Pathology Tour 2017 Sickle Cell Disease Malaria Blood Transfusion Biopsies Cancer Haematology Bilirubin Cellular Pathology Glucose Biochemistry Microbiology Urinary Tract MRSA Meningitis Thyroid Stimulation Infection Hormone Jan 17 STHK Pathology Tours 2017 1
STHK Pathology Department Understanding of how pathology works: • Making better use of pathology services. • Provide feedback. • Any issues – contact the department and speak to someone or email: pathology.support@sthk.nhs.uk • Pathology user guide: www.sthk.nhs.uk/pathology Jan 17 STHK Pathology Tours 2017 2
Phlebotomy Service • Requesting of Bloods: Using OCS • Blood test requests are ordered via OCS (maxims) • Sample requirements > all samples taken require 3 identifiers » Time of Collection » Date of Collection » Initials of Collector The way the system is used may change as modifications are introduced Jan 17 STHK Pathology Tours 2017 3
Phlebotomy Service • Phlebotomy currently have 2 in house sites St Helens and Whiston hospitals. • 7 day phlebotomy service to the wards. • Training of NHS professionals, working along side our Education & Training Department. • Phlebotomy also work along side pathology specimen reception. Jan 17 STHK Pathology Tours 2017 4
Methods of Sample Transport to Pathology • Air Tube (POD System) • Hand deliver directly to Pathology Reception Jan 17 STHK Pathology Tours 2017 5
Specimen Reception Jan 17 STHK Pathology Tours 2017 6
Specimen Reception • Specimen Reception process in excess of 2000 Blood Science requests per day, averaging about 5500 serum/urine samples • If you were to include the microbiology/histology/cytology requests on top you’re looking at 10,000 samples per day as a Pathology wide figure • On average 50-100 requests per day are received where processing is delayed or prevented due to errors in requesting or incorrectly labelled samples. With this in mind, samples/requests must be prepared in the correct manner every time Jan 17 STHK Pathology Tours 2017 7
How to label your OCS samples • One sample – One straight vertical label • Correct height – Not sticking to lid but covering existing label • Applied vertically – not around the tube • Flat – no creases, bumps or rips • Perfectly straight • Correct label on correct sample type Jan 17 STHK Pathology Tours 2017 8
Haematology – Biochemistry Department 9 Jan 17 STHK Pathology Tours 2017
Haematology • The haematology lab within Whiston Hospital is mainly responsible for the testing of the following: • Blood (Plasma) • Bone marrow cells • Haemoglobin • Blood proteins • Blood associated diseases • (Sickle Cell Anaemia, Glandular Fever) • All samples are received from the hospital itself or from surrounding areas e.g. GP clinics, other hospitals etc. Jan 17 STHK Pathology Tours 2017 10
Haematology Most routine tests include: • FBC, ESR, Blood films • Bone marrow morphology • Glandular Fever & Sickle Cell screening Specialist tests include: • Haemoglobinopathy & Thalassaemia screening • Malaria screening Jan 17 STHK Pathology Tours 2017 11
Full Blood Count Uses Fluorescence Flow Cytometry to measure Red Blood Cells Platelets White Blood Cells Fast turn around times: A&E FBC: 97% <1hour Ward FBC: 92% <1hour 1900 FBCs processed daily Use Red EDTA Sample Bottles Jan 17 STHK Pathology Tours 2017 12
Coagulation Most routine tests include: • Coagulation Screen, INR, APTR • Fibrinogen, D-Dimer Specialist tests include: • Thrombophilia, Lupus, FVIII Screens, AntiXa • Monitoring of new anticoagulant therapies DOACs Jan 17 STHK Pathology Tours 2017 13
Coagulation Jan 17 STHK Pathology Tours 2017 14
Blood Transfusion Jan 17 STHK Pathology Tours 2017 15
Jan 17 STHK Pathology Tours 2017 16
Biochemistry • The Biochemistry lab within Whiston Hospital is mainly responsible for the testing of the following : • Blood (Serum) • Urine • Cerebrospinal fluid/other fluids • Faeces Samples are received from: • Whiston/St Helens/Southport/Ormskirk hospitals and the surrounding community Jan 17 STHK Pathology Tours 2017 17
Vital statistics • During 2016, Biochemistry processed more than 6 million tests and 650,000 samples and that figure is expected to increase. • This is a monthly average of 85,000 samples. Each of these individual samples usually has multiple chemistry requests. • During Dec 2016 we ran 41,000 U&Es, 18,500 CRPs and 29,000 LFTs. U&Es, CRPs and LFTs are just 3 of the 180 different tests we offer. • 1700 tests per month are referred on. • Biochemistry operates 24/7 Jan 17 STHK Pathology Tours 2017 18
