Tài liệu Biochemhandbook2008

Title: Clinical Chemistry Laboratory Handbook Authors Names: Don Barber Scope: Clinical Chemistry laboratory service users Classification: Information Replaces: HTML based version To be read in conjunction with the following documents: None applicable Unique Identifier: Review Date: September 2009 This document is no longer authorised for use after this date Issue Status: Approved Issue No: 01 Authorised by: Don Barber Issue Date: September 2008 Authorisation Date: September 2008 Document for Public Display: Yes After this document is withdrawn from use it must be kept in an archive for10 years. Archive: server Officer responsible for archive: Date added to Archive: Clinical Biochemistry Department The Department of Clinical Biochemistry is centred at Salford Royal Hospital and provides the service for Salford Royal Hospital Trust (SRFT), Greater Manchester West Mental Health Trust and General Practitioners in Salford. It is fully accredited by CPA (UK) Ltd. In addition specialist services in endocrinology and drugs of abuse are provided for other hospitals in the NW Region. The main laboratories are sited on Level 2 in the Turnberg Building, with others in the Clinical Sciences Building. Brief details of the sample types required for biochemistry tests may be found via the 'Specimen Containers' link in the side menu. Normal ranges and other information can be found via the 'Tables of Tests' links in the side menu. We want to provide as efficient a service to you and your patients as possible, so please contact us if you have any questions, problems, complaints, or suggestions, or if you wish to arrange to visit us. Contacting the Laboratory Critical emergency Urgent standard test requests Urgent clinical enquiries Routine enquiries Normal Hours 0900 - 1720 weekdays Telephone 64963 to arrange request Tick emergency box on request form Page 3016 Telephone 64958 Weekend Service 0900 - 1245 Saturdays/Sundays Telephone 64963 to arrange request (also blood gases) Tick emergency box on request form via switchboard - Out-of-hours Page 3102 to arrange (All other times and request (also blood bank holidays) gases) Tick emergency box on request form via switchboard - Biochemistry Site maintained by Donald Barber - Last updated 1/9/2008 – ALWAYS USE AN UP TO DATE MANUAL Results enquiries Within the SRFT site, please use the iSOFT Clinical Manager computer system to look up results. Please do not telephone the laboratory for results unless there is a problem, as this slows our service down. The appearance of results on iSOFT Clinical Manager is dependent on our being supplied with the correct patient identification details, and particularly the patient's hospital number, on the request form and the sample tube. It is laboratory policy for unidentifiable samples not to be analysed. Critical emergencies - telephoning to arrange tests Most urgent work simply requires ticking of the emergency box on the request form, with no need for a telephone call. Please do telephone in the rare cases of critical emergency, e.g. cardiac, respiratory arrest or diabetic ketoacidosis, or in order to arrange blood gases or unusual tests out of hours. The repertoire of tests offered out of hours is tabulated below. Urgent work Ticking the emergency box is monitored and should not be abused, as the system is slowed down if too many samples are prioritised. Please remember that in an emergency YOU need to ensure that samples reach us quickly, but remember that blood gas samples should not be sent through the pneumatic tube delivery system. The phlebotomy service, which operates on weekday mornings only, and the messenger service, are not suited to urgent work. Outside normal hours work should be dropped off in the tray outside the laboratory and the green biochemistry buzzer pressed. Routine work Generally, please aim to get routine requests into the department by lunchtime. Requesting further tests on samples already received The department keeps most samples for a period of four weeks at 