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But all life is an experiment

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Underlying the decision made in this case were words from an American court a century ago: 'All life is an experiment'
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Originally uploaded to http://cdn.flamehaus.com/Valve_Handbook_LowRes.pdf Handbook courtesy of Valve HANDBOOK FOR NEW EMPLOYEES ============================================================ HANDBOOK FOR NEW EMPLOYEES ==============
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Laboratory medicine user handbook rev 22

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University Hospital Southampton NHS Foundation Trust LABORATORY MEDICINE G3.7 Laboratory Medicine user handbook rev 22 G3.7 Laboratory Medicine Laboratory medicine provides a comprehensive range of pathology services to the Trust, general practitioners and also to other external NHS and private sector organisations. It consists of clinical biochemistry, haematology, blood transfusion and immunology departments. Contents: - click the links or scroll down the page Key contacts Specimen transport About our services Adding additional investigations Availability of clinical advice Results reporting Telephoning of significant results Services offered Service hours Useful clinical information Quality assurance Completion of the request form Click on ‘laboratory medicine investigations’ or ‘pathology test information’ in the downloads section (on the right) for information on laboratory tests Specimen collection Special advice on sample collection Specimen rejection Click on ‘specimen rejection’ in the downloads section for the laboratory policy on sample rejection Click on ‘sample storage and disposal’ in the downloads section for details of sample retention times High risk specimens and safety Key contacts Results/General enquiries for all departments 023 8120 6464 labresults@uhs.nhs.uk Specific departmental contacts: If dialling from outside SGH preface 4 digit numbers with 023 8120, unless full number is given Clinical Biochemistry Helpline (24 hrs) 6427 Revision 22 Page 1 of 19 IF THE FIRST PAGE OF THE PROCEDURE DOES NOT HAVE RED “APPROVED METHOD” STAMP IN THE FOOTER – THAT PROCEDURE PRINTED COPY IS UNCONTROLLED. University Hospital Southampton NHS Foundation Trust LABORATORY MEDICINE G3.7 Laboratory Medicine user handbook rev 22 Clinical advice e-mail uhs.dutybiochemist@uhs.nhs.uk G3.7 Clinical director Dr Paul Cook 6419 Pathology Operations Director Consultant & Deputy Clinical Lead for Biochemistry Linda Sayburn Nicola Merrett 6435 6434 Lab Medicine Operations Rick Allan Manager 6706 POCT coordinator Haematology and Blood Transfusion Will Rivenberg 6721 Haematology Laboratory 4029 Coagulation Laboratory 4823 Blood Transfusion Lab 4620 Phlebotomy Supervisor Phlebotomy services SGH Clinical Lead Shamaila Tahsin Dr M W Jenner 4821 4874 4438 Laboratory Lead Dr M W Jenner 4438 Haematology Lab Director Dr Seonaid Pye 3162 Consultants Dr M W Jenner (Myeloma, Haematological Oncology, Blood and Marrow Transplantation) 4438 Dr S Narayanan (Myeloma, Haematological Oncology, General Haematology) 4438 Dr D S Richardson (Haematological Oncology, Blood and Marrow Transplantation) 6164 Dr K H Orchard (Haematological Oncology, Blood 4118 and Marrow Transplantation) Dr R S Kazmi (Haemostasis & Thrombosis, Blood 8862 Transfusion, General Haematology) Revision 22 Page 2 of 19 IF THE FIRST PAGE OF THE PROCEDURE DOES NOT HAVE RED “APPROVED METHOD” STAMP IN THE FOOTER – THAT PROCEDURE PRINTED COPY IS UNCONTROLLED. University Hospital Southampton NHS Foundation Trust LABORATORY MEDICINE G3.7 Laboratory Medicine user handbook rev 22 Dr Robert Lown Dr Sara Boyce Dr Tracy Burt (General Haematology) Wessex Immunology Service Immunology lab Flow Cytometry Immunology Clinic Consultant Immunologist Dr Efrem Eren Consultant Immunologist Dr Sapna Srivastava Consultant Clinical Scientist Dr Alison Whitelegg Consultant Clinical Scientist Dr Karen Smith-Baker Honorary Consultant Prof A Williams G3.7 3556 3556 5831 6615 6640 4001 6650 Mob: 07887812703 5929 2043 6976 6670 About our services Laboratory Medicine provides a comprehensive range of Pathology