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January 2019 - Introduction of IGF-1 service in RWT Blood Sciences department 

As of 24th January we started performing Insulin like growth factor 1 (IGF-1) testing in-house here at RWT and so no longer send samples away to another laboratory for analysis.  The test will be run on a weekly basis. For more information please refer to the Pathology test database. Although not yet UKAS accredited, the application for this is in progress.

January 2019 - Abbott Alinity analyser update

The Clinical Chemistry Department began using a next generation analyser called the Alinity CI system last February (see below).  The following additional tests are now in use on this system:

Ferritin, folate, chloride, HDL-cholesterol and Free T4

The underlying methodologies are again identical to existing ones in use on our other Abbott C16000 analysers and have been fully evaluated. Patient reference ranges will therefore remain the same.  The Department is applying for an extension to its UKAS 15189 accreditation scope to incorporate the new instrument.  If you have wish to discuss any aspect of this change please contact the Duty Biochemist on 01902 307999 ext. 5290

December 2018 - Microbiology update

Urine antibiotic sensitivities

There have been some changes to the way in which we are reporting urinary isolate antimicrobial sensitivities.

Many of you will have noticed that we are unable to report some antimicrobials on urine samples. This is because there has been a change to the EUCAST breakpoints for some organisms and some antibiotics such that we can no longer report nitrofurantoin on isolates other than E. coli or Enterococcus faecalis. We can also no longer report cefalexin on Proteus isolates.

This does not mean that you cannot prescribe these antibiotics to treat these organisms but it does mean that you will need to be guided clinically regarding response and if the patient gets no benefit then please change to another agent.

Several clinicians have contacted us for advice on this issue so we thought it was fair to share this information with you.

November 2018 - Microbiology update

 Microbiology currently have a number of tests out of scope of their UKAS accreditation. See attached letter for details.

May 2018 - Biochemistry update

Introduction of routine screening for sample EDTA contamination         

EDTA is a widely used anticoagulant in laboratory specimen tubes; full blood count tubes contain potassium EDTA (kEDTA) and glucose tubes fluoride EDTA. Contamination of brown top clinical chemistry serum samples with EDTA, from the full blood count and glucose tubes, during collection, is a relatively common but often unrecognised issue. EDTA contamination can result in low calcium, magnesium, alkaline phosphatase and zinc results whilst kEDTA contamination will also erroneously increase potassium.  Incorrect results adversely affect patient care and waste scarce healthcare resources.

The measurement of EDTA is the only way that contamination can be confidently identified.  The Clinical Chemistry department will join a very small group of laboratories offering this service.  The test will be added by the laboratory when the potassium result is >6.0 mmol/L. The laboratory report will indicate when EDTA contamination is possible, likely or confirmed. If you have wish to discuss any aspect of this change, please contact the Duty Biochemist on 01902 695290. Please note that the EDTA assay is not currently UKAS accredited.

March 2018 - Haematology Updates

From the 23rd January 2018 the Haematology laboratory will be using the Sebia Capillarys 3 analyser for Haemoglobinopathy screening and replaces the Sebia Capillarys Flex 2 analyser.  The Cap 3 provides faster TAT's and additional backup for chemistry, immunology and haematology for HBA1c testing, protein electrophoresis and Haemoglobinopathy testing respectively. The underlying methodology is the same and has been fully verified and will be assessed as an extension to scope at our forthcoming UKAS visit on the 14th March 2018.

Similarly the Haematology laboratory has changed the Rapid Malaria Test in use from Optimal to Carestart from the 1st March 2018.  This method is a confirmatory test to the 'gold' standard blood films for malaria parasites.  Users will see no differences to results reported.  The kit has improved sensitivity and is WHO approved. Again this test has been fully verified and will be assessed at the UKAS visit as an extension to scope.

For any queries regarding either of the above please contact Jayne Parkes (Haematology Clinical Scientist) on 01902 307999 ext 5295.        
   