4oC. If enough sample of the correct type is available and if the storage has been appropriate for the test then additional work may be requested by contacting the main enquiry number 64958. Senior staff contact numbers Dr Felicity Stewart Clinical Lead tel - 64971 pager - 07623-621388 Dr Aram Rudenski Consultant tel - 61490 pager - 07623-618535 Mr John Kane Consultant Scientist BMS4/Laboratory Manager tel - 64955 pager - 07623-606029 tel - 64952 bleep - 3102 Duty Biochemist (Main Lab) tel - 64956 bleep - 3016 Duty Biochemist (Endocrine) Drugs Laboratory Biochemist tel - 64374 Mr Stephen Scarisbrick tel - 64954 Laboratory Organisation The Clinical Biochemistry Department is organised in several sections which handle different groups of analyses. Routine biochemical 'profiles' are analysed throughout the day in the order of receipt of the samples. Most other tests (excluding emergencies) are 'batched' so that several specimens are analysed at one time. Batches are run at different time intervals, e.g. daily, weekly, depending on the number of specimens received, clinical need and the complexity and cost of assays. Test Groups The following tests are grouped and reported together: UE = Na, K, urea, creatinine* LFT = Total bilirubin, alkaline phosphatase, ALT, total protein, albumin Bone = Ca, PO4,alkaline phosphatase, albumin* Profile = UE+ creatinine + LFT + BONE* Chloride/TCO2 = Chloride, total CO2* Thyroid Function Tests = Free T4+ TSH - followed by further tests if indicated Lipid Profile Total cholesterol, triglycerides, HDL cholesterol, LDL = cholesterol (calculated) NOTE: A fasting specimen is essential for a full lipid profile which should be done on all patients before starting lipid lowering medication. A random (non-fasting) sample is adequate for an initial screen, but will only be analysed for Total and HDL-cholesterol. * Four derived values are also reported, where appropriate: - Ion gap = (Na + K) - (Cl + TCO2) - Globulins = Serum Total Protein - Serum Albumin - Calcium 'corrected' to an albumin level of 40 g/L - Iron Saturation = (Iron / Iron Binding Capacity) x 100 - Estimated GFR (uses serum creatinine plus age and gender in formula - Adults only) Specimens received in the laboratory by 15.30h Monday to Friday will normally be analysed and reported the same day for UE, creatinine, LFT, BONE, lipids, chloride/TCO2, CK, urate, AST, GGT. (The ward is responsible for delivering samples that miss the relevant messenger pick-up or in the event of a restricted messenger service.) Out of Hours Service in Clinical Biochemistry Clinical Advice As from 1 April 2007, there will be no Senior Staff On-call rota in Clinical Biochemistry. Queries regarding direct clinical care of patient, interpretation of test results or advice on test selection should be dealt with by the Consultant in charge of that patient. Emergency Investigations Repertoire (24 Hour Service) Tests Tests Serum amylase Serum Troponin T Serum bilirubin(neonatal) Serum urate Serum calcium+albumin or bone profile Serum vancomycin Serum carbamazepine Serum chloride/TCO2 Plasma ammonia Serum creatine kinase (CK) Plasma glucose (fluoride sample essential ) Serum creatinine Plasma lactate - for NICU ,ICU ,AE ,A3, B8HDU only - (fluoride sample essential) Serum CRP Serum genatmycin Serum beta-HCG Serum iron (suspected O/D, toxicity) Serum lithium (suspected O/D, toxicity) Urine Na, K, creatinine, urea Serum liver function tests Urine osmolality Serum magnesium Urine porphobilinogen (qualitative) Serum Na, K, creatinine, urea Serum osmolality Serum paracetamol CSF glucose and protein Serum phenytoin Serum phosphate Blood gases + co-oximetry Serum salicylate Carboxyhaemoglobin Serum theophylline (suspected O/D) • Tick the emergency box on the request form. • During normal working hours telephone 64963 to arrange (except A+E, EMAU, ICU, HCU, NICU, B8HDU, B3HDU) and arrange delivery to the laboratory. • Outside normal working hours see the instructions on Use of the Emergency Service in the General Pathology Section. • In