LABORATORY MEDICINE USER GUIDE

UNIVERSITY HOSPITAL GALWAY

1. THE LABORATORY MEDICINE SERVICE............................................................ 3

2. GENERAL INFORMATION ............................................................................... 4
3. USE OF THE LABORATORY ............................................................................ 12
4. PHLEBOTOMY SERVICE ................................................................................ 18
5. TRANSPORT OF SPECIMENS TO THE LABORATORY ....................................... 20
6. REPORTING RESULTS.................................................................................... 23
7. BLOOD AND TISSUE ESTABLISHMENT........................................................... 25
8. CLINICAL BIOCHEMISTRY DEPARTMENT ....................................................... 36
9. DIVISION OF ANATOMIC PATHOLOGY .......................................................... 43
10. MORTUARY SERVICES-AUTOPSY .................................................................. 53
11. IMMUNOLOGY DEPARTMENT (SUPRAREGIONAL SERVICE) .......................... 57
12. HAEMATOLOGY LABORATORY ..................................................................... 69
13. MEDICAL MICROBIOLOGY DEPARTMENT ..................................................... 73
14. VIROLOGY DEPARTMENT ............................................................................. 84
15. OUT OF HOURS (EMERGENCY SERVICE)........................................................ 87
16. ALPHABETICAL TEST DIRECTORY .................................................................. 91
The philosophy of care for Galway University Hospital (GUH) is to provide high quality and equitable care for all patients,
in a safe and secure environment and to achieve excellence in clinical practice teaching, training and research. The
Laboratory Medicine Department is committed to providing the highest quality diagnostic and consultative service for
all its users.

Although diagnostic laboratory tests are generally valid and reliable, all laboratory tests have limitations and results
should be interpreted in association with findings from history, examination and other diagnostic tests. In general
negative/not detected tests results should not be interpreted in isolation as excluding a diagnosis because false negative
results are a recognized limitation of most assays/tests. Likewise, in general, a positive/detected test result should not
be taken in isolation as confirming a diagnosis because false positive results are a recognized limitation of most
assays/tests. Please telephone the clinical staff in the laboratory if you would like to discuss the interpretation of a
result.

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1. The Laboratory Medicine Service
Galway University Hospital, Laboratory Medicine Department aims to act as a centre of service excellence, innovation
and research to support the health care mission of the Saolta Health Care Group and the HSE regionally and nationally.
Saolta University Health Care Group Medical Laboratory Directorate
The Laboratory Medicine Department at Galway University Hospital (GUH) is part of the Laboratory Medicine
Directorate (the Directorate) which reports to the Saolta Management Team.
In August 2012 GUH together with Portiuncula University Hospital Ballinasloe (PUH), Mayo University Hospital (MUH),
Sligo University Hospital (SUH), Letterkenny University Hospital (LUH) and Roscommon University Hospital (RUH) have
been combined into one hospital group, with one overall group management team, one financial budget and one WTE
ceiling. This new formation is referred to as Saolta University Health Care Group.
The information contained in this handbook relates to the Laboratory services provided at GUH currently.
Clinical Director : Prof. Margaret Murray Email: [email protected]
Laboratory Manager : Ms. Martina Doheny Email: [email protected]
Address Details:
Laboratory Medicine Directorate
University Hospital Galway
Newcastle Road
Galway, H91 YR71
Laboratory Medicine Key Disciplines:
Key Disciplines Key Support Services
Blood & Tissue Establisment Phlebotomy
Clinical Biochemistry Frontline Specimen Reception
Clinical Immunology General Laboratory Accounts
Anatomic Pathology Mortuary-Autopsy and PM Services
Haematology
Medical Microbiology and Virology

The purpose of this manual is to act as a reference guide for all users. Every effort has been made to ensure that the
information provided herein is current and accurate. The manual is subject to regular review and revision.
The manual should be used as a guide only, any queries arising or required in relation to laboratory services should be
addressed directly by contacting the relevant department or the Laboratory Manager. The Laboratory Medicine

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 Department shall not be liable to users of the manual for any consequential action by the user other than to request
the user to utilize the manual strictly as a guide reference only.

2. General Information
2.1 Location
The Laboratory Medicine Department is located on the right hand side at the rear of the main hospital block. Reception
and Specimen Delivery is located by the back of the laboratory building near the back entrance to the hospital grounds.
Postal Address: Specimen Reception Laboratory, University Hospital Galway, Newcastle Road, Galway.
2.2 General Enquiries
The four-digit numbers listed below can be dialed directly from within GUH.
When calling from outside the hospital insert (091) 54 or 89 before the extension number for UHG.

Telephone requests for results, sampling procedures or add-on tests should be directed to the appropriate department.
The telephone enquiry service should be used for emergency enquires only.

Blood and Tissue Establishment

Blood Transfusion 4422 / 4909
Tissues including stem cells 2497
Transfusion Surveillance Officers (Bleep 640/641) 4994

Clinical Biochemistry
Clerical Office 2740 / 2741

Out of Hours Enquiries (also available between 11:30-13:00) 4418

Clinical Immunology
Immunology 4401
Office 4402

Haematology
General Haematology 4419
Special Haematology 4284

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 Routine Coagulation 4283
Special Coagulation 4995
Haematinics 4880
Bone Marrows/Flow cytometry 4284

Anatomic Pathology : Histopathology, Cytopathology and Molecular Pathology

General Enquiries 4078
Cytopathology 4883

Medical Microbiology
(Phone Enquiries 09 :30-13 :00 and 15:30-17:00) only General Enquiries 2477
Diagnostics (Blood cultures, CSF, Swabs, Tissue & Fluids) 4411
Urines 4411
Faeces 4669
Respiratory & TB culture 2525
Public Health Laboratory 4916
National Reference Laboratory 4628

Virology
General Enquiries 4398

Please note the method of contacting the on-call medical scientist for the following departments :

Monday-Friday Weekends/Bank
8pm-12am Monday-Friday 12am Holidays 8am-12am Weekends/Bank Holidays
Department: (midnight) (midnight)-8am (midnight) 12am (midnight)-8am

Contact the department Contact the department

Biochemistry 4418 4418
via the Telephone via the Telephone Services
Blood and
Services team -dial 9 and team -dial 9 and request
Tissue
request connection with connection with laboratory
Establishment 4909/ 4422 4909/ 4422
laboratory department department you wish to
you wish to speak with) speak with)
Haematology 4419 4419

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 Microbiology 4411 4411

2.3 Contact Information

Key members of staff are listed below including their position and contact information.
Laboratory Name Contact
Blood and Tissue Dr. Amjad Hayat Consultant Haematologist [email protected]
Establishment Phone Ext: 2625
Ms. Margaret Tarpey Chief Medical Scientist [email protected]
Phone Ext : 4623
Clinical Biochemistry Dr. Damian Griffin Consultant Chemical [email protected]
Pathologist Phone Ext : 4825
Ms Michelle Finnegan Chief Medical Scientist [email protected]
Phone Ext : 4499
Mr. Liam Blake Principal Clinical Biochemist [email protected]
Phone Ext : 2709
Office Phone Ext : 2740/2741

Clinical Immunology Dr. Vincent Tormey Consultant Immunologist [email protected]

Phone Ext : 4402
Dr. Caríosa Lee-Brennan Consultant Immunologist [email protected]
Phone Ext : 3957
Mr. Mike Cullina Chief Medical Scientist [email protected]
Phone Ext : 4587
Office Phone Ext : 4402
Anatomic Dr. Caroline Brodie Consultant Pathologist, [email protected]
Pathology:
Phone Ext : (54) 2017

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 Laboratory Name Contact
Histopathology, Prof. Grace Callagy Consultant Pathologist [email protected]
Cytopathology and
Phone Ext : (54) 4884
Molecular Pathology
Dr. Teresa McHale Consultant Pathologist [email protected]
Phone Ext : (54) 3845
Dr. Ramadan Shatwan Consultant Pathologist [email protected]
Phone Ext : (54) 2721
Dr Mary Casey Consultant Pathologist [email protected]
Phone Ext : (54) 4928

Dr Tom Fitzgerald Consultant Pathologist [email protected]

Phone Ext : (54) 2351
Dr Yi Ling Khaw Consultant Pathologist [email protected]
Phone Ext : (54) 3852
Dr. Margaret Sheehan Consultant Pathologist [email protected]
Phone Ext : (54) 2016

Dr. Aoife Canney Consultant Pathologist [email protected]

Phone Ext : (89) 3316
Dr. Sean Hynes Consultant Pathologist [email protected]
Phone Ext : (54) 3493
Dr. Birgit Tietz Consultant Pathologist [email protected]
Phone Ext : (54) 2707
Dr. Helen Ingoldsby Consultant Pathologist [email protected]
Phone Ext : (89) 3792
Dr Sine Phelan Consultant Pathologist [email protected]
Phone Ext : (89) 3793
Dr. Anne Marie Quinn Consultant Pathologist [email protected]
Phone Ext : (54)2331
Head of Department
Dr Emer Caffrey Consultant Pathologist [email protected]
Phone Ext : 3061

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 Laboratory Name Contact
Dr Susanne Schneider Consultant Pathologist [email protected]
Phone Ext : 3061
Dr Laura Aalto Consultant Pathologist [email protected]
Phone Ext : 3846
Ms. Terri Muldoon Chief Medical Scientist [email protected]
Phone Ext : (54) 4408
Office Phone Ext : (54) 4078
Haematology Prof. Margaret Murray Consultant Haematologist [email protected]
Phone Ext:4591
Dr. Amjad Hayat Consultant Haematologist [email protected]
Phone Ext: 2625
Dr. Ruth Gilmore Consultant Haematologist [email protected]
Phone Ext : 3822
Dr. Janusz Krawczyk Consultant Haematologist [email protected]
Phone Ext :3227
Dr. Sorcha NiLoingsigh Consultant Haematologist [email protected]
Phone Ext : 4414
Dr. Yizel Nunez Consultant Haematologist [email protected]
Phone Ext : 3646
Dr. Niamh Keane Consultant Haematologist [email protected]
Phone Ext : 3058
Ms. Mary Kilcooley Chief Medical Scientist [email protected]
Phone Ext : 4514
Office Phone Ext : 4281
Medical Microbiology Prof.Martin Cormican Consultant Microbiologist [email protected]
Phone Ext : 4146
Dr. Una Ni Riain Consultant Microbiologist [email protected]
Phone Ext : 3779

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 Laboratory Name Contact
Dr. Dimitar Nashev Consultant Microbiologist [email protected]
Phone Ext : 8731

Dr. Teck Wee Boo Consultant Microbiologist [email protected]

Phone Ext : 3783
Dr. Deirbhile Keady Consultant Microbiologist [email protected]
Phone Ext : 2013
Dr. Ruth Waldron Consultant Microbiologist [email protected]
Phone Ext : 4146
Mr. Tom Whyte Chief Medical Scientist [email protected]
Phone Ext : 4429
Office Phone Ext: 4404
Virology Dr. Una Ni Riain Consultant Microbiologist [email protected]
Phone Ext : 3779

Dr. Teck Wee Boo Consultant Microbiologist [email protected]

Phone Ext : 3783
Prof.Martin Cormican Consultant Microbiologist [email protected]
Phone Ext : 4146
Dr. Deirbhile Keady Consultant Microbiologist [email protected]
Phone Ext : 2013
Dr. Dimitar Nashev Consultant Microbiologist [email protected]
Phone Ext : 8731

Dr. Ruth Waldron Consultant Microbiologist [email protected]

Phone Ext : 4146
Ms. Joanne King Chief Medical Scientist [email protected]
Phone Ext : 4575

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 Laboratory Name Contact
Phlebotomy Department Ms. Kara Burke Senior Phlebotomist [email protected]
[email protected]
Ms. Maureen Keane
Phone Ext : 2393/
Bleep : 735
Laboratory Manager Ms. Martina Doheny Laboratory Manager [email protected]
Phone Ext : 2799
Laboratory IT Manager Ms. Nuala NiiChadhain IT Manager [email protected]
Phone Ext 2644
Specimen Reception Ms. Bridie O’Donnell [email protected]
Phone Ext : 4377
GP Requisition for Cruinn Diagnostics Ltd. [email protected]
Laboratory Supplies Phone : 01 629 7400
Fax : 01 6297401
Mortuary Mr. Joesph O’Neill Senior Mortuary Technician [email protected]
Phone Ext : 4412

2.4 Population Served

Laboratory Medicine services at UHG are open to hospital clinicians and GP’s in Galway, Mayo and Roscommon to meet
the needs of the population. Patients from other regions of the country who are referred for tertiary treatments can
also avail of these services through referral by their medical attendants. Specialist Mycobacterium laboratory service is
also extended to Sligo and Letterkenny University Hospitals and National Reference Laboratory Services are provided
for some bacterial pathogens.
In 2021, in excess of 15 million requests were received by the Laboratory.

2.5 Laboratory Opening Hours

Routine samples arriving after the stated deadlines will be processed on the next routine working day.

Department Routine Hours Deadline for sample in Lab

Specimen Reception 09:00 – 20:00 h 19:45 h

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 Blood &Tissue Establishment 08:00 – 20:00 h Mon–Fri 16:00 h
10:00 – 13:00 h Sat 11:30 h
08:00 – 20:00 h Mon-Fri 17:00 h Mon-Fri
Clinical Biochemistry 10:00 – 13:00 h Sat 12:30 h Sat
Clinical Immunology 08:00 – 17:00 h Mon-Fri 16:00 h
Anatomic Pathology 08:00 – 18:00 h Mon-Fri 16: 30 h Mon-Fri
09:00 - 12:30 h Sat 11:30 h Sat
Haematology 08:00 – 20:00 h Mon-Fri 17:00 h for GUH samples
10:00 – 13:00 h Sat 16:30 h for all others
12:30 h Sat
Medical Microbiology 08:00 – 20:00 h Mon-Fri 16:30 h Mon-Fri
09:30 – 12:30 h Sat 12:00 h Sat
Virology 08:00 – 17:30 h Mon-Fri 16:00 h Mon-Fri
An on-call system operates outside normal hours for emergency work i.e. non-deferrable tests necessary for decisions
regarding patient treatment. Refer to the “On-Call/Emergency Service” section of this manual.

Routine samples arriving after the stated deadlines will be processed on the next routine working day.
An on-call system operates outside of normal hours for emergency work i.e. non-deferrable tests necessary for decisions
regarding patient treatment. Refer to the ‘On-Call/Emergency Service’ section of this manual.

2.6 Confidentiality Policy

It is the responsibility of all staff, as defined in their contract of employment to ensure that all information which they
have access to as part of their work is treated in the strictest confidence and protected from, unauthorised access. All
Staff are asked to sign a confidentiality agreement during their laboratory induction programme.

2.7 Complaints
Consumer Affairs and the National Advocacy Unit, Quality and Patient Safety Directorate have responsibility for
developing and implementing best practice models of customer care within the HSE and promotes service user
involvement across the organisation through the concept of 'Your Service Your Say'.

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3. Use of the Laboratory

3.1 Register of Users

All GPs who wish to submit specimens for analysis to the Laboratory must be included on the Medical Laboratory
Directorate register of users. All GPs must obtain, complete and submit a User Registration form. Please ensure that
the laboratory is kept updated of any changes to your contact details.
Forms can be obtained by contacting:
Liz Neville, Pathology Accounts, Laboratory Medicine Department, Galway University Hospitals, Galway
Email: [email protected]
Phone: 091 544428
Communication Policy is via email therefore it is essential that we have all service users most up to date contact details
and email addresses.
As the laboratory now provides an 08:00 – 20:00 h service we require contact details for all users during this time period
in order to ensure that critical results can be communicated urgently as per the National Laboratory Handbook
"Communication of Critical Results for Patients in the Community".
3.2 Requests to the Laboratory
The provision of legible and appropriate clinical details on the request form, together with a properly collected
specimen, allows the Laboratory to issue relevant and accurate results and to assist the clinician in the interpretation of
these results in the clinical context. Laboratory staff should be consulted where uncertainty exists about the availability,
appropriateness, or selection of tests or the nature of the specimen required. Clinical interpretation of results is
available from the clinical staff as identified in the contact information in this manual. In order to ensure compliance
with patient safety and accreditation requirments, requests not complying with the specimen and form acceptance
criteria, outlined below will be rejected. In certain exceptional circumstances e.g. irretrievable samples, such requests
may be processed.

Request Form and Sample Acceptance Criteria

All request forms and specimens must be submitted as follows:

Hospital users must use the relevant request form pertaining to the request. The main in-house request form is LMDHRF
001, please note there are other forms for specialised samples e.g. cross-matching, Histoloy/Cytology samples.
The Laboratory Emergency Request form should be used for urgent requests ONLY. (LMDERF 001)
GPs’ must use standard GP request forms. (LMDGPRF 001)

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All sites external to GUH and Merlin park should order specimen containers via Cruinn using their specific order form. A
few items may still be sourced in house in GUH Laboratories and communication has been released on these items.
Internally GUH and Merlin Park, users can obtain their supply from the GUH Laboratories.

The laboratory expects the requesting Doctors/Phlebotomists who opt to use printed labels to have safe procedures in
place for controlling and printing, affixing and checking patient details of such labels.
Please note Seperate forms and samples must be used when submitting requests for multiple departments.

Specimen Request Form

It is essential and of utmost importance that patients location and clinician are noted on each request form. This applies
to Hospital and GP forms. It is imperative the laboratory departments receive same to allow easy and immediate
transmission of results.
The patient identification section of the request form must be completed in detail.

Please note that the Board Number is the primary identifier that should be documented on the request form to ensure
the correct identification of the patient, this will enable the laboratory to promptly process and transmit critical results.

Hospital Users : Please use the patient’s full name, forename (no initials, abbreviations etc) and surname, date of birth,
board number, address, responsible clinician and patients’ location.

GP users : Please use the patient’s full name, forename (no initials, abbreviations etc) and surname, date of birth,
address and the doctors’ name and surgery. GP users are requested to provide the ‘Hospital Board Number’ (BN)
applicable to the patient on the request form if available where available.
If you are using an addressograph system please fix the label to the patient identification section of the form. If hand
written, you must use block capitals. If the addressograph label includes information such as Doctors name and surgery,
collection time/date and test required this information must also be written in the appropriate section of the form. The
information on the specimen must correspond to that on the request form. The request form must include appropriate
patient information, including specimen type, specimen site, medications and transfusion history where relevant. It is
advised to label all specimens in the presence of the patient so that they can confirm correct identification. If this is not
feasible, such as in a surgical setting where the patient is unconscious, a means of confirming the identity of the patient
from whom the sample is collected must be in place and followed. Any difficulty in obtaining the specimen should be
noted on the request form. In the case of short or scanty specimens list tests requested in order of priority.

Histopathology requirement: The specimen site must be indicated and detailed on the request form and the container.

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In the case of multipart container submission on a case each part must be clearly identified as to the site and nature of
the specimen. The detail on the request form and the specimen container must match. SHARPS containers must not be
used as specimen containers. Ensure that the lid is securely closed on the container to prevent spillage.
Patient demographics on the request form must be legible, consistent and must match the information on the specimen
container. Use addressograph labels or print the information giving the following details:
- The patient’s full forename and surname.
- The patient’s date of birth DD/MM/YY. (Ensure a consistent date of birth).
- Board Number if available for GP requests.
- Patient’s gender.
- Home address of patient (state change of home address where applicable).
- Consultant’ name and location/GP’ name, address and telephone number.
Locum doctors must give practice doctors name and address.
- The name and address of the doctor to whom the result should be communicated if different from
the requesting doctor.
- Signature of the requesting doctor (must be legible).
- The name of person who collected the specimen.
- The required analysis.
- Clinical details.
- Date and time of sample collection, nature and site of specimen.

Specimen Container
All specimen containers must be legibly labelled with patient’s full forename, surname, date of birth, (Board Number if
available), date and time of specimen collection and the signature of the person who collected the specimen.
If using addressograph labels these must be no larger than the specimen label on the container. Place the identification
label over the container label so that horizontal visual inspection of the sample is not impeded. Addressograph labels
must have all relevant details. Data on the addressograph label must not be modified. Sample fill line must remain
visible on all coagulation/INR tubes. The Blood and Tissue Establishment do not accept addressograph labels on sample
containers. The person who performs the phlebotomy must write their initials on the container.
In the case of timed urine collections state the start and finishing times. If submitting an aliquot, state the timed urine
volume.

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At Phlebotomy, the following order-of-draw is recommended when drawing multiple specimens to avoid cross
contamination from tube additives.
Blood Culture
Coagulation Tube
Serum Tube
Heparin Tube
EDTA Tube
Blood Glucose Tube

All specimens must state the nature and the site of the specimen, as well as patient identification.
Specimens should be submitted in supplied Specibags or Biohazard bags that allow separation of sample and request
form. All specimens delivered to the Laboratory including postal specimens must conform to UN packaging and
transportation guidelines.

Histopathology requirement: The specimen site must be indicated and detailed on the request form and on the
container. In the case of multipart container submission on a case each part must be clearly identified as to the site and
nature of the specimen. The detail on the request form and the specimen container must match. The lid must be
securely closed to prevent spillage.

The Request Form and specimen containers must have radiation label. When a radioactive specimen is being sent
information on the radiation dose should be given. The specimen should be delivered to the dedicated lab room for
radioactive specimens. It should be placed behind the lead shield, and the lab staff informed of its presence there.
The Request Form and specimen containers must indicate if specimen is high risk (eg TB, COVID-19, HIV or Hepatitis).
The Colorectal Programme specimen request form must include the NCSS COR number.
SHARPS containers must not be used as specimen containers.

Note : It is not possible or safe at the moment of receipt of the specimen(s) in the Division of Anatomic Pathology to
check each pot for the presence of a specimen. Therefore acceptance of a test request by the DAP staff is not
confirmation that the described specimen is present in the container, but rather that the form details and the container
details, and where applicable the sign off book details, match and contain the information required. The absence of a
described specimen may not be noted until the specimen container is opened in the sampling area of the lab. The
absence of a described specimen is recorded as a non conformance. The sender is informed of the issue as soon as
possible by the DAP staff.

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3.3 Supplies of Request Forms and Specimen Containers
All sites external to GUH and Merlin Park should order request forms and specimen containers via Cruinn using their
specific order form. A few items may still be sourced in house in GUH Laboratories and communication has been
released on these items. Internally GUH and Merlin Park, users can obtain their supply from the GUH Laboratories. In
the event of a patient requiring a 24 hour urine container from the laboratory the requesting GP should inform
Laboratory Stores in advance so the correct container can be prepared. Requisitions for laboratory stores from wards
in GUH must be received in laboratory on Monday of each week. These will be prepared and ready for collection on the
Wednesday afternoon.
Emergency supplies must be requisitioned before 11:00 h each day.

3.4 Collection of Specimens

General Guidelines
Refer to the Test Directory for a list of tests performed, the specimen required, turnaround time, reference range and
other information regarding specimen collection.
Specimens for some tests must be collected with the patient fasting, or with knowledge of when food was last taken
(e.g. glucose). Some tests must be collected in the basal state or with due regard to diurnal variations. Some tests may
be performed only after prior arrangement with the laboratory e.g. stool parasitology, PCR assay or ammonia. Where
doubt exists, the appropriate laboratory should be consulted.

Specimen Collection : Blood samples

Hand hygiene must be performed prior to commencement. Greet the patient and identify yourself and indicate the
procedure that will take place. Positive patient identification is MANDATORY. Verify that the patient meets and
requirements for the testing to be undertaken e.g. fasting status, medication status, predetermined time for specimen
collection, etc.
1. Standard precautions must be observed when taking blood.
2. Disposable non-sterile latex free gloves must be worn by the phlebotomist when taking blood in all circumstances.
3. Change gloves between patients
4. Wash hands or apply an antimicrobial gel before and after each procedure and on removal of gloves.
5. When sampling blood from any patient extreme care must be taken and every patient must be considered as
potentially high risk.
6. When taking blood ensure the limb is well supported, and the patient is aware to keep it still. The limb may need
to be supported by an assistant to achieve this.
7. When removing a blunted needle from a limb, ensure that the vacuum bottle has been disconnected from the
multi sampler area. Leaving this in situ may cause blood droplets to spray.
8. Cover the puncture site with a sterile swab or cotton wool when removing the needle to reduce the risk of blood
droplets spraying into the air.
9. Avoid spillage of blood. If spillage occurs, clean spillage immediately.

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10. If a sample bottle breaks, never attempt to pick it up. Avail of the nearest spillage kit and use accordingly to clean
the hazardous material.
11. The user of 'sharps' is responsible for their safe and appropriate use and disposal. 'Sharps' must never be left for a
colleague to tidy up.
12. Label the specimen with the appropriate patient details.
13. Place the specimen in the bag attached to the request form.
14. Take care to prevent needle stick injuries when using and disposing of needles.
Note: NEVER pour blood from one tube to another since the tubes can have different additives or coatings.

Specimen Collection : 24 h Urine Collections

Approved containers are available from the Clinical Biochemistry Laboratory. Please ensure that the identification on
the container (s) includes patient’s name, date of birth, board number or address and the name of requesting doctor.
Depending on the test requested, the container might contain a special preservative in either liquid or powder form. If
required, such preservatives will be provided in the container by the laboratory. Do not discard any preservative
provided or wash out the container. Specific requirements relating to the measurement of individual urine analytes is
given in the test menu. It is important that the following instructions are carried out with care, otherwise the results of
the test will be invalid.

Procedure
Immediately before the beginning of the collection period (usually the morning) the bladder must be emptied and the
urine discarded. Record the time and date on the container label.
All urine passed during the next 24 hours must be collected and added to the container.
At the end of the 24-hour period, the bladder must be emptied and the urine collected added to that already in the
container. Record the time and date on the container label.
After completing the collection, arrange the delivery of the container to the Clinical Biochemistry Laboratory
accompanied by the Laboratory request form.

Random Urine Collections

Freshly voided urine collected into a universal container should be sent to the laboratory without delay. Urine specimens
collected into a boric acid container are unsuitable for biochemistry analysis.

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4. Phlebotomy Service

The Phlebotomy department is based in the Out-Patients Department at UHG. The service covers both UHG and MPUH.
Phlebotomy Service
UHG
Wards (Excluding Paediatrics and Mon-Friday 7:00 to completion
Psychiatry)

OPD Mon – Thurs 08:00 – 18:00

Friday 08:00 – 14:00
Weekend (Emergency bloods only) Saturday - Sunday 07:00 – 13:00
Bank Holiday Arrangements 07:00 – 13:00 (excluding Christmas day)
GP’s May refer patients for phlebotomy by prior consultation with the Senior
Phlebotomist. Please ensure the appropriate request form is completed.
If referring patient to Phelbotomy, it must be in line with COVID-19 guidelines
i.e. patient without signs/symptoms, must present with face mask & adhere
to hospital IPC protocols
Emergency Bleep the senior Phlebotomist 735/835
Merlin Park University Hospital
Wards (Hospital 1, 2, SCU, Hospital Mon - Friday 07:00 - completion
Ground, Units 1, 4, 6, 8)

Orthopaedic Pre-assessment Clinic Monday - Wednesday 08:30 – 09:30

OPD Monday - Thursday 09:00 – 18:00
Requirements for Patients Attending Phlebotomy
All patients attending the Phlebotomy Service at the Galway University Hospital must present with the relevant
laboratory specimen request forms completed by the requesting doctor.
The relevant specimen request form(s) and container(s) should contain the essential information as defined above.
Bleep Kara Burke 735 or Maureen Keane 835 for any queries.
Safe Specimen Collection and Disposal of Materials used
Dispose of all clinical waste in accordance with National Guidelines.
- Universal precautions must be adhered to at all times.

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- Gloves must be worn at all times.
- Gloves must be changed after each patient.
- Needles must not be recapped after use.
- Dispose of sharps in a suitable sharps container.
- Dispose of all clinical waste into yellow bag.
- Uncontaminated gloves can be disposed of into clear plastic bag.

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5. Transport of Specimens to the Laboratory

5.1 General Guidelines

The transport of specimens to the Laboratory must follow ADR (UN 3373) regulations and guidelines in order to
minimise the risk of infection to those who may come in contact with the specimens e.g. taxi drivers, couriers, postal
workers, porters, laboratory staff etc. Consignors of specimens must ensure that packages are prepared in such a
manner as to meet the requirements for packaging and transport of biological material by road, rail or post in
accordance with the ADR regulations (or any such regulations that may be effected from time to time) and in accordance
with any special criteria as required by the laboratory at UHG.
The correct specimen container and laboratory request form must always be used when sending specimens to the
laboratory. It must be ensured that the container is appropriate for the purpose, is properly closed, and is not
contaminated on the outside. To avoid specimen rejection, please follow the specimen requirement instructions in the
test directory. If in doubt, contact the appropriate laboratory. Certain assays require transportation at specific
temperatures. Specific instruction is given in the test directory section.

5.2 Internal Transport of Specimens

The transport of specimens to the laboratory from UHG or MPUH locations is by the use of the portering services or the
pneumatic air tube system. The following guidelines for sending samples internally must be followed:
Specimens must be placed within the bag that is attached to the request form. This bag must then be sealed.
Specimen containers that are contaminated externally must not be sent to the laboratory.

When sending several samples to the laboratory special sealable plastic bags should be used in conjunction with the
appropriate secondary specimen transportation container/box. The secondary containers’ currently used throughout
the hospital are the 7 litre and 30 litre from Daniels Healthcare.

Blood gas specimens must never be sent to the laboratory with the needle attached.

Under no circumstances should anyone transport the primary specimen container in one’s hand or pocket.

Unfixed histopathology specimens are brought directly to the histopathology Laboratory and handed to a staff member.

Delivery of urgent unfixed specimens must be pre-arranged with the Histopathology laboratory.

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Samples for CSF by flow cytometry must be delivered to the laboratory immediately post sampling.

Methaemoglobin must be delivered immediately to the Haematology lab for testing within the one hour requriement.

Radioactive specimens for the Histopathology laboratory should be delivered to thededicated radiation room in the
Histopathology lab, placed behind the lead lined shield, and lab staff informed of its presence there.
5.3 Portering Schedules
UHG
Laboratory specimens are collected from wards and the blood room at 09:00 h and 13:30 h each weekday. Saturday
collection is between 08:00 h and 09:00 h. Ideally, specimens should be taken to coincide with collection times. The
collection of urgent or out-of-hours specimens must be organised at ward level by paging the porter on duty.
Histopathology specimens are brought directly to the Histopathology Laboratory from theatres and wards between
09.00 h and 17.00 h. Delivery of urgent unfixed specimens must be pre-arranged with the Histopathology laboratory.

MPUH
There is an hourly transportation of specimens from Merlin Park University Hospital to the Laboratory Medicine
department on the half hour each day from 07:30 h to 16:30 h. Between 17:00 h and 20:00 h there are two deliveries
depending on demand. From 20:00 h to 08:00 h the night porter in response to demand collects and delivers all urgent
specimens.

5.4 Pneumatic Tube System Transport

The Pneumatic Tube System (P.T.S.) commonly referred to as the ‘Chute’ is used mainly for the sending of specimens to
some of the Laboratory Departments. However it may also be used for the sending of many other items between
stations limited only by size and safety considerations.
Before using the ‘Chute’, please familiarise yourself with the correct operation and health & safety procedures. Please
be aware of the specimen types that can and cannot be transported using the ‘Chute’ including the carrier (shuttle)
colour and type.

To send a sample:
Place the sample in a Biohazard bag and seal the sample packet.
Place the request form in the Biohazard bag open pocket.
If using ‘Speci-bags’ seal by removing the strip and folding the bag onto the sticky surface.
Place the bag in the correct carrier type. Do not overload.

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Dial the station address number and without delay place carrier on the station for dispatch.
Check for any messages on the station.
Transportable items and carrier type:
Red carrier : Blood samples, Urine sample, Stool samples, Culture swabs, Laboratory request form,
Protected glass slides, Store requests, Laboratory reports, Small store items.
Yellow carrier : Pharmacy requests
Blue carrier : Fluid samples
Non-transportable items:
Bone Marrow samples, Blood culture samples in glass bottles (mycolytic bottles), Blood products, C.S.F samples, Fresh
tissue samples, sweat samples.
Blood Gases, P.C.R. samples, Platlet Aggregations, Frozen sections, Radioactive substances, Stem Cell Collections, Units
of blood, Histopathology/Cytopathology specimens, Respiratory Specimens, Platelet Function Tests and any item which
may break or leak in the system.

Unattended stations:
Anatomic Pathology: there is no chute facility to deliver specimens to the Anatomic Pathology and it is unsafe to attempt
to do so and is not recommended.
Clinical Immunology: stations are programmed to shutdown when the respective departments are closed i.e. overnight,
weekends and holiday periods. Check with individual departments for times.
5.5 General Practice, Primary Care and HSE Hospitals
All GMS participating GP’s in County Galway have access to collections from designated locations by WestDoc Logistics
under a Primary Care arrangement.
For hospitals in the Saolta Group or GP’s outside of Galway contact the Laboratory Manager for details.

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6. Reporting Results

6.1 iLAB
The iLAB laboratory information system (APEX) is a single integrated system operating across all laboratory disciplines
in GUH, MUH and RUH. A demographic interface exists between the Integrated Patient Management System or
IPMS and the LIS. This interface reduces the requirement for data re-entry in the laboratory, and stringent protocols
for the management of data quality enhance the integrity and consistency of the patient record in the LIS database.

Results for hospital inpatients are available to the wards under two routes.

The main route to access patients lab results is EVOLVE, which replaces the Ward enquiry function previously available
on PAS, which is no longer available with IPMS.
The second route is via a Web Lab Ward Enquiry function or APEX, the logon icon for both is located in the GUH Useful
Resources folder on the PC Desktop. To use WebLab/APEX the user must contact the LIS Manager for a Username and
Password. Histology results may ONLY be viewed using APEX.

Because the same incidence of APEX is used in GUH, MUH and RUH, results from these three locations are displayed
together. Results may extend to more than one visible page. Ward users must have a Board Number or a Chart Number
to look up inpatient results. It is possible to audit what Users have accessed any particular result/patient record whether
accessed through Evolve or directly through WebLab/APEX. Generic logons/sharing of passwords is not permitted.

6.2 HealthLinks
HealthLinks is the name given to the Department of Health funded project which allows electronic links to be established
between General Practitioners, Hospitals and the Health Service Executive to allow for the timely and secure transfer
of patient related administration, clinical data and laboratory reports. For further information on HealthLinks Contact:
[email protected]

6.3 Clinical Information Systems

Interfaces have been established with CIS in ICU (Metavision), RIS in Radiotherapy (Lantis) and Diabetic Day Unit
(Diamond) and eMED renal system. This allows for rapid electronic downloading of patient reports from a number of
laboratory departments to the patient bedside and clinical areas.

6.4 Printed Reports

Printed reports are not issued for all samples as in many circumstances electronic delivery is faster and supports ready
access in multiple patient care areas within the hospital group. (Note: A printed report is issued for all Division of
Anatomic Pathology reports. DAP reports are not available via HealthLinks). Reports are printed with reference ranges
and / or suitable comments wherever appropriate, to aid interpretation of results. Reports are provided only to the

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submitter except in exceptional circumstances where senior staff are satisfied that an exception is necessary in the
patients interest. Reports are not provided directly to patients. Reports are printed daily. Printed reports are delivered
by the portering staff to GUH wards. General practitioners reports are posted daily.

External hospital reports are printed and issued as follows:

Mayo University Hospital Reports collected daily
Roscommon University Hospital Reports posted daily
Sligo University Hospital Reports posted daily
Limerick University Hospital Limerick Reports posted daily
Portiuncula University Hospital Reports posted daily
Ennis General Hospital Reports posted daily
Letterkenny University Hopsital Reports posted daily
Galway Clinic Reports collected daily
Bons Secours Hospital Reports collected daily

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7. Blood and Tissue Establishment
7.1 Department Profile
Galway Blood & Tissue Establishment (GBTE) is fully licensed by the Health Products Regulatory Authority (HPRA,
formerly Irish Medicines Board) and holds three licences: a Blood Licence, a Tissue Licence and a Good Manufacturing
Practice (GMP) Licence. GBTE is also accredited to ISO 15189 by the Irish National Accreditation Board (INAB).
Blood, blood components and blood products are issued by GBTE for patients throughout Galway University Hospitals
(GUH).
GBTE provides an ante-natal serology screening service for GPs, Consultants in private practice and the ante-natal clinic
Mayo University Hospital, Castlebar.
Blood is also supplied by GBTE to the Galway Hospice, Roscommon University Hospital and the Bons Secours Hospital.
In emergency situations blood is supplied to Portiuncula University Hospital, Mayo University Hospital, Castlebar, the
Galway Clinic and any other hospital which require assistance.
Autologous and Allogeneic Serum Eye Drops (ASE’s), Stem Cell Collections, supply of Bone and Bone Products such as
tendons, bone chips, meniscus as well as Occular tissues such as corneas, amnion memebrane and sclera are services
which are co-ordinated from GBTE. Irradiation of Red Cells is carried out on-site in the GBTE.

7.2 Services and Products available at GBTE

GBTE stock the following blood components/products :
 Red Cells
 LG Plasma (Octaplas)
 Platelets
 Fibrinogen 1gm (Riastap)
 Flexbumin 20% and Albumin 5%
 Anti D Immunoglobulin.(Rhophylac)
 Factor Concentrates (human & recombinant) e.g. factor VIIa (Novoseven), factor VIII (Elocta), factor VIII/ human
von Willebrands factor (Wilate) factor IX (Alprolix), Prothrombin Complex Concentrate, PCC (Octaplex).
 Human Hemin (Normosang)
 Hepatitis B & Varicella Immunoglobulins
 C1 esterase inhibitor (Berinert P)
 FEIBA
 Praxbind (Idarucizumab) – reversal agent for Dabigatran

The above are issued upon receipt of a completed Blood/Blood Product Request form. Products must also be prescribed
on the “Blood & Blood Product Prescription & Transfusion Record”, BPTR (pink document) at ward level.

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RAADP Routine antenatal anti-D prophylaxis (RAADP) is given by injection to pregnant women who are RhD-negative
usually at week 28 of their pregnancy. After the birth, a blood sample will be taken to test the baby's blood group. If the
baby is RhD positive, a mother who is RhD negative will be given a further injection of anti-D immunoglobulin - this is
known as postnatal anti-D prophylaxis. If an RhD-negative woman has a potentially sensitising event DURING THE
pregnancy she will be offered anti-D prophylaxis at the time of the event: this is known as antenatal anti-D prophylaxis
or AADP. Please contact the Maternity department for more information.

7.3 Sample / Request Form Labelling Policy

Test/Product Availability Specimen Type Comment
Albumin Routine & Urgent None
Anti-D Immunoglobulin Routine & Urgent 6 ml EDTA blood
Anti-Neutrophil On Request 6 ml blood in plain gel tube Referred to IBTS
Antibodies Please state reason for request

Anti-Varicella Ig Routine & Urgent None

Autologous & Allogeneic Contact Blood and Tissue Establishment to arrange
Serum Eye Drops
Coagulation Factor Routine & Urgent None Discuss with Haematology team
Concentrates Exception: Anaesthetics
Cold Agglutinin Screen Routine 6 ml EDTA blood Deliver sample to lab at 37.
Contact GBTE for instructions prior
to sampling
Direct Coombs Test Routine & Urgent 6 ml EDTA blood
Group & Antibody Screen Routine & Urgent 6 ml EDTA blood
(Ante-natal)
Group & Hold / Group & Routine & Urgent Adults - 6 ml EDTA blood CMV / Irradiated blood must be
Cross match requested by the Clinician, if
Paeds – 4 ml EDTA blood required.
Hepatitis B Ig Routine & Urgent None
HLA Antibodies On Request 6 ml EDTA blood

HLA Typing for On Request 6 ml EDTA blood

transplants
HLA & Disease On Request 5-10 ml EDTA blood Referred to Irish Blood Transfusion
Association Service (IBTS request form is
HLA Class I typing for HLA On Request 5-10 ml EDTA blood available on Claddagh/Corrib,
matched platelets Oncology and Haematology Day
Human Platelet Antigen On Request 5 ml EDTA blood Wards).
Typing

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 Test/Product Availability Specimen Type Comment
Orthopaedic and Occular Contact Blood and Tissue Establishment to arrange
products
Peripheral Blood Stem Contact Blood and Tissue Establishment to arrange
Cell Harvest
Platelet Antibodies On Request 5-10ml blood in a plain gel Referred to Irish Blood Transfusion
tube Service (IBTS request form is
Platelet Refractoriness On Request 10 ml blood in a plain gel available on Claddagh/Corrib,
tube & 5-10 ml EDTA Blood Oncology and Haematology Day
Wards).
Plasma (LG Octaplas &) Routine & Urgent 6 ml EDTA blood Telephone request followed by
- if group unknown written request
Platelets Routine & Urgent 6 ml EDTA blood Telephone request in advance,
- if group unknown followed by written request.
Post Transfusion Purpura On Request 5-10 ml blood in a plain gel Refer to IBTS. Please state reason
tube & 5ml EDTA blood for request
RAADP By request 6 ml EDTA blood Please contact the Maternity
department for more information.
Testing for NAITP On Request 10-20 ml blood in a plain gel Referred to Irish Blood Transfusion
tube & Service (IBTS request form is
5 ml EDTA blood (mother) available on Claddagh/Corrib,
1 ml EDTA blood (neonate) Oncology and Haematology Day
5 ml EDTA blood (father) Wards).
Transfusion Reaction By Request 6 ml EDTA blood Phone Blood Bank with details and
Investigation request a Transfusion Reaction
Pack. Return all units to GBTE.
Complete the Transfusion
Reaction form and inform TSO.
Transfusion Related By Request 20 ml blood in a plain gel Referred to IBTS. Please state
Acute Lung Injury (TRALI) tube & 5 ml EDTA blood reason for request
Zygosity Testing By Request 6 ml EDTA blood Referred to IBTS. Please indicate
reason for request

Tests that are not completed on-site are recorded and referred to external laboratories for testing. Please contact GBTE
for external request forms or any queries regarding specimen referral.