February 2018 - Abbott Alinity Analyser

From the 14th February 2018 the Clinical Chemistry Department will be using a new next generation analyser called the Alinity CI system alongside existing Abbott C16000 and Abbott Architect systems for the following tests:

Albumin, alkaline phosphatase, alanine transaminase, amylase, total bilirubin, calcium, creatine kinase, cholesterol, c-reactive protein, creatinine, glucose, magnesium, potassium, phosphate, sodium, urea, total protein, high sensitivity-troponin I and TSH

The underlying methodologies are identical to existing ones and have been fully evaluated. Patient reference ranges will therefore remain the same.  The Department is applying for an extension to its UKAS 15189 accreditation scope to incorporate the new instrument.  If you have wish to discuss any aspect of this change please contact the Duty Biochemist on 01902 307999 ext. 5290

February 2018 - GP Condition Specific Profile Update

 A Chronic Liver screen profile will be available from Monday 5th February.  Please refer this  information sheet for more information.

January 2018 - Lipid Update

The introduction of West Midlands Familial Hypercholesterolaemia Service ( WMFHS), commissioned by all CCGs in the West Midlands, and availability of PCSK9 inhibitors has led to changes in lipid management and local referral pathways which we summarise briefly in this information sheet.

When requesting lipids in addition to the drop down box identifying fasting/non-fasting samples another drop down box will need completion to identify primary/secondary CVD prevention.  Please note that comments are only applicable if clinical data are entered correctly. Any queries, please contact Prof Gama or Dr Min (secretary 01902 695284)

January 2018 - Diabetes Diagnostic algorithm update

 The diabetes diagnostic pathway has been modified ( attached) to reflect changes relating to the NHS Diabetes Prevention Programme (NHS DPP), a joint initiative from NHS England, Public Health England and Diabetes UK, aimed at identifying and preventing progression of high risk individuals (those with non-diabetic hyperglycaemia) from  developing Type 2 diabetes. Non-diabetic hyperglycaemia (fasting plasma glucose 5.5 – 6.9 mmol/L) spans impaired fasting glycaemia (fasting plasma glucose 6.1 – 6.9 mmol/L). If you have any queries regarding the NHS DPP, please contact Dr Mona Sidhu ( mona.sidhu@nhs.net ) or Ms Sharon Sidhu ( sharon.sidhu@nhs.net ).

December 2017 - Analysis of Vitamin D and immunosuppressant drugs

From December 2017 the Clinical Chemistry Department started using our AB SCIEX 6500 mass spectrometer alongside our existing AB SCIEX 3200 instrument to perform the following tests:

Vitamin D and the immunosuppressant drugs cyclosporin, tacrolimus and sirolimus

The underlying methodologies are identical to existing ones and have been fully evaluated. Patient reference ranges will therefore remain the same.  The Department is applying for an extension to its UKAS 15189 accreditation scope to incorporate the new instrument.  If you have wish to discuss any aspect of this change please contact the Duty Biochemist on 01902 307999 ext. 5290

December 2017 - ICE goes live

 ICE requesting for pathology and Radiology is now live for New Cross site. TDweb requesting has now been retired, although archived reports are still available to view if required.  

September 2017 - ICE pilot for pathology e-requesting

 From Monday 18 September we are trialling the new IT system called ICE which will replace TDweb. It will include a new feature for Histopathology requesting which replaces the use of the green form.  

April 2017 - Changes to Lipid profiles requesting

 

To be compliant with NICE CG181, from Tuesday 25th April both fasting and non-fasting lipid profiles will now include:

       
  • Total cholesterol
  •     
  • HDL cholesterol
  •   
  • Triglycerides
  •     
  • Non-HDL cholesterol
   

A LDL-cholesterol will only be provided on fasting blood samples.

  

For GP surgeries in Wolverhampton, fasting glucose samples still are required for the diagnosis of diabetes.

   

If you need any more help, please do not hesitate to contact us.

 
Zikavirus

Please refer to the following link for guidance on Zikavirus. The duty Microbiologist is available via switchboard at New Cross Hospital if required.

https://www.gov.uk/guidance/zika-virus

Molecular screening for Neisseria gonorrhoeae

We have been using molecular technology to reliably identify the presence of Chlamydia trachomatis for many years and are now extending this to include Neisseria gonorrhoeae. Screening for Neisseria gonorrhoeae is completed utilising a swab or male urine in the yellow-topped container for DNA detection by PCR (the container that is already used for Chlamydia trachomatis). In addition, in terms of genital samples we will only require a high vaginal swab for culture of other associated bacteria.  We will cease to routinely culture for Neisseria gonorrhoeae from today, 8th February 2016.