the Tables of Tests those available as an emergency are marked (E). Other Analyses Ethanol – only for monitoring ethylene glycol, methanol or ethanol overdose. Requests should come from the Consultant responsible for the patient. · The following tests may be obtainable from other laboratories under strictly restricted circumstances at their discretion: - Ethylene glycol/methanol: The results of these tests will be required: Na+, K+, urea, creatinine, glucose, calcium, blood gases (or at a minimum serum bicarbonate), serum osmolality, calculation of osmolar gap, ethanol. The service is provided at Aintree Hospital, Liverpool. - Barbiturates (including phenobarbitone/Phenobarbital): The clinical need for the test to be performed urgently must be agreed between the consultant in charge of the patient and the senior member of Clinical Biochemistry staff at Royal Manchester Children’s Hospital. - Suspected inherited metabolic disease in a sick neonate: Specialised tests are conducted at either the Willink Laboratory or Clinical Biochemistry at RMCH and they will advise on their requirements in the individual circumstances. The clinician in charge of the patient should agree a protocol with RMCH for the collection and initial processing of any samples required and provide clear instructions to the on-call BMS, who will then make the necessary arrangements to receive and transfer the specimens. - Other poisoning/toxicology – Advice should be sought by Clinicians from the National Poisons Information Service, with reference to samples required and storage conditions. The laboratory will store and send sample(s) as required. For example, Drugs - Cyanide - Organophosphorus Urine paraquat - Patient treated immediately. Urine sample collected to be analysed later. Patient treated immediately. Specimens held for analysis later. Patient treated immediately. Specimens held for analysis later. Send urine for qualitative analysis. Specimen will be analysed as soon as possible either at SRFT or another laboratory. It is essential to contact the on-call BMS before collecting any samples. The on-call BMS will advise the requesting doctor who to contact if these tests are required. It is the responsibility of the clinician in charge of the patient to obtain authorisation from the laboratory performing the test and to liaise with the BMS at SRFT about the arrangements agreed. · The following tests are sometimes requested but are not available out of hours - Cyclosporin CSF xanthochromia (NB follow agreed protocol for specimen collection) Myoglobin (serum CK is available on a 24h basis) Thyroid function tests Specimens may be collected and sent to the laboratory for analysis on the next working day (Monday – Friday). - Prolactin – Special arrangements apply to requests made by Consultant Neurosurgeons only. The following problems shall be reported to the Senior Manager on-call if likely to cause delays to the availability of emergency results: Laboratory equipment or IT failure BMS staff illness or other absence Request Forms Salford Royal Hospital requests In-patient requests would normally be made via the iSoft Clinical Manager system which prints out the request form to accompany the sample on A4 paper using ward printers. If iSoft Clinical Manager fails, then each ward has a 'Downtime' folder which contains pre-printed A4 size paper request forms that must be completed by hand: This method is also to be used for the very few tests that cannot be ordered via iSoft Clinical Manager, such as urine Drugs of Abuse screens. For out-patient requests there is one (green) Clinical Biochemistry request form which can be used for all tests. Commonly requested tests have 'tick boxes' and other tests should be written in the space provided. Remember to tick the relevant box for a fasting specimen, emergency request or a private patient. General Practitioner requests There is one combined Pathology request form overprinted for individual practices which can be used for all tests. Commonly requested tests have 'tick