Reference: https://www.giveblood.ie/Old-Site-Documents/NHIRL-Customer-Handbook-pdf.pdf for details of

sample/request form labelling policy in referral site.

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Specimen Labelling Requirements for Group & Hold / Crossmatch
Please ensure prior to taking sample that the expiry date on the sample tube is in date, otherwise the sample will be
rejected
All routine crossmatch samples must be received in GBTE before 16:00h.
A Group and Hold sample lasts 72 hours from time taken.
Blood Track PDA labels are accepted on all samples. The PDA label may also be used in place of the sample taker
signature on samples from the Bon Secours, RUH, Mayo ANC and Mayo Pre-assessment clinics.

The following legible information must be recorded on the specimen (Handwritten or Bloodtrack label is only
accepted) :
 Patients full first name and surname. (Patients second names or maiden names should be used where relevant).
Unnamed newborns should be labelled with Male / Female infant of [Surname].
 Board Number or Bon Secours (G) Number
 Date of Birth
 Patient gender
 Signature of the person taking the specimen
 Date and time of specimen collection
 Patient location.
 Patients name, board number, DOB and gender are the minimum requirements to ensure positive patient
identification.

Requests Form Requirements for Group & Hold / Crossmatch

A fully completed request form (RL32), Ante-Natal form (BGF) must accompany the specimen.
An addressograph or bloodtrack label, is acceptable on the form provided the details are accurate and correct. If using
an addressoraph label ensure the location and patient’s Consultant is recorded on it or on the speific section of the
request form.

The decision to crossmatch and prescribe blood for a patient is the responsibility of the clinician. This should be
recorded in the patient’s medical notes. The patient’s current haemoglobin level must be checked prior to making the
decision to transfuse. If the original request on the patient was a Group and Screen only, the request for Blood / Blood
products must be sent on a seperate Blood and Tissue RL32 form and this will be attached to the original form in the
GBTE.

 For thresholds for Red Cell Transfusion see CLN HVIG 035, Appendix 1, available on Saolta Q-Pulse.
 For thresholds for Platelet Transfusion see CLN HVIG 036 Appendix 1, available on Saolta Q-Pulse.

The following legible information must be recorded on the specimen request form.
 Patients full first name and surname Unnamed newborns should be labelled with Male / Female infant of
[Surname]

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  Board Number or Bon Secours (G) number. Patients DOB.
 Patient gender.
 Patient location.
 Patients’ consultant.
 Name and signature of the person taking the specimen.
 Name, bleep and signature of the person requesting the test(s) / products.
 Date and time of specimen collection.
 The tests required / products (including volume / amount) requested should be clearly stated.
 Special Requirements for blood / blood products (if applicable).
 Date and time tests / products required (if applicable).
 Patient clinical details including diagnosis and / or indication for transfusion if relevant.
 Transfusion history (including details of blood group / previous transfusions / reactions / marrow or other
transplants if relevant).
 Patient Diagnosis.
 Other information deemed relevant to the GBTE.
Requests for blood components / products may be completed retrospectively in emergency situations.
Patients name, board number, DOB and gender are the minimum requirements to ensure positive patient identification.
Send sample and form directly to the Blood and Tissue Establishment.
Information on patient’s Hospital ID band, request form and blood sample must be identical.

Specimen Labelling Requirements for Antenatals/Miscellaneous Tests

Specimens submitted to the GBTE for Group and / or screen and miscellaneous tests (e.g. Neonatal Group and Coombs,
Coombs Tests, Cold Agglutinin Investigations, Pre-assessment Group and Antibody Investigations, Transfusion Reaction
Investigations).
The following legible information must be recorded on the specimen (Handwritten or Bloodtrack label is only
accepted) :
 Patients full first name and surname. Unnamed newborns should be labelled with Male / Female infant of
[Surname].
 Board Number or Bon Secours (G) Number (Patients address if hospital no. unknown).*
 Date of Birth
 Patient gender
 Signature of the person taking the specimen
 Date and time of specimen collection
 Patient location.
Patients name, board number, DOB and gender are the minimum requirements to ensure positive patient identification.
Patients Address may be used for antenatal / homebirth requests where the board no is not known.*
Request Form Requirements for Blood Group & Screen / Antenatals / Miscellaneous Tests
A fully completed blood group investigation form (BGF) must accompany the specimen.
The blood / blood product request form should accompany all other requests.

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All request forms submitted to Blood Establishment for antenatal screening or miscellaneous tests must be labelled
with the following details :
Patients full first name and surnameUnnamed newborns should be labelled with Male / Female infant of [Surname].
Board Number or Bon Secours (G) number.
 Patients Address (where hospital no. is not known).
 Patients DOB.
 Patient gender.
 Patient location.
 Patients’ consultant or GP.
 Obstetric / Transfusion history (for antenatal requests).
 Name and signature of the person taking the specimen.
 Date and time of specimen collection.
 The department / location to where the report should be referred.
 Other information deemed relevant to the GBTE.
For further information and instructions for the collection and handling of primary samples:
Refer to Clinical Policy on Saolta Q-Pulse- CLIN HVIG 06-“Request for Group and Antibody Screen, Group and Hold and
Group and Crossmatch”.

For Identification of the Primary Sample: Refer to Clinical Policy on Saolta Q-Pulse -CLIN HVIG 01 –“Positive Patient
Identification”.

Specimens must be received in GBTE within 48 h of sample collection time. Specimens received after this time require
confirmation as to storage temperature (2oC – 8oC) by an ISO 15189 accreditated facility. Specimens received after 72 h
of sample collection time are rejected. Specimens are only available for compatibility testing for 72 h post specimen
collection time after this time another specimen is required.

7.4 Unsuitable Specimens and Additional Specimens

In the event of a specimen being unsuitable for processing or where there is an analytical failure, a new sample will be
requested by phone, in writing or electronically through the LIS.

In an emergency whereby the sample / request form does not conform to the labelling criteria of GBTE, a policy is in
place for the sample taker to correct or amend the primary sample within certain parameters. When this occurs the
individual correcting the sample must complete and sign the Incident Report Form re-Specimen/Request Form
Amendments GBTE/MISC/F011 and accept responsibility for the changes to the primary sample/request.

The clinician may be requested on occasions to provide a repeat or additional sample to the Blood and Tissue
Establishment when
1) Additional tests are warranted to complete investigations e.g. antibody investigations.
or

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2) If there is no transfusion history on the Laboratory Information system and a crossmatch is requested . In such cases
the requesting clinician/ward will be contacted by scientific staff of GBTE to request the sample.

7.5 Unidentified Patients

Where the identity of the patient is unknown, ‘Male Unknown’ or ‘Female Unknown’ is handwritten on the request
form and the sample tube. The board number is recorded on the specimen and request form. The date of birth is
recorded as ‘Unknown’ but an alias date of birth i.e. the 01/01/1881 may be used. All other requirements for routine
sample labelling must be completed as per below.

7.6 Urgent Requests Policy

Please contact GBTE to indicate the nature of the emergency. During out of hours service contact the scientist via the
hospital switch board (Sun-Thurs 12 MN – 8 AM / Fri-Sat 12 MN-10 AM). All emergency samples will be processed on
receipt and will be prioritised according to clinical urgency provided there are no technical complications (mislabelled
specimen, patient has antibodies). Uncrossmatched Emergency O Rh D Negative blood is available immediately if
required.

7.7 Requests for Uncrossmatched Blood (Group O Rhesus Neg blood)

Requests for uncrossmatched blood must be made by a Clinician. A sample for Group and Cross-Match should be taken
before transfusion of uncrossmatched blood if possible. Where a patient requires a blood transfusion urgently and no
cross-matched blood is available for that patient, Group O Rhesus Negative blood is administered.

O Rhesus Neg. Emergency blood is available at all times from the Blood Establishment. Four units are available in the
blood satellite fridge in maternity gynae theatre, 2 units are available in the Theatre satellite fridge on second floor of
GUH and a further 2 units are available in the blood fridge on 2nd floor in Orthopaedic block, MPUH. GBTE must be
informed immediately if emergency blood has been taken from the satellite fridges so that it can be replaced. The
responsibility of transfusing uncrossmatched blood lies with the requesting clinician.

7.8 Delivery of Blood throughout GUH

Routine blood required for GUH is placed in the satellite blood fridges located:

GUH: 2nd floor, out-side entrance of main theatre

Gynae Theatre: within main entrance to Obs & Gynae theatre.
MPUH: 2nd floor, Orthopaedic Block, outside theatre.

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Otherwise it is taken directly from GBTE to the area where it is required. Blood Components / Products e.g. Plasma /
Platelets / Albumin are taken directly to the area where they are required; do not place in a blood fridge other than the
GBTE Issue Fridge. If they are not required, GBTE must be informed and they must returned to GBTE immediately.

7.9 Blood / Blood Product Prescription and Administration

All products must be prescribed on the “Blood & Blood Product Prescription & Transfusion Record” (BPTR) at clinical
level.
100% traceability of all blood and blood products is required by GBTE. Bloodtrack PDAs are used to transfuse blood and
platelets. The product and patient ID band are scanned on commencement as per policy CLN HVIG 08 « UHG
Administration and transfusion of Red cells to an adult patient using the Manual or Electronic Method » and CLN HVIG
017 « GUH Administration and Transfusion of Platelets to Adult and Paediatric Patients using the Electronic or Manual
Method » on Saolta Q-Pulse. The manual method is used for all other blood products or also used for blood and platelets
if bloodtrack is down or undergoing upgrade/unavailable.Here, following commencement of transfusion the middle
(peelable) completed portion of the compatibility label is removed, placed on the BPTR. The BPTR must also contain
the signatures of both administrators and the date and time. The lower portion of the compatibility label is removed
and both administrators print their names and again include the date and time. This lower portion is then placed in a
designated collection box in the clinical area where it is returned to the Blood Establishment for fating of the product.
A specific group of patients may require irradiatiated / CMV negative blood. Guidelines for this requirement is available
on Q-Pulse. See CLN HVIG 06 « UHG Request for Group and Antibody Screen, Group and Hold or Group and
Crossmatch ».

When administering blood / blood products, the checking procedure as per the relevant policies stated above, which
are available on Q-Pulse must be adhered to.

7.10 Management of Transfusion Reactions

Please refer to Clinical Policy CLIN HVIG 009 “Management of Adverse Reactions, Adverse Events & Near Misses to Blood
Components/Blood Products in the Clinical Setting” available on Saolta Q-Pulse. See also included Guidelines for
Culturing an Implicated Blood Component where a transfusion reaction is suspected.
Also available on Q Pulse - ORG-IC-0015: Guidelines for collection of blood cultures from the patient.

7.11 Maximum Surgical Blood Ordering Schedule (M.S.B.O.S)

A Maximum Surgical Blood Order Schedule (M.S.B.O.S) is in place for GUH and should be adhered to when ordering
Blood for Surgical procedures. The M.S.B.O.S is available for review as a Clinical Policy on Saolta Q-Pulse. Refer to CLN
HVIG 010. Each member of staff has a professional responsibility to avoid over exposure of patients to blood / blood
products. Over ordering of blood / blood products must be avoided and time constraints adhered to in order to prevent
wastage. Blood and Blood Products are extremely costly and are frequently in short supply.

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7.12 Indications for Irradiated & CMV-Negative Red Blood Cells & Platelets
Refer to policy CLN HVIG 06 ‘Request for Group and Antibody Screen, Group and Hold and Group and Crossmatch ’ on
Saolta Q-Pulse.

7.13 Autologous/Allogeneic Serum Eye drops (ASE’s) program

Autologous/Allogeneic Serum Eye drops (ASE’s/ALSE’s) are prepared using the patient’s sera (autologous) which is
donated by the patient as a whole blood unit or are produced from an allogeneic donor unit ordered through the Irish
Blood Transfusion Service (IBTS). GBTE processes and packages the ASE for the patient. They are issued to patients as a
treatment for persistent epithelial defects, Superior Limbal Keratoconjunctivitis (SLK), severe dry eye or as a support
measure in ocular surface reconstruction.

7.14 Autologous Stem Cells

GBTE provides an Autologous Stem Cell service to GUH and Cork University Hospital. This incorporates an autologus
haematopoietic stem cell collection and transplantation service for patients with certain malignancies e.g. multiple
myeloma, lymphomas etc. The stem cells once harvested are processed, cryogenically frozen and stored until required.
GUH Haematologists must be contacted in advance if this service may be required.

7.15 Supply of Bone and Bone Products and Occular Tissues

GBTE is a site of human application as per the EU Tissue Directive for corneas, sclera, amnion membrane, bone, tendons,
meniscus, bone chips etc. and has responsibility for other transplanted human tissue in GUH. These services are co-
ordinated by the GBTE.

7.16 Blood Track

(See also noted in Section 7.9.) Blood and platelets are processed for sign out / sign into the Establishments fridges /
platelet agitators respectively via the Blood Track system. All other Blood Products are signed out manually via the Blood
and Blood Products registers at the Establishment and satellite fridges. If Blood Track is non-functional all products must
be manually signed out of the Blood and Blood Products registers.

7.17 Clinical Advice and Service

A Responsible Person/ Consultant Haematologist with Administrative Charge (CAR) for the Blood & Tissue Establishment
is in place. This Consultant Haematologist provides an extensive advisory service and clinical advice. Examples include
indications for platelet transfusion, management of massive transfusion and the appropriate use of blood products.
Requests for clinical advice from other hospitals in the region are referred directly to the consultant Haematologists in
GUH.

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Issues relating to the Biovigilance (Haemovigilance / Tissue Vigilance) policies and protocols are referred to the
Biovigilance (Haemovigilance / Tissue Vigilance) officers. Examples include sample labelling, management of reactions.
List of Consultant Haematologists in GUH
Dr Amjad Hayat (RP/CAR) *Prof. Michael O’Dwyer
*Dr. Ruth Gilmore *Dr. Janusz Krawczyk
*Dr. Margaret Murray *Dr. Sorcha Ni Loingsigh
*Dr. Nunez Yizel *Dr. Niamh Keane
*These Consultants are available via roster held by Switch and will be available
to GBTE as needed on clinical matters that arise.
Comments or suggestions relating to the service should be addressed to the Chief Medical Scientist of the GBTE.

7.18 Turnaround Time

On receipt in GBTE specimens are date and time stamped, barcoded, initialled and logged into the LIS by the receiving
scientist.
GBTE turnaround time is defined as the length of time taken from receipt of the sample in GBTE to release of the report
/product in GBTE manually with report, visible on the LIS or via phone call.
Turnaround time for test requested by users will be reflected by clinical needs.
External specimens (GPs and ANC samples) are batched and analysed each day until 13:00 and in the afternoon on
Friday.
External specimens received after 13:00 hours will be batched and processed on the next routine working morning with
the exception of Fridays whereby all external samples will be processed on day of receipt.
If the patient has an antibody, turnaround time will depend on the serological investigations required to identify the
antibody and can vary.

Test Turnaround Time

(from receipt of sample to release of product / report)
Group and Hold * 8 Hours
Group and Antibody Screen (External User) 72 Hours
Cross-Match (Non-Urgent / Routine) ** 8 Hours
Neonatal Blood Group +/- DCT*** 8 Hours
*Turnaround Time provided the patient has no Antibodies.
**Turnaround Time is reflected by clinical needs and surgical date.
***Turnaround Time provided there are no blood grouping discrepancies

Turnaround time applies to requests received during routine hours. Requests received out-of-hours will be authorised
on the next routine working day.

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Since the introduction of Termination of Pregnancy in GUHGP specimens received in GBTE (TOP associated) on female
patients for group and antibody screens must now be labelled, processed, authorised and reported on the day of receipt
as GP’s require the written GBTE report in < 72 hours preferably within 24 hours.

7.19 CODE RED

Code Red’ is the alert used in GUH to advise the Blood Transfusion laboratory of life threatening bleeds. ‘Code red’
indicates urgency as the blood transfusion laboratory is situated away from critical areas at the rear of the hospital.
A Code red emergency should be declared if :
 Active haemorrhage is suspected
 or/and an ongoing transfusion requirement in an adult of more than 150mls per minute
 or/and the systolic BP is < 80mmHg or/and there is a poor response to fluid resuscitation
In the event of an emergency bleed, senior clinical staff activates the alert by calling a CODE RED as per policy CLN HVIG
031 «Management of Acute Massive Haemorrhage » available on Saolta Q-Pulse. When the haemorrhage is under
control clinical staff must inform the transfusion laboratory staff that the situation is now stable and stand down the
code red.

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8. Clinical Biochemistry Department

8.1 Department Profile

The Clinical Biochemistry Department uses biochemical knowledge and techniques to understand human health and to
assist in the detection, diagnosis and treatment of disease.
The Department provides a comprehensive analytical and interpretative service including assessment of liver function,
kidney function, carbohydrate and lipid metabolism, and various hormones, proteins, enzymes, therapeutic drugs,
tumour-associated substances and many other chemical and biochemical compounds. Our role is to aid and advise the
clinician on patient diagnosis, prognosis, exclusion of disease, to monitor patients’ response to treatment, development
or progression of disease and the management of chronic illness through risk stratification and the establishment of
treatment/intervention targets. The Department processes about 7 million tests per year. We provide a comprehensive
undergraduate and graduate teaching programme and are active in research, in developing projects and in the
implementation of translational scientific research. We participate in clinical trials, case conferences, ward rounds and
clinics.

The provision of a clinical biochemistry service in a prompt cost-effective, safe and user-friendly manner is dependant
on highly automated analytical systems, the use of advanced analytical techniques, electronic data processing and
information technology. The Department has an extensive internal quality assurance system and participates in national
and international quality assessment schemes.

8.2 Clinical Advice and Service

Clinical advice and interpretation is available from the Consultant Chemical Pathologist. Comments or suggestions
relating to the service should be addressed to the Chief Medical Scientist.

8.3 Out of Hours Service

A detailed list of all tests available out of hours is outlined in the section “On Call (Emergency Service)”. Clinical advice
is available if required. Access to out of hours service for GP’s is available by prior consultation with the laboratory.

8.4 Biochemistry Tests

Information on all Tests carried out in Biochemistry is to be found in the Test Directory of this manual (listed
alphabetically within the Laboratory Medicine Test Directory). Stated volumes required apply to adult patients.

In the case of paediatric patients please send as much blood as possible. Where it is appropriate (i.e.patient weight
>10kg) please use a 3.5mL tube,otherwise standard paediatric bottles may be used.

Where small sample volumes are submitted, list the tests requested in order of priority as the volume of serum/plasma
obtained will dictate how many can be performed.

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In the event of a specimen being unsuitable for processing or where there is an analytical failure, the clinician will be
informed by phone or in writing.

Test Profiles
The test profiles defined in the following table are available to requesting doctors. Please use the profile names given
below as these are the only profiles defined and recognised by the Clinical Biochemistry department. Non specific and
vague statements such as “biochemistry screen” or “bioprofile” should not be used. Terms such as cardiac enzymes,
SMAC, SMA12, SMA, hormone profile, toxicology, tumour marker etc are vague, undefined and unfocused and should
not be used in requesting tests.
Profile Name Assays included in profile
GP (GP profile) Sodium, chloride, urea, creatinine, calcium, albumin, total protein, total
bilirubin, alkaline phosphatase, alanine transferase (gamma GT if ALP
Requested by GPs only
elevated)
Potassium analysed only if specifically requested and sample received in
the lab within 3hrs of venesection or sample received centrifuged

Sodium, chloride, urea, creatinine, calcium, albumin, total protein,

If Specimen aged alkaline phosphatase, alanine transferase, (gamma GT if ALP elevated)

HP (Hospital profile) Sodium, potassium, chloride, , urea, creatinine, calcium, albumin,

inorganic phosphate, total protein, total bilirubin, alkaline phosphatase,
Requested by hospital clinicians only
alanine transferase, gamma GT.
Sodium, chloride, urea, creatinine, calcium, albumin, total protein,
If Specimen aged alkaline phosphatase, alanine transferase, gamma GT
Renal Profile – hospital requests only Sodium, potassium, chloride, urea, creatinine
If Specimen aged Sodium, chloride, urea, creatinine

LFT (Liver profile) Total protein, albumin, total bilirubin, alkaline phosphatase, alanine
transferase, gamma GT
Total protein, albumin, alkaline phosphatase, alanine transferase,
If Specimen aged gamma GT
Lipid Screen (LIP) Cholesterol, HDL, triglycerides, calculated LDL, CHOL/HDL Ratio
Iron Studies (Iron) Iron, Transferrin, calculated TIBC, transferrin Saturation
Thyroid Function Tests (TFT) Free T4, TSH

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Summary of Blood Specimen volume requirements
ADULT PATIENTS
General Biochemistry tests including
renal, liver and thyroid function, uric acid,
One plain serum gel tube (must be filled)
HCG, tumour markers, digoxin,
magnesium, lipids, iron studies, Type: Greiner Vacuette ® Serum Gel Tube
osmolality, lithium, alcohol, salicylate,
Colour Code: Gold
paracetamol, amylase, bicarbonate,
therapeutic drug monitoring and fertility
Please refer to the specific requirements for individual tests in the
Specialist tests performed in-house
alphabetical listing in the Test Menu
One fluoride oxalate tube
Glucose Type: Greiner Vacuette Tube
Colour: Grey
HbA1c One EDTA tube
Type: Greiner Vacuette Tube
Colour: Lavender
Special assays referred to external Please refer to the specific requirements for individual tests in the
laboratories alphabetical listing in the Test Menu

PAEDIATRIC PATIENTS
General Biochemistry Tests Greine Vacuette ® 3.5mL where appropriate, ( weight >10kg)
otherwise Sarstedt Brown capped 1.1mL Z-Gel tube

Plasma Glucose One fluoride oxalate tube Greiner Vacuette ® Colour: Grey where
appropriate otherwise Sarstedt Microvette ® 300 Fluoride Heparin
tube
HbA1c Greiner Vacuette ® EDTA tube where appropriate otherwise Sarstedt
Microvette ® 300 EDTA tube

Requesting doctors are advised to liaise with the laboratory in advance of specimen collection when difficulties in
obtaining blood specimens are expected. In these situations, tests requested should be ranked in order of priority.

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8.5 Turnaround Time Targets
Turnaround time (TAT) is defined as the time from receipt of specimen in the biochemistry laboratory until the result is
reported in the LIS. TAT is adversely affected when there are excessive demands for urgent assays. We will endeavor to
meet the following turnaround times for routine assays. Please see the alphabetised test list for target turnaround times
for more specialised assays.

Category Target turn around time

Urgent requests 2hours
Priority requests 3 hours
Routine requests 4 working days

8.6 GP Specimens
Ideally, samples for analysis should arrive as soon as possible or at least within 4 hours of collection. If a longer delay is
expected then blood specimens should be centrifuged prior to submission.
GP samples arriving before 19 :45 will be centrifuged on the day of receipt. Specimens due to be delivered after 20:00
should be centrifuged at the point of collection as such work may not be centrifuged until the following routine working
day with the result that the specimens will be aged and unsuitable for analysis for K+, glucose, inorganic phosphate, AST
and some other parameters.

Un-centrifuged specimens greater than two days post phlebotomy are not accepted for analysis.

Centrifuged specimens greater than seven days post phlebotomy are not accepted for analysis.

Subject to the volume of work received and the available staff resources samples will be processed as soon as possible
following receipt. The target turnaround time for routine GP requests is 2 working days.

8.7 Add on Test Requesting

Clinical Biochemistry specimens are stored in a fridge for up to 7 days. Subject to individual analyte stability, further
tests on a specimen that is already in the laboratory can be requested by submitting an additional request form. The
form should be completed as usual, with the addition of the specimen number and the additional tests required. This
number can be found by checking the laboratory enquiry screen or the paper report. GP’s should fax in the request
forms. Phone requests for add-on tests are only accepted from the Resus Unit in the ED, and remote hospital locations.

8.8 Referred Specimens

Tests not done on-site are recorded, pre-processed to ensure stability and referred to outside laboratories for analysis.
Information on these tests is included in the test directory.

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8.9 Clinical Details
The inclusion of brief clinical details including relevant medication assists the Clinical Biochemistry Laboratory in
providing the most appropriate service for requesting doctors.

8.10 Critical Results

Results falling outside defined critical limits will be telephoned to the requesting source.

8.11 Therapeutic Drug Monitoring

See the Test Directory for details of individual drug assay requirements. The time since last dose should be given on the
request form.

8.12 Fluid Analysis

We provide analysis of various fluids including pleural effusions, acetic fluids and peritoneal dialysis fluid. Appropriate
general biochemical assays are provided including pH, protein, glucose, LDH, amylase, creatinine, triglyceride, and
cholesterol. The various requirements for these fluid assays are not listed in the Test Menu section of this book.
Therefore you should contact the laboratory if you have any queries.

8.13 Near Patient Testing (NPT)

We provide an integrated NPT service for glucose monitoring, critical care blood gas analysers, HbA1c testing and
Hypoglycaemic metabolic screening packs. In order to achieve high quality results it is essential that all users adhere to
NPT policy and guidelines.

Use of analysers is only permitted following training which is organized by the Clinical Biochemistry laboratory. If training
in the use of any of the NPT analysers is required contact the Senior Medical Scientist with responsibility for NPT at ext.
2725 or email [email protected].

Follow the instructions for the disposal of waste in order to minimize health, safety and infection risks.
Critical Care analysers are located in ICU, HDU, AMAU, Theatre, CTICU, ED, NICU, Labour Ward, ESU, Shannon, Clinical
Biochemistry and SCU MPUH.
Blood glucose meters are located throughout GUH and MPUH. There are over 120 glucometers in use.
Hypoglycaemic metabolic screening packs are located in paediatric areas: Paediatric ED, Red Resus, NICU, Bernadettes,
PDU and Paediatric OPD.
HbA1c analysers are located in Paediatric OPD and DDC.

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The development of an integrated laboratory-connected and managed NPT service for critical care analysers, glucose
meters and intra-operative PTH is progressing throughout the Galway University Hospitals. The NPT service is under
the governance of the multidisciplinary Laboratory Medicine Directorate. Training and education and support
programmes developed and implemented by scientists from the Clinical Biochemistry Department are the cornerstone
of the evolving accreditable NPT service where staff are accountable, risk is minimised and the quality of results are on
a par with conventional laboratory analysers. Results of NPT analysers form part of the electronic patient record through
connectivity of all major NPT devices with iLab.

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9. Division of Anatomic Pathology

The Division of Anatomic Pathology provides a wide range of diagnostic and consultative services to clinicians and other
service users. Specimens are routinely received through the acute hospital setting, as well as from GP’s and regional
hospitals.
The division acts as a tertiary referral centre for hospitals and clinicians both regionally and supra-regionally. Advisory
services are provided through numerous multi-disciplinary team meetings as well as by direct referral. The Division of
Anatomic Pathology comprises Histopathology, Cytopathology, Molecular Pathology and Autopsy Departments.

9.1 Division Profile

The aim of the Division of Anatomic Pathology (DAP) as a Regional, Supra-Regional and Tertiary service is to provide a
high quality diagnostic service to meet National and EU objectives of reducing the incidence of cancer through early
detection and appropriate service delivery, and also to provide a high quality non-cancer related diagnostic service. The
Division is committed to providing a timely and efficient service to patients, Clinicians, General Practitioners and all
users of the service. University Hospital Galway has been designated a supra- regional status for the delivery of cancer
services and the laboratories provide a central role in the delivery of that function.
The Division of Anatomic Pathology provides a diagnostic and consultative service to clinicians and indirectly to their
patients. The Division receives, processes, and reports on tissue and cytological specimens that result from Medical,
Surgical, Paediatric, Obstetrics and Gynaecology, and General Practice. This list is not complete. The service works
closely with clinical, radiological and screening services to provide best practice patient care for diagnosis of disease and
patient management.

Histopathology provides Routine Histology and Advanced Diagnostic services. Specialised histopathology services are
provided for breast, colorectal, gynaecological, lung, liver, prostatic cancer, urology, renal, endocrine, head and neck,
cardiothoracic and skin disease. Advanced Diagnostics include an extensive immunohistochemistry, in situ-hybridization
(ISH) and direct Immunofluorescence service, in addition to the special stains, electron microscopy and frozen section
service provided.

Cytopathology services include: Diagnostic cytology; on site pathologist assisted fine needle aspiration (FNA) service &
evaluation of joint fluids for crystals.
Molecular Pathology services are provided on both histological and cytological material. This includes on site evaluation
of HER 2 status by DDISH for cancer patients, as well as mutation analysis.
This service is provided by Consultant Pathologists, Non-Consultant Hospital Doctors, Medical Scientists, Laboratory
Aides and Clerical personnel.

The Division aims to provide a comprehensive, effective and high quality service and to support the ongoing education
and training of Medical and Scientific staff. The Division is accredited by the Royal College of Pathologists for specialist
training in Histolopathology and is also accredited by the Academy of Medical Laboratory Science for the training of
Medical Scientists.

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The Division of Anatomic Pathology (DAP), University Hospital Galway's quality management system has been designed
to meet the requirements of ISO15189 2012: Medical laboratories- requirements for quality and competence. Refer to
www.inab.ie to check the current status of accreditation. The DAP is a participant in the National Histopathology Quality
Improvement Programme, and is active in EQA, and IQC. The Division regularly participates in case conferences and
multidisciplinary meetings.

9.2 General Information

The information given in the Division of Anatomic Pathology section of the User Guide is supported by the details
available in the first section of the User Guide. The details given in this first section include:
General information in relation to location, postal address, general enquiries, contact information, population served,
and the laboratory opening hours.

Guidelines for the general use of the laboratory including: register of users, requests to the laboratory, request form
and sample acceptance criteria, specimen request form, specimen container, supplies of request forms and specimen
containers, collection of specimens, and general guidelines details are provided in the first section of the user guide.
The DAP require that samples received into this lab be on the appropriate Divisional request forms and contain the
information on the request form and container as outlined in the General Information section of this guide.
The patient should be appropriately prepared for the procedure and the sample being taken. When laboratory staff are
in attendance, as may be the case in fine needle aspiration procedures, the patient should be informed.
In relation to specimens submitted to the Division of Anatomic Pathology, the type of primary sample and the anatomic
site of origin, where appropriate (e.g. BAL left lobe, Right breast biopsy) must be stated. Relevant clinical information
should be provided.
Dispose of all clinical waste in accordance with national guidelines.
The DAP uses referral services for some of its tests. Where a referral service is used it is referenced in the test report.

9.3 Specimen Acceptance

The information necessary for the acceptance of a specimen is defined for the request form and the specimen container.
The information supplied must be sufficient to match the form and the sample and sufficient to make the primary
sample traceable to an identified individual. The specimen site must be specified on the pot and the form.
Form information acceptance criteria:
 Patient’s first name and surname
 Patient’s address
 Patient’s date of birth (DOB)
 Patient’s Board number/ Hospital number, where applicable
 Name of Clinician or GP
 Location of patient e.g. ward, where applicable
 Type of primary sample and anatomic site

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  Examination requested

For Colorectal Programme Forms the NCSS COR Number is Mandatory.

Container information acceptance criteria:

 Patient’s first name and surname and
A minimum of two of the following identifiers must be present:
 Patient’s address/ DOB/ Board or Hospital number
 Type of primary sample and anatomic site

Note: it is not possible or safe at the moment of receipt of the specimen(s) in the Division of Anatomic Pathology to
check each pot for the presence of a specimen. Therefore acceptance of a specimen test request by the DAP staff is not
confirmation that the described specimen is present in the container, but rather that the form details and the container
details, and where applicable the sign off book details, match and contain the information required. The absence of a
described specimen may not be noted until the specimen container is opened in the sampling area of the lab. The
absence of a described specimen is recorded as a non conformance. The sender is informed of the issue as soon as
possible by the DAP staff.
Information on all tests carried out in Histology, Cytology, and Molecular Pathology is included in the Test Directory of
this User Guide (listed alphabetically).

9.4 Histopathology
Specimens
Specimens should be submitted intact and should not be dissected in the theatre as this may prevent proper gross
examination in the laboratory and may interfere with the selection of appropriate tissue sections for microscopy.

Containers: Histopathology request forms and prefilled specimen containers are issued from Laboratory Stores (ext
4377). Larger specimen containers and buffered formalin for use in the theatres and wards are available from the
Histopathology Laboratory ext. 4589.
Ensure that the container selected is large enough to allow the specimen to be immersed in at least twice its own volume
of buffered formalin. The container (not the lid) must be clearly labelled with the patient’s full name, date of birth, and
specimen type and anatomical site. This is particularly important in Histology where specimens may be multipart or left
or right etc. SHARPs containers are not suitable to use for Histology specimens. Ensure that the lid is securely closed
on the container.
All specimens must be received with an accompanying legible request form containing required information.
Failure to submit essential information will result in the non-acceptance of the specimen and will cause unnecessary
delays in issuing reports.

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Urgent Specimens
Urgent formalin fixed specimens should be accompanied by the request form which clearly states URGENT.
Urgent unfixed specimens e.g. frozen section must be pre-booked with the Consultant Pathologist (ext. 4589) 24 hours
in advance. (See below for detail re: Frozen section, skin or renal tissue for Immunofluorescence studies, fresh lymph
nodes query lymphoma, muscle biopsies, sural nerve biopsies).
Out of hours service requests must be arranged directly with the Consultant Pathologist through the Hospital
switchboard.

Frozen Sections
Avoid if there is a danger of infection e.g. if tuberculosis is strongly suspected, frozen sections will not be done if there
is a danger of infection. Alternative approaches to rapid diagnosis can be discussed with the Consultant rostered on
‘Frozens’.

Prior Arrangement
Please book frozen section 24 hours in advance with the Consultant Histopathologist rostered for ‘Frozens’(ext. 4589).
If possible put the operation at the beginning of the operation list.
If the operation is delayed or if it is subsequently found that the frozen section is not required, please notify the
Histopathology staff without delay at ext: 4589.
The unfixed tissue sample is transported directly to the laboratory by portering staff in a fully labelled dry container
accompanied by a fully completed request form. Include the contact details for immediate call back of frozen section
result.

If the Frozen Section is cancelled or delayed please notify the Histopathology staff as soon as possible. Tissue for frozen
section must be handed directly to a Medical Scientist, NCHD or Consultant Histopathologist.

Unbooked Frozen Sections: Frozen sections that are required but not booked during the ‘normal working hours’ (09:00
-17:00 h) must be discussed with the Consultant Histopathologist rostered for ‘frozens’ before any samples are taken
(ext. 4589).

Immunofluorescence on Skin Biopsies

Please notify the Histopathology staff (ext. 4589) at least 24 hours in advance.
Place the biopsy in a fully labelled suitable sized container without any preservative and deliver to the laboratory
immediately, with its completed request form. Include contact details.

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If the biopsy is from outside University Hospital, Galway, the sample may be sent in a suitable transport medium (e.g.
Michel’s or Zeuss medium). Ensure the package is addressed to the Histology Lab, rather than the department. The
specimen must be delivered directly to the Histology lab without delay.

Renal Biopsies for Immunofluorescence and Electron microscopy

Please notify the Histopathology staff (ext. 4589) at least 24 hours in advance.
Place the biopsy in normal saline to maintain hydration and deliver to the laboratory immediately, with completed
request form. Include contact details.

Fresh Lymph Nodes query Lymphoma

These should be booked with the Consultant Histopathologist. Please notify the department (ext. 4589) at least 24 hours
in advance.
Place the biopsy in a fully labelled, suitable sized container without any preservative and deliver to the laboratory
immediately, with completed request form. Include contact details.

Muscle Biopsies
These should be booked with the Consultant Histopathologist. Please notify the department (ext. 4589) at least 24 hours
in advance.
Place the biopsy in a fully labelled, suitable sized container, in saline moistened gauze (not drenched), and deliver to the
laboratory immediately, with completed request form.

Sural Nerve Biopsies

These should be booked with the Consultant Histopathologist. Please notify the department (ext. 4589) at least 24 hours
in advance.
Place the biopsy in a fully labelled, suitable sized container in saline moistened gauze (not drenched), and deliver to the
laboratory immediately with completed request form.

Radiation Specimen
Ensure that the container selected is large enough to allow the specimen to be immersed in at least twice its own volume
of buffered formalin. Ensure that radiation information is included on the request form and specimen container/s.
Deliver to the designated radiation laboratory room immediately with completed request form. Leave specimen
containers behind lead shield. Then notify Histology Medical Scientific Staff for specimen reception.

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Outside normal working hours
Please notify the Histopathology Department (ext. 4589) in advance of 17:00 h to enable specimen reception.
Samples which may be delayed in transit to the laboratory should be fixed or refrigerated to prevent deterioration of
the specimen. Clinicians must ensure that unfixed specimens such as CSF are not submitted outside of normal working
hours.

Post Vasectomy Analysis

Sample should be collected after a minimum of 48 hours and not longer than 7 days of sexual abstinence.
The specimen should be obtained by masturbation and ejaculated into a clean wide-necked container (provided by the
laboratory or GP). The container should be body warmed to minimise the risk of cold-shock. Condoms should not be
used in the collection as these contain spermicide, which swiftly obliterates sperm motility.
Coitus interruptus is not acceptable as a means of specimen collection as it is possible that the first portion of the
ejaculate, which usually contains the highest concentration of spermatozoa, will be lost.
Excessive heat or excessive cold could easily damage sperm. The semen specimen therefore should be brought to the
laboratory at close to body temperature.
The specimen bottle must be labelled with the Patient’s name, date of birth and date and time of collection. It must
arrive with a fully completed request form. It is best that the semen sample is delivered within 1 hour of production to
the laboratory, Monday to Friday 09:00 to 11.30 and 14.00 to16.00 h. Note: This analysis is a screening service which
does not include a formal quantification of spermatozoa per British Andrology Society guidelines and is not an
accredited test. Clinical judgement is required in the interpretation of the results.
Placentas
Placentas from labour ward should be placed in adequate formalin fixative and placed in the large size container. Ensure
both requisition form and container are labelled with specimen Placenta and with patient demographics. Clinical details
should always incluse gestational age at time of delivery, in addition to other relevant clinical information.

9.5 Cytopathology
Samples resulting from direct shedding of cells or exfoliative cytology specimens such as voided urines and sputum are
easily collected. However, Cytoscopy, Endoscopic brushings, lavages, washings, Fine Needle Aspirates (FNA), CT and
ultrasound guided techniques, magetic resonance and tomography can provide sophisticated methods to obtain
optimal samples for cytological evaluation, bringing the practice of clinical cytology to the forefront of preventive and
diagnostic medicine.
The department provides: a diagnostic cytology service, an on site Pathologist Assisted FNA service and the evaluation
of joint fluids for crystals.
Cytopathology can process fluids from any body cavity, lump or swelling, including the following:
Abdominal fluid C.S.F Pleural fluid
Ascitic fluid Cyst fluid Pericardial fluids

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 Breast aspiration Effusions Sputum
Breast cystic lesion FNA/FNAC – breast, parathyroid, Urine
thyroid lumps
Bronchial washings, lavages (LLL, Ovarian cyst fluid Joint fluids for uric acid crystals
RML,RLL,BAL,)
Crystals in body fluids / joint fluids/ Peritoneal fluid
Note: Cytology will not be performed on a ?CJD or a CJD sample
Note: Drainage bags or needles must not be submitted to the laboratory.
Test volumes, Fixation & Storage
Tests may be submitted in 30ml universal containers, containing shandon fixative fluid supplied by the laboratory.
Drainage bags or needles are not acceptable.
Bronchoscopy specimens may be submitted in 20-50 ml containers containing saline solution.
CSF’s which need to be split for microbiological assessment must be sent unfixed for microbiological assessment and
subsequently forwarded for cytological assessment.
Specimens for cytological assessment may be refrigerated overnight if a delay in delivery is anticipated.
Pathologist assistance at FNA is available in UHG. To check availability of pathologist , ring 4883, or alternatively, the
Pathologist rostered may be contacted via hospital switchboard.
Please refer to the Test Directory for further information on submission requirements. Fixative is available from the
laboratory to registered service users, by telephoning or faxing requisitions for supplies.

Joint Crystals
Samples should be submitted unfixed and refrigerated if immediate transportation to the laboratory is not possible.

Fine needle aspiration service

A Pathologist assisted Fine Needle Aspirate service is available and must be booked in advance by telephone extension
(54) 4883.

EBUS (Ultra sound guided Endobronchial Specimens)

EBUS specimens are submitted to the labortory in universal containers to which formalin has already been added
(available from Cytology Laboratory). Smears prepared at EBUS for Cytological evaluation should be labelled with
patient name, date of birth or Board No., specimen site (e.g. LN 4R) and also clearly indicate whether slide has been air
dried (for diff quik staining) or alcohol fixed (for Pap or H&E staining). Please note there is no out of hours or weekend
Diagnostic Cytology service.

