Haematology Handbook

THE DEPARTMENT OF LABORATORY HAEMATOLOGY HANDBOOK
HANDBOOK V 10.4
Date issued 02/09/22
Contents
Changes in this document since last version ....................................................................................................... 3
About the Oxford University Hospitals NHS Foundation Trust (OUH) ................................................................. 3
The John Radcliffe Hospital ............................................................................................................................. 3
The Churchill Hospital ...................................................................................................................................... 3
The Horton Hospital (Banbury) ........................................................................................................................ 3
The Nuffield Orthopaedic Centre (NOC) .......................................................................................................... 3
About us:............................................................................................................................................................... 4
Policies - Dept. of Laboratory Haematology Oxford University Hospitals Foundation Trust ................................ 5
Animal Specimens ........................................................................................................................................... 5
Billing ................................................................................................................................................................ 5
Business Continuity and Contingency Plans ................................................................................................... 5
Chain of Custody .............................................................................................................................................. 6
Confidentiality of Results .................................................................................................................................. 6
Phone Enquiry Policy (SOP Gen 001) ............................................................................................................. 6
Complaints / feedback ...................................................................................................................................... 6
Telephoning of Critical Values ......................................................................................................................... 7
Disclosure of Results ....................................................................................................................................... 7
Infectious Material ............................................................................................................................................ 7
Radioactive Samples ....................................................................................................................................... 8
Record Retention ............................................................................................................................................. 8
Referral of Tests to another Laboratory ........................................................................................................... 8
Distribution of testing on various sites within the department of laboratory Haematology ................................. 10
Quality................................................................................................................................................................. 12
Scope of Accreditation ................................................................................................................................... 12
Proficiency Testing ......................................................................................................................................... 13
Measurement of Uncertainty .......................................................................................................................... 14
The Quality Policy of the Department of Laboratory Haematology................................................................ 15
Working Hours .................................................................................................................................................... 16
Transfer of Specimens to the Laboratory ........................................................................................................... 17
Requesting of Tests ............................................................................................................................................ 18
OUH Requests ............................................................................................................................................... 19
Oxfordshire CCG GP Practices:..................................................................................................................... 19
All other locations (including referrals from other trusts): .............................................................................. 20
Sample Requirements ........................................................................................................................................ 20
Sample Types for Commonly Requested Tests. ........................................................................................... 20
Paediatric tube types in use. .......................................................................................................................... 21
General Haematology Tube requirements ..................................................................................................... 22
General Coagulation Tube requirements ....................................................................................................... 23
Coagulation screens before surgery or invasive procedures ......................................................................... 23
Specialist Coagulation testing ............................................................................................................................ 24
Who to test for heritable thrombophilia? ........................................................................................................ 24
Samples referred to the laboratory for Haemostatic or Thrombotic investigations ........................................ 25
Samples referred to the laboratory for platelet function investigations .......................................................... 26
Specialist Haematology including Molecular Haematology ........................................................................... 27
General Information ....................................................................................................................................... 27
Reporting of Results ........................................................................................................................................... 28
Oxford University Hospital Foundation Trust Users ....................................................................................... 28
What you need before you start ..................................................................................................................... 28
Login process ................................................................................................................................................. 28
Tap&Go .......................................................................................................................................................... 28
Launching Millennium .................................................................................................................................... 28
Forgotten your smartcard or it has stopped working? ................................................................................... 28
Oxfordshire ICB GP Practices ........................................................................................................................ 30
Oxford Haemato-Molecular Diagnostic Service ............................................................................................. 30
RAID Anticoagulant Dosing Service .............................................................................................................. 30
All other users ................................................................................................................................................ 30
NPEX .............................................................................................................................................................. 30
Retrospective Testing ......................................................................................................................................... 31
Sample Analysis Turnaround times .................................................................................................................... 33
Key Factors known to affect result quality .......................................................................................................... 35
Blood Transfusion ............................................................................................................................................... 37
Requests for Blood and Blood Products for Transfusion ............................................................................... 37
Patients with atypical antibodies .................................................................................................................... 37
Emergency Transfusion including Massive Haemorrhage ............................................................................ 37
Blood Ordering Schedule ............................................................................................................................... 38
Transfusion Sample Requirements ................................................................................................................ 39
Samples for Antenatal Testing: ...................................................................................................................... 39
Appendix I Normal Ranges (Adult, 13 years+, apart from ESR: 17 years +) ..................................................... 40
Appendix II, Departmental Telephone Numbers ................................................................................................ 43
Appendix III, Examples of Haematology Request forms .................................................................... 44
Changes in this document since last version
• Updated services on sites
• Updated reference ranges
• Updated EQA participation list.
• Changes made to improve accessibility
Laboratory Haematology
About the Oxford University Hospitals NHS Foundation Trust (OUH)