services to the Trust, General Practitioners and also to other external NHS and Private Sector organisations. Consent Please see the following document available on the UHS website: Consent to Examination or Treatment: Policy Patients attending adult venesection services will be asked to give verbal consent prior to blood specimens being collected. Information Governance All staff working for the Pathology have a legal duty to keep information about patients and staff members confidential and to protect the privacy of individuals. All staff adhere to the Trust’s Data Protection and Confidentiality Policy and are mandatorily required to perform annual Information Governance training. Dealing with Complaints Laboratory Medicine adheres to the Trust Policy for handling concerns and complaints. All complaints, either raised via Patient Support Services or directly to a member of staff from within the department will be thoroughly investigated and actioned to resolve any identified issues. Revision 22 Page 3 of 19 IF THE FIRST PAGE OF THE PROCEDURE DOES NOT HAVE RED “APPROVED METHOD” STAMP IN THE FOOTER – THAT PROCEDURE PRINTED COPY IS UNCONTROLLED. University Hospital Southampton NHS Foundation Trust G3.7 LABORATORY MEDICINE G3.7 Laboratory Medicine user handbook rev 22 http://staffnet/TrustDocsMedia/DocsForAllStaff/GovernanceAndSafety/HandlingConcernsandComplai ntsPolicy/HandlingConcernsandComplaintsPolicy.pdf Availability of clinical advice Consultants within each discipline are available to provide help with the interpretation of results and other clinical advice. Please refer to 'Key Contacts'. Services offered Clinical Biochemistry provides a full range of laboratory and clinical services incorporating routine biochemistry, lipids, toxicology and metabolism, endocrinology, trace metals and the co-ordination of clinical trial work and point-of-care testing. Renal stone, lipid and bone outpatient clinics are also undertaken. Haematology and Blood Transfusion provide routine Haematology, Blood Transfusion and specialised haemostasis and haemoglobinopathy testing in support of regional and national programmes as well as services to support an expanding bone marrow transplant service. The department also supports a Haemophilia service for both adults and children. Consultant and nurse-led outpatient clinics are undertaken at SGH, RSH and Lymington Hospitals. Day care facilities are available on C3 Hamwic day ward at SGH and at Lymington Hospital. Palliative care is available through Countess Mountbatten House at Moorgreen Hospital. Immunology provides routine immunological analysis into allergy, autoimmunity and protein chemistry as well as specialised analysis for the diagnosis of haematological malignancy and immunodeficiency. Follow this link for Clinical Services Outpatient service details Venesection service - see detail in Service hours (below) Point of care testing. We can provide help and advice on the implementation of point of care testing system such as hand held blood glucose meters. Please contact our POCT coordinator for further information. Service hours Clinical Biochemistry, Haematology and Blood Transfusion laboratories 24-hour service List of tests available 24 hours a day in Haematology and Coagulation Haematology: FBC Retics Revision 22 Page 4 of 19 IF THE FIRST PAGE OF THE PROCEDURE DOES NOT HAVE RED “APPROVED METHOD” STAMP IN THE FOOTER – THAT PROCEDURE PRINTED COPY IS UNCONTROLLED. University Hospital Southampton NHS Foundation Trust LABORATORY MEDICINE G3.7 Laboratory Medicine user handbook rev 22 ESR G3.7 Glandular fever (IM) screen Blood film Malaria parasite screen Sickle cell test Coagulation: Coagulation screen (CS) INR APTR D-dimer derived fibrinogen Factor assays (with approval from Haematology consultant) G6-PD screen ADAMTS13 Specialist laboratories available Monday to Friday, 9am to 5pm Clinical Biochemistry / Haematology Immunology Blood Tests - Service locations and hours (April 2011) Phlebotomy services are available at Southampton General Hospital and Lymington Hospitals. Details of times and venues are given below: - Location Opening times SGH, C level, South Laboratory Block Monday to Friday,0800 to 1645. Appointments can be booked via www.uhs.nhs.uk/bloodtests