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9.6 Molecular Pathology

The molecular laboratory provides a mutation service for Breast and Gastric HER-2, Non Small Cell Lung Cancer (NSCLC),
Colorectal Cancer (CRC) and Malignant Melanoma. The mutation statuses of predictive and prognostic markers are
reported in a panel format. The NSCLC panel reports the EGFR/ALK/ROS-1 and BRAF status, CRC panel reports the
KRAS/NRAS and BRAF status and the MM panel reports the BRAF and NRAS status. External Quality Assurance is
maintained through participation in UK NEQAS (National External Quality Assurance Scheme) and GENQA (Genomics
Quality Assurance). Request forms for molecular assays are available from the Department of Histopathology,
Cytopathology and Molecular Pathology, Ext 4078.

EGFR
Non Small Cell Lung Cancer samples are tested using the cobas® EGFR Mutation V2 Test which is CE-IVD marked. This
assay can detect mutations in EGFR exons 18, 19, 20 and 21 with at least 5% mutation level using the standard input of
50 ng per reation well. Sensitising mutations detected are: Exon 19 p.Gly719X (3 possible), Exon 19 Deletions (29
possible), Exon 21 Leu858Arg (n.2573 T>G, 2573_2574TG>GT). Resistance mutations detected are: Exon 20 insertions
(5 possible), Exon 20 p.Thr790Met (n. 2369 C>T), Exon 20 Ser768Ile. This sensitivity was replicated “in-house” using
blends of mutation and wild type DNA. This assay covers 85% of known EGFR mutations. EGFR reference sequence
LRG_304tl.

ALK
Non Small Cell Lung Cancer samples are tested using the Ventana anti-ALK (D5F3) antibody, positive cases are confirmed
using the Agilent IQ ALK FISH Breakapart Probe Kit and interpreted according to the Vysis ALK Breakapart probe package
insert. Reference Sequence LRG_310tl.

ROS-1
Non Small Cell Lung Cancer samples are tested using ROS-1 assay was carried out using the Agilent IQ ROS-1 FISH
Breakapart Probe kit and interpreted according to “Testing for ROS-1 in non-small cell lung cancer: a review with
recommendations. Bubendorf et al. Virchows Arch (2016) 469:489-503

KRAS
Samples were tested using Roche KRAS V2 LSR for detection of mutations in codons 12/13, 59/61, 117 and 146 of the
KRAS gene in DNA derived from formalin-fixed paraffin-embedded human colorectal cancer (CRC) tissue. KRAS mutation
coverage 99.1%. The Roche KRAS V2 LSR can detect KRAS mutations at ≥5% mutation level using the standard input of
50 ng per reaction well, this sensitivity was replicated with “in house” sensitivity studies. Reference sequence accession
number NM_004985.4.

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NRAS
Samples were tested using Roche BRAF/NRAS LSR for the identification of mutations in codons 12/13, 59-61, 117, 146
of the NRAS gene. The assay covers 96.3% of NRAS mutations in malignant melanomas/colorectal cancers. The Roche
BRAF/NRAS LS can detect NRAS and BRAF mutations at ≥5% mutation level using the standard input of 50 ng per reaction
well; this sensitivity was replicated with “in-house” sensitivity studies. HGVS nomenclature according to Genbanks
sequences:LRG_92tl.

BRAF
The Roche BRAF/NRAS LSR assay was used for the identification of BRAF mutations in codons G466, G469, V600X and
K601 mutations. The assay covers 96.5% of NRAS and BRAF mutations in malignant melanomas. The Roche BRAF/NRAS
LS can detect BRAF mutations at ≥5% mutation level using using the standard input of 50 ng per reaction well; this
sensitivity was replicated with “in-house” sensitivity studies. HGVS nomenclature according to Genbank sequence:
LRG_299tl.

HER-2 DDISH service

The Ventana DDISH Assay is designed to quantitatively detect amplification by light microscope of the HER2 gene via
two colourchromogenic in situ hybridization (ISH) in formalin-fixed, paraffin-embedded tissue specimens of human
breast cancer and gastric cancer. results are reported according to; Human Epidermal Growth Factor Receptor 2 testing
in Breast Cancer. American Society ofClinical Oncology/ College of American Pathologists Clinical practice Guideline
Focused Update. doi: 10.5858/arpa.2018-0902-SA.

9.7 Clinical Advice

Clinical advice and service is available from the Consultant Pathologists. Pathologists regularly participate at Multi
disciplinary meetings in the hospital. Comments relating to the service should be addressed to the Chief Medical
Scientist.

9.8 Turnaround Times

TAT: Achieve 80% by Working Day indicated
Current DAP Target Revised Interim TAT
P code
TAT UHG (X working Days)
P01 All 3-10 3-14
P02 All GI 3-10 3-14
P03 Cancer resection cases 7-10 7-14
P04 Non cancer resection cases 7-12 7-16
P05 Non Gynaecological Cytology-CSF 5 5

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 P06 Non Gynaecological Cytology-FNA 5 5
P07 Non Gynaecological Cytology- Exfoliative 5 5

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10. Mortuary services-Autopsy/Post Mortem (PM)
The Autopsy/PM Service involves the examination of the body after death primarily to establish the cause of death (a
Coroner’s requested PM). It may be used in rare cases to examine the extent of disease, disease progression or the
response to treatment (a Hospital/Consented PM).

All bodies of deceased persons who died in Galway University Hospitals, are initially transferred to the hsoptial
mortuary, even if no Autopsy/PM is indicated. Funeral arrangements cannot be finalised and bodies cannot be released
from the hospital mortuary until the mortuary staff establish whether an Autopsy/PM is requested or not, by the
Coroner, (as all deaths are currently notifiable to the Coroner) and need his permission to be released, from the hospital
mortuary.

On every ward and clinical area there is a new updated Algorithm, August 2022, clearly explaining the pathway and
process for this initial Coroner contact details and times and the email of document R688_ Rev 3, to him, step by step.

Coroner’s Autopsies/PM’s (ALL Deaths are currently Reportable to the Coroner)

When a patient dies, or is brought in dead (BID) from the community, the Coroner must be contacted.
In addition to contacting the Coroner, the Consultant Pathologist must be notified by the Registrar/Consultant and
provided with any available details on the case and the case scheduled for the PM.

Official identification of the deceased is completed by the next of kin to a member of the Gardai. If the family are not
in a position to complete the identification it can be done by a member of the Medical/Nursing staff whom the deceased
is known, both when living and deceased.

Ref : Q-Pulse IM-MR-025 updated July 2022.

Inpatient Post Mortem Checklist

(Coroner’s case)
The Consultant or Registrar speaks to the relatives of the deceased and informs them about the necessity
for a post-mortem examination and why the Coroner needs to be involved.

The Consultant or Registrar discusses the Autopsy/PM with the Next of Kin, explaining in detail what the
examination entails.
A copy of the information booklet re: post mortem examination and the hospital Bereavement booklet are
given to the family (both booklets updated July 2022).
Coroners Post Mortem form completed with the next of kin (R842)
Details of death form, R770 Rev 1, is then also completed by the Registrar/Consultant for the Consultant
Pathologist/Mortuary Staff information.
These original forms are filed in the HCR.

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The case notes together with a clinical summary of the case is sent to the Pathologist prior to the post-
mortem examination.

The Garda are contacted and asked to come to the Ward/Department to facilitate with the formal identification with
the next of kin/or staff member to whom the deceased was known to when living and deceased.

If during working hours, 9.30am-5pm, Monday-Friday, the family are informed of the availability of the Bereavement
Officer, should they like her presence at this time. If out of hours, then the business card of the Bereavement officer
should be offered/given to the grieving family for them to make contact in their own time.
Contact phone: Ext 4823. Mobile: 087 9684 271. Bleep 615.

The deceased is prepared in accordance with the hospital policy for transfer to the mortuary.
The family/next of kin can contact the mortuary dept. directly 091 544412 to find out the expected time of release of
the body, so that they can make necessary funeral arrangements.

Perinatal cases for Coroners post mortem should use Perinatal Post mortem documentation packs for Coroners post
mortems, available on the appropriate wards. The perinatal post mortem information booklet should also be provided
to parent and the perinatal post mortem.

Perinatal pathologist to be contacted with information regarding the case.

Cytogenetic testing on skin biopsy and skeletal survey is to be arranged by clinical team prior to post mortem
examination.

Coroner’s Post-Mortems brought in from the Community (BID).

The Garda to inform the Mortuary Department prior to bringing in bodies for a Coroner’s post-mortem. If after working
hours (5pm-9am), Mortuary Staff on-call can be contacted through the switchboard (30 minutes prior to arrival), to
enable Mortuary staff to be at the mortuary when the deceased arrives.
The Pathologist/mortuary staff is contacted for formal identification with the Garda (if late at night the Garda is
requested to attend the mortuary the following morning at 9.30 am for the identification).

The Garda to accompany the body to the mortuary. Details to be filled into the mortuary register, post-mortem register
and temporarily retained organ retention register.

The Garda to email completed C71 with details of deceased and circumstances of death to relevant Coroner and the
hospital mortuary.

The deceased is prepared in accordance with hospital policy for the post-mortem examination.
The post mortem protocol to be filled out.
I.D. bands to be put on to deceased wrist and leg.

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The weight and height are recorded.
The deceased clothing, jewellery or valuables are recorded in the patient’s property book in the presence of the Garda.
If organs need to be temporarily retained for further examination the Coroner is informed along with the Bereavement
Liaison Officer, who discusses/ informs this need to the next of kin.

Hospital Autopsy/Post Mortem/Non-Coroners PM

As ALL death are notifiable to the Coroner, the previous steps, as per the Algorithm are followed, re contacting the
Coroner and emailing him the form R688_Rev 3 for his awareness and consideraiton.
Once it is known that the Coroner is NOT requesting a PM, but that the Consultant/family are, then proceed with this
below process.
The Consultant or Registrar discusses the Autopsy/PM need with the Next of Kin, explaining in detail what the
examination entails.
A copy of the information booklet re: post mortem examination and the hospital bereavement booklet are
given to the family (updated July 2022).

The Autopsy/PM request and consent form should be completed, after consent to a post-mortem examination has been
received from the next of kin (Form R678 c2 Rev 4). A brief clinical history with a clinical diagnosis and a list of questions
to be answered should be included.

Post Mortem Consultation Form Completed (R770 Rev 1). These deaths should always be discussed with a Consultant
Pathologist ahead of time. The patient’s chart must accompany the body to the Mortuary. All IV lines and E.T tubes
should be left in situ in order that the Pathologist can document same, prior to the post mortem examination.

Perinatal cases for Hospital post mortem should use perinatal post mortem consent packs for Hospital consented post
mortems, available on the appropriate wards. The perinatal post mortem information booklet should also be provided
to parent and the perinatal post mortem.

Perinatal pathologist to be contacted with information regarding the case.

Cytogenetic testing on skin biopsy and skeletal survey is to be arranged by clinical team prior to post mortem
examination.

Foetus
Post-12 week Foetus
The protocol is as for a mature baby i.e. fully informed written consent of the parent for post-mortem examination is
required.

Pre-12 week Foetus

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Where pre viable foetal remains are identified they are buried or cremated in accordance with Parental preference.
These arrangements can be discussed with Parents by Medical or Midwifery staff. Bereavement Support Midwife/BSM
will liaise with the Parents to finalise the arrangements. Ext 3614, Bleep 015 or Mobile: 087 7712329.

Cremation
When cremation is the families’ choice, arrangements must be made by them through the Funeral Director.
The Funeral Director will deliver the Medical Certificate form (Form C) to the ward to be completed by a Doctor.
If the family state this at the time of death or before death, the cremation form can be downloaded from the
Crematorium website for completion.
If the decision is made after the family have returned home, the Mortuary Staff will assist the Funeral Directors with the
collection of forms where the Funeral Director is not local.
The doctor completing the form must be fully registered (post intern) on the Medical Register of Ireland and must have
seen the person alive before death and viewed the deceased remains after death.
When completed, the form should be given to the Funeral Director.
Cardiac pacemakers or any radioactive implant must be removed prior to cremation by the Medical team whom may
be assisted by the Mortuary Staff.
Mortuary staff are not responsible for arranging medical certificates for cremation.

Ref : Q-Pulse IM-MR-025 Policy on the completion of the Death Notification Form (Death Registration) at GUH updated
July 2022.
There are also several other policies/SOP’s in progress currently with Vivian, Helen and Anne that can be referenced
here as needed.

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11. Immunology Department (Supraregional Service)
11.1 Department Profile
The Department of Immunology provides a comprehensive range of tests for the immunological investigation of
patients. Our aim is to provide the highest quality of service and prompt delivery of accurate results, backed up by
specialist medical and scientific expertise. Where specific tests are not available locally we will refer samples on to
colleagues in other centres. The department is happy to assist in the interpretation of patients test results.
Interpretative comments will be added to reports where appropriate. Clinical referrals are welcome and opinions will
be given at in-patient consultations or at the immunology clinic (for allergy and immunodeficiency) or the joint
immunology / rheumatology clinic (for connective tissue diseases). The Department of Immunology is accredited by the
Irish National Accreditation Board (INAB) in compliance with the International Standard ISO/IEC 15189 (Registration
number 255MT). All tests referred to external laboratory for testing are outside of our scope of accreditation.

A list of tests offered is described in Section 16. There is a brief summary of the clinical application of each test which is
intended to be helpful but is not intended to replace discussion of individual patients. For urgent, complex or specialised
tests please discuss with medical / scientific staff before sending the specimen.

Routine serum specimens are stored for two weeks. Subject to individual stability, further immunology tests on a serum
specimen that is already in the immunology laboratory can be requested by contacting the department.

Turnaround time (TAT) is defined as the time from receipt of specimen in the Immunology laboratory until the result is
reported either in the LIS or by phone. TAT is affected when there are excessive demands for urgent assays.TAT is based
on ‘working days’. The Immunology department does not provide a weekend or out of hours service. TATs are based on
95% confidence intervals.

11.2 Guidelines for Requesting Allergy Tests

Allergen Specific IgE Tests
We receive several requests for ‘allergen specific IgE or RAST’ without stating which individual allergen test is required.
There are very many individual tests available and it is not possible for the laboratory to determine what individual
specific IgE tests are required, particularly for food allergens. The individual allergen must be selected by the requesting
doctor to confirm their suspicion obtained from the clinical history.
Specific IgE tests are tests of sensitisation which are used to support a clinical diagnosis of allergy. Specific IgE testing
provides similar, although not identical, information to Skin Prick Testing, but may be particularly valuable in assessing
some groups of patients (patients taking antihistamines, extensive eczema/dermographism). Specific IgE tests are
expensive.
Refer to the National Laboratory Handbook - Total and Specific IgE (located on www.hse.ie) for provision of indications
for allergy testing.

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Anaphylaxis
Please phone to discuss.
Blood samples (serum) for Tryptase (marker of mast cell degranulation) should be taken immediately after resuscitation
(sample 1), after 1-2 hours (sample 2) and a baseline sample at 24 hours (sample 3). It peaks within 1 hour but can be
raised for up to 6 hours.
In the refractory period after anaphylaxis, specific IgE to the causative allergen may be falsely negative. Testing should
generally be deferred for 3-4 weeks.
Food Allergy
Relatively few foods account for most IgE mediated allergic reactions in both children and adults.
In children these include egg, milk, peanut, tree nuts, kiwi.
In adults these include peanut, tree nuts, fish, shellfish, fruits.
Seeds (e.g. sesame) and fruit (e.g. kiwi) are emerging allergens.

Asthma and Rhinitis

In asthma and rhinitis testing for inhalant allergens is helpful (usually by skin testing)
House dust mite, grass pollen, tree pollen plus cat or dog
Plus other animals or moulds (alternaria, cladosporium, aspergillus) if clinically relevant.
Individual testing is more useful than panels in selecting allergens to avoid.

Pitfalls in allergen specific IgE testing:

Screening is not useful and is not a substitute for a properly taken clinical history.
Allergen specific IgE tests yield information on sensitisation, which is not always equivalent to clinical allergy.
When used indiscriminately specific IgE tests may be associated with false positive results. False negative results may
occur- but these are rare.
In atopic eczema total IgE is often markedly elevated in widespread disease and specific IgE may be present at high level
to allergens that cause no overt symptoms. In that situation positive specific IgE results therefore need careful
interpretation.
For certain labile allergens (e.g. fresh fruit such as kiwi) the specific IgE has lower sensitivity (55%), whereas Skin Prick
testing with kiwi fruit is more sensitive (90%).
Total IgE
Total IgE is of limited value and should not be used as a screening test.
A total IgE within the normal range does not exclude clinical allergy. Patients may have a normal total IgE and have
clinically relevant allergen specific IgE.
Total IgE is essential in ABPA, and is also used for asthma patients being considered for omalizumab (anti-IgE) treatment.

Who not to test

Additionally Specific IgE tests cannot help investigate non-allergic food intolerance, coeliac disease or non-specific
complaints such as headache.

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There are no specific IgE tests to additives or colours.
Specific IgE cannot help investigate contact allergic dermatitis (patch testing by a dermatologist may be of value).
Specific IgE tests are not helpful in the investigation of chronic urticaria.

11.3 Guidelines for Requesting Tests for Autoimmune Disease

Requests for unspecified ‘autoantibody screens’ are discouraged. Clinicians should ask for specific autoantibody tests
relevant to the clinical picture. If in doubt please contact the clinical immunologist / specialist registrar.
Coeliac disease
IgA anti-tissue transglutaminase antibodies (tTg) or IgA anti-endomysial antibodies are found in active disease, and can
be used to monitor compliance with treatment. IgA anti-tTG is used as the screening test (more sensitive) and positive
results confirmed by IgA anti-endomysial testing (more specific). As part of quality assurance the test method can detect
samples with absent IgA that may cause false negative results. In patients with selective IgA deficiency the IgG anti-tTG
assay is performed. NICE Guidelines, 2016s state that ‘Testing for Coeliac disease is only accurate if the person continues
to follow a gluten-containing diet during the testing period. Some gluten should be eaten in more than one meal every
day for a minimum of 6 weeks before testing’.
Pernicious anemia
Antibodies to gastric parietal cells are associated with type A atrophic gastritis and are found in up to 90% of patients
with early stage pernicious anemia. The frequency declines with disease progression. They also occur in 3% of the
normal population (the incidence rising with increasing age).
Antibodies to intrinsic factor are highly specific for pernicious anemia and are found in 50-75% of patients. They are
rarely seen in healthy individuals.
Anti-mitochondrial antibodies
Antimitochondrial antibodies occur in 95% of patients with primary biliary cirrhosis (PBC). There are several subtypes of
anti-mitochondrial antibodies. The M2 antibody subtype (anti- pyruvate dehydrogenase complex antibody) is highly
specific for PBC and its presence in 'healthy' individuals is associated with a long-term risk of PBC.
Anti-Smooth muscle antibodies
Smooth muscle antibodies (anti-actin) occur in autoimmune hepatitis but smooth muscle antibodies, particularly at low
titres may occur also in other causes of liver disease, including viral hepatitis.
Anti-LKM-1 antibodies
LKM-1 antibodies are associated with Type 2 Autoimmune Hepatitis. They may also be found in Hepatitis C.

In addition serum protein electrophoresis and quantitation of the levels of IgG, IgA and IgM should be performed.
Autoimmune Hepatitis may be associated with polyclonal hypergammaglobulinemia. Primary Biliary Cirrhosis may be
associated with elevated IgM. Primary sclerosing cholangitis has no definitive serological markers, but may be associated
with ANCA (anti-neutrophil cytoplasmic antibodies) or ANA or SMA.

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Further testing for other rare antibodies associated with autoimmune liver disease or primary biliary cirrhosis including
SLA/LP, LC-1, gp210, PML and Sp100 antibodies, are available on request.

11.4 Endocrine Disorders

Thyroid
The level of antibodies to thyroid peroxidase (TPO) are raised in autoimmune thyroiditis (90% of hypo-, >60% of hyper)
but also at low titres in post-viral and post-partum thyroiditis. They are rarely elevated in thyroid
neoplasia/nodules/cysts, but their presence does not exclude these conditions.

Adrenal failure / Gonadal failure

Antibodies to steroid producing cells of the adrenal cortex are associated with autoimmune Addison’s disease. There
may also be antibodies to steroid producing cells of ovary and testis. A small proportion of cases of premature
menopause are due to autoimmune oophoritis. Some of these patients also have adrenal failure - the same tests are
done for both.
Diabetes Mellitus
Islet cell antibodies may be found early in the course of type I (autoimmune) Diabetes Mellitus, but gradually disappear
with time. They are not found in type II diabetes.
Anti-GAD (glutamic acid decarboxylase) antibodies occur in up to 80% of type I Diabetes but may also occur in Stiff
Person Syndrome.

11.5 Dermatology
Pemphigus / Pemphigoid
Antibodies are found to the epidermal intercellular "cement" / desmosome in all forms of pemphigus, and to the
epidermal basement membrane in bullous pemphigoid.
11.6 Autoimmune Rheumatic and Renal Diseases
Rheumatoid Factor
Although present in 65% of Rheumatoid arthritis patients it is a non-specific test and is positive in a variety of conditions
(particularly at low titre) including viral infections, chronic bacterial infections, connective tissue diseases and lymphoid
malignancy. The prevalence of rheumatoid factor increases with age. It is not of value in the laboratory monitoring of
disease activity; CRP should be used.
Anti-CCP antibodies
Anti-CCP (anti-cyclic citrullinated peptide) antibodies have a sensitivity of 68% and specificity of 95% for rheumatoid
arthritis. Compared to rheumatoid factor it occurs less frequently in healthy individuals (1%), after infections (1%) and
in other connective tissue disorders (5%). Anti-CCP antibodies are present in early rheumatoid arthritis and appear to
predict the development of erosive disease.

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Antinuclear antibody (ANA)
Antinuclear antibodies are found in connective tissue diseases, other autoimmune diseases, but also occur in chronic
infections, malignancy and in normal individuals. Approximately 5-10% of normal individuals have a positive ANA at a
screening dilution of 1/80 with the prevalence of ANA increasing with age. If a positive ANA is found, further
characterisation is dependent on the clinical history, titre and immunofluorescent pattern. Low autoantibody titres are
usually not significant. ANA is most useful in the diagnosis of SLE, Scleroderma, Sjogrens Syndrome, Inflammatory
Myositis, Discoid Lupus, Mixed Connective Tissue Disease, Autoimmune hepatitis.
Cytoplasmic antibodies detected on ANA testing
Cytoplasmic staining is detected by the same immunofluorescence test as ANA. However, a positive cytoplasmic staining
is NOT a positive ANA. Some antibodies to cytoplasmic components have clinical significance whereas the relevance of
others is unknown. Antibodies to ribosomes may accompany ANA in SLE. Mitochondrial patterns are associated with
Primary Biliary Cirrhosis. In polymyositis anti-Jo-1 antibodies have a discrete cytoplasmic speckled pattern. Cytoskeletal
patterns can also be distinguished but are mainly non-specific.
Double stranded DNA (dsDNA)
Antibodies against dsDNA are present in 60% of SLE patients and constitute one of eleven ACR criteria for diagnosis. In
most instances it is pointless to request antibodies to dsDNA either without knowing the ANA result or if the ANA is
negative. If the ANA is negative dsDNA antibodies are rarely indicated unless the clinical picture is exceptional.
Histone
Antibodies are found in 18-50% of patients with SLE and in 95% of patients with drug induced SLE. If the ANA is negative
antihistone antibodies are rarely indicated.
Extractable Nuclear Antigens (ENA)
Antibodies to extractable nuclear antigens are useful in the classification of clinical subsets of connective tissue diseases
and in providing prognostic information. If the ANA is negative ENAs are rarely indicated, unless the clinical picture is
strongly suggestive of a connective tissue disease. Further characterisation may be necessary in scleroderma and
myositis, pending the ANA pattern.

Tests are first performed as a screen with further characterisation (Sm, RNP, Ro, La, Scl-70, Jo-1) if positive. An extended
ENA profile is available for patients with connective tissue diseases, scleroderma and myositis.

ENA ANA Pattern Disease Association

Ro (SSA) Speckled Sjogrens (60-80%) SLE (35%)
Subacute cutaneous lupus
Scleroderma (10-15%)
Ro 52 Speckled Connective tissue disease, Myositis

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 ENA ANA Pattern Disease Association
La (SSB) Speckled Sjogrens (50%)
SLE (15%)
Sm (Smith) Speckled SLE (highly specific, 15-30%)
RNP Speckled MCTD (100%)
SLE (40-60%)
Scleroderma (10-15%)
Scl-70 (anti- Homogenous/intense Scleroderma (25%)
topoisomerase-1) speckling + nucleolar
*Jo-1 Cytoplasmic speckled Myositis/Lung fibrosis (30%)
*PL-7 Cytoplasmic speckled Myositis/Lung fibrosis (3-5%)
*PL-12 Cytoplasmic speckled Myositis/Lung fibrosis (3%)
*EJ Cytoplasmic speckled Myositis/Lung fibrosis
*OJ Cytoplasmic speckled Myositis/Lung fibrosis
*PM-Scl (75 & 100) Fine speckled  nucleolar Polymyositis / scleroderma overlap (8-12%)
Fibrillarin Clumpy nucleolar Scleroderma
RNA polymerase III Fine speckled  nucleolar Scleroderma (15-20%)
Th/To Nucleolar Scleroderma (4%)
Nor 90 Nucleolar with mitotic dots Scleroderma
*Ku Homogenous  nucleolar Polymyositis/Scleroderma overlap
*SRP Cytoplasmic speckled Immune Mediated Necrotising Myopathy
*Mi-2 alpha and Beta Fine speckled Myositis
PCNA Cell cycle staining SLE
*TIF1-gamma Juvenile dermatomyositis (15-20%), Adult
dermatomyositis including malignancy associated DM
*MDA5 Dermatomyositis/Lung fibrosis, DM skin changes without
myositis, Juvenile Dermatomyositis (7.4%)
*NXP2 Juvenile Dermatomyositis

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 ENA ANA Pattern Disease Association
*SAE1 Dermatomyositis
*CN-1A Inclusion Body Myositis
*HMGCR Immune Mediated Necrotising Myopathy (with or
without Statin exposure)
Nucleosomes Homogenous SLE
Histones Homogenous Drug-induced lupus
Ribosomal P- Protein Cytoplasmic speckled SLE
Centromere Centromere Limited Scleroderma

Anti-neutrophil Cytoplasmic Antibody (ANCA)

ANCA are used to diagnose and monitor inflammatory activity in small vessel vasculitis, namely Granulomatosis with
Polyangiitis (GPA) (formerly Wegeners Granulomatosis), Microscopic Polyangiitis and its renal limited variant
(pauciimmune cresentic glomerulonephritis) and Churg Strauss Syndrome (eosinophilic GPA).
Positive C-ANCA (cytoplasmic) and P-ANCA (perinuclear) are further tested for specificity to PR3 (proteinase-3) and MPO
(myeloperoxidase).
C-ANCA PR3+, C-ANCA MPO+ or P-ANCA MPO+ occur in 80% of Wegeners Granulomatosis, Microscopic Polyangiitis and
in 60% of Churg Strauss Syndrome.
P-ANCA with specificities other than MPO occur in inflammatory bowel disease, sclerosing cholangitis, rheumatoid
arthritis and other autoimmune diseases where its clinical significance is unclear. Atypical C-ANCA are not clinically
significant. Atypical ANCA are found in some cases of drug induced vasculitis but are otherwise of uncertain clinical
significance.
Anti-glomerular basement membrane (anti-GBM) antibodies
Anti-glomerular basement membrane (anti-GBM) antibodies occur in >90% of patients with Goodpasture's syndrome.

Anti-phospholipid syndrome
Antiphospholipid syndrome is present when at least one clinical and one laboratory criteria are met ;
Clinical criteria:
- At least one episode of vascular thrombosis affecting any organ or tissue (excluding superficial thrombosis).
- Pregnancy morbidity 1 of 3: One or more unexplained deaths at or beyond 10 weeks gestation. One or more
premature births before the 34th weeks of gestation because of eclampsia or severe pre-eclampsia OR recognised
features of placental insufficiency.
- Three or more unexplained consecutive abortions before 10 weeks gestation.

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Laboratory criteria : IgG and/or IgM cardiolipin and/or anti- 2-glycoprotein I antibodies in medium/high titre on two
separate occasions at least twelve weeks apart.
Lupus anticoagulant (performed in haematology) : positive on two occasions at least twelve weeks apart.
Cardiolipin antibodies may be found in other autoimmune disorders, particularly SLE. Transient positive results may be
found after infections.

11.7 Neurology
Myasthenia Gravis and Myasthenic Syndromes
Impaired neurotransmission in MG is caused by the presence of antibodies to the acetylcholine receptor (AChR). They
are detectable in 90% of MG patients. They may be undetectable in 40% of patients with ocular myasthenia. Antibodies
to striated muscle are present in 30% of patients with MG - and 60% of these will also have thymoma. Lambert-Eaton-
Myasthenic Syndrome is associated with antibodies to voltage gated calcium channels (VGCC).

Peripheral Neuropathy
Certain neuro-specific autoantibodies are associated with neuropathies incorporating a range of antiglycolipid and
antiglycoprotein antibodies (e.g. antiganglioside antibodies). These tests are only available after consultation with the
neurologist and are referred directly to a reference laboratory.

Paraneoplastic syndromes
Specific paraneoplastic neurological syndromes may be associated with anti-Hu, anti-Yo, anti-Ri antibodies, anti-
amphiphysin or anti-CV2/CRMP5.
11.8 Guidelines for Requesting Immunochemistry Tests
Complement
Low C3, Low C4 Low C3, Normal C4 Normal C3, Low C4
Severe sepsis Post streptococcal GN Genetic deficiency
SLE (active) C3 nephritic factor SLE
Liver cirrhosis / failure SBE Hereditary angioedema
Malnutrition Sepsis Hypocomplementemic urticarial
vasculitis
Mixed cryoglobulinemia
Increased complement levels are associated with acute phase responses. Normal levels may reflect increased
production as well as consumption.
Serum C3 levels may remain low in some forms of membranoproliferative glomerulonephritis, due to the circulating
autoantibody C3 nephritic factor.

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Hereditary angio-oedema (C1INH deficiency)
Recurrent abdominal pain and/or deep subcutaneous swellings (angioedema) without urticaria (particularly occurring
after minor trauma), often with family history, may indicate HAE. In type 1 HAE (85%) C1 esterase inhibitor is low.
Uncommonly there may be normal C1INH level is normal with defective functional activity. C4 is low during attacks of
HAE.

Acquired C1INH deficiency

Deficiency / Consumption / Inactivation of C1INH may occur in SLE and lymphoproliferative disease. This may lead to
episodes of angio-oedema as with the inherited form. C1q is low in acquired C1INH deficiency but usually normal in
HAE.

Complement Deficiencies
CH100 and CH100A test the integrity of the classical and alternate pathways of complement activation. Their use is
limited to the investigation of suspected complement deficiencies. Early classical pathway complement component
deficiencies are associated with SLE and recurring bacterial infections. Deficiencies in the alternative and terminal
pathways are associated with recurring neisserial (meningococcal) infection. To avoid misinterpretation due to the
effects of complement consumption by immune complex formation or infection, the test should be requested when the
patient has recovered.

Immunoglobulins
IgG, IgA, IgM, and Serum Protein Electrophoresis
Essential in the investigation of suspected immunodeficiency, lymphoproliferative disease and myeloma. Abnormally
elevated levels in the absence of a monoclonal band i.e. polyclonal hypergammaglobulinemia may occur in chronic
infections / inflammatory conditions, liver disease and connective tissues disorders (e.g. Sjogren’s syndrome and SLE).
If a monoclonal band (paraprotein) is detected on electrophoresis it is quantified and immunofixation is then used to
define the heavy chain (IgG, IgA, IgM, IgD, IgE) and light chain (kappa or lambda) type. Malignant paraproteins are
usually of high concentration (>15g/L) associated with low levels of the non-paraprotein immunoglobulins and the
presence of free monoclonal light chains in the urine (Bence Jones proteins). They occur in myeloma and
lymphoproliferative disorders. Monoclonal Gammopathies of unknown significance (MGUS) are paraproteins which do
not have the typical features described above, but long-term follow up has shown that 20% may develop myeloma over
a 20 year period.
Paraprotein quantitation is used to monitor disease progression and response to therapy. The technique used to
quantitate monoclonal bands is different to that used to measure the total immunoglobulins (IgG, IgA, IgM) and results
are not directly comparable.

Urinary Free Light Chains (Bence Jones Proteins)

Urine protein electrophoresis for Bence Jones proteins (Urine free light chains) should be requested in all patients with
suspected paraproteinemia because 20% of myeloma patients do not have a detectable monoclonal band in the serum.
Early morning specimens are preferred. For disease monitoring a 24-hour collection is preferred.

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Serum Free kappa and lambda Light Chains
Abnormal serum free light chains are useful in monitoring the response to treatment in multiple myeloma and AL
amyloidosis. In MGUS, an abnormal free kappa/lambda light chain ratio may help in prediction of the longterm risk of
progression to malignancy. However, serum and urine protein electrophoresis and immunofixation remain the first line
of investigation for monoclonal disorders.

Beta 2 Microglobulin
Elevated Beta 2 microglobulin occurs in myeloma (where it is a marker of tumour load) as well as lymphoma and HIV.
Interpretation may be complex as levels are also increased in renal failure.
Cryoglobulins
Cryoglobulins are immunoglobulins that precipitate and form complexes at low temperature. Patients with
cryoglobulinemia may present with vasculitis. An unexpected rheumatoid factor with low C4 may indicate the presence
of a cryoglobulin. Detection of cryoglobulins is not possible on routinely submitted samples – the sample must be
transported in a flask and arrive at the lab at 37 C.Please note the importance of following the correct procedure for
taking and transporting the samples cannot be overestimated – failure to do so can result in a false negative result
If detected, the cryoglobulins are quantified and typed by immunofixation.
There are three types of cryoglobulin: –
Type 1: Monoclonal
Type 2: Mixed monoclonal IgM rheumatoid factor with polyclonal IgG
Type 3: Mixed polyclonal IgM rheumatoid factor with polyclonal IgG

IgG subclasses (IgG 1,2,3)

The measurement of IgG subclasses is of limited value and should only be considered in the context of identifying
primary immunodeficiency. Patients with IgA deficiency sometimes have accompanying IgG subclass deficiency.

IgG subclasses (IgG4)

The measurement of IgG4 levels is indicated in the investigation of IgG4 related disease.

Functional antibodies
The quantitative assessment of IgG to tetanus toxoid and pneumococcal capsular polysaccharide pre and post
vaccination is of value in the investigation of immunodeficiency. Functional antibody testing should only be requested
after discussion with the immunology medical staff.

CSF Oligoclonal Bands

Oligoclonal banding is defined as two or more discrete immunoglobulin bands in the CSF that are not matched by
corresponding bands in the accompanying serum sample and therefore reflects IgG synthesis within the CNS. A positive
result supports a diagnosis of multiple sclerosis but may also be observed in a variety of other infectious and
inflammatory diseases of the CNS.
Paired CSF and serum samples must be submitted.

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Serum Amyloid A
Serum amyloid A (SAA) is an acute phase protein that increases in parallel with CRP but with increased sensitivity.

Haptoglobin
Decreased serum haptoglobin is seen in any clinical situation where there is significant intravascular haemolysis as well
as some disorders with increased red cell fragility. Elevated levels may occur as part of an acute phase response.

Caeruloplasmin
Decreased levels of caeruloplasmin are seen in most cases of Wilson’s disease. As it is an acute phase protein,
occasionally normal levels may occur transiently where there is an inflammatory stimulus to the acute phase response.
Levels are also reduced in severe liver disease and severe malabsorbtive syndromes.

Alpha-1-antitrypsin
The quantitation of AAT is important in the evaluation of emphysema and neonatal and adult liver disease where low
concentrations may have diagnostic importance. AAT is a slow acute phase response and may be falsely normal during
infections. AAT genetic status (PI phenotyping) is performed in all cases of deficiency where the quantitative result is
less than the age related normal range as well as in all children with liver disease.
11.9 Guidelines for Investigation of Immunodeficiency
Please phone a Consultant Immunologist or SPR to discuss the investigation of recurrent unusual infection. The nature
of the organism, the site severity and frequency of infection may give clues into the nature of the immune defect.
Investigation is required in the following circumstances:
Family history of immunodeficiency
Infant or young child with failure to thrive, opportunistic infections, persistent infections with low virulent organisms,
sereve diarrohea, unusual extensive skin rashes
Hepatosplenomegaly
Recurring/persisting sinopulmonary infections
Recurring skin infections, abscesses or periodontitis
Recurring meningitis.

Screening tests for primary immunodeficiency should include FBC and differential, serum immunoglobulins, occasionally
IgG subclasses and functional IgG response to tetanus and pneumovax, and lymphocyte subsets (CD4 and CD8 T cells,
CD19 B cells, CD16/56 NK cells). Further tests should be directed towards the suspected arm of defence considered
deficient, and include tests of neutrophil function and the measurement of total haemolytic complement CH100, and
the alternative complement pathway CH100A. Always consider HIV as a cause of immunodeficiency.

CD4 counts
CD4 monitoring in patients with HIV is a marker of disease progression and response to therapy. Requests for CD4
counts as a “surrogate marker” of HIV infection will be refused.

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Lymphocyte Subsets (CD4 and CD8 T cells, CD19 B cells, CD16/56 NK cells)
Suspected cases of childhood T cell / combined immunodeficiency should be regarded as urgent and the laboratory
contacted as soon as possible.

Neutrophil Disorders
Indicated in the investigation of severe recurrent skin infections, chronic gingivitis, recurrent deep seated bacterial and
fungal infections.
Other referral tests are available and require prior discussion with immunology medical staff.

11.10 Guidelines relating to Genetic Referrals

Genetic testing is not performed in the Immunology laboratory. However, the department does act as a referral service
for some molecular and cytogenetic referral requests on blood samples. In most cases genetic reports are issued directly
to the requesting clinician. Genetic testing is not covered under the department’s scope of accreditation to ISO 15189.
Details for the most common genetic referrals dispatched via Immunology are included in the Alphabetic Test Directory
section of this manual. Refer to the genetic laboratories’ user guides for full details relating to sample and request form
requirements and turnaround times for testing.
Cytogenetic and molecular genetic testing by the Department of Clinical Genetics (DCG), Childrens Health Ireland (CHI),
Crumlin : refer to http://www.olchc.ie.
It is mandatory for all requests to be accompanied by a fully completed CHI Genetic request form. It is critical the
informed consent section is completed. Testing will not be carried out if forms are not completed fully.
Genetic reports are issued directly to the clinician byDCG.

Cytogenetic testing (karyotyping) by Eurofins Biomnis Dublin (Monday to Friday service), refer to
https://www.eurofins.ie/biomnis/test-information/test-request-forms for request form and sample requirements. In
most cases, Eurofins Biomnis issue the genetic report directly to the clinician. A small number of reports are issued via
Immunology Dept.

Haemochromatosis genetic testing by the Molecular Genetics Lab, Northern Molecular Genetics Service, Biomedicine
East, Central Parkway. Newcastle Upon Tyne, NE1 3BZ, UK : refer to http://www.newcastle-
hospitals.org.uk/services/northern-genetics_services_molecular-genetics.aspx Newcastle report is issued to the
Clinician by Immunology. Paper report issued only-results not available on Healthlinks.

Molecular Genetic testing for Facioscapulohumeral Dystrophy (FSHD) by Bristol Genetics Laboratory, Southmead
Hospital, Bristol, BS10 5NB, UK : refer to https://www.nbt.nhs.uk/severn-pathology/pathology-services/bristol-
genetics-laboratory-bgl/bgl-services Genetic report issued directly by Bristol to the requesting clinician.

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12. Haematology Laboratory
12.1 Department Profile
The Department of Haematology is a consultant led service which includes scientific, clerical and medical, who
participate in undergraduate and graduate teaching programmes, research, clinical trials, case conferences, ward
rounds and clinics. It provides services to Galway University Hospitals, Mayo University Hospital, Roscommon University
Hospital, General Practitioners, Community Care, and Public health in the counties of Galway, Mayo and Roscommon.
In addition the Haematology Laboratory is a regional centre for a broad range of specialized tests which is supported by
a clinical, advisory and interpretative service.

The Haematology Laboratory provides diagnostic investigations in general Haematology, routine and specialized
Coagulation, Haematinics, Flowcytometry and Haemoglobinopathy screening. Approximately 3,000 requests for routine
tests are received in the Haematology Laboratory every day and the Laboratory also performs other miscellaneous
specialized tests that may be arranged through a Consultant Haematologist or Senior Specialist Registrar.
The Haematology Laboratory is accredited by the Royal College of Pathologists for specialized training in Haematology
and also by theAcademy of Medical Laboratory Science for the training of Medical Scientists. Medical scientists are now
regulated by CORU. In addition, the Haematology Laboratory is accredited by the Irish National Accreditation Board
(INAB) in compliance with the International Standard ISO15189 (Registration number 239MT). The Laboratory has an
Internal Quality Assurance system and continues to participate in national and international quality assessment
schemes.

12.2 Availability of Clinical Advice and Interpretation

Clinical advice regarding the results of laboratory investigations is available from the Haematology medical team.
Requesting of appropriate tests and subsequent application of the test results and interpretative guidance from the
Department of Haematology must be applied to patient care by a clinician in the overall clinical context of the patient
concerned.
For this reason services are accessible only by medical practitioners or other health care professionals acting on the
recommendation of a medical practitioner. Printed reports are issued to medical practitioners. Verbal reports are
provided when appropriate to medical practitioners.
Consultant Staff hold appointments in the National University of Ireland. The department actively supports and
facilitates clinical and laboratory research projects.