boxes' and other tests should be written in the space provided. Remember to tick the relevant box for a fasting specimen, private patient or a Category II investigation. Requests from other hospitals To comply with Pathology sample acceptance policies, please supply surname, forename, date of birth and at least one other identifier, such as local hospital number or NHS number, on the request form and ensure that at least three of these items are also on the sample tube: Where samples have routed through other laboratories the local sample accession number can be used as one of the other necessary pieces of data on form and sample tube. Laboratory Reports Clinical Biochemistry paper reports are produced by the laboratory computer. A separate report is produced for each specimen received. They are delivered to wards at 12.00h and 17.00h, and to General Practices twice each day. With the introduction of the iSOFT Clinical Manager ward reporting system, results of analyses performed on the major analyser for in-patients should be available on the system within 5 minutes of their being 'authorised'. The GP electronic reporting program runs every 30 minutes. Specimen Containers Blood - Sarstedt Monovette Collection System Tests Tube type All general biochemistry and endocrine tests Plain (1 full tube for all except those below: tests + extra tube if trace elements/nutritional proteins required Glucose, lactate, alcohol Fluoride Cyclosporin, apo E genotype, lead, EDTA erythropoietin, FK506(tacrolimus), sirolimus, Ammonia, DNA/Genetics studies. Also homocysteine and Gut Hormone Profile (both must come to lab on ice within 15 minutes). Tube top colour Code in tables Brown Gel Brown Yellow Yellow Red Red Blood tubes for the following tests must be collected from the laboratory: ACTH, plasma catecholamines, insulin, Heparin renin, aldosterone, calcitonin (Send all these samples IMMEDIATELY to lab. Also Calcitonin MUST be fasting sample and insulin MUST have concurrent fluoride sample for glucose). Blood porphyrin samples should be protected from light. Heavy metals, vitamins (other than vitamins A, E and D), unusual tests Orange Orange Contact Duty Biochemist NOTE: Blood for Glucose must be collected in a fluoride tube to prevent a falsely low result. These tubes are available outside the main laboratory complex on Turnberg Building, Phase I. Order of Specimen Collection To avoid cross-contamination with potassium-containing anticoagulants (in Yellow and Red tubes) Brown Serum Gel tubes must be placed on the needle before other tubes. If using a conventional syringe and needle the blood must be transferred to the Brown Serum Gel tube first before filling Yellow or Red tubes. Fasting Specimens • • • • • • Fasting = no food or drink except plain water from 22.00h the night before A fasting specimen is essential for the Lipid Profile (Total, HDL, LDL cholesterol, triglycerides) A random (non-fasting) cholesterol is adequate for an initial screen. It is important to know whether or not a patient is fasting for interpretation of a glucose result. Ask the patient if they are fasting. If the patient says yes tick the fasting box on the request form. Urine Universal bottles for random specimens and 24-hour collection bottles without preservatives can be collected from outside the laboratory. 24-hour collection bottles with preservative or acid can be obtained on request from Clinical Biochemistry Reception. These bottles are essential for metadrenaline and/or 5HIAA collections. Faeces Small containers for random specimens are available outside the laboratory. Tables of Tests The pages accessed by clicking on one of the buttons in the left hand frame contain an alphabetical list of individual tests and groups of tests. Where appropriate, reference ranges are given. Please be aware that for some analytes, reference ranges are method dependent and differ in different laboratories. Important examples include hormones, enzymes and amylase. For drug analyses, you may be familiar with levels expressed in