SGH, children - Butterfly room, C level Monday to Friday by appointment only, Call 023 8120 2024 Lymington Hospital Monday to Friday, 0730 to 1645. Appointments can be booked via www.uhs.nhs.uk/bloodtests Revision 22 Page 5 of 19 IF THE FIRST PAGE OF THE PROCEDURE DOES NOT HAVE RED “APPROVED METHOD” STAMP IN THE FOOTER – THAT PROCEDURE PRINTED COPY IS UNCONTROLLED. University Hospital Southampton NHS Foundation Trust LABORATORY MEDICINE G3.7 Laboratory Medicine user handbook rev 22 Royal South Hants Community Monday to Friday 0800 to 1800 Diagnostics Centre Saturdays 0800 to 1530 G3.7 Appointments can be booked via www.uhs.nhs.uk/bloodtests Please note that appointments may be necessary for special procedures such as dynamic function tests Completion of the request form Request forms need to be properly completed. A request form must accompany all specimens sent to the laboratory and should clearly state the following information: • Surname and forename • Hospital /NHS Number • Date of birth • Sex • Ward/Clinic and Consultant code • Type of specimen • Date and time of collection • Investigations required • Relevant clinical information • Identification of priority status. eQuest (electronic requesting) is the preferred method for the requesting of tests in Chemical Pathology, Haematology, Coagulation and Immunology as it leads to quicker processing times and reporting. Specimen Collection Samples should be collected into appropriate tubes and sent to the laboratory. Please allow tubes to fill to capacity. This is especially true of coagulation, where underfilled samples are unsuitable for testing and will be rejected. The laboratories at SGH are open and able to receive samples 24 hours a day, 7 days a week. Samples should be clearly labelled with the patient's name and date of birth. A request form that provides patient information, specimen type and tests required should accompany samples. The requirements for samples for Blood Transfusion are more stringent, due to the prescription nature of the request. Both the sample and request should contain a minimum of the following information: • Full name (no abbreviations) Revision 22 Page 6 of 19 IF THE FIRST PAGE OF THE PROCEDURE DOES NOT HAVE RED “APPROVED METHOD” STAMP IN THE FOOTER – THAT PROCEDURE PRINTED COPY IS UNCONTROLLED. University Hospital Southampton NHS Foundation Trust LABORATORY MEDICINE G3.7 Laboratory Medicine user handbook rev 22 • Hospital number and/or NHS Number G3.7 • Date of birth • Date and time sample taken • Signature of person taking blood Failure to adhere to Blood Transfusion request guidelines WILL result in the rejection of the request, without exception. A table of specimen requirements for commonly requested tests is provided below: Test Anticoagulant Adult tube top colour Routine Biochemical profile, lipids, etc. Serum Separator Tube (SST) with Gel Gold Glucose Fluoride Oxalate Grey HbA1c EDTA Mauve FBC and ESR EDTA Mauve Coagulation Citrate Sky Blue Immunology investigations Serum Separator Tube (SST) with Gel Gold Lithium Serum Separator Tube (SST) with Gel Gold Group and Save/Crossmatch EDTA Pink NT-Pro BNP Lithium Heparin Green ACTH EDTA Mauve PTH Lithium Heparin Green HIT screen Serum Red For all the above tubes, please ensure that the maximum fill is attained. Failure to do this may mean that the laboratories are unable to perform certain tests. When using UHS electronic requesting system eQuest, it is imperative that the request-generated barcodes are of good quality (i.e. they are complete with a clear gap at either end), are attached to the correct sample and are attached straight, along the length of the tube, NOT around it. Failure to observe these instructions WILL lead to delays in processing and testing samples. Revision 22 Page 7 of 19 IF THE FIRST PAGE OF THE PROCEDURE DOES NOT HAVE RED “APPROVED METHOD” STAMP IN THE FOOTER – THAT PROCEDURE PRINTED COPY IS UNCONTROLLED. University Hospital Southampton NHS Foundation Trust LABORATORY MEDICINE G3.7 Laboratory Medicine user handbook rev 22 G3.7 Special advice on sample collection The information below is intended to provide advice on patient preparation and specimen collection for specific tests where results may be affected by these factors: Faecal Immunochemical Testing (FIT) Requesting source should contact the lab for FIT sampling kits and advice. Glucose Tolerance Test GTTs on Non-pregnant patients can be performed by the Venesectors in Pathology Outpatients. G.P.s who wish to use this service should send the patient, with a completed request form for a GTT to the Venesectors at Pathology Outpatients at 0845 on Monday, Tuesday, Wednesday and Friday morning. (Please note that Thursday is not possible due to large haematology clinics that morning.) Clinicians with hospital beds should arrange for their juniors to do the tests on the wards. In pregnancy GTT's are carried out at Princess Anne Hospital in the antenatal Day Unit by special arrangement, telephone 023-8079-6303. These are generally requested by the Obstetrician at P.A.H. The patient must have taken an unrestricted diet, including adequate carbohydrate, for at least 3 days prior to the test. The patient must be fasted for 10-16 hours before the test begins (plain water only allowed) and for the duration of the test. It is therefore convenient to commence the test first thing in the morning. Cryoglobulins Prior to taking a blood sample, please contact the immunology lab to collect a flask containing water maintained at 37°C. The sample must be taken and returned to the laboratory within 1 hour of the flask being collected in a plain tube (Red topped) and must arrive by 1.30pm to allow time for processing. Trace Elements sample requirements Urine samples Random urine samples/plain 24-hour urine aliquots should be collected into Sterilin universal containers or other suitable trace element-free containers. Whole blood samples 2mL Teklab lithium heparin tubes (paediatric samples) Greiner sodium heparin for Trace Elements Analysis Vacuettes (adult samples) External laboratories Revision 22 Page 8 of 19 IF THE FIRST PAGE OF THE PROCEDURE DOES NOT HAVE RED “APPROVED METHOD” STAMP IN THE FOOTER – THAT PROCEDURE PRINTED COPY IS UNCONTROLLED. University Hospital Southampton NHS Foundation Trust LABORATORY MEDICINE G3.7 Laboratory Medicine user handbook rev 22 G3.7 If sending serum/plasma samples, whole blood samples should be collected as stated above, and then spun and separated into trace-element free polycarbonate tubes (these should not have rubber gaskets/O-rings in the lid as they are sources of contamination). For any queries, please contact the Trace Elements laboratory: uhs.traceelements@uhs.nhs.uk Sweat tests Current Cystic Fibrosis unit sweat collection procedure Sweat Test Process • Identify patient • Select forearm (avoid cuts) • Cleanse skin with steret • Wipe skin with sterile water & gauze • Attach gel discs to each probe (only touch if wearing gloves) • Apply red probe to lower arm and secure with straps • Apply black probe to lower arm but higher than red probe • Switch machine on • Machine will beep when finished (after 5 mins) • Remove black probe • Remove red probe • Throw both gel discs away • Cleanse arm with sterile Water & Gauze • Attach collection plate to area previously covered by the red probe • Push down (should see blue dye appear to confirm working) • Secure with straps • Cover with bandage/cling film • Leave for 30 minutes or until 3-4 clear blue rings seen in window • Flip plastic cover off collection plate • Pull plastic tubing out of collection plate and cut at base • Use plunger to push sweat collected into collection pot • Put small collection pot into specimen bottle & send to Trace Elements lab with specimen form. N.B. We measure sweat chloride only in this laboratory. Creatinine Clearance test Collect a special urine collection bottle from the laboratory; this contains a small amount of thymol as a preservative. Patient empties bladder; discard this urine and note the time on the bottle. Revision 22 Page 9 of 19 IF THE FIRST PAGE OF THE PROCEDURE DOES NOT HAVE RED “APPROVED METHOD” STAMP IN THE FOOTER – THAT PROCEDURE PRINTED COPY IS UNCONTROLLED. University Hospital Southampton NHS Foundation Trust LABORATORY MEDICINE G3.7 Laboratory Medicine user handbook rev 22 G3.7 For the next 24 hours every drop of urine passed by the patient must be added to the bottle. Advise the patient to pass urine before opening their bowels if necessary. 