Haematology Laboratory Phone Numbers

Specimen Reception 4377
Laboratory Supplies 4377 Fax: 091 542881
Laboratory Office 4281
General Haematology Laboratory 4419
Routine Coagulation 4283
Special Coagulation 4995

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Haematinics 4880
Bone Marrow/Flow Cytometry 4284
Special Haematology 4284
Insert (091) 54 before extension number for direct access from outside.
The telephone enquiry service should be used for emergency enquiries only.

12.3 Out of Hours Service

An out of hours service operates outside normal hours for emergency work.
Monday-Friday 20:00 to 08:00 h the following day
Saturday 13:00 to 10.00 h the following day
Sunday/Bank Holiday 10:00 to 08:00 h the following day
Do not forward routine requests to the laboratory during on-call hours.

To contact staff out of hours

Post midnight laboratory on-call personnel must be contacted via hospital switchboard (dial 9). Failure to do this may
result in prolonged turnaround times for urgent requests.

12.4 Add on Test Requesting

Telephoned requests for add-on tests are accommodated provided the usual criteria for acceptance of the added test
are met by the form and specimen in the laboratory. In instances where extra information is required the requesting
Physician will need to send a completed request form to the haematology laboratory.

12.5 Haematology Laboratory Tests

Refer to the Test Directory of this manual (listed alphabetically within the Laboratory Medicine Test Directory) for a list
of tests performed, the specimen required, turnaround time and other information regarding specimen collection.
Some tests may be performed only after prior arrangement with the laboratory. Where doubt exists, the appropriate
laboratory should be consulted. Specialised Haematology and Coagulation tests are available at the discretion of
Haematology team.

12.6 Reporting
Telephoned reports will be given in cases of urgency to an identified responsible person but not directly to the patient.
Faxed Reports for reasons of confidentiality it is the policy of UHG not to fax reports.
Copy reports will only be issued to persons other than the requesting clinician, when this is clearly indicated on the
request form or on receipt of a written request.
Supplementary results such as morphologies will not reach the patients record until after the initial report is available.
In the case of Health Links a second report is sent out at a later date.

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Apex Results are available in the Laboratory information system (APEX) to HSE West Area Hospitals who use the
laboratory service. Enquiries on lab results should be made through the “Ward Enquiry Function” of the laboratory
information system (APEX). In addition, results can also be accessed by EVOLVE.
Hard copy results are delivered daily to both the acute hospitals and to the General Practitioners (Monday-Saturday).
GPs’ may receive results electronically via ‘Healthlinks’.
Referral Laboratory Reports: The Haematology Laboratory will follow up on any referral test report not reported by the
referral site within the defined turnaround times.
Analytical Failures: In the event of an urgent specimen being unsuitable for processing or where there is an analytical
failure, the clinician will be informed by phone or through the Healthlink or Apex reporting system. A hard copy report
will follow.
Reference ranges : Age and sex related ranges where applicable are quoted on the Haematology test report form.

12.7 Specimen Retention Policy

Routine full blood count, coagulation and haematinic samples will be stored for 2-3 days. Bone marrow slides are stored
indefinitely.

12.8 Haematology Specimen Rejection Policy

Please refer to Request form and Sample Acceptance Criteria for detailed sample submission guidelines located under
Use of the Laboratory section 3.0- Requests to the Laboratory. However the following specimens cannot be processed
by the Haematology Laboratory :

Leaking specimen containers (infection risk)

Unlabelled specimens
Information on request form and specimen at variance with each other
Specimens not labelled or containing minimum acceptance criteria of full name plus date of birth or hospital number
Incorrect preservative/anticoagulant
Incorrectly filled specimens
Clotted FBC or Coag specimens
Specimens received not attached to speci-bag
Specialised tests rejected with no requesting consultant specified

Definitions

Turnaround time: Time of receipt of specimen in the Haematology Laboratory to the time of authorization of results.

In Progress: Analysis incomplete. Refer to particular test turn around times in this manual.

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Referral Laboratory: An external laboratory to which a sample submitted for a supplementary or confirmatory
examination procedure and report.

Emergency on Call Service: Out of hours call service provided for emergency specimens.

Urgent: Samples accompanied by Urgent (Red Flash) forms are prioritized in the laboratory process and on
authorization; results will be available on the Laboratory Information System. Urgent Specimen results are telephoned
if the Laboratory receives a specific request to do so, or where test results are in the range as indicated for Telephoning
by the Laboratories Standard Operating Procedures.

Request Forms:
GUH Emergency Request Form (LMDERF 001)
GUH Laboratory Request Form (LMDHRF 001)
GP Request Form (LMDGPRF 001)
Haematology Day Ward Request Form (GHAEM/F/021)
Bone Marrow Request Form (G HAEM/F/015) RL57a

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13. Medical Microbiology Department
(Division of Clinical Microbiology)

13.1 Department Profile

The Division of Clinical Microbiology incorporates the Department of Medical Microbiology and the Department of
Virology. The Department of Medical Microbiology comprises the clinical diagnostic laboratory and the Public Health
Laboratory (PHL), and the GUH National Reference Laboratory Services. GUH National Reference Laboratory Services
comprises the National Salmonella, Shigella and Listeria Reference Laboratory (NSSLRL) and the National
Carbapenemase Producing Enterobacterales Reference Laboratory (NCPERL). The Division has a staff of more than 50
people including medical, scientific and clerical staff.

The Medical Microbiology Department in GUH provides a full diagnostic and advisory service for hospitals, General
Practitioners and Community Care in the HSE Western area. Specialist Mycobacterium laboratory service is also
extended to Sligo and Letterkenny University Hospitals. In the case of seriously ill patients or those with complex
conditions a telephone discussion with medical staff may be important prior to samples being submitted or results being
reported. The National Salmonella, Shigella and Listeria Reference Laboratory (NSSLRL) provides a national typing
service for Salmonella, Shigella and Listeria isolates to clinical laboratories. The NSSLRL also types isolates from food and
animal laboratories to enable detection of sources of human infection in the event of an outbreak.

The National Carbapenemase Producing Enterobacterales Reference Laboratory (CPERL) provides a national molecular
testing service for isolates to clinical laboratories.
The Division is committed to delivery of an equitable and responsive service within the limits of the resources available.
The Department of Medical Microbiology is accredited by the Irish National Accreditation Board (INAB) in compliance
with the International Standard ISO/IEC 15189 (Registration number 223MT). The Public Health Laboratory is accredited
by INAB in compliance with ISO/IEC 17025 (Registration number 097T).

13.2 Access to Service

Requesting of appropriate tests and subsequent application of the test results and interpretive guidance from the
Department of Medical Microbiology must be applied to patient care by a clinician in the overall clinical context of the
patient concerned.
For this reason services are in general accessible only by medical practitioners or other health care professionals acting
on the recommendation of a medical practitioner. Written reports are issued to medical practitioners. Verbal reports
are provided to medical practitioners or in certain circumstances to other health care professionals. Please note that
results of antibiotic sensitivity testing are often not reported in full (selective reporting). If a suitable antibiotic for a
specific patient is not identifiable from a report you may be able to obtain additional test results by telephoning the
laboratory.

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It is not appropriate to instruct patients or their relatives / friends to telephone the department of Medical Microbiology
for results. The Department cannot verify the identity of the caller and does not have a relationship with the patient to
ensure that the result is properly understood and acted on.

The name and contact details of the medical practitioner requesting a test must be clearly legible on the request form.
The medical practitioner signing the request form is responsible for ensuring that the test request is appropriate and
that issues of consent to testing and privacy have been dealt with appropriately.
Changes to levels of service outlined here may be necessary from time to time, users will be informed of any significant
changes in access to services by email.
13.3 Consultation Service
Specialist Registrars: 091 544573
Prof. Martin Cormican: 091 544146
Dr. Deirbhile Keady: 091 542013
Dr. Una Ni Riain: 091 893779
Dr. Teck Wee Boo: 091 893783
Dr. Dimitar Nashev 091 893783
Dr. Ruth Waldron 091 544146
13.4 Out of Hours Service
There is a Medical Scientist on duty to provide an out of hours service :

Monday-Friday 20:00 to 08:00 h the following day

Saturday 12:30 to 08 :00 h the following day
Sunday/Bank Holidays 08:00 to 08:00 h the following day

Until 24 :00 h the following service is available :

- All normally Sterile Body Fluids
- Blood cultures
- Corneal scrapings
- Specimens from ICU / HDU, Haematology / Oncology.
- All other specimens deemed urgent by Consultant Microbiologist.

Post 24 :00 h the following service is available :

- CSF
- Blood cultures
- Urgent tissues and fluids
- Paediatric urines

All specimens requiring urgent work must be sent with an Emergency ‘Red Flash’ form outside of normal working hours.
Specimens are processed in order of priority with CSF normally being given priority.

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Results of Microscopy are available as soon as the Medical Scientist has performed and authorised them on the LIS.

To contact the Medical Scientist after 17 :30 please dial 4411. Due to the geographic layout of the department the
Medical Scientist may be outside of telephone coverage for short periods. In the event of difficulties please contact
switchboard (Dial ‘9’) who can contact the person by mobile phone.
A Consultant Microbiologist is On-Call during these periods ; please contact the Medical Scientist / Switchboard for
contact details.

SARS COV-2 PCR testing Out Of Hours service

There is a Medical Scientist on duty to provide an Out of Hour Service:
Monday - Friday 20.00 - 08.00 the following day
Saturday 16.00 - 08.00 the following day
Sunday 08.00 - 08.00 the following day

13.5 Guidelines for Requesting Microbiology Tests

The Department of Medical Microbiology should also be contacted before any exceptionally urgent or specialised
investigation is requested.
In all cases where a test result is considered urgent the medical practitioner making the request or other responsible
medical practitioner should contact the laboratory in advance of specimen submission if possible or after a reasonable
interval to ensure that the specimen has been received and that he/she receives the result.

Specimen Retention
Additional examinations may be requested during specimen storage time by telephoning the Department. Rejected
specimens are also retained as per the following retention times.

Specimen Retention Time

Swabs 1 week @ 2 – 8oC
Tissues
4 weeks @ 2 – 8oC
Fluids
CSF > 3 months @ -80oC
Urines 72 h @ 2 – 8oC
Faeces 1 week @ 2 – 8oC
Respiratory specimens for routine culture 1 week @ 2 – 8oC

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 Specimen Retention Time
Respiratory specimens for TB culture > 1 month @ -20oC
(decontaminated prior to TB culture and therefore are unsuitable for other
investigations)
Normally sterile site specimens (not usually decontaminated) > 1 month @ -20oC
Urines unsuitable for TB culture 10 days @ 2 - 8oC
SARS COV-2 PCR Swabs 1 week @ 2-8C

Unsuitable Specimens and Additional Examinations

In the event of a specimen being unsuitable for processing or where there is an analytical failure, the clinician will be
informed by phone or in writing or electronically through the LIS. If additional laboratory testing is required by the
clinician on a sample previously received, please contact the laboratory to investigate the feasibility of using the initial
specimen for analysis.
General Collection and Transport Guidelines
Where possible, collect specimen prior to the administration of antimicrobial therapy.
Collect specimen with as little contamination from indigenous microbial flora as possible to ensure that the specimen
will be representative of the infective site.
Collect specimen using sterile equipment and aseptic technique to prevent introduction of foreign microorganisms.
Collect an adequate amount of specimen. Inadequate amounts may yield false-negative results.
Most specimens collected with a swab and transported dry are unacceptable.
Identify the specimen source and / or specific site correctly so that proper culture media will be selected during
processing in the laboratory. Special requests such as Diphtheria, actinomyces, nocardia etc should be noted on the
request form.
If members of the public are asked to collect their own or another persons sample and to take sample to the laboratory
instructions should be given regarding how and when to collect the sample and deliver the samples to the laboratory in
timely manner. In particular they should be reminded to put the correct collection dates on both the specimen and the
request form.
Specimens should be transported as soon as possible. If processing is delayed, refrigeration is preferable to storage at
ambient temperature, with the following exceptions :
Bloods Cultures - hold at room temperature to await transport by chute/porter
CSF- deliver immediately by hand to a Medical Scientist in the department
Specimens, which are difficult to replace (e.g. spinal fluid) should be given directly to one of the medical or scientific
staff of the Department to minimise risk of delay or loss.
Do not submit CSF, glass blood culture bottles (mycololytic) or respiratory specimens to the laboratory via the ”chute”
transport system.

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Microbial cultures submitted by other laboratories for further identification should be submitted in pure culture on the
appropriate medium in a sealed, screw capped tube. Petri plates are generally not acceptable because they cannot be
properly sealed for transport.
Specimens submitted in formalin preservative are unsuitable for culture.
Where there is a suspicion of Brucellosis or other Hazard Group 3 pathogen, it is essential that this be indicated clearly
on the request form.

CSF Specimens
Table 1 Normal CSF values
Leucocytes Neonates (less 28 days) 0 - 30 cells x 106/L

Infants (1-12 months) 0 - 15 cells x 106/L

Children / Adults (1 year +) 0 - 5 cells x 106/L

These values represent the upper and lower limits of normality. Bacterial or viral infection may still need to be
considered where leucocyte counts are near the upper normal limits in neonates and young children.
Enteric Samples
All samples must be submitted to the laboratory in a clean sterile laboratory-approved specimen container with an
appropriately completed laboratory request form. The optimal time of collection of specimens should be as soon as
possible after onset of illness. Molecular assays for enteric pathogens in use in the department are intended for use
with liquid/loose stool samples submitted from symptomatic patients. Formed stool samples are not suitable for testing
and are rejected.
In-patient (excluding ED, Paeds, and Maternity but including nursing homes and district hospitals) stools are examined
for C. difficile toxin DNA only. C. difficile assay testing is also performed on request from out-patient clinicians and on
all liquid stool samples received from the community. Children < 2years are not processed for Clostridium difficile.
If specific testing for additional pathogens is required please telephone the Department of Medical Microbiology as
soon as possible indicating the specific additional testing you wish to request. All other faeces specimens are examined
for Salmonella, Shigella, Campylobacter, Verotoxin / Shiga toxin producing E. coli, Cryptosporidium Spp. and Giardia
DNA. (Out-patients include A/E, SSU (St. Endas) and MAU and Emergency Surgical Ward - St. Nicholas)
Culture of Yersinia spp. and Vibrio spp. are performed on Consultant Microbiologist request only when relevant clinical
details are provided.
Screening in relation to test of clearance or contacts of outbreaks for VTEC, Salmonella, Shigella Campylobacter is done
using routine culture methods rather than molecular methods.
If a patient has a sample processed for C. difficile toxin B gene or VTEC, Campylobacter, Salmonella, Shigella,
Cryptosporidium or Giardia in the previous six days this sample is rejected.
Rotavirus and Adenovirus are tested for in specimens from children aged less than 5 years of age.

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Ova & Parasite testing; A basic iodine preparation screen is performed. Please contact Consultant Microbiologist if a full
concentration is required.This test is restricted to patients with relevant clinical details.
H. pylori antigen testing is available for patients with dyspepsia aged less than 45 years with no “alarm symptoms”. Stool
samples should be submitted within 24 hours of collection for best results.
Note: "Alarm symptoms" are dyspepsia with gastrointestinal bleeding, difficulty swallowing, unintentional weight loss,
abdominal swelling and persistent vomiting.

Urine Samples
Culture is performed on all Urines. Urine microscopy is only performed routinely on children <18 years of age and
pregnant women, however microscopy may be requested in certain circumstances following discussion with a
Consultant Microbiologist.
Urine specimens that are received in plain universal containers that are older than 48 hours or urine specimens that
are received in boric acid containers and are more than 96 hours old are unsuitable for culture and will be rejected.
Urine samples submitted for microscopy and culture must be submitted in a urine sample tube, a Vacuum urine tube.
Urine is initially collected in a primary urine beaker, then transferred via integrated transfer device to the Yellow
Vacuette® urine tube, which is submitted to the laboratory. Do Not submit the transfer beaker to the Laboratory as it
will be rejected.

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Sputum and TB Specimens
Sputa specimens that are older than 48 hours are unsuitable for routine culture and may be rejected. The Department
of Medical Microbiology does not routinely accept more than three sputum specimens for Mycobacterium culture in a
single episode of illness (taken on 3 consecutive days). Please contact the laboratory if additonal specimens are
required in a specific case. Early morning urines are not validated to be processed by Mycobacterium culture and may
only be processed in consultation with a Consultant Microbiologist.

Dermatophyte Culture – Collection and Transport

Only use Dermatological transportation packs, ‘Dermapak’ available from the Specimen reception at the Laboratory.
Nails: Disinfect area with 70% alcohol. Scrape. Clip infected areas. Collect debris under nail. Do not send whole nail.
Skin: Disinfect area with 70% alcohol. Scrape surface of skin at margin of lesion.
Hair: With forceps collect 10 to 12 hairs with shaft intact, as well as much loose skin and scale as possible.
Label Dermapak and insert specimen.
Specimens will only be processed if transported as above. Specimens received between glass slides, or in universals are
not acceptable for Mycological investigation.

Blood Cultures – Guidelines for Collection

Only take blood cultures when there is a clinical need to do so.

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Blood cultures are taken to identify patients with bacteraemia. There are many signs and symptoms in a patient which
may suggest bacteraemia and clinical judgement is required, however the following indicators should be taken into
account when assessing a patient for signs of bacteraemia/sepsis:
 Core temperature out of range e.g. >38.5ºC or hypothermia.
 Focal signs of infection.
 Abnormal heart rate (raised); blood pressure (low or raised) or respiratory rate (raised).
 Chills/rigors.
 High or very low white cell count.
 New confusion.

NB. Signs/symptoms may be minimal in the very young or very old. Cultures should be collected as soon as possible
after identification of a possible bacteraemia/focus of infection, and before antibiotic therapy is started. All blood
cultures should be documented in the patient notes with date, time, collection site and indication stated.

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Always make a fresh stab
Do not collect blood from existing lines/cannulae or take blood from above a peripheral IV line.
If a central line is in-situ, cultures may be collected from this and also from a separate periphera site.
Avoid femoral vein puncture where possible in view of difficulty in cleaning/disinfecting the skin adequately at this site.

Thoroughly disinfect the skin before inserting the needle

Identify a suitable venepuncture site before skin disinfection.
Thoroughly clean the patient’s skin before venepuncture.
Use soap and water to clean the visibly soiled skin and then clean uour own hands.
Use 2% chlorhexidine in 70% isopropyl alcohol impregnated swab to disinfect the patient’s skin and allow to dry.

Once disinfected, don’t touch the skin again

To avoid contamination from the collector’s fingers (even if gloved), do not palpate the site after it has been disinfected.

Disinfect the culture bottle cap before transferring the sample

Remove the plastic cover just before collection the sample – the top will be clean but not sterile. Disinfect the tops of
the culture bottles with a 2% chlorhexidine in 70% isopropyl alcohol impregnated swab. Allow the alcohol to fully
evaporate before inoculating the bottle.
If collection blood for other tests, always inoculate the blood culture first.
NB. The use of blood collection adapter caps without winged blood collection sets is not recommended. It is not
possible to accurately judge sample volume and there is potential for possible backflow of blood culture medium into
the patient’s vein.

Skin Preparation
Wash your hands with soap & water and dry.
Clean any visibly soiled skin on the patient with soap & water and dry.
Apply a disposable tourniquet (if applicable) and palpate to identify vein.
Clean skin with 2% chlorhexidine in 70% isopropyl alcohol impregnated swab and allow to dry.
If culture is being collected from a central line, disinfect the access port with a 2% chlorhexidine in 70% isopropyl
impregnated swab and allow to dry.

Kit Preparation
Label bottles with appropriate patient information. Ensure the barcodes on the bottles are not covered by additional
labels, and that any tear-off barcode labels are not removed.
Clean the tops of the culture bottles with a 2% chlorhexidine in 70% isopropyl alcohol impregnated swab and allow to
dry.

Sample Collection
Use needle & syringe or winged blood collection method as below:

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Needle & Syringe Method:
Wash & dry your hands again or use alcohol hand gel and apply clean gloves (sterile gloves are not necessary).
Insert needle into prepared site. Do not palpate again after cleaning.
Collect sample & release tourniquet.
Cover the puncture site with an appropriate dressing.
If collecting blood for other tests, always inoculate the blood culture bottles first.
Inoculate blood into culture bottles; do not change the needle in between sample collection and inocultation; inoculate
the aerobic culture first.
Discard needle & syringe into a sharps container.
Wash hands after removal of gloves.
Record the procedure with indication for culture, time, site of venepuncture and any complications in the patient’s
record.

Winged Collection Method

Wash & dry your hands again or use alcohol hand gel and apply clean gloves (sterile gloves are not necessary).
Attach winged blood collection set to blood culture adapter cap.
Insert needle into prepared site. Do not palpate again after cleaning.
Place adapter cap over blood culture collection bottle and pierce septum.
Hold bottle upright & collect sample – use bottle graduation lines to accurately gauge sample volume; inoculate the
aerobic culture first.
After collection of sample, release tourniquet.
Cover the puncture site with an appropriate dressing.
Discard winged blood collection set into a sharps container.
Wash hands after removal of gloves.
Record the procedure with indication for culture, time, site of venepuncture and any complications in the patient’s
record.

GUH National Reference Laboratory

National Salmonella, Shigella and Listeria Reference Laboratory

The National Salmonella, Shigella and Listeria Reference Laboratory (NSSLRL) provides a national typing service for
Salmonella, Shigella and Listeria isolates to clinical laboratories as well as food and animal laboratories. The NSSLRL also
has a pivitol role in investigating and tracking of Salmonella and Shigella outbreaks. A number of serological and
molecular methodologies are available for outbreak analysis.
The NSSLRL Users Guide and request form can be downloaded from the Saolta website
https://saolta.ie/documents/national-salmonella-shigella-listeria-reference-laboratory-users-guide
https://saolta.ie/documents/nsslrl-request-form

National Carbapenemase Producing Enterobacterales Reference Laboratory (CPERL)

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The CPE reference laboratory, department of Medical Microbiology, Galway University Hospitals (GUH) provides a
clinically supported service for the detection of carbapenemase producing Enterobacterales.
This service is offered to all medical laboratories in hospitals throughout Ireland.
CPE Reference Lab user Guide is available at :
https://saolta.ie/documents/national-carbapenemase-producing-enterobacterales-cpe-reference-laboratory-users-
guide
https://saolta.ie/documents/cpe-request-form-issue-21

13.6 Turnaround Times

Turnaround time is defined as the time from receipt of specimen in the laboratory until the result is reported either by
LIS (Laboratory Information System) or by phone. Turnaround times are quoted in the alphabetical test directory and
are intended as a guide which we will endeavour to meet. If further work is required, the turnaround times may be
extended by one or more days.

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14. Virology Department (Division of Medical Microbiology)

14.1 Department Profile

The Virology Department, within the Division of Clinical Microbiology, is committed to providing a timely and efficient
clinical diagnostic service to clinicians investigating infections of viral and of other aetiology, mainly in the HSE Western
area, and aims to meet the needs of patients and all clinical personnel responsible for clinical care. It provides service
to Galway University Hospitals, Mayo University Hospital, Roscommon University Hospital, Galway Clinic, Bon Secour
Hospital Galway, Portiuncula University Hospital, Nursing-Home-Clinicians, General Practitioners, Community Care, and
Public health in the counties of Galway, Mayo and Roscommon. The Department of Virology is accredited by the Irish
National Accreditation Board (INAB) in compliance with the International Standard ISO/IEC 15189 (Registration number
223MT).

14.2 Availability of Clinical Advice and Interpretation

Clinical advice on viruses, within the Laboratory’s range of interest, is available by contacting Prof. M. Cormican (Ext
4146), Dr. Una Ni Riain (Ext 3779) , Dr. Deirbhile Keady (Ext 2013) Dr. Teck Boo (Ext 3783), Dr. Dimitar Nashev (Ext 3783),
Dr. Ruth Waldron (Ext4146) or the Registrar or House Officer (Ext 4573).

14.3 Out of Hours Service

To contact Medical Staff out of hours, contact the Hospital Switchboard who will alert the Medical Staff on call after
17.30.

14.4 Add on Test Requesting

Additional testing will only be performed on receipt of a written request.
14.5 Virology Tests
Refer to the Test Directory of this manual for a list of tests performed, the specimen required, turnaround time,
reference range, if applicable, and other information regarding specimen collection. Some tests may be performed only
after prior arrangement with the laboratory. Where doubt exists, the Virology laboratory should be consulted.If deemed
appropriate, results will be telephoned. To ensure early transmission of results, the clinician to whom the results are to
be conveyed, must be clearly indicated on the request form and doctor’s name, address (for GPs), phone number and
(for in-house) bleep number should be included.For urgent investigations it is necessary to first telephone the Virology
Laboratory to make arrangements for processing such requests. The emergency form must state the reason for the
urgency of the test. Please note in relation to Virology tests that in addition to the requirements for completion of the
request form as given in the General Information section of this book the following also applies:
Where confidentiality demands, patient’s initials may be used, but it is mandatory that date of birth is supplied.Please
do not use code.
The type of specimen must be indicated. If it is a swab, the swabbed site should be identified.

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Clinical history and date of onset of illness, are particularly important in determining the test(s) to be performed where
the investigations are extended.

Please send a seperate complete sample of clotted blood when requesting Virology tests. A seperate complete
sample of clotted blood is essential for HIV or Hepatitis tests. Aliquots or samples previously tested for other analytes
cannot be processed for HIV or Hepatitis, and generally contain insufficient volume to allow additional Virology tests
to be performed.

SARS CoV-2 PCR Testing and Extended Viral Panel Testing

SARS CoV-2 PCR Testing is currently available.
A nasopharyngeal swab should be submitted in viral transport medium which is available from the Virology Laboratory
(Ext4398)
For more details on sample collection, please contact the Microbiology Staff.
Urgent SARS CoV-2 PCR requests must be brought to the attention of Microbiology Medical Staff.
Extended Viral Panel Requests must also be brought to the attention of Microbiology Medical Staff
Female Cervical Specimens
Clean the cervix with a large swab or sterile gauze, to remove mucous, before sampling. This is essential as mucous
present in the sample may render it unsuitable for testing. Remove the sterile swab from the wrapper and insert into
the endocervical canal until the tip is no longer visible and rotate the swab at the columnar epithelium junction for 3 –
5 seconds. Withdraw the swab without touching the vaginal surface and break it into the transport medium. Transport
the specimen so that it reaches the laboratory within 24 hours of taking. Do not remove liquid from the vial.
Male Urethral Specimens
For male patients collect a urethral sample by inserting the sterile swab 2 – 4 cm into the urethra, and break the swab
into transport medium. If possible urination should be avoided for 1 hour prior to sampling. Transport the specimen so
that it reaches the laboratory within 24 hours of taking. Do not remove liquid from the vial.
CMV Detection
Blood for CMV PCR should be collected into 8ml Greiner K2EDTA tubes and should be hand-delivered to the Virology
Department within three hours of venepuncture. Testing is only available in certain circumstances and following
approval by a Consultant Microbiologist.
Blood for CMV pp65 must be collected in an EDTA tube and received in the laboratory before 11.00 a.m.. This test is
only available in exceptional circumstances and must first be approved by a Consultant Microbiologist.
Urine for DEAFF test must be received in the laboratory before 11.00 am Monday to Thursday to allow dispatch to the
NVRL on the day of collection.
Molecular Virology Specimens (PCR, Viral Load, Genotype)
Blood specimens for molecular virology testing should be collected in 8ml Greiner K2EDTA tubes only and should arrive
in the Virology Laboratory within three hours of phlebotomy and be given directly to a staff member. Deadline for
receipt of molecular samples is 4.00pm.Opthalmic SpecimensCarefully remove excess exudates from the surface of the
eye before sampling. Using the Abbott Multicollect kit, vigorously apply the swab to the lower lid conjunctiva of the

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affected eye and break the swab into the transport medium. Transport the specimen so that it reaches the laboratory
within 24 hours of taking.
Post Mortem Specimens
Blood for serological investigations must be collected in plain blood collection tubes and care taken not to contaminate
the outside of the container. Specimens must be transported according to the specimen transport guidelines. Specimens
with obvious contamination of outside surface of containers will be destroyed.
Urine Specimens
For Legionella Urinary Antigen test, freshly voided urine, in a sterile universal container, should be sent to the laboratory,
without delay. For DEAFF test see 5.2 above.
Viral Antibodies
Requests for “Viral Studies”, “Viral Screen”, “Routine Virology” or “Atypical Screen” will not be processed. It is necessary
that tests to specific agents be requested, as viral antibody panels are no longer performed. Failure to supply the
required clinical history will lead to delays in processing and / or reporting.
Viral Isolation Specimens
Please consult the Consultant Microbiologist before taking specimens for virus isolation. Viral transport swabs with
viral transport medium are available from the Laboratory Stores (Ext 4377) on request.
Influenza and RSV Detection
During the season, Influenza A and B, and RSV A and B detection is available after prior approval by a Consultant
Microbiologist. AA nasal/nasopharyngeal should be submitted in viral transport medium which is available from
Laboratory Stores (Ext 4377). For more details on sample collection please contact the Microbiology Medical Staff.
14.6 Specimen Retention Policy
Serum and plasma specimens are currently stored frozen for one to two years. However due to deterioration and, in
some instances, reduction of antibody, it is advised to send a fresh specimen when requiring further tests, unless it is
within a few days time-frame of sending the original specimen.
14.7 Turnaround Times
Turaround time (TAT) is defined as the time from receipt of a specimen in the Virology laboratory until the result is
reported either in the LIS or by phone. The Department aims to result 95% of all samples within the stated turnaround
times. Turnaround times may be affected in certain circumstances such as infectious disease outbreaks, where certain
tests may have to be prioritized to the detriment of others.
14.8 Telephoning for Virology Results
Users may call the laboratory to check on results. Please note that as soon as results are authorised they may be
available within the hospital on screen on the PAS system and for General Practitioners on Healthlinks. Whenever
possible, direct access to results from the screen is preferable as recording of verbally communicated laboratory results
is more liable to error than accessing results directly from the screen. Please note that this is a read from screen service
– non-medical staff will not be able to interpret results or offer any advice but will refer you to medical staff if you

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15. Out Of Hours (Emergency Service)
The out of hours service is restricted to true emergencies. The turn-around time will be adversely affected if excessive
demands are made on the service.
Test Laboratory Unrestricted Restricted*
Alanine amino Transferase (ALT) Clinical Biochemistry 
Albumin (Blood) Clinical Biochemistry 
Alcohol (Ethanol Clinical Biochemistry 
Alkaline phosphatase (Alk Phos) Clinical Biochemistry 
Amikacin / Amikin1 Medical Microbiology 
Ammonia Clinical Biochemistry 
Amylase Clinical Biochemistry 
APTT Haematology 
Aspartate amino Transferase (AST) Clinical Biochemistry 
Bicarbonate Clinical Biochemistry 
Bilirubin (Total and Direct) Clinical Biochemistry 
Blood Culture2 Medical Microbiology 
Blood Gases Clinical Biochemistry 
Calcium Clinical Biochemistry 
Carbamazepine Clinical Biochemistry 
Carboxyhaemoglobin Clinical Biochemistry 
Chloride Clinical Biochemistry 
Creatine Kinase (CK) Clinical Biochemistry 
Creatinine Clinical Biochemistry 
CRP Clinical Biochemistry 
CSF – Culture / Microscopy Medical Microbiology 
CSF – Glucose and Protein Clinical Biochemistry 

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 Test Laboratory Unrestricted Restricted*
D-Dimers Haematology 
Differential WCC Haematology 
Digoxin Clinical Biochemistry 
ESR Haematology 
Fibrinogen Haematology 
Frozen Section Histology 
Full Blood Count Haematology 
Gamma GT Clinical Biochemistry 
Gentamicin 6
Clinical Biochemistry 
Glucose Clinical Biochemistry 
Group and Coombs Blood & Tissue Establishment 
Group and Crossmatch Blood & Tissue Establishment 
Group and Hold Blood & Tissue Establishment 
HCG Levels Clinical Biochemistry 
INR Haematology 
Iron Clinical Biochemistry 
Lactate3 Clinical Biochemistry Available at POC
LDH Clinical Biochemistry 
Lithium4 Clinical Biochemistry 
Magnesium Clinical Biochemistry 
Malaria Screen Haematology 
Methotrexate Clinical Biochemistry 
Osmolality Clinical Biochemistry 
Paracetamol Clinical Biochemistry 
Phenytoin Clinical Biochemistry 
Phosphate Clinical Biochemistry 

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 Test Laboratory Unrestricted Restricted*
Potassium Clinical Biochemistry 
Protein – Total Clinical Biochemistry 
Prothrombin Time (PT) Haematology 
Reticulocyte Count Haematology 
Salicylate Clinical Biochemistry 
Sickle Cell Screen Haematology 
Sodium Clinical Biochemistry 
Theophylline Clinical Biochemistry 
Thyroid Function Tests Clinical Biochemistry 
Tobramicin 1 Medical Microbiology 
Transfusion Reaction Invest Blood & Tissue Establishment 
Troponin T Clinical Biochemistry 
Urea Clinical Biochemistry 
Uric acid Clinical Biochemistry 
Urinary Creatinine Clinical Biochemistry 
Urinary Electrolytes Clinical Biochemistry 
Urinary Urea Clinical Biochemistry 
Urinary Osmolality Clinical Biochemistry 
Urine Microscopy and Culture5 Medical Microbiology  (Paeds only)  (Paeds only)
Valproate Clinical Biochemistry 
Vancomycin 6
Clinical Biochemistry 

Requiring Consultation
1. Referred daily to Galway Clinic. Submit before 12 noon.
2. Submit vial before 23:00
3. Lactate is available on all Blood Gas analysers
4. These drugs are available in “over-dose” situations only

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5. Only paediatric urines are routinely processed post mid midnight.
6. Available 08:00 to 20:00 only, daily

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16. Alphabetical Test Directory
Acanthamoeba Molecular analysis (Amoebic Keratitis)
Laboratory: Medical Microbiology: - referred to Micropathology Ltd., UK
Specimen: Corneal scraping on a dry sterile swab (available from Medical Microbiology)
Turnaround: 1 month
Report: Presence or absence of Acanthamoeba genus DNA
ACTH
Laboratory: Clinical Biochemistry:
Specimen: 4.0 mL K+ EDTA blood on ice
Turnaround: 1 week
Ref. Range: On report form
Activated Partial Thromboplastin Time (APTT)
Laboratory: Haematology
Specimen: 2.7 mL blood in a 0.109m Sodium Citrate tube (1.0 mL Paediatric tubes are available). Do not
refrigerate specimen. To be received in Lab within 6 hours of draw.
Comment: See Coagulation screen. Must fill bottle to mark. Can be used to monitor Heparin therapy.
Turnaround: 1 day
Ref. Range: Refer to report
Activated Protein C Resistance (APC-R) (see Thrombophillia Screen)
Laboratory: Haematology
Specimen: 2.7 mL blood in a 0.109m Sodium Citrate tube (1.0 mL Paediatric tubes are available)
Comment: Fresh specimen required. Must fill bottle to mark.
Turnaround: 5 weeks
Ref. Range: Refer to report
Adalimumab (trough levels and antibodies)
Laboratory: Immunology: – referred to Immunology Dept, Northern General hospital, Sheffield
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 6 weeks
Report: Drug levels (mg/L) : Suboptimal, therapeutic and supratherapeutic drug levels
Antibodies : Negative = <10AU/ml
Adenovirus / Rotavirus Antigen
Laboratory: Medical Microbiology
Specimen: Faeces collected in acute phase of illness 1-2 g in leak proof container. Delay > 2 h refrigerate
@ 2-8OC
Comment:Rotavirus and Adenovirus are tested for in specimens from children aged less than
5 years of age.
Turnaround: 2 working days
Report: Rota / Adenovirus antigen detected / not detected
Adrenaline / Noradrenaline / Dopamine

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See “ Catecholamines/Fractionated Metanephrines”

Alanine amino Transferase (ALT)

Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 2 hours. Priority: 3hours. Routine: 4 working days
Ref. Range: On report form
Adjusted Calcium
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Comment: Calculated parameter
Turnaround: Urgent: 2 hours. Priority: 3hours. Routine: 4 working days
Ref. Range: On report form
Albumin
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 2 hours. Priority: 3hours. Routine: 4 working days
Ref. Range: On report form
Albumin (Urine) / Microalbumin
Laboratory: Biochemistry Laboratory, Roscommon University Hospital
Specimen: Urine in plain vacutainer – part of new BD urine collection system
Comment : Date of collection must be stated on the request form.
Turnaround: See RCH TAT
Ref. Range: Refer to report
Alcohol (Ethanol)
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube filled completely & delivered immediately to the laboratory.
If delay in transport to laboratory is expected, 4.0mL blood collected into a fluoride oxalate
(grey top) tube filled completely is the preferred sample.
Comment: Do not use alcohol wipes. Analysis for medical use only
Turnaround: Urgent: 1hour. All other requests : 3hours
Interpretation : On report form
Aldosterone
Laboratory: Clinical Biochemistry
Specimen: 2 x 5 mL: k+EDTA (Plasma) & Delivered to laboratory immediately.
Comment: Please provide clinical/antihypertensive medication details.
Turnaround: 3 weeks
Ref. Range: On report form
Aldosterone/Plasma Renin Activity Ratio
Laboratory: Clinical Biochemistry

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Specimen: 2 x 5 mL: k+EDTA (Plasma) & Delivered to laboratory immediately
Comment: Please provide clinical/antihypertensive medication details
Turnaround: 3 weeks
Ref. Range: On report form
ALK Translocation (EML4-ALK translocation)
Laboratory: Department of Histopathology, Cytopathology and Molecular pathology
Specimen: Tissue samples already processed by the Histopathology Laboratory, arrange via consultant
pathologist.
Comment; Testing available on request by Pathologist.
Referrals : Contact the Department of Histopathology, Cytopathology and Molecular pathology on 4078
Turnaround; 5 – 10 working days after request from Pathologist received.
Report: Integral part of Histopathology report issued by Division of Anatomic Pathology, Department
of Histopathology, Cytopathology and Molecular Pathology.
Alkaline phosphatase (Alk Phos)
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 2 hours. Priority: 3hours. Routine: 4 working days
Ref. Range: On report form
Allergen Specific IgE (Rast)
Laboratory: Immunology
Specimen: 5.0 mL blood in a plain gel tube. Must specify allergen according to history.
Comment : Those not performed in GUH are referred to Immunology Dept, Northern General Hospital,
Sheffield. Note restrictions in place for referral requests.
Turnaround: 7 working days
Ref. Range: 0 - 0.35 kUA/L
Alpha-1-Antitrypsin
Laboratory: Immunology
Specimen: 5.0 mL blood in a plain gel tube
Turnaround: 5 working days
Ref. Range: 0.9 - 2.0 g/L
Alpha-1-Antitrypsin Phenotyping
Laboratory: Immunology : referred to Alpha One Foundation, Beaumont Hospital, Dublin.
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 6 weeks
Report: See report- including interpretative comment
Alpha fetoprotein (AFP)
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Priority: 1 working day. Routine: 4 working days
Ref. Range: On report form

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Alpha-1-iduronidase (Screen for Hurlers Syndrome)
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: 5.0 mL K+ EDTA whole blood and 5.0 mL fresh urine
Comment: Specimens must be sent to the laboratory Mon – Tue am only.
Turnaround: 1 – 3 weeks
Ref. Range: On report form including interpretative comment
17-Alpha-OH-Progesterone >1 year old
Laboratory: Clinical Biochemistry :- referred to external laboratory for analysis
Specimen: 7.0 mL blood in a plain gel tube delivered to the laboratory same day
Turnaround: 6 weeks
Ref. Range: On report form
17-Alpha-OH-Progesterone <1 year old
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: Clotted whole blood collected when baby is at least 2 days old
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Aluminium
Laboratory: Clinical Biochemistry: -referred to external laboratory for analysis,
Specimen: 5.0 mL Na+ heparin whole blood
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Amikacin
Laboratory: Medical Microbiology
Specimen: 1.0 – 5.0 mL blood in a plain gel tube
Comment: Specify time specimen collected indicating Peak or Trough.
Turnaround: 1 day
Ref. Range: Post dose/Peak: 20-30 mg/L. Pre-dose/Trough: <8.0 mg/L
Amino Acids
Laboratory: Clinical Biochemistry: -referred to external laboratory for analysis,
Specimen: 2.0 mL Li Heparin blood
Comment: Full clinical information and reason for request must accompany specimen.
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Amino Acids (Urine)
Laboratory: Clinical Biochemistry: -referred to external laboratory for analysis,
Specimen: 1.0 mL plain urine specimen
Comment: Full clinical information and reason for request must accompany specimen
Turnaround: 1 – 3 weeks
Report: On report form

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Ammonia
Laboratory: Clinical Biochemistry
Specimen: 4.0 mL EDTA stasis free whole blood
Comment: Please inform laboratory in advance. Place specimen on ice and transport to the laboratory
within 30 minutes of venepuncture
Turnaround: Once laboratory informed in advance results will be available in 1 hour
Ref. Range: On report form
Amoeba antibodies
Laboratory: Virology: -referred to Hospital for Tropical Diseases, London WCIE 6AU
Specimen: 7.0 mL blood in a plain gel tube
Comment: Available in only very specific cases and following prior arrangement with a Consultant
Microbiologist.
Turnaround: 2 – 3 weeks
Report: Positive/Negative with comment if result positive
Amphetamine
See “Toxicology Screen”
Amylase
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent 1hour. Priority: 3hours. Routine: same day
Ref. Range: On report form
Amylase/Creatinine Clearance Ratio (Urine)
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube plus a random urine specimen
Turnaround: 1 working day
Interpretation: On report form
Androstenedione
Laboratory: Clinical Biochemistry : referred to external laboratory for analysis
Specimen: 5.0 mL blood in a plain gel tube
Turnaround: 3 week
Ref. Range: On report form
Antenatal Serology
Laboratory: Blood & Tissue Establishment
Specimen: 6.0 mL EDTA K2E blood
Turnaround: Within 24 h, with the exception of weekends and bank holidays and in the event of additional
testing requirement or for an antibody which requires extensive investigation
Ref. Range: N/A
Antibody Titration
Laboratory: Blood & Tissue Establishment

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Specimen: 6.0 mL EDTA K2E blood
Turnaround: Within 1 day, with the exception of weekends and bank holidays and in the event of additional
testing or if an antibody that requires extensive investigation
Ref. Range: N/A
Anti IgA Antibodies
Laboratory: Immunology: – referred to NHS Blood & Transplant, Sheffield
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 6 weeks
Report: Positive/Negative
Anti-Acetylcholine Receptor Antibodies
Laboratory: Immunology: – referred to Immunology Laboratory, Churchill Hospital, Oxford OX3 7LJ.
Specimen: 5.0 mL blood in a plain gel tube
Turnaround: 6 weeks
Report: Positive/Negative
Anti-Adrenal Antibodies
Laboratory: Immunology: – referred to Immunology Dept, Northern General Hospital, Sheffield
Specimen: 5.0 mL blood in a plain gel tube
Turnaround: 6 weeks
Report: Positive/Negative
Anti Beta-2 Glycoprotein-1 Antibodies
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 7 working days
Ref. Range: Refer to report
Anti Beta-Interferon Neutralising Antibodies
Laboratory: Immunology- referred to UCL, London.
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 6 weeks
Report: Positive/Negative
Anti Basal Ganglia Antibodies
Laboratory: Immunology :-referred to UCL, London.
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 6 weeks
Report: Positive/Negative
Anti-Cardiac Muscle Antibodies
Laboratory: Immunology: – referred to Immunology Dept, Northern General Hospital, Sheffield
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 6 weeks
Report: Positive/Negative

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Anti Cardiolipin Antibodies
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 7 working days
Ref. Range: On report form including interpretative comment
Anti-CASPR2 antibodies
Laboratory: Immunology: – referred to Immunology Dept, Churchill Hospital, Oxford OX3 7LJ.
Specimen: 5.0 mL blood in plain gel tube. CSF analysis also available.
Comment: Refer to anti-VGKC
Turnaround: 6 weeks
Report: Refer to report
Anti CCP (Citrullinated Cyclic Peptide)
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Comment : Requests for Anti-CCP will also be tested for Rheumatoid Factor
Turnaround: 7 working days
Report: Negative <10 U/mL
Anti-Centromere Antibodies
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 7 working days
Report: Positive/Negative
Anti-C1q Antibody
Laboratory: Immunology: – referred to Immunology Dept, Northern General Hospital, Sheffield
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 6 weeks
Report: Positive/Negative
Anti-D Quantitation
Laboratory: Blood & Tissue Establishment: - referred to IBTS, St James’s Street, Dublin 8
Specimen: 6.0 mL EDTA K2E blood
Turnaround: Test performed Tuesdays and Thursdays only
Ref. Range: N/A
Anti-dsDNA Antibody
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Comment : Only performed in the context of positive ANA
Turnaround: 7 working days
Ref. Range: Refer to report
Anti-ENA Screen (Extractable Nuclear Antigens: Sm / RNP / Ro / La / Scl-70 / Jo-1)

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Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 7 working days
Report: Refer to report.
Anti-Endomysial Antibodies
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Comment: IgA anti-endomysial antibody test if IgA anti-tTG screening test positive.
Turnaround: 10 working days
Report: Positive/Negative
Anti-GABA (anti-glutamate receptor antibodies)
Laboratory: Immunology: – referred to Immunology Dept, Churchill Hospital, Oxford OX3 7LJ.
Specimen: 5.0 mL blood in plain gel tube. CSF analysis also available.
Turnaround: 6 weeks
Report: Refer to report
Anti-Ganglioside Antibodies
Laboratory: Immunology: – referred to Neuroscience Group, Institute of Molecular Medicine, John
Radcliffe Hospital, Oxford
Specimen: 5.0 mL blood in plain gel tube
Comment: As several types of anti-ganglioside antibodies occur please specify test required and provide
clinical details.
Turnaround: 6 weeks
Report: Positive/Negative
Anti-Gastric Parietal Cell Antibodies
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 7 working days
Report: Positive/Negative
Anti-GBM Glomerular Basement Membrane (GBM) Antibodies
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 5 working days
Report: 0 – 10 U/mL
Anti-Glutamic Acid Decarboxylase (GAD) Antibodies
Laboratory: Immunology
Specimen: 5.0 mL blood in a plain gel tube
Turnaround: 3 weeks
Ref Range: 0-9 IU/mL
Anti-Glycine Receptor Antibodies
Laboratory: Immunology: – referred to Immunology Dept, Churchill Hospital, Oxford OX3 7LJ.