One of the largest NHS teaching trusts in the country. It provides a wide range of general and specialist clinical
services and is a base for medical education, training, and research. The Trust is one of the largest employers
in Oxfordshire, primarily based in Headington, Oxford and comprises:
The John Radcliffe Hospital

• Accident and Emergency
• Acute medical and surgical services, trauma, intensive care, cardiac, infectious diseases, women’s
services, and children’s services.
The Churchill Hospital
• Non-emergency specialist services
• Renal medicine and transplant, clinical and medical oncology, dermatology, chest medicine, and
palliative care.
The Horton Hospital (Banbury)
• Accident and emergency services
• General hospital service, maternity, and paediatric services.
The Nuffield Orthopaedic Centre (NOC)
• Orthopaedics, rheumatology, and rehabilitation.
• Specialist haemophilia care
About us:
The main Haematology Department, including Blood Transfusion, is situated on Level 4 of the John Radcliffe
Hospital, Headington, Oxford, and provides a comprehensive service to Oxfordshire and other, more distant
referring laboratories.
This service includes the following:

1. Routine Haematology,
2. Antenatal and neonatal haemoglobinopathy screening service in line with NHSE screening guidance
3. Routine Haemostasis
4. Blood Transfusion service
5. Morphology and Leukaemia Immunophenotyping service
6. A comprehensive molecular diagnostic service for a range of haematological conditions. (More information
can be found at: link to oxford genetics laboratories )
On the Horton General Hospital site, the department is located in the Pathology building and provides the
following services:
1. Routine Haematology and Morphology
2. Routine Haemostasis
3. Blood Transfusion service
This provides a comprehensive service to the hospital as well as local GPs in the North of Oxfordshire, and
South of Northamptonshire.
On the Churchill Hospital site, the department provides the following services:
1. Routine Haematology, haemostasis, and blood product issue support, 8am-7pm Monday to Friday, from the
Laboratory Medicine Building. Located opposite Car Park 5. Use Air Tube Station 14 to send samples. This
laboratory is referred to as Laboratory Medicine (LM)
2. On the Nuffield Orthopaedic Centre site there is no routine Haematology or Blood Transfusion
laboratory, and all these services are supported from the John Radcliffe. However, from March 2022
Specialist Haemostasis and Thrombophilia diagnostic and monitoring service for patients with inherited
haemostatic defects. (The Oxford Haemophilia and Thrombosis Centre, OHTC). The OHTC is located to
the rear of the NOC campus near to Old Road in Headington.
24/7/365 services are maintained on both the John Radcliffe and the Horton sites.
Policies - Dept. of Laboratory Haematology Oxford University Hospitals Foundation Trust
Policy Statements
Animal Specimens
We do not accept animal specimens for laboratory testing
Billing
• Work to support NHS care of OUH patients will be managed following Trust budget setting process, with
cross-charging from Directorate of Pathology and Laboratory Medicine to appropriate Division / Directorate
based on monthly outcome against plan.
• Work to support Oxfordshire CCG NHS workload will be billed by OUH commissioning according to the
agreed overall Contract on a monthly basis.
• In the absence of a specific exceptional contract, the standard Laboratory Medicine Terms and conditions
will apply. (link to OUH website, laboratory medicine page ).
• In case of initial referral of work for the first time to the laboratory, or a significant change (considered to be
an increase of greater than 20 percent by activity), please contact the laboratory prior to referral, so that the
laboratory can assure you that they have the capacity and resources to meet your request.
• Receipt of a sample for testing will be deemed to be acceptance of a contract with OUH Foundation Trust,
the work will be invoiced within 30 days of completion and payment is expected within 30 days of invoice
being raised. It is the sender’s responsibility to manage the process of raising purchase order numbers, if
that is required by the sending organisation.
• Private Patients:
o The OUH sees a variety of Private Patients, they need to be registered with the OUH Private Patient
Office (link to OUH website, private patients), and the bills for the Laboratory Medicine fraction of
their care will be raised as part of their overall care. If insurance is involved, they need to sign a
Pre-authorisation with the relevant Insurance Company.
o Non-OUH patients, the Department is happy to provide services for other organisations that provide
care to Private Patients, but as the Department will have no relationship with the individual patient,
any bill will be the responsibility of the sending organisation. The Department will not bill individual
patients.
• Clinical Trials:
o Clinical Trials at OUH if there is a laboratory component to the Trial should have agreed the financial
aspects of the study with the Joint R&D office based at the Churchill Hospital, while obtaining ethical
approval. Details of any support required from OUH laboratories should be agreed in advance of
the Trial commencing, contact labtrials.ouh@nhs.net
o Individual projects can be agreed directly with the laboratory on a case-by-case basis, please
contact Laboratory Manager, Haematology and labtrials.ouh@nhs.net, well in advance.
Business Continuity and Contingency Plans