In summary the requestor will be making the assessment of what you want us to look for by either only sending us an HVS where non-sexually transmitted infection is likely or sending both an HVS for culture and an endocervical swab for molecular testing where STI is a possibility. This means that our investigations will be more clinically relevant.

The links below provide the algorithym for testing of genital infection and letter issued to all GP users detailing the changes to the service.

Flow chart for testing for genital infection and management in primary care

Letter issued prior to the commencement of molecular screenign for Neisseria gonorrhoeae   

For further information please contact Microbiology on 01902 307999 ext 8257.

New improved creatinine method

We are pleased to announce that from 9th December 2015 we will be using an enzymatic method for the measurement of serum and urine creatinine.

Serum creatinine forms the cornerstone of acute kidney injury (AKI) and chronic kidney disease (CKD) diagnoses and monitoring.  The NICE Chronic Kidney Disease Guideline CG182 and the Renal Association guideline on AKI both recommend measurement using the enzymatic technique. 

This new method, which is more specific for creatinine, has a number of advantages

  • It avoids over diagnosis of CKD particularly in diabetic patients
  • It reduces misclassifications and fluctuations in CKD stage
  • It is more accurate for AKI diagnosis

For further information please contact the Duty Biochemist on 01902 695290 or email rwh-tr.ClinicalChemistryHelpdesk@nhs.net

National Pathology Week 2015

Staff within Pathology raised awareness of both the services available and potential careers during National Pathology Week in November. Representatives from Blood Transfusion and Microbiology engaged with staff and patients at New Cross encouraging blood donor registration, raising awareness of Sickle Cell and Thalassaemia, illustrating the potential introduction of primary urine containers within Microbiology and career development for medical students.

 
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Pathology also presented 'Disease Detectives'. A number of local schools visited the department and took part in various acitvities run by Pathology staff and representative from the University of Wolverhampton.

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Protocol for RSV Testing Winter 2015/16

Please click the link below to view the letter issued by Dr. D. Dobie on the 16th October 2015.

RSV Testing Protocol letter 

 Acanthamoebae Investigations

Microbiology will cease to provide this service as of the 1st October 2015, we are no longer accredited to provide this test.

Following consultation with the Opthalmology team and a review by the Eye Infirmary comparing Acanthamoebae culture and PCR, a decision has been made that any samples requiring Acanthamoebae investigations will be sent to a private laboratory for PCR. This service will be managed solely by the Opthalmology team and will provide a turn around time of 24 hours, compared with the current 5 days for culture results.

 

Yersinia Serodiagnosis Serology

Public Health England have announced that they have withdrawn the Yersinia serodiagnosis service with immediate effect. The recommended method of diagnosis of Yersiniosis is the microbiologically isolation of Yersinia species from faecal specimens.

Letter from PHE detailing suspension of Yersinia serodiagnosis services


RWT Pathology wins HSJ Award

Wolverhampton’s pathology laboratory team has scooped a major national accolade at the Health Service Journal (HSJ) Value in Healthcare Awards.

The laboratory was named winner in the Value and Improvement in Pathology Services category at the awards ceremony held at the Grosvenor House, London, on 23rd September 2014.

You can read more from the official press release.


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Chemistry Test Turnaround Times

The Department has always aimed to provide a high quality service responsive to users’ needs. Maintenance of quick test turnaround times is important to support this aim and the following historical targets have been set for most tests:

- Urgent Tests: Reported within 1 hour of receipt of sample

- Routine Ward Tests: Reported within 4 hours of receipt of sample

- Routine GP/Outpatient Tests: Reported within 24 hours of receipt of sample

The Department is in the process of revalidating these targets with service users and developing new tools to monitor and report on compliance with the targets. The following links provides an example of the monitoring reports being produced:

General Test Turnaround Times.

Emergency Department Test Turnaround Times.

If you have any comments about test turnaround times please contact us to let us know.