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Specimen: 5.0 mL blood in plain gel tube. CSF analysis also available.
Turnaround: 6 weeks
Report: Refer to report
Anti-Histone Antibodies
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 3 weeks
Report: Positive/Negative
Anti-IA2 Antibodies
Laboratory: Immunology: – referred to Immunology Dept, Northern General hospital, Sheffield
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 6 weeks
Report: Positive / Negative
Anti-Insulin Antibodies
Laboratory: Immunology: – referred to Immunology Dept, Northern General hospital, Sheffield
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 6 weeks
Ref. Range: 0-5 mg/l
Anti-Intrinsic Factor Antibodies
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 2 weeks
Report: 0 – 6 U/mL
Anti-Islet Cell Antibodies
Laboratory: Immunology: – referred to Immunology Dept, Northern General hospital, Sheffield
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 6 weeks
Report: Positive / Negative
Anti-Jo–1 Antibodies
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 10 working days
Report: Positive/Negative
Anti-La (SS-B) Antibodies
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 10 working days
Report: Positive/Negative
Anti-LGil antibodies

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Laboratory: Immunology: – referred to Immunology Dept, Churchill Hospital, Oxford OX3 7LJ.
Specimen: 5.0 mL blood in plain gel tube. CSF analysis also available.
Comment: Refer to anti-VGKC
Turnaround: 6 weeks
Report: Refer to report

Anti-Liver Kidney Microsomal (LKM) Antibodies

Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 7 working days
Report: Positive/Negative
Anti-Myelin Associated Glycoprotein (MAG) Antibodies
Laboratory: Immunology: – referred toImmunology Laboratory, Churchill Hospital, Oxford OX3 7LJ.
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 6 weeks
Report: Positive/Negative
Anti-Mitochondrial Antibodies
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 7 working days
Report: Positive/Negative
Anti-M2 Mitochondrial (Pyruvate Dehydrogenase) Antibodies
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 3 weeks
Report: Positive/Negative
Anti--MUSK Antibodies
Laboratory: Immunology:– referred to Immunology Laboratory, Churchill Hospital, Oxford OX3 7LJ.
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 6 Weeks
Report: Positive/Negative
Anti-Myeloperoxidase (MPO) Antibodies
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 5 working days
Ref. Range: 0 - 3.5 IU/ml
Anti-Natalizumab (Tysabri) Antibodies
Laboratory: Immunology: – referred to Barts Hospital, London
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 4 weeks

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Report: Positive/Negative
Anti-Neuromyelitis Optica Antibodies
Laboratory: Immunology: – referred to Immunology Laboratory, Churchill Hospital, Oxford OX3 7LJ.
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 6 weeks
Report: Positive/Negative
Anti-Neuronal Nuclear Cell (Hu Ri) Antibodies
Laboratory: Immunology:– referred toImmunology Laboratory, Churchill Hospital, Oxford OX3 7LJ.
Specimen: 5.0 mL blood in plain gel tube
Comment: Supply clinical details and specify if other neuronal antibody tests required.
Turnaround: 6 weeks
Report: Positive/Negative
Anti-Neutrophil Cytoplasmic Antibodies (ANCA)
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 5 working days
Report: Screened at 1/20
Negative / C-ANCA / P-ANCA / Atypical ANCA
Positives tested for anti-MPO and anti-PR3. See report form for interpretative comment.
Anti Nuclear Antibody (ANA)
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 7 working days
Report: Screened at 1/80
Negative/Positive. Positive results titre 1/80 to 1/1280. ANA Pattern reported.
Anti NMDA Receptor Antibodies
Laboratory: Immunology: referred to Immunology Laboratory, Churchill Hospital, Oxford OX3 7LJ.
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 6 weeks
Report: Positive/Negative
Anti-Ovarian Antibodies
Laboratory: Immunology: – referred to Immunology Dept, Northern General Hospital, Sheffield
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 6 weeks
Report: Positive/Negative
Anti-Paraneoplastic Antibodies: See anti-Hu Ri Yo
Laboratory: Immunology: – referred to Immunology Laboratory, Churchill Hospital, Oxford OX3 7LJ.
Specimen: 5.0 mL blood in plain gel tube. CSF analysis also available.
Comment: Supply clinical details and specify if other paraneoplastic antibody tests ( CV2/CRMP5,
Ma1/Ma2, anti-amphiphysin, anti-titan abs) required.

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Turnaround: 6 weeks
Report: Positive/Negative
Anti-Pemphigus & Pemphigoid Autoantibodies
Laboratory: Immunology: - referred to Immunology Dept, St James Hospital, Dublin 12
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 6 weeks
Report : Positive/Negative
Anti-Phospholipase 2A receptor (PLA2R) antibodies
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 3 weeks
Ref. Range: 0-14 RU/mL
Anti-Platelet antibody investigation
Laboratory: Blood & Tissue Establishment: - referred to IBTS, St James’s Street, Dublin 8
Specimen: 6.0 mL EDTA K2E blood
Turnaround: Variable
Ref. Range: N/A

Anti-Proteinase 3 (PR3) Antibodies

Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 5 working days
Ref. Range: 0 -2 IU/ml
Anti-Purkinje Cell (Yo) Antibodies
Laboratory: Immunology: referred toImmunology Laboratory, Churchill Hospital, Oxford OX3 7LJ.
Specimen: 5.0 mL blood in plain gel tube. CSF analysis also available.
Comment: Supply clinical details and specify if other neuronal antibody tests required.
Turnaround: 6 weeks
Report: Positive/Negative
Anti-Ribosomal P Protein Antibodies
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 3 weeks
Report: Positive/Negative
Anti-Ro (SS-A) Antibodies
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 10 working days
Report: Positive/Negative

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Anti-Salivary Gland Antibodies
Laboratory: Immunology: – referred to Immunology Dept, Northern General Hospital, Sheffield
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 6 weeks
Report: Positive/Negative
Anti-Scl-70 (Topoisomerase 1) Antibodies
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 10 working days
Report: Positive/Negative
Anti-Skeletal (Striated) Muscle Antibodies
Laboratory: Immunology: – referred to Immunology Dept, Northern General Hosptial, Sheffield
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 6 weeks
Report: Positive/Negative
Anti-Sm (Smith) Antibody
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 10 working days
Report: Positive/Negati
Anti-Smooth Muscle Antibodies
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 7 working days
Ref. Range: Positive/Negative
Anti-Soluble Liver Antigen (SLA) Antibodies
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 3 weeks
Report: Positive/Negative
Anti-Streptolysin-O (ASO)
Laboratory: Virology
Specimen: 7.0 mL blood in plain gel tube
Comment: Available in specific cases only and by prior arrangement with a Consultant Microbiologist.
Turnaround: 1 week
Report: Reported in International Units. Normal Range <200 IU.
Antithrombin (see Thrombophilia Screen)
Laboratory: Haematology
Specimen: 2.7 mL blood in a 0.109m Sodium Citrate tube.

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Comment: Requests should be received by the laboratory within eight hors of phlebotomy.
Details of anticoagulant therapy required. Must fill bottle to mark.
Turnaround: 5 weeks
Ref. Range: Refer to report
Anti-Thyroid Peroxidase (TPO) Antibodies
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 5 working days
Ref. Range: 0 – 25 IU/ml
Anti-Tissue TransGlutaminase (tTG) Antibodies (Coeliac Screen)
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Comment: IgA anti-tTG antibody test. If selective IgA deficiency then IgG anti-tTG test performed. Refer
to Section 11.3 for information regarding gluten intake prior and during testing.
Turnaround: 7 working days
Ref. Range: IgA anti tTG : 0-10 IU/ml. IgG anti-tTG : 0-7 IU/ml
Anti-U1-RNP Antibodies
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 10 working days
Report: Positive/Negative

Anti-Voltage Gated Calcium Channel (VGCC) Antibodies

Laboratory: Immunology: – referred to Immunology Laboratory, Churchill Hospital, Oxford OX3 7LJ.
Specimen: 5.0 mL blood in plain gel tube. CSF analysis also available.
Turnaround: 6 weeks
Report: Positive/Negative
Anti-Voltage Gated Potassium Channel (VGKC) Antibodies
Laboratory: Immunology: – referred to Immunology Laboratory, Churchill Hospital, Oxford OX3 7LJ.
Specimen: 4.0 mL blood in a plain gel tube. CSF analysis also available.
Turnaround: 6 weeks
Report : Positive/Negative

Anti-Xa Level (Low M.W. Heparin Assay)

Laboratory: Haematology
Specimen: 2.7 mL blood in a 0.109m Sodium Citrate tube (2 samples required).
Comment: Requests should be received in the laboratory within one hour of phlebotomy and should be
taken 4-6 hours post dose. Please included type of LMWH. State time of the last heparin dose
on the request form and sampling time. Must fill bottle to mark.

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Turnaround: 1 week
Arsenic (Urine)
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: 200mL aliquot urine (note volume of 24 h collection)
Turnaround: 3 – 4 weeks
Ref. Range: On report form
Ascitic Fluid - Cytology
See “ Effusions”
Ascitic Fluid (see Fluid / Tissue / Pus)
Laboratory: Medical Microbiology
Specimen: Fluid including clots in sterile universal container
Comment: If delay refrigerate @ 2-8OC.
Turnaround: Microscopy: 1 working day. Culture: 3 working days
Report: Microscopy: Cell count, Differential and Gram stain
Culture: Any clinically significant isolate with the appropriate sensitivities
Aspartate amino Transferase (AST)
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 2 hours. Priority: 3hours. Routine: 4 working days
Ref. Range: On report form

Aspergillus fumigatus precipitins

Laboratory: Virology: -referred to: PHL, Cumberland Infirmary, Carlisle CAZ 7HY
Specimen: 7.0 mL blood in a plain gel tube
Comment: Available only in specific circumstances and with prior approval of a Consultant
Microbiologist.
Turnaround: 2 – 3 weeks
Report: Positive/Negative with comment if result positive.
Aspirates - Cytology
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Cells obtained from any palpable lump/mass or cyst
Comment: Prepare immediately on site: Clearly label 2 frosted coded slides with patient name, DOB or
BN. Air dry one smear, label this slide’ Air Dried’, and fix the second one with cytofix spray.
Wash any fluid remaining in syringe/needle into green cyto fixtative in a Universal container.
In the case of pathology assisted F.N.A’s this collection of specimens is performed by lab staff.
For pathologist assisted FNA, please telephone the laboratory to prebook. Ref FNA.
Turnaround: 80% by 5 working days
Report: Neoplastic / Non-neoplastic cells

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Autoantibody Tests
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Comment: Select specific autoantibody test(s) pending clinical picture
In addition to those listed under the ‘Guidelines for requesting Immunology tests’ section of
handbook,other autoantibody tests may be available. Please discuss with laboratory.
Turnaround: 1-3 weeks depending on individual autoantibody and whether additional specialized test
methods required.
AutoImmune ENA Panel – Profile includes anti-: nRNP, Sm, SS-A, Ro-52, SS-B, Scl-70, PM-Scl, Jo-1, Centromere, PCNA,
dsDNA, Nucleosomes, Histones, Ribosome-P protein and AMA-M2
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 3 weeks
Report: Positive / Negative
AutoImmune Inflammatory Myopathy panel includes anti-: Mi-2 alpha, Mi-2 beta, TIF1 gamma, MDA5, NXP2, SAE1,
Ku, PM-Scl100 and PM-Scl75, OJ, EJ, Jo-1, PL-7, PL-12, SRP and Ro-52
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 3 weeks
Report: Positive / Negative

Autoimmune Liver Disease Panel – Profile includes anti: AMA-M2 (pyruvate dehydrogenase complex), M2-3E (BPO,
fusion protein of the E2 subunits of the alpha-2-oxoacid dehydrogenases of the inner mitochondrial membrane),
Sp100, PML, gp210, LKM-1, LC1, SLA/LP and Ro52.
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 3 weeks
Report: Positive / Negative
Autoimmune Systemic Sclerosis Panel – Profile includes anti-Scl-70, Centromere A, Centromere B, RNA Pol III(RP11
and 155), Fibrillarin, NOR 90, Th/To, PM-Scl 100, PM-Scl75, Ku, PDGFR and Ro-52
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 3 weeks
Report: Positive / Negative
Avian precipitins (Bird Fancier’s disease)
Laboratory: Virology: referred to PHL, Cumberland Infirmary, Carlisle CAZ 7HY
Specimen: 7.0 mL blood in a plain gel tube
Comment: Available only in specific circumstances and with prior approval of a Consultant
Microbiologist.
Turnaround: 2 – 3 weeks

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Report: Positive/Negative

Bacterial PCR (For sterile fluids and Tissues). S.aureus PCR (Mec A and CoA) , Group A Streptococcus DNA, N.
meningitidis DNA, Haemophilus influenzae DNA and Streptococcus pneumoniae DNA.
Laboratory: Medical Microbiology
Specimen: Sterile tissue or 0.5ml of fulid in leak-proof sterile container
Comment : Available only by prior arrangement with Microbiology Medical Staff
Turnaround: 1 week (Verbal report available on positive samples)
Report: Targets Detected/Not Detected.
Bartholin’s Abscess (see Swab / Pus)
Laboratory: Medical Microbiology
Specimen: Aspirate or swab pus using a sterile swab in charcoal agar. If delay refrigerate @ 2-8OC
Comment: Endocervical / Urethral swabs are routinely cultured for N. gonorrhoeae. All other specimens
must specify N. gonorrhoeae on request if required.
Turnaround: 3 working days
Report: Culture report: Any clinically significant isolate with the appropriate sensitivities
Bartonella henselae PCR
Laboratory: Virology: -referred to Health Protection Agency, Respiratory & Systemic Infection Lab,
Colindale London NW9 5HT
Specimen: Tissue samples for 16SrRNA gene sequencing only.
Comment: By prior arrangement with Microbiology Medical Staff.
Turnaround: 2-3 weeks
Report: Positive/Negative
BCR-ABL
Laboratory: Haematology: - referred to CMD Laboratory, St James Hospital, Dublin 8
Specimen: 3 x 3.0 mL K3 EDTA blood, or Bone Marrow in RPMI
Comment: Test available Monday –Thursday only
Turnaround: 120 days
Ref. Range: N/A

Bence - Jones proteins (Urine Free Light Chains)

Laboratory: Immunology
Specimen: Early morning sample preferred for screening– minimum 15mls. 24h urine for quantification
and disease monitoring. Plain container no preservatives. Note: Yellow Vacuette® urine tubes
are unsuitable. Refer to section 8.11 for 24hr sample collection details..
Turnaround: 10 working days
Report: Positive/Negative: Typing by Immunofixation. Quantification of BJP 24h output or BJP
concentration - g/l
Beta-hydroxybutyrate
See “Ketones”

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Beta-2-Microglobulin
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 5 working days
Ref. Range: < 60 years : 0.8 – 2.4 mg/l, >60 years : 0 – 3.0 mg/L
Beta-2-Transferrin
Laboratory: Immunology: referred to Immunology Dept, Northern General Hospital, Sheffield
Specimen: 5.0 mL blood in plain gel tube and ear/nasal discharge in universal container
Turnaround: 3 weeks
Report : Positive/Negative
Bicarbonate
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 2 hours. Priority: 3hours. Routine: 4 working days
Ref. Range: On report form
Bile Acids
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: 1 working day Mon to Fri
Ref. Range: On report form
Bilirubin - Conjugated
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 2 hours. Priority: 3hours. Routine: 4 working days
Ref. Range: On report form
Bilirubin - Total
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 2 hours. Priority: 3hours. Routine: 4 working days
Ref. Range: On report form
Biopsy
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Submit specimen intact to laboratory in 10% Neutral Buffered Formalin
Comment: Health & Safety precautions
Report: Histological diagnosis
Biotinidase
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: 5.0 mL Li Heparin blood
Comment: Full clinical information and reason for request must accompany specimen

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Turnaround: 1 – 3 weeks
Ref. Range: On report form

Blood Culture
Laboratory: Medical Microbiology
Specimen: 8.0 -10.0 mL in Bactec Aerobic and Anaerobic vial, 1.0 -3.0 mL in Paediatric vial. For
Mycobacteria / Fungi use 1.0 -5.0 mL in Myco/Lytic vial
Comment: Deliver to Laboratory ASAP. Use the Chute to 411. Delivery by Porter if glass bottles. Bactec
vials MUST reach Microbiology within 4 hours of Collection.
Turnaround: 1 week for aerobic, anaerobic and paediatric vials, 21 days for query endocarditis and 6 to 7
weeks for Myco/Lytic vial. Gram stain results of all new positive blood cultures are
telephoned to the relevant medical team within 2 hours of positivity. Identification and
susceptibility testing results will be available in 24-48 hours.
Report: Any Growth.
Blood Film
Laboratory: Haematology
Specimen: 3.0 mL K3 EDTA blood, (1.0 mL Paediatric tubes are available)
Comment: Blood films will be made, examined and reported on patients FBC results which satisfy the
criteria laid down by this laboratory in the guidelines ‘Indications for blood film examination’. If a clinician specifically
requests a blood film which falls outside of these guidelines this will also be examined where
the request form provides clinical details.
Turnaround: Where clinical details are supplied urgent requests for blood films will receive immediate
attention. Routine differentials are reported within 1 day. For GP specimens, 2 working days.
Report: N/A
Blood Gases (pH, pCO2, pO2, Bicarbonate, Base Excess, Total CO2)
Laboratory: Clinical Biochemistry. Also available on Blood Gas analysers located in A/E, ICUs, NICU, AMAU,
labour ward, theatre and SCU.
Specimen: Blood in a Li Heparin syringe
Comment: If delay between sample collection and arriving in the laboratory is greater than 15 minutes
send on ice.
Turnaround: 15 minutes
Ref. Range: On report form
Blood Product for Culture
Laboratory: Medical Microbiology
Specimen: Bactec Blood culture vials. If delay leave on ward until collection by Porter.
Comment: Ensure labeling as per Haemovigilance procedure. Delivery by Porter if glass bottles. Store on
ward @ RT. Do not refrigerate.Plastic bottles may be sent by ‘Chute’.
Turnaround: 1 week.
Report: Any Growth.
Body Cavity Fluid Cytology (Pleural, Peritoneal, Pericardial, Abdominal and Ascite Fluid).

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Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Collect fresh 10 – 20 mL specimens into twist top leak proof 20 mL or 50 mL Universal
containers containing Shandon Cytospin Collection Fluid (green fixative solution). Refrigerate
overnight if necessary.
Comment: Indicate type of primary specimen and site and side of origin (e.g. left lobe BAL). Indicate
clinical history on test requisition and reason for test.
Turnaround: 80% by 5 working days
Report: Detection of neoplastic and non neoplastic cells
Bone Marrow Culture
Laboratory: Medical Microbiology
Specimen: 1.0 -3.0 mL in Paediatric vial. For Mycobacteria / Fungi use 1.0 -5.0 mL in Bactec
Myco/Lytic vial.
Comment: Delivery by Porter if glass bottle. Do not refrigerate.Plastic bottles may be sent by ‘Chute’.
Turnaround: 1 week for paediatric vial and 6 to 7 weeks for Myco/Lytic vial.
Report: Any Growth.
Bone Marrow Examination
Laboratory: Haematology
Specimen: Bone Marrow Aspirate spread on glass slides. Aspirate and Biopsy fixed in Bouin’s solution
Comment: All bone marrows are preauthorized by SPR Haematology and prearranged with both the
laboratory and point of clinical activity. All BMA requests should be accompanied by an EDTA
(FBC) specimen. All requests must be accompanied by fully completed relevant request forms
for bone marrows, immunophenotyping or cytogenetics.
Turnaround: 2 weeks.
Report: Qualitative report by Consultant Haematologist.
Bordetella pertussis antibodies
Laboratory: Virology – referred to Atypical Pneumonia Unit, Collindale Avenue, London NW9 5HT
Specimen: 7.0 mL blood in a plain gel tube
Comment: Available only in very specific cases and following prior arrangement with a Consultant
Microbiologist.
Turnaround: 2-3 weeks
Report: Positive/Negative
Bordetella Species (Whooping cough / Pertussis)– culture
Laboratory: Medical Microbiology
Specimen: Perinasal swab (available from Medical Microbiology)
Comment: Contact Laboratory prior to sending to ensure fresh media is available. If delay refrigerate @
2-8OC.
Turnaround: 10 days
Report: “Bordetella pertussis” Not isolated or “Bordetella pertussis” isolated

Borrelia burgdorferi antibodies (Lyme Disease)

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Laboratory: Virology.
Specimen: 7.0 mL blood in a plain gel tube. (For CSF-PCR see under Cerebrospinal Fluid)
Turnaround: 1 - 2 weeks (In-house screen). Samples referred for further testing 2-3 weeks.
Report: Not Detected, if negative. A Provisional report will be issued on any sample giving reactive
findings on initial testing. These specimens are referred to the PHE, Rare and Imported
Pathogens Laboratory, Porton Down for further testing and a final report.
BRAF mutation
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Tissue samples already processed by the Histopathology Laboratory, arrange via consultant
pathologist.
Comment; Testing available on request by Pathologist.
Referrals Contact Department of Histopathology, Cytopathology and Molecular pathology on 4078
Turnaround; 5 – 10 working days after request from Pathologist received
Report: Integral part of Histopathology report issued by Division of Anatomic Pathology, Department
of Histopathology, Cytopathology and Molecular Pathology.
Bronchial Brush Specimen
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Sample can be spread on a glass slide, one slide may be air dried and labelled for Diff quik
stain, and one slide spray fixed. Label slides and container to include name,date of birth and
sample site.
Comment: Indicate clinical history on test requisition, and the specific site sampled.
Turnaround: 80% by 5 working days
Report: Detection of neoplastic and non neoplastic cells. Detection of infectious organisms.
Bronchial Wash Specimen
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Collect fresh specimens (0.5 – 50.0 mL) into twist top, leak proof 50 – 100 mL specimen cups.
Do not add fixative but refrigerate if storage required. Transport to the laboratory, ASAP.
Refrigerate or add fixative if delay unavoidable.
Comment: Indicate clinical history on test requisition, and the reason for test.
Turnaround: 80% by 5 working days
Report: Detection of neoplastic and non neoplastic cells. Detection of infectious organisms.
Broncho Alveolar lavage fluid (BAL) - Culture
Laboratory: Medical Microbiology
Specimen: BAL in sterile container
Comment: If delay refrigerate @ 2-8OC.
Turnaround: 3 working days for routine culture, 6 to 7 weeks for Mycobacteria culture.
Report: Culture with sensitivities, if appropriate, as well as microscopy and culture for Mycobacteria
Broncho Alveolar lavage fluid - Cytology
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology

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Specimen: Collect fresh 0.5 – 50 mL BAL (indicate if RUL, RLL, LUL, LLL) in a twist top, leak proof
50 – 100 mL specimen container. Submit to laboratory ASAP. Refrigerate or add fixative if
delay unavoidable.
Comment: Indicate clinical history on test requisition form and reason for test.
Turnaround: 80% by 5 working days
Report: Detection of neoplastic and non neoplastic cells. Detection of infectious organisms.
Brucella abortus antibodies
Laboratory: Virology: referred to Liverpool Clinical Laboratories, Royal Liverpool and Broadgreen
University Hospitals Trust
Specimen: 7.0 mL blood in a plain gel tube
Comment: Available only in very specific circumstances and with prior approval of a Consultant
Microbiologist.
Turnaround: 2-3 weeks
Report: Negative/Positive.
Bursa Fluid
Laboratory: Medical Microbiology
Specimen: Fluid in sterile container.
Comment: If delay refrigerate @ 2-8OC.
Turnaround: 3 working days
Report: Culture with sensitivities, if appropriate
CA 125
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Priority : 1 working day. Routine : 2 working days
Ref. Range: On report form
CA 15-3
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Priority: 1 working day. Routine: 4 working days
Ref. Range: On report form
CA 19-9
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Priority: 1 working day. Routine: 4 working days
Ref. Range: On report form
Cadmium (Urine)
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: 24 hour urine collection
Turnaround: 1 – 3 weeks
Ref. Range: On report form

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Caffeine
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: Plain clotted sample
Comment: Method not suitable for analysis in adults
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Calcitonin
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: 5.0 mL blood in a plain gel tube sent to lab immediately
Comment: Send fasting specimen. Must be separated and frozen within 15 minutes of phlebotomy.
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Calcium
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 2 hours. Priority: 3hours. Routine: 4 working days
Ref. Range: On report form
Calcium -ionised
Laboratory: Clinical Biochemistry: -also available on Blood Gas analysers located in A/E, ICUs, HDU, NICU,
AMAU, labour ward, theatre and SCU
Specimen: Blood in a balanced heparin syringe
Comment: Send specimen to laboratory within 15 minutes of collection
Turnaround: 15 mins
Ref. Range: On report form
Calcium (Urine)
Laboratory: Clinical Biochemistry
Specimen: 24 hour acidified urine collection
Turnaround: 1 working day
Ref. Range: On report form
Cannabis
See “Toxicology Screen”
Carbamazepine (Tegretol)
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Comment: Take specimen immediately before next dose (trough specimen)
Turnaround: 1 week
Therapeutic range: On report form
Carbapenemase Producing Enterobacteriaceae Screen
Laboratory : Medical Microbiology

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Specimen : Rectal swab in transport medium / faeces sample. Delay > 2 h refrigerate @ 2-8°C.
Comment : Restricted to specific groups of hospitalized patients. Non hospitalized patients are screened
by pior arrangement with a Consultant Microbiologist.
Turnaround : 3 working days.
Report : CPE isolated / Not isolated.
Carboxyhaemoglobin
Laboratory: Clinical Biochemistry
Specimen: Blood in a Heparinised syringe
Turnaround: 15 minutes
Ref. Range: On report form
Cardiac biopsy
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Submit specimen intact to laboratory in 10% Neutral Buffered Formalin.
Comment: Health & Safety precautions.
Report: Histological diagnosis
Carnitine, Acetyl
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: 2 blood spots on Newborn Screening card, air dry for 2 hours
Comment: Full clinical information and reason for request must accompany specimen
Turnaround: 1 – 3 weeks
Ref. Range: On report form including interpretative comment.
Carnitine, Free & Total
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: 5.0 mL Li Heparin blood
Comment: Full clinical information and reason for request must accompany specimen
Turnaround: 1 – 3 weeks
Ref. Range: On report form including interpretative comment
Carotene
See “Vitamin A”
Catecholamines/Fractionated Metanephrines
(Adrenaline/Noradrenaline/Dopamine/Metanephrine/Normetanphrine/3-methoxytyramine - Urine)
Laboratory: Clinical Biochemistry:- referred to external laboratory for analysis
Specimen: 24 hour acidified urine collection
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Catheter / Intravascular Cannulae / Tips
Laboratory: Medical Microbiology
Specimen: Lines and Tips from arterial /venous lines cut to 4 cm in sterile container.
Comment: Only send where there is evidence of infection. Urinary catheters not tested. If delay
refrigerate @ 2-8°C.

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Turnaround: 3 working days
Report: Any clinically significant isolate with the appropriate sensitivities
Cat Scratch Disease Antibodies
See “Bartonella henselae PCR”

CD34 Viability
Laboratory: Haematology
Specimen: Frozen sample supplied from cryobiology lab , with special request form correctly filled
Comment: Requires prior arrangement with flowcytometry
Turnaround: 1 day
Ref.Range Not available
CEA
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Priority: 1 working day. Routine: 4 working days
Ref. Range: On report form
Cerebrospinal Fluid (Molecular analysis for Pathogens)
Laboratory: Medical Microbiology: - referred to Irish Meningococcal and Streptococcal Reference
Laboratory /National Virus Reference Laboratory when unavailable on site.
Specimen: 0.5 mL CSF in plain leak-proof sterile container
Turnaround: 1-2 weeks (Verbal report available on positive samples within 2-5 working days)
Report: Detected/Not Detected.
Cerebrospinal Fluid – Culture / Microscopy
Laboratory: Medical Microbiology
Specimen: 3 specimens in sterile containers hand delivered to Medical Microbiology without delay.
Comment : If Xantochromia is requested a CSF sample should be received in the laboratory wrapped in
tinfoil. Culture reported only on CSFs with an elevated cell count.
Turnaround: Microscopy: 2 hours. Culture: 3 days.
Report: Microscopy & Culture
Cerebrospinal Fluid – Viral PCR (HSV and VZV)
Laboratory: Medical Microbiology
Specimen: 0.5 mL CSF in plain leak-proof sterile container
Comment : Available only by prior arrangement with Microbiology Medical Staff
Turnaround: 1-2 weeks (Verbal report available on positive samples)
Report: Targets Detected/Not Detected
Cerebrospinal Fluid - Cytology
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: 3ml – 20 mL cerebral spinal fluid, lumbar puncture or ventricular tap in a 20 mL universal
container. Refrigerate overnight if necessary as the cells are sensitive to temperature and
cellular degeneration occurs if left at room temperature for extended periods of time.

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Comment: Indicate clinical history on test requisition and reason for test. Submit immediately to
laboratory. Fixative may NOT be added if specimen is to be shared with microbiology for
assessment. Please submit to microbiology department directly and request Urgentpersonal
delivery directlyfrom Microbiology for subsequent Cytological assessment. Please note there
is no on call or emergency out of hours service available in the Diagnostic Cytology laboratory.
Specimens must be received by 16;00 h for same day processing. There is no weekend service
available in Diagnostic Cytology.
Note: Cytology will not be performed on a ?CJD or a CJD sample
Turnaround: 80% by 5 working days
Report: Detection of neoplastic and non neoplastic cells. Detection of infectious organisms.
Cerebrospinal Fluid - Glucose
Laboratory: Clinical Biochemistry
Specimen: 1.5 mL CSF specimen
Comment: Send all CSF samples to Micro for processing, send simultaneous plasma glucose specimen
Turnaround: 1 – 3 hours
Ref. Range: CSF Glucose level is normal approximately two thirds of the plasma glucose value

Cerebrospinal Fluid - Lactate

Laboratory: Clinical Biochemistry - referred to external laboratory for analysis
Specimen: 300 uL CSF in a Fluoride Oxalate tube
Comment: Advisable to contact lab in advance of taking specimen
Turnaround: 3 days
Ref. Range: On report form
Cerebrospinal Fluid - Neurodegenerative biomarkers (CSF Tau/Phospho Tau/ Beta amyloid)
Laboratory: Immunology – referred to Immunology St James Hospital Dublin
Specimen: CSF -2.5mls required for analysis
Comment: CSF by LP; received in Sarstedt 2ml screw cap tubes (contact lab for supply of tubes). Sample must
reach the lab within 2hours of collection, Mon-Friday
Specific request form to be completed – obtained from Immunology lab
Turnaround: 4-6 weeks
Report: Refer to St James report for full
Cerebrospinal Fluid - Protein
Laboratory: Clinical Biochemistry
Specimen: 1.5 mL CSF specimen
Comment : Send all CSF samples to Micro for processing
Turnaround: 1 – 3 hours
Ref. Range: On report form
Cerebrospinal Fluid – Oligoclonal bands and CSF IgG Index
Laboratory: Immunology
Specimen: Minimum of 0.5mL of CSF specimen and 5.0 mL blood in plain gel tube.

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Comment : Sample must be received in the lab within 7 days of collection.
Turnaround: 3 weeks
Report: See report form including interpretative comment
Cerebrospinal Fluid Shunt
Laboratory: Medical Microbiology
Specimen: 4 cm cut from line placed in a sterile container.
Comment: Only send where evidence of infection. If delay refrigerate @ 2-8OC.
Turnaround: 3 working days
Report: Any clinically significant isolate with the appropriate sensitivities
Ceruloplasmin
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 5 working days
Ref. Range: Male : 0.15-0.3 g/l Female : 0.16-0.45 g/L

Cervical Swab
Laboratory: Medical Microbiology
Specimen: Swab in transport medium. If delay refrigerate @ 2-8OC.
Comment: Endocervical / Urethral swabs are routinely cultured for N. gonorrhoeae. All other specimens
must specify N. gonorrhoeae on request if required.
Turnaround: 3 working days
Report: Culture report: Any clinically significant isolate with the appropriate sensitivities.
Chlamydia pneumoniae Serology
Laboratory: Virology: - referred to Health Protection Agency, Bristol BS2 8EL
The National Virus Reference Laboratory, Dublin.
Specimen: 7.0 mL blood in a plain gel tube
Comment: By prior arrangement with Microbiology Medical Staff
Turnaround: 1 – 3 weeks
Report: Positive/Negative

Chlamydia psittaci Antibodies

Laboratory: Virology: -referred to Health Protection Agency, Bristol BS2 8EL
Specimen: 7.0 mL blood in a plain gel tube
Comment: Available only in very specific circumstances and with prior approval of a Consultant
Microbiologist.
Turnaround: 2 – 5 working days
Report: Detected / Not Detected
Chlamydia trachomatis (PCR)
Laboratory: Virology
Specimen: Abbott Multicollect swab preferably delivered to the laboratory within 24 h of collection.

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Comment: If delay refrigerate @ 2-8OC.
Turnaround: 10 working days
Report: Detected / Not Detected
Chloride
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 2 hours. Priority: 3hours. Routine: 4 working days
Ref. Range: On report form

Chloride (Urine)
Laboratory: Clinical Biochemistry
Specimen: 24hr urine collection
Turnaround: 1 working day
Ref. Range : On report form
Cholesterol
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Comment : Ideally a patient should fast for 12 hours. However, if a patient is unable or unwilling to fast
for 12 hours a specimen taken after a 9 hour fast is acceptable
Turnaround: Urgent: 2 hours. Priority: 3hours. Routine: 4 working days
ESCG Target Value:Standard <5.0mmol/L High-Risk <4.0mmol/L

Cholesterol/HDL Ratio
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Comment : Calculated parameter
Turnaround: Urgent: 2 hours. Priority: 3hours. Routine: 4 working days
Interpretation: High risk >5.0, desirable <3.5.
Cholinesterase Phenotyping
Laboratory: Clinical Biochemistry: -referred to external laboratory for analysis
Specimen: 4.0 mL blood in a plain gel tube
Turnaround: 1 – 3 weeks
Report: On report form including interpretative comment
Chromogranin A/B
Laboratory: Clinical Biochemistry: referred to external laboratory for analysis
Specimen: 4.0mL K+ EDTA, on melted ice
Turnaround: 1-3 weeks
Ref. Range: On report form
Chromosomal Analysis
Refer to Cytogenetic

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Clostridium difficile Toxin B gene detection
Laboratory: Medical Microbiology
Specimen: Faeces 1-2 g during acute phase of illness in leak proof laboratory container. If delay 24h
refrigerate @ 2-8OC. > 72 h – freeze @ -20OC.
Comment: C. difficile requests are appropriate in particular in hospitalized patients who have developed
diarrhoea while receiving antimicrobial agents.
Turnaround: 5 working days
Report: C. difficile toxin B gene Detected/ Not Detected
An additional test, for detection of Clostridium difficile toxin, will be performed on all stools
which have C. difficile toxin gene detected. This will be reported as
C.difficle toxin Detected/ Not Detected including relevant interpretative comments.
Clozapine (Clozaril)
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: 7.0 mL K+ EDTA blood
Turnaround: 1 – 3 weeks
Therapeutic Range: On report form
Coagulation Factor Assays (incl Factors – II, V, VII, VIII:C, IX, XI, XII, and FX)
Laboratory: Haematology
Specimen: 2 x 2.7 mL blood specimens in 0.109m Sodium Citrate tubes, (1.0 mL Paediatric tubes are
available).
Comment: Prior arrangement with the coagulation laboratory, contact 091 544995. It is important that
the specimen container is filled to the mark.
Turnaround: 1 day for routine specimens. Specimens with emergency form 2 hours, in consultation wit the
Laboratory. Telephoned requests for faster turnaround time can be accommodated when
specifically requested.
Ref. Range: See individual assay
Coagulation Factor XIII
Laboratory: Haematology : referred to NCHCD, St James’s Hospital
Specimen: 2 x 2.7 mL blood specimens in 0.109m Sodium Citrate tubes, (1.0 mL Paediatric tubes are
available).
Comment: Prior arrangement with the coagulation laboratory, contact 091 544995. It is important that
the specimen container is filled to the mark.
Turnaround: 4 weeks
Ref. Range: Refer to report
Coagulation Screen
Laboratory: Haematology
Specimen: 2.7 mL blood specimens in 0.109m Sodium Citrate tubes, (1.0 mL Paediatric tubes are
available). Do not refrigerate specimen. To be received in lab within 6 hours of draw.