In the event of a local, regional, or national disaster, Oxford University Hospitals NHS Trust have
comprehensive contingency plans in place to ensure the impact on care and specifically on laboratory
services is minimised. With standardisation of testing across our various sites we have worked to ensure most
of the common workload can be performed from more than one site.
Chain of Custody
Chain-of-Custody is a record of disposition of a specimen to document who collected it, who handled it, who
performed the analysis, is often required when results are to be used in a court of law, (e.g., in Paternity
testing cases). The Dept. of Laboratory Haematology does NOT provide this service. In certain appropriate
cases with relevant consent, samples or test results originally used for clinical care would be released if no
longer required for clinical testing.
Confidentiality of Results
OUH Hospitals Laboratory Haematology Department is committed to maintaining the confidentiality of patient
information. To work towards this goal, we aim to minimise the transmission of results by telephone and aim to
maximise the use of electronic transmission of results to systems with audit trail of access to the results. The
Department follows the policy of the Oxford University Hospitals Foundation Trust, with regards to patient
confidentiality and as such all staff are required to complete training in Information Governance and maintain
competence.
Phone Enquiry Policy (SOP Gen 001)

Results will only be released to a referring clinician or their approved representative. Third parties including
patients, or their relatives will be referred to the ordering clinician. We will want to ensure anyone phoning has
legitimate authority to receive the results. Patients would need to be clearly identified by use of NHS or MRN
number AND full name or date of birth. Provision of appropriate information before enquiring will greatly assist
prompt and accurate response to enquiries and reporting.
Complaints / feedback
Although we always like to hear about the things we have done well, we would also like to hear about the things
we could do better.
The Oxford University Hospitals NHS Foundation Trust (OUH) is committed to providing the very highest
standards of care.
We will always try our best to get things right, but sometimes mistakes happen. When they do, it is vitally
important to put things right as soon as possible, and to ensure that the same mistakes do not happen again. If
as a user you feel that the department has not fulfilled its obligations to you, please contact the department as
below. These contact details can also be used for feedback and questions about services provided
• Laboratory Manager: Dan Smith (email to Dan.smith@ouh.nhs.uk ) 01865 220337

• Quality Manager: Andrew Platt (email to Andrew.platt@ouh.nhs.uk ) 01865 857663
Making a Formal Complaint

Please put your complaint in writing to:
Chief Executive
Oxford University Hospitals NHS Foundation Trust
Headley Way
Headington
Oxford OX3 9DU
Email: complaints@ouh.nhs.uk
link to OUH website, complaints
Telephoning of Critical Values
The Critical Values policy is described below:
Definition of a Critical Value: A Critical Value is defined as one which is such at variance with normal (expected
values) as to be life threatening unless something is done promptly and for which some corrective action could
be taken.
Abnormal results are not considered Critical Values: Most laboratory tests have established reference ranges
which are the results that are typically seen in a group of healthy individuals. While results outside these ranges
may be considered abnormal, that is not the same as “critical”.
Action taken when a result exceeds the Critical Values: In addition to normal reporting staff will attempt to
telephone or otherwise contact the ordering clinician as quickly as possible. For this reason, each request should
be accompanied by contact details to allow the laboratory to contact a referring clinician. The following limits
apply to inpatients and primary care.
Critical Values for FBC include:

• WBC >25.0x109/l (if not post op)
• Haemoglobin < 75 g/l (when unexplained by clinical data/diagnosis)
• Platelet count < 30 x 109 /l (when unexplained by clinical data/diagnosis)
• Neutrophil count < 0.8 x 109 /l (when unexplained by clinical data/diagnosis)
Critical Values for Coagulation testing include:

• INR > 7.9 (patients on Warfarin)
• PT > 25.0 seconds (unless known to be receiving anti-coagulation therapy)
• APTT >50.0 seconds (unless known to be receiving anti-coagulation therapy)
• Fibrinogen <1.0 g/l (new presentation)
The appearance of significant features on a blood film (not diagnosed / unexpected change) to include but not
limited to:
• New diagnosis of Malaria infection
• New diagnosis of Acute Leukaemia
• New diagnosis of red cell fragmentation syndrome (HUS, DIC, TTP)
Disclosure of Results
Results will only be released to a referring clinician or their approved representative. Third parties including
patients, or their relatives will be referred to the ordering clinician.
Infectious Material
All samples will be treated by the department as potentially hazardous; however, samples from patients who
are known to pose an infection risk should have this information appropriately recorded on the request form and
all samples should have an approved danger of infection sticker on them. It is the duty and responsibility of
the sender to be aware of the risks and to arrange for appropriate packaging, labelling and
transportation.
• Both the form (if available) and the specimen label must carry a common warning label indicating in black
on a yellow background.
• The label must be clearly visible to anyone handling the specimen but should not carry clinical details.
• Apart from the common warning label, the electronic order or request form must give sufficient clinical
information to enable laboratory staff to know which precautions to take.
Because of the extra work and stress involved in processing ‘high risk’ specimens it is important that the
category is limited to those specimens where it is a matter of medical opinion that the patient concerned is likely
to be carrying a hazard group-3 pathogen.
• Each specimen must be sealed in a double plastic bag.

• Place labels:
o One on the specimen container
o One EPR specimen envelope or on the request form.
• Please ensure that the correct number of samples are sent, as no decanting will be possible on high-risk
samples.
Blood taken from the following patient's must be treated as “high-risk” specimens:
• Patients known to be HIV positive.
• Patients known to be HTLV1 positive.
• Patients who are known to be Hepatitis B or C positive
• Intravenous drug abusers.
• Patients from other known high-risk groups.
• Please contact the department before sending samples from patients suspected of having any form of Viral
Haemorrhagic fever (VHF), as these will require special processing and only minimal tests will be performed.
• Samples from patients with confirmed VHF must not be sent to the department, as we are not equipped to
handle them
For further information see ACDP. 2013.Categorization of biological agents according to hazard and categories
of containment London. HMSO. (link to HSE document on approved list of biological agents )
Labels are available from: Oxuniprint, stock code – DOIL0001, Danger of Infection Label pk 250
Radioactive Samples
Specimens from patients receiving radioactive tracers or material should be marked as such. Please include
the date and time of receipt and the isotope used. These samples will be handled in such a way as to protect
the health and safety of our staff while meeting the needs of the patient. This may involve some delay in the
processing of the sample. Please ensure testing is truly necessary before requesting testing on patients
immediately after such treatment.
Record Retention
The Department retains requests, sample material and test results for the retention periods recommended by
the Royal College of Pathologists, in “Retention and Storage of pathological records and specimens 5th edition
2015” link to RCPath website, retention of clinical material
Referral of Tests to another Laboratory

Although the vast majority of the analytical methods that the department offers are performed on one of the
three sites, there are a number of tests that are referred to other external laboratories. This will happen for one
of the following reasons:
1. The test requires expertise or equipment that the department does not have
2. The low number of requests is such that, it would not be possible to maintain suitable skills or
competence in the analytical method, so they are referred to another referral laboratory
3. In extremis, routine tests may be referred in the case of catastrophic analyser failure, as part of the
departmental service contingency plan
Referring laboratories are chosen that provide equal performance to our own and are regularly asked to provide
evidence of continuing UKAS accreditation, (or evidence of continued progress towards UKAS accreditation)
and acceptable EQA performance. A list of the referring laboratories is held in the department and is available
on request to the quality manager.
Referred samples will be sent off by the laboratory using appropriate postal or courier methods and the
laboratory will manage the dispatch and return of results process. A process of monitoring TAT for these
samples is in place.
Where possible reports will be sent out using similar mechanisms used for internal processing; however, they
will contain the name of the processing laboratory and reference ranges where appropriate.
OUH will invoice for samples referred to another laboratory at the price charged to OUH, plus a small
administrative charge plus if required any courier costs.
Distribution of testing on various sites within the department of laboratory Haematology
The department operates 4 laboratories on four sites within the OUH FT. this document describes the scope of
practice on each site.
Churchill site
• FBC (including Retic)