different units. Therefore please check your patient's result carefully against the reference ranges given in this book or on the laboratory report. If in doubt, contact the laboratory. Specimen volumes In this table, tests are described individually. Multiple tests can be done on one full 7.5ml blood specimen but 2 tubes are needed if trace elements/nutritional proteins are required in addition to other tests. Specialist tests not listed Certain rarely requested or very specialised tests have not been included. Please contact a Chemical Pathologist or Duty Biochemist for advice. Codes used in the Tables of Tests Specimens Sample Containers S = Serum B = Brown (gel) B = Blood Y = Yellow (fluoride-oxalate) P = Plasma R = Red (potassium-EDTA) U = Urine O = Orange (lithium-heparin - obtain from lab) F = Faeces CSF = Cerebrospinal fluid EMU = Early morning urine ERY = Erythrocyte Others (E) = Test available as an Emergency by arrangement with the laboratory SRFT = Salford Royal Hospital Trust Table: ACE - ALP Isoemzymes Turnround time Instructions/ comments Reference Range Specimen Test Sample Centre S ACE see Angiotensin Converting Enzyme Brown Wythenshawe 2-4 weeks 15-55 IU/L C CSF ACE Plain Neurology London 2-3 weeks <1.2 IU/L P/U Adrenaline See catecholamines S AFP Brown SRFT <72 hours <5.8 KU/L P Adrenocorticotrophin (ACTH) Orange SRFT <1 week Contact Endocrine laboratory 64374. Up to 46 ng/L at 09.30h or Red S Alanine aminotransferase Brown (ALT) (E) SRFT <24 hours 2-50 IU/L S Albumin (E) Brown SRFT <24 hours 35-50g/L U Albumin:creatinine ratio ("microalbumin EMU SRFT <72 hours M<2.5umol/mmol F<3.5umol/mmol P Alcohol 2ml Yellow SRFT As soon Send to as laboratory possible promptly. Unstable. Absent U Alcohol Fresh urine SRFT <4 days Send to laboratory promptly. Unstable. Absent P Aldosterone Orange Leeds 3-4 weeks S Alkaline phosphatase (E) Brown SRFT <24 hours Adult range 30130 IU/L S Alkaline phosphatase isoenzymes Brown Bradford 2 weeks By arrangement only. See report Usually See report measured with renin. Arrange with laboratory before collecting samples. Complex protocol. Patients should not be on diuretics or certain other antihypertensive drugs. Table: Alpha-1-acid Glycoprotein – Amiodarone Specimen Test Sample Centre S Alpha-1-acid glycoprotein (Orosomucoid) Brown SRFT <72 hours S Alpha-1-antitrypsin Brown SRFT <72 hours S Alpha-1-antichymotrypsin Brown Sheffield 2-3 weeks See report S Alpha-1-microglobulin Brown Sheffield 2-3 weeks See report S Alpha-fetoprotein (tumour marker) Brown SRFT <72 hours <5.8 KU/L S Alpha-fetoprotein (pregnancy) Brown Bolton Daily (MonFri) Gestation affects results. See report B Alpha fucosidase Red Willink 2-3 weeks See Mucopolysaccharides See report B Alpha galactosidase Red Willink 2-3 weeks See Mucopolysaccharides See report P Aluminium Orange Liverpool 2 weeks Must be orange tube. <0.5 umol/L Serum tubes have significant contamination. P Amino acids Orange Willink 2-3 weeks U Amino acids Random Willink urine 2-3 weeks See report U d-Aminolevulinic Acid (ALA) Random SRFT urine in darkened bottle <2 weeks Protect from light. Send Up to 4.4 to laboratory immediately umol/mmol after collection. creatinine S Amiodarone Brown 2-4 weeks Trough level sample. Drug and metabolite desethyl amiodarone have very long half-lives (10-100 days). Blackburn Turn Instructions/ comments Reference round Range time 0.5-1.2g/L Phenotyping is arranged when needed. Send to lab immediately on ice 1.1-2.1g/L See report See report Table: Ammonia – Base Excess P Ammonia (E) 5ml Red SRFT <24 hours S Amylase (E) Brown SRFT <24 hours S Amylase isoenzymes and macroamylase Brown Great Ormond 2-3 Street weeks See report S Androstenedione Brown SRFT <4 days M: 2.110.8nmol/L F: 1.011.5nmol/L Child below 11y <2nmol/L S Angiotension converting enzyme (ACE) Brown Wythenshawe 2-4 weeks 15-55 IU/L S ANTIBIOTICS Brown SRFT <6 hours See Microbiology information page See specific drug entries ANTICONVULSANTS Brown SRFT or <24 hours (Carbamazepine, Ethosuximide, Phenobarbitone, Phenytoin, Primidone) RMCH for phenobarbitone Sample pre-dose. Please state dose. All drugs can be measured on a single sample. Half-life and time to steady-state - see individual drugs for further details See report for therapeutic ranges Newcastle 2-3 weeks Contact lab. Send See report immediately to lab on ice. Immunology 2-4 weeks See report By arrangement only. Unstable. 