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Comment: Profile includes, PT, INR, derived Fibrinogen and APTT. Details of anticoagulant therapy
required. Must fill bottle to mark. INR is used to monitor warfarin. APTT may be used to
monitor Heparin therapy.
Turnaround: 1 day for routine specimens. Specimens with emergency card 2 hours. Telephoned requests
for faster turnaround time can be accommodated when specifically requested.
Ref. Range: Refer to report
Cocaine
See “Toxicology”
Coeliac Screen
See ‘Anti-Tissue TransGlutaminase (tTG) Antibodies’
Cold Agglutinins
Laboratory: Blood & Tissue Establishment
Specimen: 6.0 mL EDTA K2E blood
Comment: Specimen needs to be transported to the Blood & Tissue Establishment in a flask at 37ºC
before 15.30
Turnaround: Within 12 h
Ref. Range: N/A
Complement: C1 Esterase Inhibitor
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 5 working days
Ref. Range: 0.15 – 0.43 g/L
Complement: C1 Esterase Inhibitor Functional Assay
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube.
Comment: Must arrive in Immunology on the same day it was taken . Time and date of collection must
be stated on request form
Turnaround: 5 weeks
Ref. Range: 70-130%
Complement: C1q
Laboratory: Immunology: – referred to Immunology Dept, Northern General Hospital, Sheffield
Specimen: 5.0 mL blood in plain gel tube
Comment : Specimen referred for testing if CH100 functional activity is abnormal.
Turnaround: 11 weeks
Ref. Range: Refer to Report
Complement: C2/C5/C6/C7/C8/C9
Laboratory: Immunology: – referred to Immunology Dept, Northern General Hospital, Sheffield
Specimen: 5.0 mL blood in plain gel tube
Comment: Only if abnormal CH100 or CH100A Functional Activity
Turnaround: 6 weeks

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Ref. Range: On report form including interpretative comment
Complement: C3/C4
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 5 working days
Ref. Range: C3: 0.75 – 1.86 g/L
C4: 0.13 – 0.49 g/L
Complement: C3 Nephritic Factor
Laboratory: Immunology: – referred to Immunology Dept, Northern General Hospital, Sheffield
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 6 weeks
Report: Positive/Negative
Complement: CH100 (Total Haemolytic Complement) Functional Activity CH100 (Total) and CH100A (Alternate
Pathway)
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Comment: Must arrive in Immunology on the same day it was taken . Time and date of collection must
be stated on the request form.
Turnaround: 5 weeks
Ref.range: Refer to report form
Conjunctivitis (Bacterial Culture)
Laboratory: Medical Microbiology
Specimen: Swab of conjunctiva in transport medium
Comment: If delay refrigerate @ 2-8OC.
Turnaround: 3 working days
Report: Culture report: Any clinically significant isolate with the appropriate sensitivities.
Conjunctivitis (Chlamydia trachomatis)
Laboratory: Virology
Specimen: Swab of conjunctiva in Abbott Multicollect tube.
Comment: If delay refrigerate @ 2-8OC.
Turnaround: 10 working days
Report: Detected / Not Detected
Copper
Laboratory: Clinical Biochemistry: referred to external laboratory for analysis
Specimen: 7.0 mL blood in a Na+. EDTA trace element tube (available from Clinical Biochemistry lab).
Turnaround: 3weeks
Ref. Range: On report form
Copper (Urine)
Laboratory: Clinical Biochemistry: referred to external laboratory for analysis
Specimen: 24 hour urine sample

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Turnaround: 1 – 3 weeks
Ref. Range: On report form
Corneal Scrapings / Intraocular Fluids
Laboratory: Medical Microbiology
Specimen: Pre-inoculated media available from lab/ If sufficient fluid use sterile container.
Comment: Contact Laboratory to collect fresh culture plates and slide for corneal scrapings. Deliver to
Laboratory immediately.
Turnaround: 3 days
Report: Clinically significant isolate with the appropriate sensitivities
Cortisol
Laboratory: Clinical Biochemistry
Specimen: 7.0mL blood in a plain gel tube
Turnaround: Priority: 1 working day. Routine: 4 working days
Ref. Range: On report form
Cortisol (Urine)
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: 24 hour urine collection
Turnaround: 1 – 3 weeks
Ref. Range: On report form
COVID-19 see SARS
See “SARS CoV-2 (PCR) ”
Coxiella burnetii IgM Antibodies (Q fever)
Laboratory: Virology : referred to the Rare + Imported Pathogens Reference Laboratory
Specimen: 7.0 mL blood in a plain gel tube
Turnaround : 2-3 weeks.
Report: See report form including interpretative comment.
Coxsackie B Virus
See “Enterovirus”
C Peptide
Laboratory: Clinical Biochemistry
Specimen: 7.0mL fasting blood in a plain tube delivered immediately to the laboratory
Turnaround: 1 week.
Ref. Range: On report form
Creatine Kinase (CK)
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 2 hours. Priority: 3hours. Routine: 4 working days
Ref. Range: On report form
Creatinine

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Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 2 hours. Priority: 3hours. Routine: 4 working days
Ref. Range: On report form
Creatinine (Urine)
Laboratory: Clinical Biochemistry
Specimen: 24 hour urine sample
Turnaround: 1 working day
Ref. Range: On report form
Creatinine Clearance
Laboratory: Clinical Biochemistry
Specimen: 24 hour urine in plain container and 7.0mL blood in plain gel tube taken at some point during
the urine collection. It is important that the blood and urine are received in the laboratory as
a matched pair.
Turnaround: 1 working day
Ref. Range: On report form
Interpretation: Creatinine clearance may be higher during normal pregnancy due to glomerular
hyperfiltration.
Creutzfeld-Jakob Disease (CJD, 14-3-3 Protein)
Laboratory: Medical Microbiology: Referred to Beaumont Hospital and then onwards to Edinburgh
Specimen: 2 - 5mls of CSF
Comment: Available only in very specific circumstances and with prior approval of a Consultant
Microbiologist.
Turnaround: 3 - 6 weeks
Report: Positive/Negative
CRP (C Reactive Protein)
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 2 hours. Priority: 3hours. Routine: 4 working days
Ref. Range: On report form
Cryoglobulins
Laboratory: Immunology
Specimen: 10 .0 mL blood in plain tube (provided by lab), 10.0 mL EDTA blood, transported immediately
at 37oC. Contact laboratory who will provide suitable flask for transport of sample at 37oC.
Comment : Requests accepted Mon – Thurs 8h-16h. Friday 8h -13h.
Turnaround: 8 working days
Report: Positive/Negative.
If positive then quantified by Cryocrit and typed by Immunofixation
Cryptococcal Antigen
Laboratory: Virology

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Specimen: 7.0 mL blood in a plain gel tube
Comment: Available only in very specific circumstances and with prior approval of a Consultant
Microbiologist.
Turnaround: 1 week
Report: Detected/Not Detected
Cryptosporidium spp
Laboratory: Medical Microbiology
Specimen: Faeces 1-2 g during acute phase of illness in leak proof Laboratory container. If delay
refrigerate @ 2-8OC.
Comment: Cryptosporidium spp is tested routinely on all outpatients.
Turnaround: 2 working days
Report: Cryptosporidium DNA detected / Not detected.
Crystals for Uric acid assessment
See Joint Aspirates Department of Histopathology, Cytopathology and Molecular Pathology
CSF – Culture & Microscopy / Glucose / Protein / Lactate
See “Cerebrospinal Fluid – Culture & Microscopy / Protein / Glucose / Lactate”
CSF- Cerebrospinal Fluid- Flow Cytometry
Laboratory: Haematology
Specimen: Transfix tube which must be collected from flowcytometry dept prior to lumbar puncture. If
this is not available use RPMI prepared by the flowcytometry dept which uses an accurate
volume of 2ml RPMI added to the CSF container. Collect between 1.5 – 2.0ml of CSF into the
transfix and mix by inversion 5-10 times. CSF sample must be transported immediately to the
flow cytometry laboratory where processing begins.
Comment: Requests for flow cytometry tests should only be received Monday –Thursday between 9am
and 5pm unless prior arrangements have been made with Flow Cytometry.
Prior arrangement is required with flowcytometry for CSF analysis. Samples must be returned
directly after sampling, to the flow cytometry lab. Full clinical information and reason for
request must accompany specimen
Turnaround: 3-5 working days
Ref.Range: Interpretation by Consultant Haematologist on report form.
CSF – Oligoclonal bands and CSF IgG Index
See “Cerebrospinal Fluid – Oligoclonal bands and CSF IgG Index”
CSU – Catheter Urine
Laboratory: Medical Microbiology
Specimen: Specimen of Urine in Urine vacuum tube container.
Comment: Contact Laboratory Medical staff as routine submission of CSU is not appropriate. If delay
refrigerate @ 2-8OC.
Turnaround: Microscopy: 4 hrs for Urines received 8am to 12 midnight. Paeds Urines only processed post
midnight. Culture 3 working days.
Report: Microscopy : Cell count& Culture and sensitivities if appropriate

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Curettings
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Submit specimen to laboratory in 10% Neutral Buffered Formalin.
Comment: Health & Safety precautions
Report: Histological diagnosis
CV2/ CRMP5
Laboratory: Immunology: – referred to Immunology Department, Churchill Hospital, Oxford OX3 7LJ
Specimen: 5.0 mL blood in plain gel tube. CSF analysis also available.
Turnaround: 6 weeks
Report: Positive/Negative
Cyanide
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: 24 hour urine collection
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Cyclosporin (Neoral)
Laboratory: Clinical Biochemistry
Specimen: 4.0 mL K+ EDTA whole blood
Comment : Collect sample pre-dose. State date/time of sample collection clearly on request form.
Turnaround: 1 week
Ref. Range: Patient specific
Cystic Fibrosis – Genetic Test
Laboratory: Immunology: – referred to Department of Clinical Genetics, CHI, Crumlin, Dublin.
Specimen: 5.0 mL EDTA whole blood.
Comment : It is mandatory for all requests to be accompanied by a fully completed CHI Genetic request
form. It is critical the informed consent section is completed. Testing will not be carried out if
forms are not completed fully. A CF patient information request form (CF PID), may be
submitted, CHI request forms can be download from www.olchc.ie
Turnaround: Up to 10 weeks
Report: Refer to report- including interpretative comment

Cyst Fluid
Department of Histopathology, Cytopathology and Molecular Pathology. Please refer to Aspirates/ effusions
Cytogenetics: Chromosome Analysis / KaryotypingAdults (age >5 years)
Laboratory: Immunology:- referred to Eurofins Biomnis (Mon – Fri service). .
Specimen: 5.0 mL of blood in Lithium Heparin tube (to be kept at room temperature only)
Comment: Eurofins Biomnis request form to be submitted with samples for testing (available at
https://www.eurofins.ie/biomnis/test-information/test-request-forms) Clinical details must be provided.
Turnaround: 15 working days
Report: Refer to report- including interpretative comment

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Cytogenetics: Chromosome Analysis / Karyotyping Paediatric (age <5 years)
Laboratory: Immunology:- referred to Department of Clinical Genetics, CHI, Crumlin
Specimen: 2.0 mL of blood in Lithium Heparin tube (to be kept at room temperature only)
Comment: Sample preferably to arrive in lab by 12:00 on Thursdays for transport to DCG
It is mandatory for all requests to be accompanied by a fully completed CHI Genetic request
form. It is critical the informed consent section is completed. Testing will not be carried out if
forms are not completed fully. CHI request forms can be download from www.olchc.ie
Turnaround: 2 -4 months
Report: Refer to report- including interpretative comment
Cytogenetics: Microarray / aCGH
Laboratory: Immunology:- referred to Department of Clinical Genetics, OLCH, Crumlin
Specimen: 5.0 mL of blood EDTA
Comment : It is mandatory for all requests to be accompanied by a fully completed CHI Genetic request
form. It is critical the informed consent section is completed. Testing will not be carried out if
forms are not completed fully. CHI request forms can be download from www.olchc.ie
Turnaround: up to 5 weeks
Report: Refer to report- including interpretative comment
Cytomegalovirus (CMV-DEAFF)
Laboratory: Virology: - referred to the National Virus Reference Laboratory, Dublin.
Specimen: Freshly voided urine
Comment: Request must be approved by the Microbiology Medical Staff. Specimens must be delivered to the Virology
laboratory by 11 :00am to ensure same day dispatch to the NVRL.
Turnaround: 1-3 weeks
Report: Positive/Negative
Cytomegalovirus (CMV – PCR)
Laboratory: Virology: - referred to the National Virus Reference Laboratory, Dublin
Specimen: 8ml K2EDTA Greiner tube
Comment: Specimens must be delivered directly to a staff member in the Virology laboratory within 3
hours of phlebotomy. Request must be approved by the Microbiology Medical Staff.
Turnaround: 1 – 3 weeks
Report: Detected/Not Detected
Cytomegalovirus (CMV) IgG / IgM Antibodies
Laboratory: Virology
Specimen: 7.0 ml blood in a plain gel tube
Turnaround: 1-2 days
Report: Detected / Not Detected
Cytomegalovirus (CMV – PP65 Antigenaemia)
Laboratory: Virology: - referred to the National Virus Reference Laboratory, Dublin
Specimen: 5.0 mL blood in an EDTA tube

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Comment: Available only in very specific circumstances and with prior approval of a Consultant
Microbiologist. Please call to discuss if this test is required.
Turnaround: 1-3 weeks
Report: Positve/Negative
Cytotoxic Antibodies (solid organ transplantation)
Laboratory: Immunology: – referred to Tissue Typing Laboratory, Immunology, Beaumont Hospital,
Dublin.
Comment: Discuss with tissue typing lab in Beaumont
Specimen: 5 ml blood in plain gel tube
Turnaround: 4 weeks
Ref range: Refer to report form
D-Dimers
Laboratory: Haematology
Specimen: 2.7 mL blood in a 0.109m Sodium Citrate tube. Specimen must be tested within 24 hours of
draw. One specimen sufficient for D-Dimer and Coagulation screen. D-Dimer can be added
onto a Coagulation screen request that is less than 24 hours old by telephone or by request
form.
Turnaround: 1 day routine specimens. Specimens received on emergency form 2 hours.
Ref. Range: Refer to report
DDISH, HER-2 Status Evaluation
Laboratory : Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Tissue samples already processed by the Histopathology Laboratory, on Request from
Consultant Pathologist only.
Comment; Testing available on request by Pathologist.
Turnaround; 5 – 10 working days after request from Pathologist received
Report: Integral part of Histopathology report issued by Division of Anatomic Pathology
Dengue fever Antibodies
Laboratory: Virology: -referred to the National Virus Reference Laboratory, Dublin.
Specimen: 7.0 mL blood in a plain gel tube.
Comment: Available only in very specific circumstances and with prior approval of a Consultant
Microbiologist.
Turnaround: 1 – 3 weeks
Report: Positive/Negative
Dermatophytosis
Laboratory: Medical Microbiology
Specimen: Hair, Nail clippings, skin scrapings in Dermapak.
Comment: Refer to Medical Microbiology section for collection & transport. If delay refrigerate @ room
temperature.
Turnaround: Microscopy: 1 week. Culture: 5 to 6 weeks.
Report: Microscopy & Culture

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DHEA Sulphate
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: 7.0 mL blood in a plain tube
Comment: Assay only available by request from Endocrine Team or by prior agreement with Dr.Damian
Griffin / Dr. Paula O’Shea
Turnaround: 3 weeks
Ref. Range: On report form
Digoxin
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Comment: Take specimen six hours post dose, Hypokalaemia is associated with an enhanced response
to digoxin. Potassium should always be measured when digoxin toxicity is suspected.
Turnaround: Urgent: 1hour. All other requests: same day
Therapeutic Range: On report form
Dihydropyrimidine Dehydrogenase (DPD) Activity
Laboratory: Clinical Biochemistry: referred to external laboratory for analysis,
Specimen: K+ EDTA blood, and a urine specimen
Turnaround: 1 – 3 weeks
Report: See report form
Diphtheria (Culture of Throat swab)
Laboratory: Medical Microbiology
Specimen: Swab in charcoal medium. If delay refrigerate @ 2-8OC.
Comment: Contact Laboratory prior to sending swab to ensure fresh media is present.
Turnaround: 1 week
Report: Culture Report: Any clinically significant isolate with the appropriate sensitivities
Direct Coombs Test
Laboratory: Blood & Tissue Establishment
Specimen: 6.0 mL EDTA K2E blood
Turnaround: 1 hour
Ref. Range: N/A
Dopamine
Laboratory: Clinical Biochemistry: -referred to external laboratory for analysis
Specimen: 24 hour urine sample
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Duodenal Aspirate
Laboratory: Medical Microbiology
Specimen: Fluid in sterile universal container
Comment: If delay refrigerate @ 2-8OC.
Turnaround: 3 working days

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Report: Culture Report: Any clinically significant isolate with the appropriate sensitivities.
Duodenal Smear for Giardia intestinalistrophozoites.
Laboratory: Medical Microbiology
Specimen: Smear on slide. If delay refrigerate @ 2-8OC.
Turnaround: 1 week
Report: Giardia intestinalis detected / not detected
Ear Swab
Laboratory: Medical Microbiology
Specimen: Swab any pus or exudate with in transport medium
Comment: If delay refrigerate @ 2-8OC.
Turnaround: 3 working days
Report: Culture Report: Any clinically significant isolate with the appropriate sensitivities
Echinococcus (Hydatid cyst) antibodies
Laboratory: Virology: -referred to Hospital for Tropical Diseases, London WCIE 6AU
Specimen: 7.0 mL blood in a plain gel tube
Comment: Available only in very specific circumstances and with prior approval of a Consultant
Microbiologist.
Turnaround: 2 – 3 weeks
Report: Positive/Negative
ECHO Virus
See “ Enterovirus IgM antibodies”
Ecstacy
See “Toxicology Screen”
Effusions
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Collect 10-20 ml fresh specimen into a twist top leak proof 20ml or 50 ml sample bottle
containing Shandon Cytospin collection fluid (green fixative solution available from
Laboratory).Refrigerate overnight if necessary
Comment: Indicate clinical history on test requisition, and reason for test. Do not submit drainage bags
or large volumes of fluid for disposal in Laboratory
Turnaround: 80% by 5 working days.
Report: Detection of neoplasticand non neoplastic cells
eGFR
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in plain gel tube
Turnaround: Urgent: 1 hour. Priority: 3 hours. Routine: 4 working days
Comment : Calculated parameter
Interpretation: On report form
EGFR Mutation analysis

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Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Tissue samples already processed by the Histopathology Laboratory, arrange via consultant
pathologist.
Comment; Testing available on request by Pathologist.
Referrals Contact the Department of Histopathology, Cytopathology and Molecular pathology on 4078
Turnaround; 5 – 10 working days after request by Pathologist received.
Report: Integral part of Histopathology report issued by Division of Anatomic Pathology, Department
of Histopathology, Cytopathology and Molecular Pathology.
Electron Microscopy
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Tissue
Comment: Discuss with appropriate Consultant Histopathologist at least 24 hours in advance of surgery.
Report: Histological diagnosis
Endocervical Swab
Laboratory: Medical Microbiology
Specimen: Swab in transport medium
Comment: Endocervical / Urethral swabs are routinely cultured for N. gonorrhoeae. If delay refrigerate
@ 2-8OC.
Turnaround: 3 working days
Report: Culture Report: Any clinically significant isolate with the appropriate sensitivities.
Enterobius vermicularis (Sellotape slide for Pinworms)
Laboratory: Medical Microbiology
Specimen: Apply sellotape to anal area, fix to slide, send to Laboratory. If delay refrigerate @ 2-8OC.
Turnaround: 2 working days
Report: Presence or Absence of E. vermicularis.
Enterovirus (PCR)
Laboratory: Medical Microbiology
Specimen: 0.5 mL CSF in plain leak-proof sterile container
Comment: On Consultant Microbiologist request
Turnaround: 1 week
Report: Enterovirus RNA: Detected/ Not Detected.
Epstein – Barr Virus (EBV) Antibodies
Laboratory: Virology:
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: 1 – 2 days
Report: Detected/Not Detected
Erythropoietin
Laboratory: Haematology: Referred toMedLab Pathology.
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: 2 weeks

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Ref. Range: Refer to report
Erythrovirus B19 IgM + IgG antibodies
Laboratory: Virology-referred to the National Virus Reference Laboratory, Dublin
Specimen: 7.0 mL blood in a plain gel tube. Available only in specific circumstances.
Turnaround: 3 weeks
Report: Postivie/Negative
ESR (Erythrocyte Sedimentation Rate)
Laboratory: Haematology
Specimen: Minimum 2mls blood in EDTA purple top tube for ESR and FBC.
Paediatric FBC and ESR request require a 3 ml Adult EDTA purple top tube.
Comment: Requests should be received by the laboratory within 24 hours of phlebotomy.
Turnaround: 1 day routine specimens. Telephoned requests for faster turnaround time can be
accommodated on particularly urgent specimens
Ref. Range: Refer to report
Ethylene Glycol
Laboratory: Clinical Biochemistry: -referred to external laboratory for analysis
Specimen: EDTA, Li. Heparin or plain non-gel tube
Comment: Contact Dr. Damian Griffin/Dr Paula O’Shea who will advise as to the necessity for having the
assay referred as an emergency
Turnaround: Arranged for each assay
Ref. Range: On report form
Extended Spectrum Beta Lactamase (ESBL) culture
Laboratory: Medical Microbiology
Specimen: Rectal swab in transport medium/Faeces sample. Delay > 2 h refrigerate @ 2-8OC.
Comment: Restricted to specific groups of hospitalized patients. Non hospitalized patients are screened
by prior arrangement with a Consultant Microbiologist.
Turnaround: 3 working days
Report: ESBL isolated / not isolated
Eye Swab
Laboratory: Medical Microbiology
Specimen: Swab in transport medium (charcoal)
Comment: If delay refrigerate @ 2-8OC.
Turnaround: 3 working days
Report: Culture Report: Any clinically significant isolate with the appropriate sensitivities.
Fabrys Disease
Laboratory : Clinical Biochemistry-Referred to External Laboratory for Analysis
Specimen : Blood Spot Card obtained from Clinical Biochemistry
Comment : Consent may be required if additional testing is performed
Turnaround : 4 weeks
Report : On Report Form

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Factor Inhibitor Studies
Laboratory: Haematology
Specimen: 3 x 2.7 mL blood in a 0.109m Sodium Citrate tube
Comment: Prior arrangement with coagulation laboratory necessary. Must fill bottle to mark.
Turnaround: 1 week
Ref. Range: N/A
Factor V Leiden Mutation
Laboratory : Haematology : referred to NCHCD, SJH, Dublin
Specimen : 5.0 ml blood in EDTA tube
Comment : APCR <2 or positive lupus only will be sent to SJH for testing. This must be written on the
Haematology request form. A signed patient consent form for genetic testing is required by
the laboratory before analysis can be processed.
Turnaround : 4 weeks
Ref Range : N/A
Faecal Elastase
Laboratory: Clinical Biochemistry: -referred to external laboratory for analysis
Specimen: 100 mg minimum formed faeces sample
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Faeces – Molecular analysis, Microscopy, Culture and Antigen Detection
Laboratory: Medical Microbiology
Specimen: 1-2 g faeces collected in acute phase of illness in leak proof container. If delay refrigerate @
2-8OC
Comment: Shigella Spp. survival may be compromised @ 2-8OC – delay reduces isolation
Turnaround: 3 working days
Report: Molecular : Bacterial DNA Detected/Not Detected. Culture: Any clinically significant isolate-
all samples with pathogen DNA detected (Except Campylobacter spp)
Farmers Lung Antibodies (Micropolyspora Faenii)
Laboratory: Virology: - referred to PHL, Cumberland Infirmary, Carlisle CAZ 7HY
Specimen: 7.0 mL blood in a plain gel tube
Comment: Available only in specific circumstances and with prior approval of a Consultant
Microbiologist.
Turnaround: 2 – 3 weeks
Report: Positive/Negative
FDP’s (Fibrinogen degradation products)
Laboratory: Haematology
Specimen: 2.0 mL blood in special FDP bottle supplied on request by coagulation laboratory
Comment: Must fill bottle to mark
Turnaround: 1 day

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Ref. Range: Refer to report
Ferritin
Laboratory: Haematology
Specimen: 5.0 mL blood in a plain gel tube. Specimen to be received within 24hrs of phlebotomy for
whole blood and 3 days if sample spun.
Turnaround: 4 days
Ref. Range: Refer to report
Filaria Antibodies
Laboratory: Virology: -referred to Hospital for Tropical Diseases, London WCIE 6AU
Specimen: 7.0 mL blood in a plain gel tube
Comment: Available only in specific circumstances and with prior approval of a Consultant
Microbiologist.
Turnaround: 2 – 3 weeks
Report: Positive/Negative
Fine Needle Aspiration Biopsy - FNAB
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Submit specimen to laboratory in 10% Neutral Buffered Formalin.
Turnaround : 80% by 5 working days
Report: Histological diagnosis
Fine Needle Aspirates (FNAS) of breast, thyroid, axilla, parotid, submandular, lymph node and cysts.
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Superficial and deep seated lesions. Deep seated lesions that need ultrasonic, CT or
fluoroscopic guidance may be required. Use a 22 – 25 gauge fine needle and a 10 – 20 mL
syringe for collection of specimen. Clearly label two frosted glass slides with patients name,
DOB, and /or BN. Prepare thin even smears. For optimal diagnosis, air dry one slide for diff
quik stain, please label as ‘Air Dried.Immediately after preparation, spray a complete even
coating of Cell-Fixx onto the other slide(s) from a distance of 25 – 30 cm (10 – 12 inches).
Fixed slides should be labelled in pencil with patient Name DOB and or BN. Labelling should
be carried out before spray fixing. Fixed and air dried slides should be placed in slide mailers
clearly labelled on the outside with patient’s addressograph. Needle wash may be collected
into Shandon Cytospin Collection Fluid in a Universal container green fixative solution and
submitted to the laboratory for processing. Please indicate exact location of sample site on
request form and specimen container.Pathologist assisted FNAs must be prebooked by
contacting the laboratory officeext:4078 / 4492 or Cytology laboratory Prep ext 4883. Contact
with Pathologist rostered on Cytology may also be made via switchboard.
Comment : Additional Sample may be taken for Flow cytometry if clinically indicated
Turnaround: 80% by 5 working days
Report: Correlated with clinical presentation. Allow on site evaluation, rapid turn a round time.
Flecainide Acetate
Laboratory: Clinical Biochemistry:- referred to external laboratory for analysis

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Specimen: 4.0 mL blood in a non-gel tube
Turnaround: 1 – 3 weeks
Target Range: On report form
Flow Cytometry (Immunotyping of Leukaemias and Lymphomas)
Laboratory: Haematology
Specimen: 3.0 mL K3 EDTA blood or Bone Marrow aspirate in EDTA or Lymph Node Biopsy in RPMI
Comment: Prior arrangement with consultant Haematologist or SPR
Requests for flow cytometry tests should only be received Monday –Thursday between 9am
and 5pm unless prior arrangements have been made with Flow Cytometry.
Turnaround: 3 - 5 days
Report: Contact Consultant Haematologist.
FLT3 – Mutation
Laboratory: Haematology: -referred to CMD Laboratory, St James Hospital, Dublin 8.
Specimen: 3.0 mL K3 EDTA blood, or Bone Marrow in RPMI.
Comment: Arrange through Haematology Registrar, or Consultant Haematologist.
Turnaround: 1 Month
Report: See report form.

Foetus
Laboratory : Refer to Autopsy Section

Folate (Serum)
Laboratory: Haematology
Specimen: 5.0 mL blood in a plain gel tube. Specimen to be received within 24hrs of phlebotomy for
whole blood and 2 days if sample spun.
Turnaround: 4 days
Ref. Range: Refer to report
Fragile X Chromosome
Laboratory: Immunology:- referred to Department of Clinical Genetics, CHI, Crumlin
Specimen: 5.0 mL blood in EDTA tube
Comment : It is mandatory for all requests to be accompanied by a fully completed CHI Genetic request
form. It is critical the informed consent section is completed. Testing will not be carried out if
forms are not completed fully. CHI request forms can be download from www.olchc.ie
Turnaround: up to 26 weeks
Ref Range : See report- including interpretative comment
Free light chains
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 10 working days
Ref. Range: Kappa light chains 3.3 – 19.4 mg/L

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 Lambda light chains 5.7 – 26.3 mg/L
Kappa / Lambda Ratio 0.26 – 1.65
Kappa / Lambda Ratio 0.37-3.1 applies for patients with stage 3 CKD or above

Fresh Tissue
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Submit specimen intact to laboratory UNFIXED.
Comment: Lymph nodes for query lymphoma, Frozen section and Muscle biopsy to be confirmed with
Consultant Histopathologist on frozens at least 24 hours in advance. Skin biopsies and renal
biopsies for DIF to be confirmed with Histopathology laboratory staff at least 24 hours in
advance. Health & Safety precautions
Report: Histological diagnosis
Free T4
See “Thyroxine”

Frozen Sections
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Fresh tissue
Turnaround: Same day
Comment: Avoid if there is a danger of infection e.g if tuberculosis is strongly suspected. Frozen sections
will not be done where there is a danger of infection. Alternative approaches to rapid
diagnosis can be discussed with the Consultant rostered on ‘frozens’.
Prior Arrangement: Please book frozen section 24 hours in advance with the Consultant Histopathologist rostered
for ‘frozens’ (ext. 4589). If possible put the operation at the beginning of the operation list. If
the operation is delayed or if it is subsequently found that the frozen section is not required,
please notify the Histopathology Department without delay at ext: 4589.The unfixed tissue
sample is transported directly to the laboratory by portering staff in a fully labelled
accompanied by a fully completed request form. Include contact details for immediate call
back of frozen section result.Tissue for frozen section must be handed directly to a Medical
Scientist, NCHD or Consultant Histopathologist.
Unbooked Frozen Sections: Frozen sections that are required but not booked during the
‘normal working hours’ (09:00 -17:00 h) must be discussed with the Consultant
Histopathologist rostered for ‘frozens’ before any samples are taken.
Report: Histological diagnosis
FSH
Laboratory: Clinical Biochemistry
Specimen: 7.0mL blood in a plain gel tube
Turnaround: Priority : 1 working day. Routine : 2 working days
Ref. Range: On report form

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Fructosamine
Laboratory: Clinical Biochemistry
Specimen: 7.0mL blood in a plain gel tube
Turnaround: 2 weeks
Ref. Range: On report form
Full Blood Count
Laboratory: Haematology
Specimen: 3.0 mL K3 EDTA blood, (1.0 mL Paediatric tubes are available).
Comment: After 24 hours, WBC differential and red cell indices are affected by EDTA changes. Ensure
samples are not taken from a drip site as this results in dilution of the sample. In cases of
platelet clumping special sample bottles (thrombo exact) are available upon request. For use
in platelet counting only.
Turnaround: 1 day routine specimens. Specimen’s received on emergency form 2 hours.
For HDW specimens 45 minutes. For GP specimens 2 working days.
Telephoned requests for faster turnaround time can be accommodated on particularly urgent
specimens.
Ref. Range: Refer to report
Fungal Microscopy and Culture
Laboratory: Medical Microbiology
Specimen: Transport swab. Tissue / pus in sterile container. Hair, nail clippings, skin scrapings in
Dermapak. Delay > 2 h refrigerate @ 2-8OC.
Comment: Refer to Medical Microbiology section
Turnaround: Microscopy: 1 week. Culture: 5 to 6 weeks.
Report: Microscopy: Presence or absence of Fungal elements. Culture: Growth / No Growth
G6PD Quantitation
Laboratory: Haematology: -referred to Special Haematology, St James Hospital, Dublin 8
Specimen: 3.0 mL K3 EDTA blood
Turnaround: 2 weeks
Ref. Range: See report form
G6PD Screening
Laboratory: Haematology
Specimen: 3.0 mL K3 EDTA blood. (1.0 mL Paediatric tubes are available).
Turnaround: 1 day
Ref. Range: N/A
Galactose-1-phosphate
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: 3.0 mL Li Heparin blood.
Comment: Contact laboratory before collecting sample. Full clinical information and reason for request
must accompany specimen
Turnaround: 1 – 3 weeks

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Ref. Range: On report form
Galactose-1-phosphate uridyl transferase
Laboratory: Clinical Biochemistry:- referred to external laboratory for analysis
Specimen: 3.0 mL Li Heparin blood
Comment: Collect sample on Mon-Wed mornings. Full clinical information and reason for request must
accompany specimen
Turnaround: 1 – 3 weeks Ref. Range: On report form
Galactomannan antibodies
Laboratory: Virology: -referred to the Department of Microbiology, St. James’ Hospital, James Street,
Dublin 8
Specimen: 7.0 mL blood in plain gel tube
Comment: Only available in very specific cases and following approval by a Consultant Microbiologist
Turnaround: 1 – 2 weeks
Report: Positive/Negative
Gamma-glutamyl-transferase (γ-GT)
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 2 hours. Priority: 3hours. Routine: 4 working days
Ref. Range: On report form
Gastrin
Laboratory: Clinical Biochemistry: - referred external laboratory for processing
Specimen: Fasting EDTA sample sent to the lab on melting ice
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Gastrointestinal Tract Hormones (GIT Hormones): incl. Pancreatic Polypep, C-Term Glucagon, Vasoactive Polypep,
Somatostatin and CART
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: 4.0mL K+ EDTA blood per hormone assay, on melted ice
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Genital Swab
Laboratory: Medical Microbiology
Specimen: Swab in transport medium. Delay > 2 h refrigerate @ 2-8OC.
Comment: Endocervical swabs and Urethral swabs are routinely cultured for N. gonorrhoeae. All other
specimens must specify N. gonorrhoeae on request if required.
Turnaround: 3 working days.
Report: Any clinically significant isolate.
Gentamicin/Genticin
Laboratory : Clinical Biochemistry
Specimen : 7.0mL blood in a plain gel tube. Delay >2h refrigerate @2-8°C.

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Comment : State time collected and if Peak or Trough specimen
Turnaound : Analysed during routine working hours only.
Therapeutic Range : On report form
Glucagon
See “Gastrointestinal Tract Hormones”

Glucose
Laboratory: Clinical Biochemistry
Specimen: 4.0 mL Fluoride Oxalate blood
Comment : Fasting : Ideally a patient should fast for 12 hours. However, if a patient in unable or unwilling to fast
for 12 hours a specimen taken after a 9 hour fast is acceptable”.
Turnaround: Urgent: 2 hours. Priority: 3hours. Routine: 4 working days
Ref. Range: On report form
Group and Coombs
Laboratory: Blood & Tissue Establishment
Specimen: EDTA K2E 6.0 mL (cord blood specimen) EDTA K2E 4.0 mL from infant
Turnaround: 4 hours
Ref. Range: N/A
Group and Crossmatch
Laboratory: Blood & Tissue Establishment
Specimen: EDTA K2E 6.0 mL blood
Turnaround: 40 mins (for an urgent crossmatch)
Ref. Range: N/A
Group and Hold
Laboratory: Blood & Tissue Establishment
Specimen: EDTA K2E 6.0 mL blood
Turnaround: 1 hour (for an urgent Group and Hold)
Ref. Range: N/A

Growth Hormone
Laboratory: Clinical Biochemistry
Specimen: 7.0mL blood in a plain gel tube, must arrived in lab same day. It should only be requested as
part of a dynamic function test. In general, a random growth hormone measurement has very
little diagnostic value.
Turnaround: 3weeks
Interpretation: On report form
Gut Hormone Profile
See “Gastrointestinal Tract Hormones”
Haemochromatosis – C282Y and H63D Genetic Mutations

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Laboratory: Immunology:- referred to Molecular Genetics Lab. Northern Molecular Genetics Service,
Biomedicine East, Central Parkway. Newcastle Upon Tyne, NE1 3BZ, UK
Specimen: 5.0 mL blood in EDTA tube
Comment: Must specify genetic test on request form. The patient must be >16 years old and the EDTA
sample must be fresh and not used for other testing.
Turnaround: up to 8 weeks
Ref range: On report form including interpretative comment. Paper report ONLY.

HbA1c
Laboratory: Clinical Biochemistry
Specimen: 4.0 mL EDTA blood
Turnaround: 2 working days
Ref. Range: On report form
Haemoglobin A2
Laboratory: Haematology – referred to St James Hospital.
Specimen: 3.0 mL K3 EDTA blood, (1.0 mL Paediatric tubes are available).
Comment : Request form must give clinical details, transfusion history and ethnic origin of
patient. Levels of HbA2 will be affected by the presence of iron deficiency.
Turnaround: 4 weeks
Ref. Range: On report form
Haemoglobin F
Laboratory: Haematology - referred to St James Hospital
Specimen: 3.0 mL K3 EDTA blood, (1.0 mL Paediatric tubes are available).
Comment: Request form must give clinical details, transfusion history and ethnic origin of patient.
Turnaround: 4 weeks
Ref. Range: On report form
Haemoglobin S
Laboratory: Haematology - referred to St James Hospital
Specimen: 3.0 mL K3 EDTA blood, (1.0 mL Paediatric tubes are available).
Comment: Request form must give clinical details, transfusion history and ethnic origin of patient.
Turnaround: 4 weeks
Ref. Range: On report form
Haemoglobinopathy Screens
Laboratory: Haematology - referred to St James Hospital
Specimen: EDTA sample required
Comment: Request form must give clinical details, transfusion history and ethnic origin of patient. Levels
of HbA2 will be affected by the presence of iron deficiency. Thalassaemia cannot be excluded
in the presence of iron deficiency.
Turnaround: 4 weeks
Ref. Range: On report form

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Haemophilus influenzae B Antibodies (IgG)
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 5 weeks
Ref. Range: Minimum Protective Level >0.15 mg/L
Optimum Protective Level >1.00 mg/L
Haemosiderin (Urine)
Laboratory: Haematology
Specimen: First morning urine specimen in a plain universal container.
Turnaround: 3 - 5 days
Ref. Range: N/A
Hantavirus Antibodies - Serum
Laboratory: Virology: - Referred to HPA, Special Pathogens Reference Unit, Wiltshire SP4 OJG
Specimen: 7.0 mL blood in plain gel tube
Comment: Only available in very specific cases and following approval by a Consultant Microbiologist
Turnaround: 1-3 weeks
Report: Positive / Negative
Haptoglobin
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 5 working days
Ref. Range: 0.3-2.0 g/l
HCG, Total
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent requests: 1hour. Priority : 3 hours. Routine : same day
Ref. Range: On report form
Helicobacter pylori Faecal Antigen Test
Laboratory: Medical Microbiology
Specimen: Faeces collected in a leak proof container.
Comment: H. pylori is available for patients with dyspepsia aged less than 45 years with NO “alarm
symptoms”. Stool samples should be submitted within 24 hours of collection, Monday to
Friday. Specimens that are aged, where the date of collection is not stated or without relevant
clinical details will not be processed.
Turnaround: 2 working days.
Report: H. pylori ‘antigen’ detected / Not detected.
Heinz Bodies
Laboratory: Haematology
Specimen: 3.0 mL K3EDTA blood (1.0 mL Paediatric tubes are available).

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Comment: Prior authorization by Consultant Haematologist or SPR. Arrange with Haematology
laboratory before taking specimen.
Turnaround: 2 days.
Ref. Range: N/A
Hepatitis A IgM Antibody
Laboratory: Virology
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: 1 week
Report: Detected / Not Detected
Hepatitis A Virus Total Antibody
Laboratory: Virology
Specimen: 7.0 mL blood in plain gel tube
Turnaround: 1 week
Report: Detected / Not Detected
Hepatitis B Surface Antigen
Laboratory: Virology
Specimen: 7.0 mL blood in a plain gel tube
Comment: Requests for testing post “Needlestick” injury should be notified to the laboratory in advance
of sending the specimen, as these samples are processed urgently.
Turnaround: 2 working days
Report: Detected / Not Detected.
Hepatitis B Antibody
Laboratory: Virology
Specimen: 7.0 mLblood in a plain gel tube
Comment: Requests for testing post “Needlestick” injury should be notified to the laboratory in advance
of sending the specimen.
Turnaround: 2 working days
Report: Levels reported as mIU/ml with relevant comment regarding protective levels and advice on
further vaccination
Hepatitis B Core Antibody (anti-HBc)
Laboratory: Virology
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: 2 working days
Report: Detected / Not Detected
Hepatitis B DNA / Viral Load
Laboratory: Virology: -referred to the National Virus Reference Laboratory, Dublin
Specimen: 8ml K2EDTA Greiner tube
Comment: Specimen must be delivered to a Virology staff member within 3 hours of phlebotomy and
before 4pm.
Turnaround: 1 – 3 weeks

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Report: Reported in IU/ml with comment where relevant
Hepatitis C Antibody
Laboratory: Virology
Specimen: 7.0 mL blood in a plain gel tube
Comment: Requests for testing post “Needlestick” injury should be notified to the laboratory in advance
of sending the specimen.
Turnaround: 2 working days. Samples referred for further testing 1-2 weeks.
Report: Not Detected, if negative. A Provisional report will be issued on any sample giving reactive findings on initial
testing. These specimens are referred to the NVRL for further testing and a final report.

