 01603 286286.
For information about key factors that are known to affect test performance and result interpretation click here
Phlebotomy information can be found here
For advice on use of vacutainers click here.
For advice on urine containers click here
For a full list of tests please see Supra-Regional Assay and Advice Service (SAAS) for Calcium and Bone Metabolism
For any assay or sample queries not answered on the website, please contact our lab at [email protected]
For more information on the bone service: please visit: https://www.sas-centre.org/centres/bone-markers/norwich
SAAS Bone Metabolism Service
The full range of tests currently offered by the SAAS lab at NNUH are:
Please click here to download standard information for referring laboratories.
General Lab enquires (Toxicology): 01603 287430 (Ext 3430)
General Lab enquires (Endocrinology/MSS):
01603 289419 (Ext 5419)
NNUH only
The laboratory can be found in East Block Level 1 sign posted ‘Pathology’
EWS-D-001 Last updated 22/09/26 (7)