15-47umol/L Up to 100 IU/L Gentamycin and Vancomycin are analysed in Biochemistry on behalf of Microbiology S Orange P Anti-diuretic hormone S Anti-Insulin Antibodies Brown S Apo-lipoproteins A/B Brown Glasgow 4 weeks See report S Apo-lipoprotein E phenotyping Red Christies 4 weeks See report S Aspartate aminotransferase (AST) Brown SRFT <24 hours 11-55 IU/L (E) B Base excess (E) See Blood gases Table: Bence-Jones Protein – CA199 Specimen Test Sample Centre U Bence-Jones protein Fresh SRFT random urine B Bicarbonate-arterial (E) see below Blood gases S Beta-2-microglobulin Brown S Bile acids U P Turn Instructions/ round comments time <1 week Serum sample at same time BJP = free monoclonal light chains Reference Range Not detectable Sheffield 2-4 weeks 1.2-2.4 mg/L Brown Stepping <1 Hill week 0-14 umoles/L Bile pigments Fresh urine SRFT <24 hours Deliver to laboratory Bilirubin-absent as soon as possible Urobilin(ogen)-trace after collection. Bilirubin (neonatal) 0.3ml Brown SRFT Neonatal <24 hours Protect from light. SRFT <24 hours Done only if 0-5 umol/L (adults) indicated clinically or biochemically. Protect from light. SRFT <24 hours Interpretation depends on gestational age (E) S Bilirubin (conjugated) Brown - adults Brown - neonates Neonatal S Bilirubin (total) Brown 1-20 umol/L (E) F Blood-occult Small random SRFT sample <1 week B BLOOD GASES (E) pH pCO2 pO2 Act. bicarbonate Base excess 3ml arterial blood in heparinised syringe SRFT <1 hour Collect in heparinised syringe. Remove needle and cap syringe with a luer-lock plug. Send to laboratory on ice, but do NOT send through the pneumatic tube system. Ensure that the syringe is LABELLED. S CA-125 Brown SRFT S CA-153 Brown Sheffield 2 weeks <30 KU/L S C199 Brown SRFT <35 KU/L <3 days <2 weeks Send specimens on Negative three consecutive days. pH 7.35-7.45 pCO2 4.5-6.0kPa pO2 12.0-15.0kPa Actual HCO3 : 2128mmol/L Base excess : -2 to +2mmol/L <28 KU/L Table: Calcitonin - Ceruloplasmin Specimen Test Sample Centre Turn Instructions/ round comments time P Calcitonin Brown Hammersmith S Calcium Brown SRFT <24 hours (E) Reference Range Place sample on ice and transfer immediately to laboratory. <18.9 ng/L Avoid venous stasis when taking blood. Reported as "corrected" calcium ie. adjusted for albumin concentration. Adult range 'Corrected' calcium: 2.10-2.60 mmol/L U Calcium 24h Urine SRFT <24 hours 2.5-7.5 mmol per 24h U(+S) Calcium Excretion Index plus %Tubular Reabsorption of Phosphate Random urine SRFT Daily Concurrent serum for Monda bone profile and U&E yis ESSENTIAL. Friday CEI - 0.0130.037 Calculus Dry specimen UCL Weekl Do not put in y preservative. Not applicable S Carbamazepine Brown SRFT <24 hours Therapeutic range: 4-12 mg/L S Carbohydrate Deficient Brown Transferrin (CDT) Sheffield 3-4 weeks B Carboxyhaemoglobin see Co-oximetry Sample pre-dose. Please state dose. Average T 1/2 = 24h. Usual time to steady state = 5d (oral). See anticonvulsants. %TRP - 84-95% <2.6% <1 hour (E) Brown S Carcinoembryonic antigen (CEA) SRFT <72 hours SRFT <4 Arrange with weeks laboratory before collecting specimens P Red Catecholamines (plasma). See Plasma metadrenalines U Catecholamines (urine) 24h Urine SRFT in acid preservativ e <2 Collect with acid weeks preservative. Metadrenalines performed initially followed by catecholamines if indicated. Noradrenaline up to 1.0 umol/24h Adrenaline up to 0.2 umol/24h S Ceruloplasmin Brown <72 hours 0.15-0.60 g/L SRFT <5ug/L Table: Chloride - Copper Specimen Test Sample Centre S Brown SRFT <24 hours Chloride Turn round time Instructions/ comments Reference Range 95-105 mmol/L (E) S Cholesterol (total) Brown SRFT <24 hours S HDLcholesterol Brown