Hepatitis C Antigen
Laboratory : Virology
Specimen: 7.0 mL blood in a plain gel tube
Comment : Only available in very specific cases and following approval by a Consultant Microbiologist
Turnaround : 3-5 working days
Report : Not Detected/Detected
Hepatitis C PCR / Viral Load / Genotype
Laboratory: Virology
Specimen: 8ml K2EDTA Greiner tube. Two tubes if genotype is also required.
Comment: Specimen must be delivered to a Virology staff member within 3 hours of phlebotomy and
before 4pm. The Greiner tubes are available from Laboratory Stores (EXT 4377)
Turnaround: 10 days
Report: Viral Load reported in IU/ml with comment where relevant
Hepatitis D Antibody
Laboratory: Virology: - referred to referred to the National Viral Reference Laboratory, Dublin
Specimen: 7.0 mL blood in a plain gel tube
Comment: Request must be approved by Consultant Microbiologist
Turnaround: 2-4 weeks
Report: Positive/Negative
Hepatitis E Antibody
Laboratory: Virology: - referred tothe National Viral Reference Laboratory, Dublin
Specimen: 7.0 mL blood in a plain gel tube
Comment: Request must be approved by Consultant Microbiologist
Turnaround: 2 – 4 weeks
Report: Positive/Negative

Heriditary Spherocytosis Screen (Flow Cytometry)

Laboratory: Haematology: Referred to Crumlin Hospital
Specimen: 3.0 mL K3EDTA blood, at room temperature.

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Comment: Requests for flow cytometry tests should only be received Monday –Thursday between 9am
and 5pm unless prior arrangements have been made with Flow Cytometry.
Samples must be received within 24hours. Full clinical information and reason for request
must accompany specimen.
Turnaround: 4 weeks
Ref. Range: Interpretation by Consultant Haematologist on report form.
Herpes simplex virus antibody
Laboratory: Virology: -Referred to HPA, Sexually Transmitted + Blood Borne Virus Laboratory, Colindale.
Specimen: 7.0 mL blood in a plain gel tube
Comment: Only referred to Reference Laboratory in exceptional circumstances and with prior approval
of a Consultant Microbiologist
Turnaround: 1 – 3 weeks
Report: Positive/Negative
Herpes simplex virus - PCR
Laboratory: Medical Microbiology
Specimen: 0.5 mL CSF in plain leak-proof sterile container or swab in viral transport medium from genital
site.
Comment: On Consultant Microbiologist request
Turnaround: 1 week
Report: HSV 1 & 2 DNA: Detected/ Not Detected.
5-HIAA (Urine)
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: 24 hour acidified urine collection
Turnaround: 1 – 3 weeks
Ref. Range: On report form
High Density Lipoprotein (HDL)
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Comment : Ideally a patient should fast for 12 hours. However, if a patient in unable or unwilling to fast
for 12 hours a specimen taken after a 9 hour fast is acceptable”.
Turnaround: Urgent: 2 hours. Priority: 3hours. Routine: 4 working days
Ref. Range: On report form
High Vaginal Swab (HVS)
Laboratory: Medical Microbiology
Specimen: Swab in transport medium . Delay > 2 h refrigerate @ 2-8OC.
Comment: Endocervical swabs and Urethral swabs are routinely cultured for N. gonorrhoeae. All other
specimens must specify N. gonorrhoeae on request if required.
Turnaround: 3 working days
Report: Any significant pathogen and susceptibilities if appropriate.
Histoplasma Antibodies

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Laboratory: Virology: -referred to The Health protection Agency, Mycology Reference Laboratory Bristol
BS2 8EL
Specimen: 7.0 mL blood in a plain gel tube
Comment: Only available in very specific cases and following approval by a Consultant Microbiologist
Turnaround: 1 – 3 weeks
Report: Positive/Negative
Histology Tissue Specimen
Laboratory: Department of Histopathology, Cytopathology and Molecular PathologySpecimen:Submit
specimen intact to laboratory in 10% Neutral Buffered Formalin.
Comment: Health & Safety precautions
Report: Histological diagnosis

HITS (Heparin Induced Thrombophilia Syndrome)

Laboratory: Haematology
Specimen: 7.0 mL blood in a plain gel tube.
Comment: Arrange with Haematology team
Turnaround: 1 day (Mon – Fri)
Ref. Range: Positive / Negative
HLA B27 Typing
Laboratory: Immunology ; Referred to Eurofins Biomnis Laboratories Ltd., Three Rock Pd., Sandyford
Business Est. Sandyford, Dublin 18
Specimen: 5.0 mL EDTA blood
Comment : Restricted test-restricted to the following disciplines Rheumatology, Opthalmology &
Orthopaedics. Please phone labotatory if there are exceptional reasons why this test is
essential
Turnaround: 3 weeks
Report: Eurofins Biomnis report is issued by Immunlogy – refer to report for interpretation
HLA Typing
Laboratory: Referred to Eurofins Biomnis Laboratories Ltd., Three Rock Pd., Sandyford Business Est.
Sandyford, Dublin 18
Specimen: 7.0 mL EDTA blood
Comment : Restricted test
Turnaround: 3 weeks
Report: Eurofins Biomnis report is issued by Immunlogy. Refer to report.
Homocysteine
Laboratory: Clinical Biochemistry
Specimen: 4.0 mL EDTA blood delivered to the laboratory within 60 minutes of collection
Turnaround: 1 week
Ref. Range: On report form
Human Immunodeficiency Virus antigen/antibody

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Laboratory: Virology
Specimen: 7.0 mL blood in a plain gel tube.
Turnaround: 2 working days. Samples referred for further testing 1-2 weeks.
Report: Not Detected, if negative. A Provisional report will be issued on any sample giving reactive
findings on initial testing. These specimens are referred to the NVRL for further testing and
a final report.
Human Immunodeficiency (HIV) PCR / Viral Load / Genotype
Laboratory: Virology
Specimen: One 8 ml Greiner K2EDTA Vacuette tube (Ref: 455040) for viral load testing. Two tubes if
Genotype is also required.
Comment: Specimen must be delivered to a Virology staff member within 3 hours of phlebotomy.Greiner
tubes should be used to collect both adult and paediatric samples. Only samples collected in
these tubes are suitable for processing. The Greiner tubes are available from Laboratory
Stores (Ext 4377). Samples must be received in the laboratory before 4pm.
Turnaround: 1 – 3 weeks
Report: Detected/Not detected
Human T-Lymphocyte Virus
Laboratory: Virology: -referred to National Viral Reference Laboratory, Dublin.
Specimen: 7.0 mL blood in a plain gel tube
Comment: Only available in specific cases and following approval by the MicrobiologyMedical staff
Turnaround: 2 – 4 weeks
Report: Reported in IU/ml

Huntington’s Disease
Laboratory: Immunology: – referred to Department of Clinical Genetics, OLCH, Crumlin, Dublin.
Specimen: 0.5 ml blood in EDTA tube
Comment : It is mandatory for all requests to be accompanied by a fully completed CHI Genetic request
form. It is critical the informed consent section is completed. Testing will not be carried out if
forms are not completed fully. CHI request forms can be download from www.olchc.ie
Turnaround: Up to 12 weeks
Ref range: Refer to report- including interpretative comment
Hurler’s Syndrome Screen
See “Alpha-1-iduronidase”
Hydatid antibodies
Laboratory: Virology: -referred to the Hospital for Tropical Diseases, London WCIE 6AU
Specimen: 7.0 mL blood in a plain gel tube
Comment: Only available in very specific cases and following approval by a Consultant
Microbiologist
Turnaround: 2 – 3 weeks
Report: Positive/Negative

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Hydatid Cyst
Laboratory: Medical Microbiology
Specimen: Fluid from liver to sterile container. Delay > 2 h refrigerate @ 2-8OC.
Turnaround: 2 working days
Report: Presence or absence of Echinococcus sp.
17-Hydroxyprogesterone (infants)> and <1year old
Referred to external laboratory for analysis.
See “17-Alpha-OH-Progesterone, < 1 year old »
Immunoglobulins IgG / IgA / IgM and Serum Protein Electrophoresis
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 10 working days
Ref. Range: Immunoglobulin Levels:
Age IgG g/L IgA g/L IgM g/L
14 years-Adult 7 -16 0.7 -4 0.4 -2.3
For Age-related Paediatric Ranges see report
Electrophoresis / Immunofixation: Report with interpretative comment.
Note: electrophoresis results reported for patients > 30 years
IgD
Laboratory: Immunology: – referred to Immunology dept, Northern General hospital, Sheffield
Specimen: 5 mL blood in plain gel tube
Turnaround: 6 weeks
Ref. Range: Refer to report
IgE (Total)
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 7 working days
Ref. Range: Age IgE kU/L
11yrs - adult 4 -100
For Age-related Paediatric Ranges see report
IgG Subclasses (IgG1, IgG2, IgG3)
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 10 working days
Ref. Range: IgG1 g/L IgG2 g/LIgG3 g/L
Adult 3.2-10.2 1.2-6.6 0.2 -1.9
For Age-related Paediatric Ranges see report

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IgG Subclasses (IgG4)
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 10 working days
Ref. Range: IgG4 g/L
Adult 0-1.29
IL28B genotyping
Laboratory: Immunology ; referred to National Virus Reference Laboratory, UCD.
Specimen: 8.0 mL EDTA blood
Turnaround: 4 weeks
Ref. Range: Refer to report- including interpretative comment
Immunofluorescence Biopsies - Renal
Laboratory: Please notify the Histopathology Department (ext. 4589) at least 24 hours in advance.
Specimen: Place the biopsy in normal saline to maintain hydration and deliver to the laboratory
immediately. Include contact details on request form.
Comment: Health & Safety precautions
Report: Histological diagnosis
Immunofluorescence Bipsies - Skin
Laboratory: Please notify the Histopathology Department (ext. 4589) at least 24 hours in advance.
Specimen: Deliver to the laboratory immediately. Include contact details on request form.
Comment: Health & Safety precautions
Report: Histological diagnosis
Immunophenotyping (Flow Cytometry)
Laboratory: Haematology
Specimen: 3.0 mL K3 EDTA blood or Bone Marrow aspirate in EDTAor Lymph Node Biopsy in RPMI
Comment: Requests for flow cytometry tests should only be received Monday –Thursday between 9am
and 5pm unless prior arrangements have been made with Flow Cytometry.
Prior arrangement with Consultant Haematologist or SPR.
Turnaround: 2 – 5 days
Report: Contact Consultant Haematologist
Infliximab (trough levels)
Laboratory: Immunology
Specimen: 5.0 mL blood in a plain gel tube
Turnaround: 5 working days
Interpretation: Induction (week 2) ≥20µg/ml
Induction (week 6) ≥10µg/ml
Post induction (week 14) ≥3µg/ml
Maintenance ≥3µg/ml

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Comment : Antibodies to Infliximab will be reflex tested if necessary. Negative = <10ng/mL
Influenza A virus
Laboratory: Virology
Specimen: Combined nasal/throat swab in viral transport medium
Comment: Seasonal availability only
Turnaround: 2-3 working days
Report: Detected/Not Detected
Influenza B virus
Laboratory: Virology
Specimen: Combined nasal/throat swab in viral transportmedium.
Comment: Seasonal availability only
Turnaround: 2 - 3 working days
Report: Detected/Not Detected
INR (International Normalised Ratio)
Laboratory: Haematology
Specimen: 2.7 mL blood in a 0.109m Sodium Citrate tube. (1.0 mL Paediatric tubes are available).
Comment: Fill bottle to mark. Details of anticoagulant therapy required. Do not refrigerate specimens
for INR. INR is used to monitor Warfarin therapy.
Turnaround: 1 day
Ref. Range: See report form
Insulin
Laboratory: Clinical Biochemistry
Specimen: 7.0mL fasting blood in a plain gel tube delivered immediately to the laboratory
Turnaround: 1 week
Ref. Range: On report form
Insulin Like Growth Factor 1
Laboratory: Clinical Biochemistry.
Specimen: 7.0 mL fasting blood in a plain gel tube, delivered to laboratory same day
Turnaround: 3 weeks
Ref. Range: See report form
Interleukin 6
Laboratory: Clinical Biochemistry.
Specimen: 7.0 mL blood in a plain gel tube
Comment: Specimen must be receievd in the laboratory on the day of venepuncture.
Turnaround: Urgent: 2 hours. Priority: 3hours. Routine: 4 working days
Ref. Range: See report form
Intraocular Fluids / Corneal Scrapings
Laboratory: Medical Microbiology
Specimen: Pre-inoculated media. If sufficient fluid use sterile container.

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Comment: Contact Laboratory to collect fresh culture plates and slide for corneal scrapings. Deliver to
Laboratory immediately.
Turnaround: 3 days
Report: Clinically significant isolate with the appropriate sensitivi
Intra – Uterine Contraceptive Device (IUCD)
Laboratory: Medical Microbiology
Specimen: Intra Uterine Device. Delay > 2 h refrigerate @ 2-8OC.
Comment: Only submit for culture with relevant clinical details. Endocervical swabs and Urethral swabs
are routinely cultured for N. gonorrhoeae. All other specimens must specify N. gonorrhoeae
on request if required.
Turnaround: 3 working days
Report: Clinically significant isolate with the appropriate sensitivities
Intravascular Cannulae - Culture
Laboratory: Medical Microbiology
Specimen: Cut 4cm of line to sterile container. Delay > 2 h refrigerate @ 2-8OC.
Comment: Only submit specimen for culture where indications of infection are present.
Turnaround: 3 working days
Report: Clinically significant isolate with the appropriate sensitivities.
Iron
Laboratory: Clinical Biochemistry
Specimen: Fasting sample required. 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 2 hours. Priority: 3hours. Routine: 4 working days
Ref. Range : On report form
Iron Stain (Perla Prussian Blue – Cytochemical Stain)
Laboratory: Haematology
Specimen: Bone marrow spread on a glass slide
Comment: As for Bone Marrow testing
Turnaround: 2 weeks
Ref. Range: N/A
JAK -2 Mutation
Laboratory: Haematology: - referred to CMD Laboratory, St James Hospital, Dublin 8
Specimen: 3 x 3.0 mL K3 EDTA blood
Comment: Test available Monday-Thursday only
Turnaround: 120 days
Ref. Range: N/A
Joint Aspirates – Uric Acid Crystals
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: 5-10 mls fresh specimen in a universal container. Do not use fixative. Specify if cytology or
crystal analysis is required. Please do not inject any material into joint before obtaining joint

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 fluid sample. Submit sample to laboratory ASAP.Refrigerate overnight if necessary. Please use
powder free gloves to avoid contamination of sample by powder .
Comment: Indicate clinical history on test requisition and reason for test.
Turnaround: 80% by 5 working days
Report: Detection of inflammatory conditionsJoint Fluid
Laboratory: Medical Microbiology
Specimen: Specimen in sterile container. Delay > 2 h refrigerate @ 2-8OC.
Turnaround: 3 working days
Report: Clinically significant isolate with the appropriate sensitivities
Joint Fluid – Uric Acid Crystals
Please refer to Joint Aspirates
Karyotyping
See Cytogenetics
Ketones – Beta-hydroxybutrate, Acetoacetate and Pyruvate
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 2 hours. Priority: 3hours. Routine: 4 working days
Ref. Range: On report form
Kleihauer Test for Foetal Cells
Laboratory: Haematology
Specimen: 3.0 mL K3 EDTA blood - fresh.
Comment: Limited service available.This test is not available in UCHG for Rh determination. Request
form must contain relevant clinical details.
Turnaround: 1 day (Mon – Fri) – not available on weekends.
Ref. Range: N/A
KRAS Mutation analysis
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Tissue samplesalready processed by the Histopathology Laboratory,
Request from Arrange via consultant pathologist.
Comment; Testing available on request from consultant Pathologist.
Referrals Contact the Department of Histopathology, Cytopathology and Molecular pathology on 4078
Turnaround; 5 – 10 working days after request from Pathologist received
Report: Integral part of Histopathology report issued by Division of Anatomic Pathology
Lactate
Laboratory: Clinical Biochemistry: -also available on Blood Gas analysers located in A/E, ICUs, HDU, NICU,
AMAU, Labour ward, theatre and SCU.
Specimen: Blood in a balanced heparin syringe delivered to laboratory within 15 minutes of collection.
Comment: Advisable to contact lab in advance of taking specimen
Turnaround: 15 mins
Ref. Range: On report form

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Lactate Dehydrogenase (LDH)
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 1hour. Priority : 3 hrs. Routine: same day.
Ref. Range: On report formLead
Laboratory: Clinical Biochemistry: referred to external laboratory for analysis
Specimen: 7.0 mL blood in a Na+. EDTA trace element tube.
Turnaround: 1 month
Ref. Range: On report form
Legionella culture
Laboratory: Medical Microbiology
Specimen: Sputum or BAL in 60 mL sterile container. Delay > 2 h refrigerate @ 2-8OC.
Comment : Atypical pneumonia.
Turnaround: 10 days
Report: Legionella sp isolated / Not isolated.
Legionella pneumophila Urinary Antigen
Laboratory: Virology
Specimen: Plain random urine specimen in a sterile Universal container
Comment: Specimen to arrive in laboratory within 24 hours of collection
Turnaround: 1 working day
Report: Detected / Not Detected
Leishmania antibody
Laboratory: Virology: -referred to The Hospital for Tropical Diseases, London WCIE 6AU
Specimen: 7.0 mL blood in a plain gel tube
Comment: Only available in very specific cases and following approval by a Consultant Microbiologist
Turnaround: 2 – 3 weeks
Report: Positive/Negative
Leptospira antibody
Laboratory: Virology : referred to National Virus Reference Laboratory
Specimen: 7.0 mL blood in a plain gel tube.
Turnaround: 2-3 weeks.
Report: Positive/Negative
Leucocyte Alkaline Phosphatase (LAP) Cytochemical Stain
Laboratory: Haematology
Specimen: 6.0 mL Li Heparin blood
Comment: Prior authorization by Haematology SPR.
Turnaround: 2 days
Ref. Range: Refer to report
Leucocyte Mixed-Esterase Stain (Cytochemical Stain)
Laboratory: Haematology

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Specimen: Bone marrow slides
Comment: Prior authorization by Haematology SPR.
Turnaround: 2 days
Ref. Range: N/A
Leucocyte Esterase Stain (Cytochemical Stain)
Laboratory: Haematology
Specimen: 3.0 mL K3 EDTA blood
Comment: Prior authorization by Haematology SPR.
Turnaround: 2 days
Ref. Range: N/A

Leucodystrophy Screen: Very Long Chain Fatty Acids

Laboratory: Clinical Biochemistry: -referred to external laboratory for analysis
Specimen: 3.0 mL K+ EDTA blood
Turnaround: 1 – 3 weeks
Ref. Range: On report form
LH
Laboratory: Clinical Biochemistry
Specimen: 7.0mL blood in a plain gel tube
Turnaround: Priority : 1working day. Routine : 2 working days
Ref. Range: On report form

Lipoprotein (a)
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Lithium
Laboratory: Clinical Biochemistry
Specimen: 7.0mL blood in a plain gel tube
Comment: Sample 12 hours post dose
Turnaround: Urgent: 1hour. All other requests: 3hours
Therapeutic Range: On report form
Liver core biopsy- (Hep C, Primary tumour or metastases)
Laboratory: Histopathology
Specimen: Submit specimen intact to laboratory in 10% Neutral Buffered Formalin.
Comment: Health & Safety precautions.
Report: Histological diagnosis
Lletz
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology

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Specimen: Submit specimen intact to laboratory in 10% Neutral Buffered Formalin.
Comment: Health & Safety precautions.
Report: Histological diagnosis
Low Density Lipoprotein (LDL)
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Comment: Calculated parameter
Turnaround: Urgent: 2 hours. Priority: 3hours. Routine: 4 working days
Ref. Range: On report form
Lupus Anticoagulant Screen
Laboratory: Haematology
Specimen: 2 x 2.7 mL blood in 0.109m Sodium Citrate tubes
Comment: Details of anticoagulant therapy required. Must fill bottle to mark. Samples must submitted
within 6 hours of draw.
Turnaround: 5 Weeks.
Ref. Range: Qualitative Positive/Negative
Lyme Disease Antibodies
See “Borrelia burgdorferi”
Lymph Nodes for Query Lymphoma
Laboratory : Department of Histopathology, Cytopathology and Molecular Pathology
Specimen : Fresh Tissue. Submit specimen intact to laboratory UNFIXED
Comment : To be confirmed with Consultant Histopathologist at least 24 hours in advance. Immediately
Dispatch to the lab.
Report : Histological diagnosis.

Lymphocyte subsets CD3 (T cell) CD4 (T helper) CD8 (T cytotoxic) CD19 (B cell) CD16/56 (NK cell)
Laboratory: Immunology
Specimen: 5.0 mL blood in EDTA bottle. Do not refrigerate.
Comment: Record time and date of collection on form. Samples must be kept at room temperature,
deliver to Immunology within 48 hours.
Turnaround: 3 working days
Ref. Range: Refer to report
Lymphogranuloma venereum antibodies
Laboratory: Virology: -referred to the Health Protection Agency, South West Lab. Bristol BS” 8EL
Specimen: 7.0 mL blood in a plain gel tube
Comment: Only available in very specific cases and following approval by a Consultant Microbiologist
Turnaround: 2 – 4 weeks
Report: Positive/Negative
Lysosomal Enzymes (Plasma and White Cell Enzyme Screen)
Laboratory: Clinical Biochemistry: -referred to external laboratory for analysis

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Specimen: 5.0 mL blood in EDTA tube.
Comment : Contact laboratory prior to specimen collection. Monday and Tuesday am only
Turnaround: 1 – 3 weeks
Ref. Range: See report form
Magnesium
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 2 hours. Priority: 3hours. Routine: 4 working days
Ref. Range: On report form
Magnesium (Urine)
Laboratory: Clinical Biochemistry
Specimen: 24 h collection
Turnaround: 1 working day
Ref. Range: On report form
Malaria Screen
Laboratory: Haematology
Specimen: 3.0 mL K3 EDTA blood. Fresh sample required.
Comment: Blood film is examined microscopically. The blood is tested for the presence of parasite
associated enzyme. Positive specimen forwarded to Microbiology Laboratory. Travel history
and clinical details essential. When submitting malarial requests please alert the Laboratory.
Turnaround: 1 day (Mon – Fri). Results of this test done out of hours or on weekends are confirmed by
second scientist as soon as possible on the next working day.
Report: Positive / Negative. Where clinically indicated a negative specimen may be referred to a
reference centre for analysis by PCR.
Malignancy
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology Specimen:Submit
specimen intact to laboratory in 10% Neutral Buffered Formalin.
Comment: Health & Safety precautions
Report: Histological diagnosis
Manganese
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: 4.0 mL in a trace element EDTA tube.
Turnaround: 3 – 4 weeks
Ref. Range: See report form
Measles IgG antibody
Laboratory: Virology
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: 1 – 2 weeks
Report: Detected / Not Detected
Measles IgM antibody

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Laboratory: Virology :- referred to National Virus Reference Laboratory
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: 2-3 weeks.
Report: Detected / Not Detected
Meningococcal C vaccine antibodies - Serum
Laboratory: Immunology: – referred to Immunology Dept, Meningococcal Reference Unit, Manchester
Medical Microbiology Partnership
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 6 weeks
Ref range: Refer to report
Meningococcal PCR
Laboratory: Medical Microbiology.
Specimen: Greater than 200 ul CSF in a sterile plain tube or EDTA blood
Comment: Sample to be handed to Medical Microbiology staff member
Turnaround: 1 – 5 working days
Report: Meningococcal DNA Detected/Not detected
Mercury - Urine
Laboratory: Clinical Biochemistry: -referred to external laboratory for analysis
Specimen: 24 h urine collection
Turnaround: 1 – 3 weeks
Ref. Range: See report form
Metabolic Screen (Amino Acid Chromatography)
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: Li Heparin or clotted blood specimen
Comment : Full clinical details must accompany request
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Metabolic Screen (Urine Amino Acid Chromatography)
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: Plain random urine specimen
Comment : Full clinical details must accompany request
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Metanephrines (Metanephrine/Normetanphrine/3-methoxytyramine - Plasma)
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: 1 x 5 mL: k+EDTA (Plasma) on ice patient fasting cannulated and supine for 30 mins.
Delivered to laboratory immediately.
Comment: Specimen must be delivered immediately to the lab post phlebotomy.
Turnaround: 1 – 3 weeks
Ref. Range: On report form

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Metanephrines (Urine)
See “Adrenaline / Noradrenaline / Dopamine”
Methadone
See “Toxicology Screen”

Methaemoglobin
Laboratory: Haematology
Specimen: 3.0mL in a Lithium Heparin Syringe
Delivery during the hours of 9.30 a.m. to 12.30 and 2 p.m. to 5 p.m. Monday to Friday.
Immediate delivery to the laboratory for testing within the one hour requirement.
Comment: Clinical Details are essential.
Turnaround: 2 days
Ref. Range: Refer to report

Methicillin-Resistant Staph aureus (MRSA)

Laboratory: Medical Microbiology
Specimen: Swab in transport medium. Delay > 2 h refrigerate @ 2-8OC.
Comment: Restricted to specific groups of hospitalized patients. Pre-op screens from GPs. Other Non
hospitalized patients are screened by prior arrangement with a Consultant Microbiologist.
Turnaround: 3 working days.
Report: MRSA isolated / Not isolated.
Methotrexate (Maxtrex)
Laboratory: Clinical Biochemistry
Specimen: 5.0mL blood in a non-gel tube
Comment: State date/time of sample collection clearly on request form. Measured on patients on high-
dose Methotrexate. Contact Lab in advance and state time of infusion on request form.
Turnaround: 1 – 2 hours
Ref. Range: Guidance on report form
Methylmalonic Acid (Plasma)
Laboratory: Haematology: - referred to external laboratory for analysis
Specimen: Frozen Serum x 2ml OR Frozen Plasma x 2ml
Turnaround: 5 weeks
Ref. Range: On report form
Methylmalonic Acid (Urine)
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: Plain random urine specimen
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Microalbumin / Creatinine Ratio

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See ‘Albumin (Urine) / Microalbumin’

Microarray/aCGH
See Cytogenetics: Microarray/aCGH
Micropolyspora faenii (Farmer’s Lung)
See: “Farmer’s Lung antibodies”

Molecular Genetics
See to section 11.10 Guidelines relating to genetic referrals
Morphine (Opiates)
See “Toxicology Screen”
Morphology
Laboratory: Haematology
Specimen: 3.0 mL K3 EDTA blood or Blood film
Comment: Blood films are made, examined and reported on patients FBC results which satisfy the
criteria laid down by the laboratory in the guidelines ‘Indications for blood film examination’.
When a blood film is specifically requested which falls outside of these guidelines this will be
examined where the request form provides clinical details.
Turnaround: Where clinical details are supplied urgent requests receive immediate attention. Routine
differentials are reported within 1 day. Routine Morphologies reported within 4 days.
Report: See report form
Mouth Swab
Laboratory: Medical Microbiology
Specimen: Swab in transport medium. Delay > 2 h refrigerate @ 2-8OC.
Turnaround: 3 working days
Report: Presence of pathogens/ No Pathogens isolated.

MRD-CLL (Minimum Residual Disease detection of Chronic Lymphocytic Leukaemia)

Laboratory: Haematology
Specimen: 3.0ml K3EDTA
Comment: Samples must be received within 24 hours. Full clinical information and reason for request
must accompany specimen.
Turnaround: 3 -5 working days.
Report: Interpretation by Consultant Haematologist on report form.
MRSA (Methicillin-Resistant Staph aureus)
Laboratory: Medical Microbiology
Specimen: Swab in transport medium. Delay > 2 h refrigerate @ 2-8OC.
Comment: Restricted to specific groups of hospitalized patients. Pre-op screens from GPs. Other Non
hospitalized patients are screened by prior arrangement with a Consultant Microbiologist. .

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Turnaround: 3 working days.
Report: MRSA isolated / Not isolated.
MSU – Midstream Urine
Laboratory: Medical Microbiology
Specimen: Specimen in Boric Acid Universal container. Use plain sterile Universal container for Paediatric
specimen or urine volumes < 20 mL. Specimen of Urine in Urine vacuum tube container.
Comment: Urine taken at mid-point of urination. Delay >2 h refrigerate @ 2-8OC
Turnaround: Microscopy: 4 hrs for Urines received 8am to 12 midnight. Paeds Urines only processed post
midnight. Culture: 3 working days
Report: Microscopy: Cell count. Culture: Presence of significant pathogen and sensitivities if relevant.

Mumps IgG antibody

Laboratory: Virology
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: 1-2 weeks
Report: Detected / Not Detected/EquivocalMumps IgM antibody
Laboratory: Virology : Referred to NVRL
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: 1 -2 weeks.
Report: Detected / Not Detected
Muscle Biopsies
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Fresh tissue
Comment: Immediate dispatch to laboratory where tissue pieces are frozen / formalin fixed. Fresh tissue
samples to be confirmed with the Consultant Pathologist (on frozens) at least 24 hours in
advance.
Report: Histological diagnosis
Mycobacteria Testing
Laboratory: Medical Microbiology
Specimen: Specimen of sputa, BAL in sterile 60 mL container. Early morning urine in 100 mL sterile
container by prior arrangement only. Fluids / tissues in sterile containers. Blood Culture /
Bone Marrow aspirate, heavily blood stained fluids in Bactec Myco/Lytic (red cap) vials. Delay
> 2 h refrigerate @ 2-8OC.
Comment: Decontaminated respiratory specimens are retained for 7 weeks. They are unsuitable for
other investigations once decontaminated.The mycobacteria culture system is not validated
for processing urine specimens.
Turnaround: Microscopy: 1 working day. Culture: 6 to 7 weeks
Report: Microscopy: Presence or absence of AAFB. Culture: Mycobacteria sp isolated / Not isolated &
sensitivities if relevant.

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Mycobacteria PCR - Xpert assay
Laboratory: Medical Microbiology
Specimen: Specimen of sputa, BAL in sterile 60 mL container. Fluids / tissues in sterile containers.
Minimum volume for CSF sis 600µl.
Comment: Xperts are performed on all initial specimens with AAFB seen on microscopy or by prior
arrangement with Microbiology Medical Staff. Grossly blood stained samples are not suitable
for GeneXpert.
Turnaround: 1-2 working days (Verbal report available on positive samples)
Report: MTB Complex DNA Detected/Not Detected.

Mycology
Laboratory: Medical Microbiology
Specimen: Transport swab. Tissue / pus in sterile container. Hair, nail clippings, skin scrapings in
Dermapak. Refer to Medical Microbiology section.
Comment: Delay > 2 h refrigerate @ 2-8OC.
Turnaround: 5 to 6 weeks
Report: Microscopy : presence or abscence of fungal elements Culture : Fungi Isolated/Not Isolated.

Mycoplasma pneumoniae antibody

Laboratory: Virology: -Referred to National Virus Reference Laboratory, Dublin
Specimen: 7.0 mL blood in a plain gel tube
Comment: Available only in very specific cases and following prior arrangement with a Consultant
Microbiologist
Turnaround: 2-3 weeks
Report: Positive/Negative
Myoglobin
Laboratory: Clinical Biochemistry : - referred to external laboratory for analysis
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: 1 – 2 weeks
Ref. Range: On report form
Myositis Specific and Associated Antibodies Screen
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 10 working days
Report: Positive/Negative
Please refer to the table on Page 55 & 56 for details
(Antibodies detected on the Myosistis screen denoted by *) .
Neoplasm

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Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Submit specimen intact to laboratory in 10% Neutral Buffered Formalin.
Comment: Health & Safety precautions
Report: Histological diagnosis
Neutrophil Function Test – Dihydrorhodamine Flow Cytometry Assay of Respiratory Burst Activity
Laboratory: Immunology
Specimen: 5 mL blood in EDTA must be kept at room temperature. Do not refrigerate.
Control sample must also be taken. Samples must be delivered to lab within 24 hours.
Comment: Testing must be first discussed with immunology medical/scientific staff
Turnaround: 2 days
Report: Normal/Abnormal
N. meningitidis PCR
See “Meningococcal PCR”

Neisseria gonorrhoeae PCR

Laboratory: Virology
Specimen: Abbott Multicollect swab delivered to the laboratory within 24 h of collection.
Comment: If delay refrigerate @ 2-8OC.
Turnaround: 10 working days
Report: Detected / Not Detected
Noradrenaline (Adrenaline/Dopamine)
See “Catecholamines”
Norovirus detection
Laboratory: Medical Microbiology
Specimen: Faeces in spoon container. Delay < 24 h refrigerate @ 2-8OC. Delay > 24 freeze @ -20OC.
Comment: Only processed by prior arrangement with microbiology consultant.
Turnaround: 1 working day
Report: Norovirus antigen detected / Not detected. Molecular: Norovirus Genotype 1 & 2 RNA
detected / Not detected
Nose Swab
Laboratory: Medical Microbiology
Specimen: Swab in transport medium. Delay > 2 h refrigerate @ 2-8OC.
Comment: Only processed for S. aureus.
Turnaround: 3 working days
Report: S. aureus isolated / Not isolated.
NRAS
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen : Tissue samples already processed by the Histopathology laboratory, arrange via Consultant
Pathologist
Comment : Testing available on request by Pathologist

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Referrals : Contact the Department of Histopathology, Cytopathology and Molecular Pathology on 4078
Turnaround : 5-10 working days after request from Pathologist received
Report : Integral part of Histopathology report issued by the Division of Anatomic Pathology,
Department of Histopathology, Cytopathology and Molecular Pathology
NT-ProBNP
Laboratory: Clinical Biochemistry
Specimen: 7.0mL blood in a plain gel tube
Turnaround: Priority : 1 working day. Routine : 2 working days
Ref. Range: On report form
Oestradiol
Laboratory: Clinical Biochemistry
Specimen: 7.0mL blood in a plain gel tube
Turnaround: Urgent: 1hour. Priority: 1 working day. Routine : 2 working days
Ref. Range: On report form
Opiates
See “Toxicology Screen”
Organic Acids
Laboratory: Clinical Biochemistry:- referred to external laboratory for analysis
Specimen: Plain urine specimen
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Osmolality
Laboratory: Clinical Biochemistry
Specimen: 7.0mL blood in a plain gel tube
Turnaround: Urgent: 1hour. Priority: same day. Routine: 4 working days
Ref. Range: On report form

Osmolality (Urine)
Laboratory: Clinical Biochemistry
Specimen: Plain random urine specimen
Turnaround: Urgent : 1hour. Priority : same day. Routine : 2 working days
Ref. Range: On report form
Osmotic Fragility
Laboratory: Haematology
Specimen: 5.0 mL Li fresh Heparin blood and a normal control specimen in 5.0 mL Li Heparin
Comment: Authorisation by Haematology SPR and arrangement with laboratory. The specimen must
reach the laboratory before 11:00 on day of analysis.
Turnaround: 2 days
Ref. Range: See report form.

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Ova / Cysts / Parasites
Laboratory: Medical Microbiology
Specimen: Faeces in leak proof container. Delay > 2 h refrigerate @ 2-8OC.
Comment: Cryptosporidium and Giardia detection by moleculatr technique. Other ova and parasites are
rarely detected in faeces. Examination for other O&P is only performed when specific
additional parasite is specified on the request form, accompanied by relevant clinical
information.
Turnaround: 3 days for Cryptosporidium and Giardia molecular detection. 1 week for parasite
concentration.
Report: Cryptosporidium / Giardia Detected / Not Detected.Ova, Cysts or Parasites Seen / Not seen.

Ovarian Cyst Fluid, Neoplastic/Non-Neoplastic Cells

See Effusions/ FNA
Paracetamol
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 1hour. All other requests : 3hours.
Interpretation : On report form
Paraneoplastic Antibodies
See “Autoantibodies: Anti-Neuronal Antibodies”
Paraquat - Urine
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: Plain random urine specimen
Turnaround: 1 day if prior notification received
Ref. Range: On report form
Parvovirus / B 19 IgM Antibodies
See “Erythrovirus B19”
Pelvic Cavity Wash (Diaphragm, Gutter or Cul de sac Wash)
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology Specimen:Collect 10
- 20 mL fresh specimen into a twist top leak proof 20 mL or 50 mL universal sample bottle
containing Shandon Cytospin Collection Fluid (green fixative solution). Refrigerate overnight
if necessary.
Comment: Indicate clinical history on test requisition and reason for test.
Turnaround: 80% in 5 working days
Report: Detection of neoplastic and non neoplastic cells
Penile Swab
Laboratory: Medical Microbiology
Specimen: Swab in transport medium. Delay > 2 h refrigerate @ 2-8OC

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Comment: Treated as skin swab. For investigation for Neisseria gonorrhoeae a Urethral swab must be
sent.
Turnaround: 3 working days
Report: Any significant pathogen and susceptibilities if appropriate.
Pericardial Fluid – Pleural Fluid - Cytology
See “Effusions”
Pericardial Fluid / Peritoneal Fluid / Pleural Fluid
Laboratory: Medical Microbiology
Specimen: Specimen in sterile container (include clotted material). Delay > 2 h refrigerate @ 2-8OC.
Turnaround: 3 working days
Report: Growth / No Growth & sensitivities if required
Peritoneal Fluid - Cytology
See “Effusions”

Pernasal Swab / Pertussis

Laboratory: Medical Microbiology
Specimen: Pernasal swab (available from Medical Microbiology).
Comment: Delay > 2 h refrigerate @ 2-8OC.
Turnaround: 10 days
Report: Growth / No Growth of Bordetella sp
Phenylalanine
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: 2.0 mL Li Heparin blood and a Gutherie card
Comment: Request form MUST include clinical details
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Phenytoin (Epanutin)
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Comment : Take specimen immediately before next dose (trough specimen)
Turnaround: 1 week
Therapeutic. Range: On report form
Phosphate -inorganic
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 1hour. Priority: 3 hours. Routine : 2 working days
Ref. Range: On report form
Phosphate (Urine)
Laboratory: Clinical Biochemistry

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Specimen: 24 hour urine collection
Comment: Used in conjunction with serum inorganic phosphate to calculate IPeGFR
Turnaround: 1 working day
Ref. Range: On report form
Phytanic Acid
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: 3.0 mL EDTA blood
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Pippelle Biopsy
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology Specimen:
Specimen : Submit specimen to laboratory in 10% Neutral Buffered Formalin.
Comment: Health & Safety precautions
Report: Histological diagnosis
Pinworm
Laboratory: Medical Microbiology
Specimen: Apply sellotape to anal area, fix to slide, send to Laboratory. Delay > 2 h refrigerate @ 2-8OC.
Turnaround: 1 week
Report: Ova seen / Not seen
Placenta
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Submit specimen intact to laboratory in 10% Neutral Buffered Formalin.
Comment: Placentas from labour ward should be placed in adequate formalin fixative and placed in the
large size container. Ensure both requisition form and container are labelled with specimen
Placenta and with patient demographics. Clinical details should always incluse gestational age
at time of delivery, in addition to other relevant clinical information.
Health & Safety precautions
Report: Histological diagnosis
Plasma Viscosity
Laboratory: Haematology
Specimen: 3 x 3.0 mL K3 EDTA blood
Comment: Must be received in laboratory within 2 hours of phlebotomy
Turnaround: 1 day
Ref. Range: Refer to report
Platelet Aggregation Studies
Laboratory: Haematology
Specimen: 6 x 2.7 mL blood specimens in 0.109m Sodium Citrate tubes. Please supply samples from a
normal control in conjunction with the test specimens.
Comment: Prior authorization by Consultant Haematologist or SPR. Arrange with Coagulation laboratory
before taking specimen. Patient must not take any anti-platlet medications for 1 week prior

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 to test (incl. aspirin, NSAIDA, Clopidogrel/plavix, cough suppressants). Discard the first
specimen when obtaining blood from patient as there may be some platlet activation present
which will influence the test results. Specimens must reach the Coagulation laboratory no
later than 11:00 on the day of analysis. Must fill bottles to mark.
Turnaround: Àssay performed on day of appointment
Ref. Range: N/A
Pleural Fluid - Cytology
See “Effusions”
Pleural Fluid Microscopy & Culture
Laboratory: Medical Microbiology
Specimen: Pleural fluid in sterile container. Delay > 2 h refrigerate @ 2-8OC.
Turnaround: Microscopy: 1 working day. Culture: 3 working days
Report: Microscopy: Cell count, Differential and Gram stain
Culture: Growth / No Growth & sensitivities if required

Pneumococcal PCR
Laboratory: Medical Microbiology
Specimen: Greater than 200 ul CSF in a sterile plain tube or EDTA blood
Comment: Sample to be handed to Medical Microbiology staff member
Turnaround: 1 – 5 working days
Report: Pneumococcal DNA: Detected / Not Detected
Pneumococcus IgG/ IgG2 antibodies
Laboratory: Immunology
Specimen: 5.0mL blood in plain gel tube
Turnaround: 5 weeks
Ref range: Pneumococcus IgG: 11.0 - 320.8 mg/L
Pneumococcus IgG2: 1.2 – 107.1 mg/L
Pneumocystis jiroveci investigation
Laboratory: Medical Microbiology
Specimen: BAL or induced sputum only. Delay > 2 h refrigerate @ 2-8OC.
Turnaround: 2 weeks
Report: Pneumocystis DNA detected / Not detected

PNH Screening (Paroxysmal Nocturnal Haemoglobinuria) by Flow Cytometry

Laboratory: Haematology:
Specimen: 3.0 mL K3 EDTA blood
Comment : Requests for flow cytometry tests should only be received Monday –Thursday between 9am
and 5pm unless prior arrangements have been made with Flow Cytometry.
Samples must be received within 24 hours. Full clinical information and reason for request
must accompany specimen.