Bartonella (Cat Scratch) Serology

Public Health England have announced that they have withdrawn the antibody testing service for Bartonella spp. (the cause of Cat Scratch Disease, Trench Fever and Angiomatosis)

Unfortunately there is currently no other laboratory in the country that is able to supply this test. The reference laboratory have been having difficulties with the current assay for some months but have reached a point where they cannot resolve the difficulties and they are not satisfied that the test meets the standards that they require.They are working on an alternative test but no timescale has been given with regard to when this test will be available again.

If you have patients where you believe Bartonella is likely to be the cause and you wish to confirm this then the only mechanism currently is to send biopsy material for 16S rRNA testing, which is possible for those patients undergoing lymph node surgery but otherwise is unlikely to be useful for most patients.

Please bear this information in mind when seeing patients with lymphadenopathy. We will be unable to process blood samples requesting Bartonella serology and we will remove it from the e-requesting system. I will keep you informed of any further developments.

 New look to the website

Hello and welcome to our new website. We hope you find the design easy to navigate and simpler to find the information you require. We have also developed a 'News' page to keep you informed of our services and other related articles that may be of interest.

If you have any suggestions regarding the website please feel free to contact us via the contact us page.

Clinical Chemistry is in the ITN news!

This laboratory was the first in the UK to routinely offer a high sensitivity troponin I assay in conjunction with gender specific reference ranges:

See press release

See ITN clip


 Transition to ISO 15189:2012

In 2009 CPA became a wholly owned subsidiary of UKAS as part of a strategy to contribute to the modernisation of pathology services in the UK. As part of this modernisation and development UKAS is currently managing the transition of all CPA accredited laboratories to UKAS accreditation to the internationally recognised standard ISO 15189:2012, Medical Laboratories – particular requirements for quality, competence.

Our pathology services are likely to be assessed to ISO 15189 during 2015. CPA accredition will continue to exist during the transition phase to compliance to ISO 15189. We will keep you informed, however if you have any concerns please feel free to contact us.

New CKD equation in use

The equation used for calculating eGFR will change to the CKD-EPI equation on Monday 17th November 2014.

The CKD-EPI equation is more accurate than the currently used 4-variable MDRD equation. This may lead to minor changes in classification around CKD stage 3a. This change is in line with recent NICE Guidance on the early identification and management of chronic kidney disease: http://www.nice.org.uk/guidance/cg73

The correction for ethnic origin will also change. Multiply by 1.159 for patients of African-Caribbean origin. As with the current MDRD equation, the CKD-EPI equation is not validated for use in acute renal failure, pregnancy, oedematous states, amputees or malnourished people.

If you have any queries or concerns regarding this, please contact the duty biochemist on extension 5290.

Changes to Troponin Testing

Important Troponin Assay changes from Monday 3rd November at 10am 2014

The current protocol for high sensitivity Troponin I will be changing. Instead of samples collected at 0 and 6 hours, samples should now be taken at 0 and 3 hours. Please contact us if you would like a copy of the updated gender specific diagnostic algorithms.

This change is in line with recent NICE Guidance on the use of high sensitivity cardiac troponin assays in the earlier rule out of Acute MI: http://www.nice.org.uk/guidance/DG15.

It will be possible for 6 hour Troponin I requests to be made until 4pm on Monday 3rd November 2014 for those patients already on the care pathway prior to initiation of the change.

Please Note that Troponin testing is not considered appropriate in primary care. For acute chest pain within 24 hours of onset refer to the Emergency Department or Acute Medical Unit. For chest pain of longer duration suggest contact the Cardiology Registrar via switchboard.

If you have any queries or concerns regarding this, please contact the Duty Biochemist on extension 5290.

 

Faecal Calprotectin Testing available from 1st October 2014

We are pleased to announce the launch of the new faecal calprotectin (fCp) service. Attached is a leaflet for GPs to explain the utility of the test; a leaflet for patients on how to collect samples; a set of instructions on how to e-request fCp and a copy of the ‘Primary care management of diarrhoea pathway’ agreed between Gastroenterology and the CCG.


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Page last updated: 30/01/2018
Next review date: 30/01/2020

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