SRFT <24 hours Brown S LDLcholesterol SRFT <24 hours P Chromogranin Red to lab Hammersmith More A and B immediately than 2 on ice weeks Total cholesterol must be interpreted in the light of full fasting lipid profile (Chol, Trig, HDL, LDL). A fasting sample is essential for lipid profile. Other special tests available by arrangement with Dr Stewart or Dr Rudenski. < 5.0 mmol/L (Primary prevention) <4.0 mmol/L (JBS2 target for high CVD risk) Part of Gut Hormone profile Chromogranin A- <60 pmol/L >1.0 mmol/L (JBS2 target for high CVD risk males) >1.2 mmol/L (JBS2 target for high CVD risk females) <3.0 mmol/L (Primary prevention) <2.0 mmol/L (JBS2 target for high CVD risk) Chromogranin B- <150 pmol/L S Cholinesterase Brown MRI More than 2 weeks Arrange with laboratory 620-1370 U/L Dibucaine, fluoride and scopalamine inhibitors used to determine phenotype and suxamethonium sensitivity. S Cobalamine Brown SRFT <24 hours Brown SRFT <24 hours S P Conjugated bilirubin - adults - neonates Done only if 0-5 umol/L (adults) indicated clinically or biochemically. Protect from light. B Co-oximetry 3ml arterial heparinised SRFT <1 hour Collect in heparinised syringe. Remove needle and cap syringe with a luer-lock plug. Send to laboratory on ice. Make sure the sample is labelled. (E) 191-663 ng/L Oxyhaemoglobin 9598% Carboxyhaemoglobin Non-smokers less than 1.5% Smokers up to 5.0% Methaemoglobin <1.5% Sulphaemoglobin None S Copper Brown SRFT <1 week 13-24 umol/L U Copper 24h Urine SRFT <4 weeks Up to 1.0 umol/24h Table: Cortisol - Digoxin S Cortisol Brown SRFT <2 days U Cortisol (Urinary free) 24h Urine SRFT <3 weeks S C-peptide See Insulin S C-reactive protein (CRP) (E) Brown SRFT <24 hours S Creatine kinase (CK) (E) Brown SRFT <24 hours CK is raised after M: 24-195 IU/L muscular activity F: 24-170 IU/L and in patients on statin therapy. S Creatinine (E) Brown SRFT <24 hours Adults(>15 years) F:44-80 umol/L M:62106 umol/L Child ranges are age related. See reports. 9-17 mmol/24h 09.00h and midnight samples, if not part of dynamic test 9am sample 250 to 650 nmol/L Midnight sample 60 to 250 nmol/L. Up to 400nmol/24h See report Up to 10mg/L See also eGFR Estimated Glomerular Filtration Rate U Creatinine (E) 24h Urine SRFT <24 hours U/S Creatinine clearance See also Dynamic Tests SRFT Daily (Mon-Fri) Correct identification of patient on both urine and plasma specimens is essential, B Cyclosporin A Red SRFT <4 days Pre-dose or 2 hour Therapeutic range post dose sample. varies with clinical circumstance. S Diazepam Brown Regional Daily (Mon-Fri) Please state dose. See report for therapeutic range S Digoxin Brown SRFT <24 hours Sample at least 8 hours after dose. Please state dose and time since last dose. Average half-life = 26h, usual time to steady state = 710d. Up to 2 ug/L = toxicity unlikely. 2-3 ug/L = borderline. Above 3 ug/L = toxic. PLEASE NOTE: Assessment of digoxin toxicity is primarily CLINICAL. Check K+ Table: DHEAS – FK506 Specimen Test S Sample Dihyroepiandrostenedione Brown sulphate Centre SRFT Turn Instructions/comments Reference round Range time <4 days Females 1-12 umol/L (DHEAS) Males 2.2-15.2 umol/L U Drug Screen (drugs of abuse) 30ml Urine SRFT <4 days State drugs suspected. Absent Screen includes cocaine, narcotics, amphetamines, benzodiazepines. Indicate if cannabis, barbiturates or alcohol required. S Electrolytes (Na/K) (E) Brown SRFT <24 hours Avoid haemolysis and delay See individual tests S Electrophoresis - protein Brown SRFT <1 week Must use clotted blood tube. If myeloma suspected also send random urine. Interpretation given on report U Electrophoresis - urine See Bence-Jones protein S Epilim (Valproate) Brown SRFT <24 hours Monitoring of valproate levels in epilepsy is not normally indicated. S Erythropoeitin Brown Kings 2-4 weeks Send to laboratory promptly for separation 5-25 IU/L S Estimated Glomerular Filtration Rate Brown SRFT <24 hours Calculated from serum creatinine, age and gender in adults only. Performed automatically on appropriate patients when U&E requested. CKD