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Turnaround: 3-5 working days
Ref Range: Interpretation by Haematologist
POC – Products of Conception
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Submit specimen to laboratory in 10% Neutral Buffered Formalin.
Comment: See also Foetus. Health & Safety precautions
Report: Histological diagnosis
Porphyrin Screen
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: 10.0 mL EDTA blood, 10.0 mL Li Heparin blood, 5g fresh faeces and a 24 hour urine collection
Comment: All specimens must be protected from light
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Post-Vasectomy Analysis
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Semen
Comment: Available Monday to Friday 09:00 to 16:00 h. Refrigerate overnight if necessary. Indicate
clinical history on test requisition. Include the collection time and date.
Report: Histological diagnosis
Potassium
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL fresh blood in a plain gel tube
Comment : GP specimens MUST be received in the laboratory within 3 hours of venesection or
centrifuged.
Turnaround: Urgent: 1hour. Priority: 3 hours. Routine : 2 working days
Ref. Range: On report form
Potassium (Urine)
Laboratory: Clinical Biochemistry
Specimen: 24 hour urine collection
Turnaround: 1 working day
Ref. Range: On report form
Pre-albumin
Laboratory: Clinical Biochemistry: -referred to external laboratory for analysis
Specimen: 4.0 mL blood in a plain gel tube
Turnaround: 1 – 3 weeks
Ref. Range: Male: 0.2 – 0.5 g/L Female:0.1 – 0.4 g/L
Pregnancy Test
See “HCG Total”
Primidone/Mysoline

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Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Comment : Take specimen immediately before next dose (trough specimen)
Turnaround: 1 week
Therapeutic Range: On report form
NT-ProBNP
See « NT-ProBNP »
Procalcitonin
Laboratory: Clinical Biochemistry.
Specimen: 7.0 mL blood in a plain gel tube, received in the laboratory within 6 hours of venepuncture.
Turnaround: Urgent: 2 hours. Priority: 3hours. Routine: 4 working days
Ref. Range: See report form
Procollagen Peptide Type 3
Laboratory: Clinical Biochemistry: -referred to external laboratory for analysis,
Specimen: 5.0 mL blood in a plain tube, received in lab within 1hr
Comment: Do not use a gel tube
Turnaround: 1 – 3 weeks
Ref. Range: On report form

Progesterone
Laboratory: Clinical Biochemistry
Specimen: 7.0mL blood in a plain gel tube
Turnaround: Priority:1 working day. Routine: 4 working days
Interpretation: On report form
Prograf
See “ Tacrolimus”
Proinsulin
Laboratory: Clinical Biochemistry: -referred to external laboratory for analysis
Specimen: 4.0 mL fasting blood in a Li Heparin tube, send to the laboratory immediately
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Prolactin
Laboratory: Clinical Biochemistry
Specimen: 7.0mL blood in a plain gel tube
Turnaround: Priority : 1 working day. Routine : 2 working days
Ref. Range: On report form
Prostatic Core Biopsy
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology

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Specimen: Submit specimen intact to laboratory in 10% Neutral Buffered Formalin. Ensure each
container clearly indicates site and information matches details given on form.
Comment: Health & Safety precautions
Report: Histological diagnosis
Protein
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 1hour. Priority: 3 hours. Routine : 2 working days
Ref. Range: On report form
Protein (Urine)
Laboratory: Clinical Biochemistry
Specimen: 24 hour urine collection
Turnaround: 1 working day
Ref. Range: On report form

Protein C
Laboratory: Haematology
Specimen: 2.7 mL blood in a 0.109m Sodium Citrate tube
Comment: Requests should be received in the laboratory within 2 hours of phlebotomy.
Details of anticoagulant therapy required. Must fill bottle to mark.
Turnaround: 5 weeks
Ref. Range:Refer to report
Protein S and Free Protein S
Laboratory: Haematology
Specimen: 2.7 mL blood in a 0.109m Sodium Citrate tube
Comment: Requests should be received in the laboratory within 2 hours of phlebotomy. Must fill bottle
to mark. Details of anticoagulant therapy required.
Turnaround: 5 Weeks
Ref. Range: Refer to report
Prothrombin Gene Mutation
Laboratory: Haematology:- referred to NCHCD, SJH, Dublin
Specimen: 5.0 mL blood in EDTA tube
Comment: Consent form for genetic analysis must accompany each request for this test. These are
available in the ‘thrombophilia genetic mutation requests’ folder in the GUH Useful Resources
folder on PC Desktop or by contacting the Haematology Lab
Turnaround: 4 weeks
Ref range: N/A
Prothrombin Time (PT)
Laboratory: Haematology
Specimen: 2.7 mL blood in a 0.109m Sodium Citrate tube. (1.0 mL Paediatric tubes are available).

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Comment: Details of anticoagulant therapy required. Do not refrigerate specimens for PT. Must fill bottle
to mark.
Turnaround: 1 day
Ref. Range: Refer to report
PSA Total
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Priority : 1 working day. Routine : 2 working days
Ref. Range: On report form
PTH
Laboratory: Clinical Biochemistry
Specimen: 7.0mL blood in a plain gel tube delivered to the laboratory same day
Turnaround: 1 working day
Ref. Range: On report form
PTH Related Peptide
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: Contact lab for special tube
Turnaround: 1 - 3 weeks
Ref. Range: On report form
Punch Biopsy
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Submit specimen intact to laboratory in 10% Neutral Buffered Formalin.
Comment: Health & Safety precautions. Where specimen is for DIF do not use fixative. See
Immunofluorescence.
Report: Histological diagnosis
Pyruvate Kinase Screening (PK)
Laboratory: Haematology: -referred to Special Haematology, St James Hospital, Dublin 8.
Specimen: 1 x 3.0 mL K3 EDTA blood
Turnaround: 2 weeks
Report: Positive / Negative
Q Fever
See “Coxiella burnetii”
Quantiferon Test
Laboratory : Immunology ; referred to the TB Laboratory, Microbiology, Mater Hospital, Dublin
Specimen : Set of 4 specific Quanitferon tubes and Quantiferon request form – available only from the
Immunology dept
Comment : The 4 samples must reach the laboratory within 16 hours of collection, Monday – Thursday
only before 5pm. NO Friday samples accepted
Turnaround: 3 weeks
Report: Positive/Negative

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Radiation Surgical specimens
Laboratory: Histopathology Radiation Room
Specimen: Formalin fixed tissue. Ensure that the container used is large enough to ensure volume of
fixative x 2 times specimen size. Request form and specimen container must be clearly
labeled as radioactive, with form information to include time, quantity and volume of dose
given.
Comment: The specimen should be delivered to the dedicated lab room for radioactive specimens,
placed behind the lead lined shield, and lab staff informed of its presence there. Report:
Histological diagnosis
RCD 11 Refractory Coeliac Disease Type 11 Detection by Flow Cytometry
Laboratory: Haematology
Specimen: Duodenal biopsies in RPMI.
Comment: Requires prior arrangement with flowcytometry. RPMI is supplied by flowcytometry lab.
Scientist collects sample directly from ward.
Turnaround: 3-5 working days
Ref. Range: Interpretation by Consultant Haematologist on report form
Red Cell Folate
Laboratory: Haematology, Referred to MedLab Pathology
Specimen: 3.0 mL K3 EDTA blood, (1.0 mL Paediatric tubes are available).
Comment: Requests should be received in the laboratory within 8 hours of phlebotomy
Turnaround: 3 weeks
Ref. Range: Refer to report
Reducing Substances (Urine and Faeces)
Laboratory: Clinical Biochemistry :- referred to external laboratory for analysis
Specimen: Faeces specimen, inclusive of liquid element of stool
Comment : Must be frozen within 1hr of collection
Turnaround: 3 – 4 weeks
Report: On report form
Renal Biopsy for Direct Immunofluorescence (DIF)
Laboratory: Please notify Histopathology staff (ext. 4589) at least 24 hours in advance.
Specimen: Place the biopsy in normal saline to maintain hydration and deliver to the laboratory
immediately. Include contact details on request form.
Comment: Health & Safety precautions
Report: Histological diagnosis
Renal Biopsy for Electron Microscopy
Laboratory: Please notify Histopathology Staff (ext. 4589) at least 24 hours in advance
Specimen: Place the biopsy in normal saline to maintain hydration and deliver to the laboratory
immediately. Include contact details on request form.
Comment: Health & Safety precautions
Report: Histological diagnosis

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Renin
Laboratory: Clinical Biochemistry
Specimen: 4.0 mL K+ EDTA blood
Comment: Please provide clinical/antihypertensive medication details.
Turnaround: 3 weeks
Ref. Range: On report form
Respiratory Syncytial Virus
Laboratory: Virology
Specimen: Combined nasal/throat swab in viral transport medium
Comment: Seasonal availability only
Turnaround: 2- 3 working days
Report: Detected/Not Detected
Reticulocyte Count
Laboratory: Haematology
Specimen: 3.0 mL K3 EDTA blood, (1.0 mL Paediatric tubes are available).
Comment: Requests should be received in the laboratory within 8 hours of phlebotomy.
Turnaround: 1 day
Ref. Range: Refer to report
Rheumatoid Factor IgM
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Comment : Requests for Rheumatoid Factor will also be tested for Anti-CCP
Turnaround: 5 working days
Ref. Range: 0 – 14 IU/ml
Rickettsia sp. antibodies
See “Coxiella”
Ristocetin CoFactor (RiCof) (VW F : RiCof)
Laboratory: Haematology
Specimen: 2 x 2.7 mL blood in a 0.109m Sodium Citrate tube. (1.0 mL Paediatric tubes are available).
Comment: Prior authorization by Consultant Haematologist or SPR. Arrange with coagulation laboratory
before taking specimen. Must fill bottles to mark.
Turnaround: 4 weeks
Ref. Range: Refer to report
ROS-1
Laboratory : Department of Histopathology, Cytopathology and Molecular Pathology
Specimen : Tissue samples already processed by the Histopathology laboratory, arrange via Consultant
Pathologist
Comment : Test available on request by Pathologist
Referrals : Contact the Department of Histopathology, Cytopathology and Molecular Pathology on 4078
Turnaround : 5-10 working days after request from Pathologist received

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Report : Integral part of Histopathology report issued by the Division of Anatomic Pathology,
Department of Histopathology, Cytopathology and Molecular Pathology
Rotavirus / Adenovirus Faecal Antigen
Laboratory: Medical Microbiology
Specimen: Faeces collected in acute phase of illness 1-2g in leak proof container. Delay > 2 h refrigerate
@ 2-8OC.
Comment: Rotavirus and Adenovirus are tested for in specimens from children aged less than 5 years of
age.
Turnaround: 1 working day.
Report: Rota / Adenovirus antigen detected / Not detected.
Rubella IgG Antibody
Laboratory: Virology
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: 2 working days
Report: Reported in IU/ml with relevant comment
Rubella IgM Antibody - Serology
Laboratory: Virology
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: 2 working days
Report: Detected / Not Detected
Salicylate
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 1hour. All other requests : 3hours.
Interpretation : On report form
SARS CoV – 2 (PCR)
Laboratory: Virology
Specimen: Combined nasal/throat /nasopharyngeal swab in viral transport medium
Comment: If delay refrigerate @ 2-8OC.
Turnaround: 1 - 2working days
Report: Detected / Not Detected / Indeterminate
Schistosoma haematobium
Laboratory: Medical Microbiology
Specimen: Urine in sterile container. Delay > 2 h refrigerate @ 2-8OC.
Comment: Only performed on request on patients after recent travel to endemic area.Urine volume
>10ml (The urine must be obtained between 10:00-14:00 h on the day of testing).
Turnaround: 1 working day
Report: S. haematobium detected / not detected

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Schistosomal haematobium antibodies
Laboratory: Virology: -referred to the Hospital for Tropical Diseases, London WCIE 6AU
Specimen: 7.0 mL blood in a plain gel tube
Comment: Only available in very specific cases and following approval by a Consultant Microbiologist
Turnaround: 2 – 3 weeks
Report: Positive/Negative
Selenium
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: 7.0 mL trace element EDTA tube
Comment : Transport to Lab ASAP
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Semen Analysis
See “Post-Vasectomy analysis”
Serum Amyloid A (SAA)
Laboratory: Immunology : referred to Immunology dept, Northern General hospital, Sheffield
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 3 weeks
Ref. Range: refer to report
Serum Protein Electrphoresis (SPE)
Refer to Immunoglobulins.
SHBG
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Comment : Female – only analysed where testosterone >1.2nmol/L.
Turnaround: Priority : 1 working day. Routine : 2 working days
Ref. Range: On report form
Sickle Screen (Sickledex)
Laboratory: Haematology
Specimen: 3.0 mL K3 EDTA blood
Comment: Must give clinical details, transfusion history and ethnic origin of patient. Test not valid on
children under six months of age. All sickledex requests are referred for further confirmation
of results by HPLC.
Turnaround: 1 day for screen. 4 weeks for confirmation by HPLC
Report: Positive / Negativ E
Sirolimus
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: 4.0 mL EDTA blood
Turnaround: 1 – 3 weeks

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Ref. Range: Patient specific
Skin Punch Biopsy for Direct Immunofluorescence (DIF)
Laboratory: Please notify Histopathology staff (ext. 4589) at least 24 hours in advance.
Specimen: Place the biopsy in a fully labelled suitable sized container without any preservative and
deliver to the laboratory immediately, with completed request form. Include contact details.If
the biopsy is from outside University Hospital, Galway, the sample may be sent in a suitable
transport medium (e.g Michel’s or Zeuss medium). Ensure the package is addressed to the
Histology Lab rather than the Histology department. The specimen must be delivered directly
to the Histology lab without delay.
Comment: Health & Safety precautions
Report: Histological diagnosis
Skin Swab
Laboratory: Medical Microbiology
Specimen: Swab in transport medium. Delay > 2 h refrigerate @ 2-8OC.
Comment : Only skin swabs with relevent clinical details will be processed
Turnaround: 3 working days
Report: Any significant pathogen & sensitivities if required
Sodium
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 1hour. Priority: 3 hours. Routine : 2 working days
Ref. Range: On report form

Sodium (Urine)
Laboratory: Clinical Biochemistry
Specimen: 24 hour urine collection
Turnaround: 1 working day
Ref. Range: On report form
Sodium Valproate (Epilim)
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Comment : Take specimen immediately before next dose (trough specimen)
Turnaround: 1 week.
Therapeutic Range: On report form
Somatomedin (IGF1)
See “IGF1”
Sputum Culture
Laboratory: Medical Microbiology
Specimen: Purulent specimen in 60ml sterile container. Delay > 2 h refrigerate @ 2-8OC.

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Comment: Salivary specimens will be discarded. Specimens >48hr old will be rejected for culture.
Turnaround: 3 working days
Report: Any significant pathogen & sensitivities if required.
Sputum - Cytology
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: 0.5 ml to 20 mL spontaneous or induced fresh specimen collected into a 20 mL or 50 mL twist
top leak proof universal container.
Comment: Indicate clinical history on test requisition and reason for test. Sputum must be deeply
coughed from lungs. Avoid oral contamination and saliva. Early morning upon rising is the
preferred collection time. Refrigerate if necessary.
Turnaround: 80% by 5 working days
Report: Detection of neoplastic and non neoplastic cells.Detection of infectious organisms.
Stem Cell Quantification
Laboratory: Haematology
Specimen: 3.0 mL K3 EDTA blood or specimen from aphaeresis collection.
Comment: All Stem Cell quantifications must be preauthorized by Consultant Haematologist or SPR and
prearranged with both laboratory and point of clinical activity. Specimen must be
accompanied by special request form available from the Haematology laboratory and signed
on receipt in the laboratory.
Turnaround: 1 day
Ref. Range: N/A

Strongyloides antibodies
Laboratory: Virology: -referred to the Hospital for Tropical Diseases, London WCIE 6AU
Specimen: 7.0 mL blood in a plain gel tube
Comment: Only available in very specific cases and following approval by a Consultant Microbiologist
Turnaround: 2 – 3 weeks
Report: Positive/Negative
Ref. Range: N/A
Sural Nerve Biopsies
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Fresh tissue
Comment: Immediate dispatch to laboratory where tissue pieces are osmicated/formalin fixed.
Report: Histological diagnosis
Surgical Specimens for Histological Examination
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Formalin fixed tissue
Comment : Health & Safety precautions
Report: Histological diagnosis
Swab - Culture

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Laboratory : Medical Microbiology
Specimen : Swab in transport medium. Delay > 2h refrigerate @2-8°C
Turnaround : 3 working days
Report : Presence of significant pathogen and sensitivities if relevant.
Sweat Test
Laboratory: Clinical Biochemistry
Specimen: Sweat collected by the Macroduct Sweat Collection System
Turnaround: Newborn screening programme samples : 1hour. All other samples : 1 working day
Ref. Range: On report form

Synovial Fluid
Laboratory: Medical Microbiology
Specimen: Specimen in sterile container. Delay > 2 h refrigerate @ 2-8OC.
Turnaround: 3 working days.
Report: Any significant pathogen & sensitivities if required.
Synovial Fluid – Cytopathology
See Joint aspirate”
Syphilis (Treponema pallidum) antibodies
Laboratory: Virology
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: 2-3 working days
Report: Detected/Not Detected

T3 (Total)
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: 1 week
Comment : Assay only available by request from Endocrine Team or by prior agreement with Dr. Damian
Griffin
Ref. Range: On report form
Tacrolimus (Prograf/Advagraf)
Laboratory: Clinical Biochemistry
Specimen: 4.0 mL K+ EDTA blood
Comment : Collect sample pre-dose. State date/time of sample collections clearly on request form.
Turnaround: 1 week
Ref. Range: Patient specific
Tambocor Levels
See “Flecainide”
Tartrate Resistant Acid Phosphatase (TRAP) Cytochemical Stain

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Laboratory: Haematology
Specimen: 3.0 mL K3 EDTA blood/Bone marrow slides
Comment: Prior authorization by Haematology SPR. To reach lab within 8 hours of phlebotomy.
Turnaround: 2 days
Ref. Range: N/A
Tear Duct - Culture
Laboratory: Medical Microbiology
Specimen: Swab in Transport medium. Delay > 2 h refrigerate @ 2-8OC.
Turnaround: 3 working days.
Report: Any significant pathogens & sensitivities if required.
Testosterone
Laboratory: Clinical Biochemistry
Specimen: 7.0mL blood in a plain gel tube collected between 8 -10 am
Turnaround: Priority : 1 working day. Routine : 2 working days
Ref. Range: On report form
Tetanus Toxoid IgG Antibodies
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 5 weeks
Ref. Range: Minimum Protective Level > 0.01 IU/mL
Optimum Protective Level > 0.10 IU/Ml
Theophylline (Aminophylline)
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Comment: Take specimen immediately before next dose (trough specimen)
Turnaround: 1 week
Therapeutic Range: On report form
Thiamine
See “Vitamin B”
Thiopurine methyl transferase (TPMT)
Laboratory: Clinical Biochemistry: - referredto external laboratory for analysis
Specimen: 5.0 mL K+ EDTA blood
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Throat Swab
Laboratory: Medical Microbiology
Specimen: Swab in transport medium. Delay > 2 h refrigerate @ 2-8OC.
Turnaround: 3 working days.
Report: Haemolytic Streptococci isolated / Not isolated.

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Thrombophilia Screen (incl: PT/INR, APTT, Fibrinogen (derived), Antithrombin, Protein C, Free Protein S,
APCResistance, Lupus inhibitor)
Laboratory: Haematology
Specimen: 4 x 2.7 mL blood in a 0.109m Sodium Citrate tube.
Comment: Requests should be received in the laboratory within 4 hours of phlebotomy Mon – Fri during
routine working hours. Clinical details and relevant patient and family history are required.
Testing should not be done during thrombotic period or while the patient is on anticoagulant
therapy. Must fill bottles to mark.
Turnaround: 5 weeks
Ref. Range: Refer to report
Thyroglobulin
Laboratory: Clinical Biochemistry:- referredto external laboratory for analysis
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Thyroxine Free (Free T4)
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Priority : 1 working day. Routine : 2 working days
Ref. Range: On report form
Total Iron Binding Capacity (TIBC)
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube. Fasting specimen required.
Turnaround: Urgent: 1hour. Priority: 3 hours. Routine : 2 working days
Ref. Range: On report form
Tissue
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology y
Specimen: Submit specimen intact to laboratory in 10% Neutral Buffered Formalin.
Comment: Health & Safety precautions
Report: Histological diagnosis
Tissue / Biopsy
Laboratory: Medical Microbiology
Specimen: Specimen in Sterile container for routine culture and microscopy. Delay > 2 h refrigerate @
2-8OC.
Turnaround: 3 working days
Report: Growth / No growth & sensitivities if required.
Tobramycin
Laboratory: Medical Microbiology. Referred to external laboratory.
Specimen: 7.0 mL blood in a plain gel tube. Delay > 2 h refrigerate @ 2-8OC.
Comment: State time collected and if Peak or Trough specimen

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Turnaround: 1 day.
Ref. Range: Post dose/Peak: 5-8mg/L. Pre-dose/Trough: <1.0mg/L (once daily) &<2.0mg/L Multi dose).
Toxicology / Drug Screen Urine (Benzodiazepines, barbiturates, opiates, cocaine, propoxyphene, cannabis,
amphetamine, methadone, phencyclidine, phenothiazine, alcohol)
Laboratory: Clinical Biochemistry: - referred to external laboratory for analysis
Specimen: 10.0 mL fresh plain urine
Turnaround: 1 – 3 weeks
Comment : Parental consent required in patients <18 years old
Report: On report form
Toxocara Antibodies
Laboratory: Virology: -referred to the Hospital for Tropical Diseases, London WCIE 6AU
Specimen: 7.0 mL Blood in a plain gel tube
Comment: Only available in specific cases and following approval by the Microbiology Medical Staff.
Turnaround: 2 – 3 weeks
Report: Positive/Negative
Toxoplasma gondii IgG antibodies
Laboratory: Virology
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: 1-2 working days
Report: Detected/Not Detected.

Toxoplasma gondii IgM antibodies

Laboratory: Virology
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: 1-2 working days
Report: Not Detected, if negative. A Provisional report will be issued on any sample giving reactive findings on initial
testing. These specimens are referred to the Health Protection Agency, Singleton Hospital Swansea SA2 8QA for further
testing and a final report.
Toxoplasma gondii antibody /avidity/dye test
Laboratory: Virology: Referred to the Health Protection Agency, Singleton Hospital, Swansea SA2 8QA
Specimen: 7.0 mL blood in plain gel tube
Comment: Available only in specific cases and approval of a Consultant Microbiologist
Turnaround: 1 – 2 weeks
Report: Detailed report with relevant comment.
Transferrin
Laboratory: Clinical Biochemistry
Specimen: 7ml blood in plain gel tube. Fasting specimen required.
Turnaround: Urgent: 1hour. Priority: 3 hours. Routine : 2 working days
Ref. Range: On report form
% Transferrin Saturation

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Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube. Fasting specimen required.
Comment: Calculated Parameter
Turnaround: Urgent: 1hour. Priority: 3 hours. Routine : 2 working days
Ref. Range: On report form
Transfusion Pack (Blood product) for culture
Laboratory: Medical Microbiology
Specimen: Bactec Blood culture vials. If delay leave on ward until collection by Porter.
Comment: Ensure labeling as per Haemovigilance procedure.
Turnaround: 1 week.
Report: Any Growth.
Transthyretin (pre-albumin)
See “ Pre-albumin”
Trichomonas vaginalis
Laboratory: Medical Microbiology
Specimen: Urethral or Endo-Cervical swab in transport medium (charcoal).
Turnaround: 3 working days
Report: Trichomonas vaginalis detected / not detected. This is a non-accredited test.

Triglycerides
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Comment : Ideally a patient should fast for 12 hours. However, if a patient in unable or unwilling to fast
for 12 hours a specimen taken after a 9 hour fast is acceptable”.
Turnaround: Urgent: 1hour. Priority: 3 hours. Routine : 2 working days
Ref. Range: On report form
Troponin T
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 1hour. All other requests : 3 hours
Ref. Range: On report form
Trypanosoma cruzi Antibodies
Laboratory: Virology: -referred to the Hospital for Tropical Diseases, London WCIE 6AU
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: 2 – 3 weeks
Report: Positive/Negative
Tryptase (Mast Cell)
Laboratory: Immunology
Specimen: 5.0 mL blood in plain gel tube

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Comment: For investigation of anaphylaxis serial samples are required and the timing must be specified.
Timing of samples:Immediately after resuscitation (record time) ; At 1-2 hours post reaction
(record time) and at 24 hours post reaction (baseline)
Turnaround: 3 weeks
Ref. Range: 0-14 units
TSH (Thyroid Stimulating Hormone)
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Priority : 1 working day. Routine : 2 working days
Ref. Range: On report form
TSH Receptor Antibodies
Laboratory: Clinical Biochemistry:- referred to external laboratory for analysis.
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: 1 – 3 weeks
Ref. Range: On report form

Tuberculosis Testing
Laboratory: Medical Microbiology
Specimen: Specimen of sputa, BAL in sterile 60 mL container. Early Morning Urine in a 100 mL sterile
container. Fluids / Tissues to Sterile containers. Blood Culture / Bone Marrow aspirate, heavily
blood stained fluids to Bactec Myco/Lytic (red cap) vials.
Comment: Delay > 2 h refrigerate @ 2-8OC.
The mycobacteria culture system is not validated for processing urine specimens. The
Department of Medical Microbiology does not routinely accept more than three sputum
specimens for Mycobacterium culture in a single episode of illness
Turnaround: Microscopy : 1 working day. Culture : 6 to 7 weeks.
Report: Mycobacteria isolated / Not isolated.
Tumour
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Submit specimen intact to laboratory in 10% Neutral Buffered Formalin.
Comment: Health & Safety precautions.
Report: Histological diagnosis
TURP
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Submit specimen to laboratory in 10% Neutral Buffered Formalin.
Comment: Health & Safety precautions
Report: Histological diagnosis
Ulcer Swab
Laboratory: Medical Microbiology
Specimen: Swab in transport medium. Delay > 2 h refrigerate @ 2-8OC.

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Comment Rejected in the absence of relevant clinical details.
Turnaround: 3 working days.
Report: Any significant isolates / No pathogens isolated.
Urea
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 1hour. Priority: 3 hours. Routine : 2 working days
Ref. Range: On report form
Urea (Urine)
Laboratory: Clinical Biochemistry
Specimen: 24 hour urine collection
Turnaround: 1 working day
Ref. Range: On report form
Urethral Swab
Laboratory: Medical Microbiology
Specimen: Swab in transport medium. Delay > 2 hr Refrigerate @ 2-8OC.
Turnaround: 3 working days.
Report: Any significant isolates & sensitivities if required.
Uric Acid
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube
Turnaround: Urgent: 1hour. Priority: 3 hours. Routine : 2 working days
Ref. Range: On report form
Uric Acid (Urine)
Laboratory: Clinical Biochemistry
Specimen: 24 hour urine collection
Turnaround: 1 working day
Ref. Range: On report form
Urine Culture – Midstream Urine
Laboratory: Medical Microbiology
Specimen: Specimen of Urine in Urine vacuum tube container.
Comment: Urine taken at mid-point of urination. Delay >2 h refrigerate @ 2-8OC
Turnaround: Microscopy: 4 hrs for Urines received 8am to 12 midnight. Paeds Urines only processed post
midnight. Culture: 3 working days
Report: Microscopy: Cell count. Culture: Presence of significant pathogen and sensitivities if relevant.
Urine - Diagnostic Cytology
Laboratory: Department of Histopathology, Cytopathology and Molecular Pathology
Specimen: Immediate fixation is necessary.Collect 10 – 20 mL fresh voided or catheterized urine or
bladder wash specimen into a universal bottle containing Shandon Cytospin Collection Fluid
(greenfixative solution) available from the Diagnostic Cytology laboratory.

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Comment: Indicate clinical history on test requisition and reason for test. Patients must be well hydrated
before collecting urine. Any instrumentation must be noted on the requisition form. For
routine urine collection, emphasize the need for a clean catch specimen. Random mid-day
collection is preferred. First morning specimen is not suitable for Cytological analysis.
Refrigerate specimens overnight if necessary.
Turnaround: 80% by 5 working days
Report: Detection of neoplastic and non neoplastic cells
Urine Protein Electrophoresis
Refer to ‘Bence Jones Protein’
Urine Protein Creatinine Ratio (PCR)
Laboratory: Clinical Biochemistry
Specimen: Urine: Early morning sample preferred
Turnaround: 1 working day
Ref. Range: On report formInterpretation: UTI should be considered. Persistent proteinuria (2 abnormal
PCR’s at least 1 week apart) is a significant risk factor for both renal & cardiovascular
morbidity & mortality. Management guidance at
http://www.nephrology.ie/images/CKD_Ireland.pdf
Urine Schistosomiasis (see Schistosoma haematobium)
Laboratory: Medical Microbiology
Specimen: On patients after recent travel to endemic area. Urine volume >10mL. (The urine must be
obtained between10:00-14:00 on the day of testing). Delay > 2 h refrigerate @ 2-8OC.
Turnaround: 1 working day.
Report: S. haematobium detected / not detected.
Ustekinumab (trough levels)
Laboratory: Immunology: – referred externally to Eurofins Biomnis
Specimen: 5.0 mL blood in plain gel tube
Turnaround: 6 weeks
Report: Drug levels and antibodies if necessary.
Vaginal Swab
Laboratory: Medical Microbiology
Specimen: Swab in transport medium. Delay > 2 h refrigerate @ 2-8OC.
Comment: Endocervical swabs and Urethral swabs are routinely cultured for N. gonorrhoeae. All other
specimens must specify N. gonorrhoeae on request if required.
Turnaround: 3 working days.
Report: Any significant isolates & sensitivities if required.
Vancomycin
Laboratory: Clinical Biochemistry
Specimen: 7.0 mL blood in a plain gel tube. Delay > 2 h refrigerate @ 2-8OC.
Comment: State time collected and if Peak or Trough specimen
Turnaround: Analysed during routine working hours only.

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Ref. Range: On report form
Vancomycin Resistant Enterococci (VRE)
Laboratory: Medical Microbiology
Specimen: Rectal Swab in transport medium/Faeces sample. Delay > 2 h refrigerate @ 2-8OC.
Comment: Restricted to specific groups of hospitalized patients. Non hospitalized patients are screened
by prior arrangement with a Consultant Microbiologist.
Turnaround: 3 working days.
Report: VRE isolated / Not isolated.

Varicella-zoster Virus IgG antibodies

Laboratory: Virology
Specimen: 7.0 mL blood in a plain gel tube.
Turnaround: 5 working days. Samples from pregnant patients who have been in contact with chickenpox
are processed urgently if received before 2pm Monday to Friday. The request must be marked
as Urgent with clinical details, and the requesting clinician’s contact number, clearly stated.
The laboratory should be contacted (Ext 4398) to alert staff that the sample is in transit.
Indeterminate results are referred to the NVRL for confirmation.
Report: Reported as Detected/Not detected with relevant comment. .
Varicella-zoster Virus IgM PCR
Laboratory: Virology :- referred to National Virus Reference Laboratory
Specimen: Vesicular fluid or skin scrapings in a Viral Transport Medium swab
Turnaround: 2 - 3 weeks.
Report: Detected / Not Detected
Vedolizumab (trough levels)
Laboratory: Immunology
Specimen: 5.0 mL blood in a plain gel tube
Turnaround: 5 working days
Interpretation : Induction (week 2) ≥28µg/ml
Induction (week 6) ≥24µg/ml
Post induction (week 14) ≥15µg/ml
Maintenance ≥12µg/ml
Comment : Antibodies to Vedolizumab will be reflex tested if necessary. Negative = <10ng/mL

Very Long Chain Fatty Acids

See “ Leucodystrophy Screen”
Vincent’s Angina
Laboratory: Medical Microbiology
Specimen: Mouth Swab in transport medium. Delay > 2 h refrigerate @ 2-8OC.
Turnaround: 3 working days.
Report: Vincents organisms seen / not seen.

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Vitamin A (Retinol)
Laboratory: Clinical Biochemistry: -referred to external laboratory for analysis
Specimen: 5.0 mL blood in a non gel tube, protect from light
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Vitamin B1 (Thiamine)
Laboratory: Clinical Biochemistry: - referredto external laboratory for analysis
Specimen: 10.0 mL blood in a Li. Heparin tube. Contact laboratory before collection. Mon/Tues. morning
only
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Vitamin B2 (Riboflavin)
Laboratory: Clinical Biochemistry: - referred toexternal laboratory for analysis
Specimen: 10.0 mL blood in a Li. Heparin tube. Contact laboratory before collection. Mon/Tues. morning
only
Turnaround: 1 – 3 weeks
Ref. Range: On report form
Vitamin B6 (Pyridoxyl Phosphate)
Laboratory: Clinical Biochemistry: -referred toexternal laboratory for analysis
Specimen: 10.0 mL blood in a Li. Heparin tube. Contact laboratory before collection. Mon/Tues. morning
only
Turnaround: 1 – 3 weeks
Ref. Range: On report form gHb
Vitamin B12
Laboratory: Haematology
Specimen: 5.0 mL blood in a plain gel tube
Comment: Specimen to be received within 24hrs of phlebotomy for whole blood and 2 days if sample is
spun.
Turnaround: 4 days
Ref. Range: Refer to report
Vitamin D (25 Hydroxy Vitamine D3 / Hydroxycholecalciferol)
Laboratory: Clinical Biochemistry
Specimen: 7.0mL blood in a plain gel tube
Turnaround: 2 – 3 weeks
Ref. Range: On report form
Vitamin E (Tocopherol)
Laboratory: Clinical Biochemistry: -referred toexternal laboratory for analysis
Specimen: 5.0 mL blood in a non gel tube, protect from light
Turnaround: 1 – 3 weeks
Ref. Range: On report form

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VMA
See “Catecholamines”

Von Willebrands Factor Antigen (vWF:Ag)

Laboratory: Haematology
Specimen: 2 x 2.7 mL blood in 0.109m Sodium Citrate tubes
Comment: Requests should be received in the laboratory within 8 hours of phlebotomy. Must fill bottle
to mark.
Turnaround: 4 weeks
Ref. Range: Refer to report
VRE
See “Vancomycin Resistant Enterococci”
Weil’s Disease
See “Leptospira IgM”
White Blood Cell Differential Cell Count
Laboratory: Haematology.
Specimen: 3.0 mL K3 EDTA blood, (1.0 mL Paediatric tubes are available) or Blood film. Laboratory will
make blood film on fresh blood.
Comment: White Cell Differential will be done automatically on all fresh FBC specimens. As EDTA
artifacts can appear within 2 hours of phlebotomy it is important that films (where
neccessary) are made from fresh blood (less than one day old).
Turnaround: 1 day routine specimens, Specimens received on emergency form : 2 hours.
Ref. Range: See report form.

White Cell Enzyme Studies (Screen for Hurler’s)

See “Lysosmal Enzyme Screen”
Whooping Cough
Laboratory: Medical Microbiology
Specimen: Pernasal swab (available from Medical Microbiology). Delay > 2 h refrigerate @ 2-8OC.
Comment: Contact Laboratory prior to ensure fresh media is available.
Turnaround: 10 days.
Report: Bordetella sp isolated / not isolated.
Whooping Cough antibodies
See “Bordetella pertussis.”
Wound Swab
Laboratory: Medical Microbiology
Specimen: Swab in transport medium. Delay > 2 h refrigerate @ 2-8OC.
Turnaround: 3 working days.
Report: Any significant pathogens & sensitivities if required.

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Yellow fever antibodies
Laboratory: Virology: -referred to the Health Protection Agency, Special Pathogens Reference Unit, Porton
Down, Salisbury SP4 OJG
Specimen: 7.0 mL blood in a plain gel tube
Comment: Only available in very specific cases and following approval by a Consultant Microbiologist
Turnaround: 1 – 3 weeks
Report: Positive /Negative
Yersinia Antibodies
Laboratory: Virology: - referred to the Health Protection Agency, Laboratory of Enteric Pathogens,
Colindale, London NW9 5EQ
Specimen: 7.0 ml blood in a plain gel tube
Comment: Only available in very specific cases and following approval by a Consultant Microbiologist
Turnaround: 2 – 3 weeks
Report: Detected/Not Detected
Zinc
Laboratory: Clinical Biochemistry. Referred to external laboratory.
Specimen: 7.0 mL blood in a Na+. EDTA trace element tube.
Comment : Transport to Lab ASAP
Turnaround: 3 weeks
Ref. Range: On report form

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GLOSSARY OF ABBREVIATIONS

List of abbreviations used in the Hand Book

AAFB Acid Alcohol Fast Bacilli

AAT Alpha-1-antitrypsin
ACR Americian College of Rheumatology
AChR Acetylcholine Receptor
ADR Accord for Transport of Dangerous Goods by Road
ALP Alkaline Phosphatase
ALT Alanine Aminotransferase
ANA Anti Nuclear Antibodies
ANCA Anti-neutrophil cytoplasmic antibodies
APTT Activated partial thromboplastin time
ASAP As Soon As Possible
AST Asparate aminotransferase
BAL Bronchoalveolar Lavage
BJP Bence Jones Protein
BMA Bone Marrow analysis
BN Board Number
C3 Third component of complement
C4 Fourth component of complement
CCP Cyclic citrullinated peptide
CIS Clinical Information System
CK Creatine Kinase
CM Centimeter
CMV Cytomegalovirus
CNS Central Nervous System

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CPA Clinical Pathology Accreditation (UK)
CRP C-reactive protein
C/S Culture and Sensitivity
CSF Cerebrospinal Fluid
CSU Catheter Specimen Urine
CTICU Cardiothorasic intensive care unit
D Day
ED Emergency Department
EDTA Ethylene Diamine Tetra Acetic Acid (anticoagulant)
ENA Extractable Nuclear Antigens
ESR Erythrocyte Sedimentation Rate
FBC Full blood count
FISH Fluorescent in situ hybridisation
GAD Glutamic acid decarboxylase
GBM Glomerular basement membrane
GBTE Galway Blood & Tissue Establishment
GGT Gamma glutamyl transferase
G&H Group and Hold
GMS General medical service
GP General Practitioner
GUH Galway University Hospital
H Hour
HAE Hereditary Angio-oedema
Hb Haemoglobin
HbA1c Glycated haemoglobin
HBsAg Hepatitis B surface antigen
HCG Human chorionic gonadotrophin
HDL High density lipoprotein

Laboratory Medicine User Guide - Version: 3.12 Index: LM/MDOC/009

Authorised on: 18th of August 2022 Authorised by: Martina Doheny Due for review on: 18th August 2023
Author(s): GUH Laboratory Medicine Directorate Page 189 of 192
HDU High dependency unit
HIV Human Immunodeficiency Virus
HPLC High Performance Liquid Chromatography
HSE Health Service Executive
HSV Herpes Simplex Virus
HTLV Human T-Lymphocyte Virus
ICU Intensive care unit
IBST Irish Blood Transfusion service
Ig Immunoglobulin
INR International normaliised ratio
LDH Lactate dehydrogenase
LDL Low density liporrotein
LIS Laboratory Information System
LUH Letterkenny University Hospital
MG Myasthenia Gravis
MUH Mayo University Hospital
MGUS Monoclonal gammopathy of unknown significance
MPUH Merlin Park University Hospital
MPO Myeloperoxidase
MSU Mid Stream Urine
Myco/F Mycobacteria / Fungi
N/A Not applicable
NSAIDS Non steroid anti-inflammatory drugs
OPD Out Patients Department
O/P Ova and Parasites
PAS Patient Administration System
PBC Primary Biliary cirrhosis
PBU Premature baby unit

Laboratory Medicine User Guide - Version: 3.12 Index: LM/MDOC/009

Authorised on: 18th of August 2022 Authorised by: Martina Doheny Due for review on: 18th August 2023
Author(s): GUH Laboratory Medicine Directorate Page 190 of 192
PCR Polymerase Chain Reaction
PM Polymyositis
POC Point of care
PR Proteinase
PTH Parathyroid hormone
PTS Pneumatic Tube System
PUH Portiuncula University Hospital
RAST Radioallergosorbent test
RBC Red Blood Cell
RUH Roscommon University Hospital
RIBA (Strip Immunoassay)
RIS Radiotherapy Information System
RNP Ribonucleo Protein
RT Room Temperature
SCU Special Care Unit
SD Solvent Detergent
SLE Systemic lupus erythematosus
Sm Smith
SMA Smooth Muscle antibody
SPEP Serum Protein Electrophoresis
SPR Specialist Registrar
T4 Thyroxine
TA GvHD Transfusion associated graph versus host disease
TAT Turn around time
TB Tuberculosis
TIBC Total iron binding capacity
TPO Thyroid peroxidase
TSH Thyroid stimulating hormone

Laboratory Medicine User Guide - Version: 3.12 Index: LM/MDOC/009

Authorised on: 18th of August 2022 Authorised by: Martina Doheny Due for review on: 18th August 2023
Author(s): GUH Laboratory Medicine Directorate Page 191 of 192
tTg Transglutaminase antibodies
UCD University College Dublin
UHG University Hospital Galway
UIBC Unbound iron binding capacity
UK United Kingdom
UN United Nation
UPEP Urine Protein Electrophoresis
VGCC Voltage gated calcium channels
VRL Virus Reference Laboratory
W Week
WBC White blood cell count

Laboratory Medicine User Guide - Version: 3.12 Index: LM/MDOC/009

Authorised on: 18th of August 2022 Authorised by: Martina Doheny Due for review on: 18th August 2023
Author(s): GUH Laboratory Medicine Directorate Page 192 of 192