24 hours later, empty bladder again and add to the collection, and note the time. The collection does not have to be exactly 24 hours, but we must know the exact times of starting and ending the collection (to the nearest minute). At any time during the urine collection take a venous blood sample into a lithium heparin tube for plasma creatinine estimation. Separate request cards must be written to accompany the urine sample and blood sample. 5-HIAA For 24 hours prior to starting the using collection patients should refrain from eating or drinking any of the items listed below or any food or drink containing these items: Broccoli, Cauliflower, Brussel Sprouts, Egg Plants, Mushrooms, Citrus Fruits and Tomatoes (including juices), Bananas, Avocados, Plums, Passionfruit, Pineapple, Alcohol (wine and beer), Processed meats (loaves, salami, sausages, ham), Fish, Seafood, Nuts, Seeds, Berries and Caffeine (including products containing chocolate). Specimen rejection Specimens will be rejected if they are unsuitable for the investigations requested or if the identity of the patient is in doubt. This is to prevent misleading results being reported that could lead to inappropriate patient management. The Laboratory Medicine specimen rejection policy contains full details and can be accessed using the link located in the downloads section of this web page. High risk specimens and safety All specimens must be collected into leak resistant containers. The container must be appropriate for the purpose, properly closed and not contaminated on the outside. All specimens are regarded as high risk, but if they are taken from a patient who is known to be infected with a blood-borne agent such as hepatitis B virus and HIV, another serious infectious disease such as tuberculosis or typhoid, or from those at risk of being infected by one of these agents, then extra care should be taken to highlight this. These specimens should be labelled as HIGH RISK on the request form. Specimen transport All sample containers from a single request are to be sealed into a clear plastic specimen bag by the person taking the sample. Specimen request forms/support documents must not be placed in the same compartment as the sample. UHS specimen transport arrangements: Samples are collected from wards on a frequent basis by the portering service. However, using the pneumatic tube delivery (POD) system improves sample turnaround times and reduces pressure on Revision 22 Page 10 of 19 IF THE FIRST PAGE OF THE PROCEDURE DOES NOT HAVE RED “APPROVED METHOD” STAMP IN THE FOOTER – THAT PROCEDURE PRINTED COPY IS UNCONTROLLED. University Hospital Southampton NHS Foundation Trust LABORATORY MEDICINE G3.7 Laboratory Medicine user handbook rev 22 G3.7 portering staff. The system cannot be used for blood and blood products for transfusion, nor for Cellular Pathology samples that are immersed in liquid formalin fixative. It should also not be used for: - · Sputum samples · CSF samples for xanthochromia (? SAH) The system should be used for all other Pathology samples including blood cultures. All samples for Laboratory Medicine should be sent to POD station number 8355 GP Practice specimen transport and collection arrangements: Samples are collected from surgeries and clinics on a daily basis. For details of frequency and times please contact: Transport Department 140 Mauretania Road Nursling Industrial Estate Southampton SO16 6YS Tel: 023 80748027 Adding Additional Investigations Immunology: Cell based assays only viable for 48 hours. Serological tests - please note that requests for retrospective testing can be made up to 3 weeks ONLY after the sample has been taken, subject to the sample volume remaining being sufficient and the nature of the retrospective request Clinical Biochemistry: Specialist Biochemistry, Endocrinology investigations: 3 weeks Automated investigations: 24 hours Trace Element: 1 Month Urine drug screen - one month Chromatography investigations: 1 month Blood Transfusion: Depends on 'sample validity '. A sample is valid for 7 days when stored at 4C as long as the patient has not been transfused in the last month. If patient has been transfused in last month, the sample is only valid for 72 hours from when the transfusion started or