Stage 2 (60-89 mls/min) Not detectable CKD Stage 3 (30-59 mls/min) CKD Stage 4 (15-29 mls/min) CKD Stage 5 (<15 mls/min) P Ethanol 2ml Yellow SRFT <4 days Send to laboratory promptly. Unstable. Absent U Ethanol Fresh urine SRFT <4 days Send to laboratory promptly. Unstable Absent P Ethylene Glycol 2 x 2ml Yellow SRFT As soon By arrangement only as possible Absent S Ferritin Brown SRFT <24 hours Females 15-150 ug/L Males 30-400 ug/L B FK506 (Tacrolimus) 2.5ml Red SRFT <4 days Pre-dose. See also Therapeutic Renal Services Guidance range varies on use with clinical circumstance. Table: Folate – Gut Hormones Turn round Instructions/comments ReferenceRange time Specimen Test Sample Centre S Folate Brown SRFT <24 hours S Follicle stimulating hormone (FSH) Brown SRFT <2 days S Brown Gammaglutamyl transpeptidase (GGT) SRFT <24 hours S Gastrin Red to lab Hammersmith More Arrange with laboratory <40 pmol/L immediately than 2 before collecting on ice weeks samples. Patient must be fasted overnight. Stop H2 antagonists for 72h and omeprazole for 2 weeks prior to test. Send immediately to laboratory S Gentamycin Brown SRFT 3.8-16 ug/L Menstrual cycle phase M: 2-12U/L affects results in women F: excl. cycle peak: 4-13U/L mid-cycle peak: 522U/L post menopausal: 26-135U/L M: <60 IU/L F: <40 IU/L <6 See Microbiology hours information page Trough Level Target Neonate - <2mg/L Adult - <1 mg/L Peak Level Target 3-5 mg/L P Glucagon Red to lab Hammersmith More Arrange with laboratory <50 pmol/L immediately than 2 before collecting on ice weeks samples. Patient must be fasted overnight. Part of Gut Hormone Profile. B Glucose (capillary) 0.5ml Yellow SRFT <24 Can be collected in hours laboratory Done immediately if urgent Capillary blood Fasting<5.6mmol/L See also glucose tolerance test P Glucose (E) 1.0ml Yellow SRFT <24 Fluoride oxalate (yellow) Venous plasma hours specimen is essential. Fasting: 3.0 - 6.0 mmol/L See also glucose tolerance test CSF Glucose (E) 0.5ml Yellow SRFT <24 Interpret in relation to hours serum level. S Growth Hormone Brown SRFT <4 days P Gut hormones Red to lab Hammersmith More Profile includes glucagon See individual immediately than 2 VIP, Pancreatic hormone entries. on ice weeks polypeptide, gastrin, somatostatin chromogranin A and B. Contact lab before taking sample. Must be fasting sample. 2.5 - 3.9 mmol/L see also GTT for Fasting <3.3ug/L diagnosis of acromegaly Non-fasting <4.7 ug/L Table: Haematinics– Ion Gap Specimen Test Sample Centre Turn Instructions/ comments round time Reference Range S Brown SRFT <24 hours See specific entries. Haematinics Vitamin B12 Folate Ferritin Iron/TIBC B/U 'Heavy Metals' see also Lead, Mercury Varies Guildford 2-4 weeks Contact lab. Sample requirements vary with metal and form of exposure. See report S HCG beta subunit Brown SRFT <24 hours More sensitive than urine M: <2.6 mU/L assay for choriocarcinoma F:(non-pregnant) <5.3 mU/L (postmenopausal) <8.3 mu/L S HDL-Cholesterol Brown SRFT <24 hours Fasting sample JBS2 targets: males >1.0mmol/L females >1.2mmol/L P Homocysteine Red Cardiff 2-3 weeks Must be transported immediately on ice to lab. 0-16 umol/L U 5-Hydroxyindole (5HIAA) 24h urine SRFT with preservative <3 weeks Collect with acetic acid < 50 umol/24h preservative - Contact lab for bottle. S Brown 17-alphaHydroxyprogesterone RMCH 2 weeks Up to 6 nmol/L U Hydroxyproline : creatinine ratio Random urine (2nd specimen passed after overnight fast) SRFT <4 weeks S Insulin Orange - C peptide Same sample Guildford for More adults than 2 weeks RMCH for neonatal <1 samples week S IGF-1 Insulin related Brown growth factor 1 SRFT <4 days S Ion gap Brown SRFT <24 hours Must be fasting OH pro/creat. ratio:- males and premenopausal females: < 19umol/mmol post menopausal females: rises continuously with age Arrange with laboratory See report before collecting samples. Always collect glucose See report samples at the same time. SEND TO LAB IMMEDIATELY. See reportnormal ranges are sex and age dependent Calculated: (Na + K) - (Cl + TCO2) 12-20 mmol/L