Biochemistry Analysis Highly automated – to cope with high workload Sample types – • Serum • Plasma • Urine • Fluids The lab has 3 Centaur XPs for the analysis of endocrine and serology tests In 2016, the laboratory performed 2 million tests. Jan 17 STHK Pathology Tours 2017 19
Jan 17 STHK Pathology Tours 2017 20
Specimen Rejection Criteria • Unlabelled samples • Insufficient patient information – 3 identifiers on form plus 2 identifiers on sample • Insufficient sample volume • Wrong sample tube used • Pro-longed transport • Contaminated sample • Haemolysed sample (no potassium/phosphate/folate...) • More than one patient sticker/request per form Jan 17 STHK Pathology Tours 2017 21
One form, 2 patients - Example – this request would be rejected. Jan 17 STHK Pathology Tours 2017 22
Automation problems • Sample barcodes must be applied straight and central. • Twisted barcodes cannot be read, leading to a delay in results. • Barcode should be of a good print standard, poor print quality – barcode can not be read Jan 17 STHK Pathology Tours 2017 23
Automation problems • Ensure that the correct sample label is on the correct tube. • Barcodes for yellow and brown blood bottles are sometimes put on the wrong coloured tube which may lead to incorrect results. Jan 17 STHK Pathology Tours 2017 24
SUMMARY • Highly automated system • Reliant on Barcoded samples Sufficient sample volume • Barcode links to patient sample type and tests requested • Errors in sample tube barcode can lead to incorrect results Jan 17 STHK Pathology Tours 2017 25
Microbiology Department operational 24/7 Jan 17 STHK Pathology Tours 2017 26
Microbiology • The Microbiology Laboratory tests the following sample types: • Urines • Faeces • Mucosal and soft tissue • Lower respiratory tract • Fluids • CSFs (Meningitis) • Blood cultures • Other swabs e.g. wounds Blood Cultures Swabs • All samples are again received from the hospital itself or from surrounding areas e.g. GP clinics, other hospitals etc. The clinical details are extremely important – affects sample processing Jan 17 STHK Pathology Tours 2017 27
UTI(Urinary Tract Infection) Investigation • UF1000 examines urine samples (Micro result): • White Blood Cells • Bacteria • 600 urines processed daily. 95% resulted within 24hrs • Use Green urine bottles. • At least 5mls • Sensitivity testing involves the testing of antibiotic discs against the bacteria present to determine: • Susceptible antibiotics (effective). • Resistant antibiotics (non-effective). Jan 17 STHK Pathology Tours 2017 28
MRSA Screening • Routinely processed (nasal or full screens • Provisional culture results within 24 hours • Confirmed by PCR • Determine the source of an outbreak (wards, community) Jan 17 STHK Pathology Tours 2017 29
CSF Analysis • CSF sent to the laboratory is analysed for the following: • Microbiology: (Samples 1 & 3) Appearance White Blood Cell Count Red Blood Cell Count (RBC comparison ?SAH) Gram Stain • Biochemistry: (Samples 2 & 4) Glucose Protein Jan 17 STHK Pathology Tours 2017 30
Faeces Testing Tests involved: • C. difficile • H. pylori • Adeno/Rota/Norovirus • General culture plates • Parasitology Jan 17 STHK Pathology Tours 2017 31
Automated Microbiology MALDI-TOF Analyser • Method for microorganism identification from clinical cultures • Process from sample loading to result takes 3 minutes per sample • Uses mass spectrometry to vaporise bacteria • Vaporised ions are accelerated through a flight tube • Ions hitting the detector cause an electrical signal which is recorded • measures the size and number of different proteins by how fast they move through a vacuum to give an ID • Allows 24/7 identification of organisms • Quicker provisional identification of blood culture isolates Jan 17 STHK Pathology Tours 2017 32
Automated Microbiology Vitek2 • Works alongside the MALDI-TOF • Automated sensitivity testing system • Detects phenotypes and analyses MIC patterns Measures light passing through a well containing a mix of antibiotic and bacteria If cloudy, the bacteria is resistant to the antibiotic if clear the bacteria is sensitive. • Tests up to 60 isolates at one time with sensitivity results available between 6-8hrs. Jan 17 STHK Pathology Tours 2017 33
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