must not be more than 72 hours old when transfusion begins. Kleihaur can be added up to 7-days. Revision 22 Page 11 of 19 IF THE FIRST PAGE OF THE PROCEDURE DOES NOT HAVE RED “APPROVED METHOD” STAMP IN THE FOOTER – THAT PROCEDURE PRINTED COPY IS UNCONTROLLED. University Hospital Southampton NHS Foundation Trust LABORATORY MEDICINE G3.7 Laboratory Medicine user handbook rev 22 G3.7 Coagulation: Test to be added INR, CS, DD, Lupus Anticoagulant APTR Thrombophilia screen Factor assays, Protein C/S, Antithrombin, Thrombin Time, Von Willebrand antigen, Collagen Binding assay, Ricof, Platelet aggregation, PFA 100, Thromboelastogram, Any other specialist coagulation test Time limit 12 hours 4 hours Not possible to add 1 hour after venesection Not possible to add Automated Haematology: Test to be added FBC, IM (glandular fever) screen, Haemoglobinopathy screen, Sickle cell screen, Film, ESR, Reticulocyte, nucleated RBC Malaria parasite screen G-6-PD screen Time limit 1 day 1 day Needed fresh 1 day If the required investigation is not listed above, please contact the relevant laboratory Results Reporting • Validated results are reported electronically to UHS results servers eQuest and ICE. • Electronic reports are produced for GP sources every 2 hours 05:00-22:00 for delivery via EDI PMIP services. • Hard copy reports for valid locations are printed and dispatched every working day, including Saturdays. Telephoning of significant results Revision 22 Page 12 of 19 IF THE FIRST PAGE OF THE PROCEDURE DOES NOT HAVE RED “APPROVED METHOD” STAMP IN THE FOOTER – THAT PROCEDURE PRINTED COPY IS UNCONTROLLED. University Hospital Southampton NHS Foundation Trust LABORATORY MEDICINE G3.7 Laboratory Medicine user handbook rev 22 G3.7 Samples may be "fast tracked" and results telephoned back when necessary. Results for these samples will normally be available within 2 hours of receipt in the laboratory. Please call ext. 8890 and provide patient's details so that the sample may be identified. Occasionally unexpected abnormal results are produced. If this occurs, laboratory staff will endeavour to telephone these results to the requesting source. Useful clinical information Common causes of spurious results Please ensure that you follow instructions when collecting and storing samples. Inappropriate sample collection, storage and transport can interfere with a number of results. Same examples are given in the table below: Problem Common causes Effect Incorrect tube fill/mixing Delay in separation of plasma overnight storage delay in transit ALL analytes may be compromised Increased K, PO4, LDH Storage Biochemistry samples in a fridge Increased K Haemolysis Expelling blood through a needle into the tube Vigorous shaking Increased K, PO4, ALT, LDH, Mg, Iron Extremes of temperature Inappropriate collection site Sample taken from drip arm Increased drip analyte e.g. K , Glucose Dilution effect low results Incorrect container or anticoagulant No fluoride oxalate E.D.T.A. contamination Decreased glucose Decreased Ca Increased K Li sample collected into Li Heparin Increased Li Revision 22 Page 13 of 19 IF THE FIRST PAGE OF THE PROCEDURE DOES NOT HAVE RED “APPROVED METHOD” STAMP IN THE FOOTER – THAT PROCEDURE PRINTED COPY IS UNCONTROLLED. University Hospital Southampton NHS Foundation Trust LABORATORY MEDICINE G3.7 Laboratory Medicine user handbook rev 22 G3.7 Hormone profiles PROBLEM MALE PATIENTS Erectile dysfunction Infertility Gynaecomastia/ galactorrhoea FEMALE PATIENTS ? Menopause {?PCO; hirsutism;virilisation;alopecia Amenorrhoea/oligomenorrhoea Infertility Galactorrhoea APPROPRIATE REQUESTS LH FSH Prolactin Testosterone (08.00-10.00H) LH FSH Prolactin Testosterone (08.00-10.00H) LH FSH Prolactin HCG Testosterone (08.00-10.00H) Oestradiol; thyroid function tests (LFT's & renal profile) For women 11.1 mmol/L or 2) A fasting plasma glucose concentration > 7.0 mmol/L or 3) A 2-hour glucose post 75g oral GTT of > 11.1 mmol/L A GTT should not be necessary if the fasting plasma glucose is > 7.0 mmol/L, but this needs to be confirmed on another occasion if the patient has no symptoms. Patients with impaired fasting glycaemia ("IFG") (fasting plasma glucose > 6.1 but less than 7.0 mmol/L) should be assessed with an oral GTT. Impaired glucose tolerance ("IGT") is defined as a fasting plasma glucose of 7.8 but 5 mmol/L Possible causes (rare genetic causes excluded) Spurious 1. Haemolysed samples Revision 22 Page 15 of 19 IF THE FIRST PAGE OF THE PROCEDURE DOES NOT HAVE RED “APPROVED METHOD” STAMP IN THE FOOTER – THAT PROCEDURE PRINTED COPY IS UNCONTROLLED. University Hospital Southampton NHS Foundation Trust LABORATORY MEDICINE G3.7 Laboratory Medicine user handbook rev 22 G3.7 2. Delay in separating plasma from cells - the ideal is within 1 hour of venepuncture. Values after 6 hours are unacceptable 3. Samples refrigerated at 4 C 4. Unusually cold weather - potassium leaks into plasma during transport 5. Collection into inappropriate tubes (e.g. fluoride tubes used for glucose; potassium EDTA tubes for blood counts) 6. Vigorous mixing 7. Patients open and close their fist repeatedly during venesection 8. Very high white cell counts: > 2000 x 109/L (leukaemias) 9. Very high platelet counts: > 1000 x 109/L 10. Abnormally permeability of red cells: cold agglutinins; infectious mononucleosis; inherited red cell membrane defect (rare) True hyperkalaemia Normal kidneys excrete excess potassium promptly - within hours. Hyperkalaemia generally occurs with renal failure plus another factor. Life-threatening hyperkalaemia is almost always encountered in those with impaired renal function. Drugs 1. Potassium supplements 2. Potassium sparing diuretics - triamterene; amiloride; spironolactone 3. Drugs that interfere with the renin/aldosterone axis: a. ACE inhibitors—e.g. captopril; enalapril b. ACE 11 receptor blockers- e.g. losartan; candesartan c. nonsteroidal anti-inflammatory drugs d. heparin; tacrolimus; cyclosporin; trimethoprim-sulphamethoxazole e. Drugs that inhibit membrane ATPase -digoxin; β-Blockers Combinations of the above are particularly risky Diet 1. Potassium-containing salt substitutes (low salt) 2. High potassium foods if end-stage renal failure Acute renal failure: Especially if catabolic—sepsis; injury; intravascular haemolysis; GIT bleed Chronic renal failure: If no other exacerbating factors potassium may be maintained until GFR 7.5 mmol/l) :muscle weakness; paraesthesiae; rarely: flaccid paralysis Risk increases with rising potassium but there is not close correlation - patients with chronic renal failure may be more resistant ECG abnormalities are the best guide to risk plasma potassium (mmol/L): rough correlation [1] 6.5-7.0 Peaked T waves [2] 7.0-8.0 Prolonged P-R interval; flattening then loss of P waves; Widening of QRS complexes with deep S waves [3] > 8.0 Sine wave pattern progressing to ventricular fibrillation then cardiac arrest [4] > 10.0 Generally fatal Can progress rapidly from [1] to [3], particularly if plasma sodium or ionised calcium is low Hyperkalaemia with peaked T waves is serious Hyperkalaemia with more advanced ECG changes is life-threatening Low plasma potassium 3.0 mmol/L Potassium supplements or potassium sparing drugs are advised with diuretics if: · pre-treatment potassium is 3.0 – 3.2 mmol/L · potassium falls to 3.0 – 3.2 mmol/L after 4 weeks on diuretics · the patient has a potassium-losing disorder (e.g. cirrhosis, nephrotic syndrome; chronic diarrhoea) Replacement of a serious body deficit takes a long time. Quality Assurance All Pathology departments have a mature quality management system, as described in the Pathology quality manual. The following departments are UKAS accredited medical laboratories: Department of Haematology & Blood Transfusion. UKAS accreditation number: 8149 Department of Clinical Biochemistry UKAS reference number:8483 Department of Immunology UKAS reference number: 8696 (The UKAS ISO15189 schedule of accreditation are detailed on the UKAS website https://www.ukas.com/find-an-organisation/ Please refer to the attached document G3.7a laboratory medicine investigations for the accreditation status of individual tests We are accredited for training Biomedical Scientists and Clinical Scientists by the Health Care Professions Council (HCPC). Revision 22 Page 19 of 19 IF THE FIRST PAGE OF THE PROCEDURE DOES NOT HAVE RED “APPROVED METHOD” STAMP IN THE FOOTER – THAT PROCEDURE PRINTED COPY IS UNCONTROLLED.
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