• Clotting screen / INR / D-Dimer
• Electronic issue of blood products (blood, platelets, plasma)
NOC site

• Factor assays
• VWD investigations
• Thrombophilia investigations
• Haemostatic investigations
• Platelet function investigations
• HIT screening
• TTP investigations
Horton site

• ESR
• Malaria investigations
• Glandular Fever
• Sickle Screen
• Blood film examination
• G6PD assay
• Blood Group and antibody screening / investigation
• Issue of blood products (blood, platelets, plasma)
JR site

• ESR
• Malaria investigations
• Glandular Fever
• Sickle screen
• Plasma viscosity
• Blood film examination
• Bone marrow examination
• LMW Heparin testing
• DOAC testing (Rivaroxaban, Apixaban etc)
• Blood Group and antibody screening / investigation
• Issue of blood products (blood, platelets, plasma)
• Foetal-maternal haemorrhage estimation
• ABO titres
• Haemoglobinopathy diagnosis, including AN & NN screening service
• Flow cytometry: acute / chronic leukaemia investigations, MRD analysis & PNH
• Molecular investigations for
o Cancer / leukaemia
o Haemoglobinopathy / Anaemia investigations
Quality
Scope of Accreditation
The Department attained ISO 15189:2012 accreditation in July 2016 after assessment by UKAS against the
Standard ISO-15189 Medical laboratories—Requirements for quality and competence. The department is
assessed on an annual basis, with the last inspection being March 2021
For accredited scope of practice please see below
(Current UKAS scope of accreditation )
Any tests referred to in this handbook which are not explicitly covered in the scope of practice above are by
definition NOT part of the laboratory’s external accreditation. They should as far as practicable still be covered
by the Laboratory Quality Management system, including QC and initial verification.
Update: June 2022.

A part of strategic OUH trust decisions, The OHTC and associated laboratory testing has moved from its existing
site to a new purpose-built facility on the NOC campus in Headington Oxford.
This move has been verified as acceptable by internal laboratory processes and has been submitted for UKAS
assessment in April 2022. However, until this assessment process is complete; tests performed on this site
should be considered to be out of scope of the current ISO 15189 accreditation. If you would like to discuss
this issue, please contact the quality manager (Haematology quality manager email address )
• The Department takes part in a wide variety of National External Quality Assurance Schemes.
• The Department is annually assessed by the MHRA for conformance with the Blood Safety and Quality
Regulations.
• The Department contributes as required to the Foundation Trusts assessment by CQC against relevant
standards.
Proficiency Testing
The laboratory is committed to participation at least 40 different external Quality assurance schemes as well as
a variety of internal quality control process to ensure the consistent quality of results produced. External QA
schemes selected are chosen based on suitability of the laboratory’s needs. Where possible EQA schemes will
be accredited to ISO 17043 international standard or hold equivalent markers of quality, participation in
individual schemes is kept under regular review
Schemes we participate in as of June 2022 include:
Scheme Site Frequency Section

NEQAS FBC all Every 1 month Core automated
NEQAS Automated WBC differential all Every 2 months Core automated
NEQAS Reticulocytes all Every 2 months Core automated
NEQAS Sickle JR2, HGH Every 2 months Core automated
NEQAS G6PD assay HGH Every 2 months Core automated
NEQAS Plasma Viscosity JR2 Every 1 month Core automated
NEQAS ESR JR2, HGH Quarterly Core automated
NEQAS GF (not pilot, but not accredited) JR2, HGH Quarterly Core automated
LabQuality GF (commercial scheme) JR2 Quarterly Core automated
NEQAS Nucleated RBC (pilot) all Every 6 months Core automated
NEQAS Malaria RDT JR2, HGH Quarterly Core automated
NEQAS Haemoglobinopathy Adult JR2 Every 2 months Haemoglobinopathy
NEQAS Haemoglobinopathy Neonate JR2 Every 1 month Haemoglobinopathy
NEQAS Haemoglobinopathy Liquid Capillary JR2 Every 2 months Haemoglobinopathy
NEQAS Routine Coagulation all Every 2 months Core automated
NEQAS DOAC programme JR, NOC Quarterly Haemostasis
ECAT Post analytical platelet function NOC Every 6 months Haemostasis
RCPAQAP PFA (commercial scheme) NOC Every 6 months Haemostasis
NEQAS Thrombophilia NOC Quarterly Haemostasis
NEQAS ADAMTS 13 NOC Every 6 months Haemostasis
NEQAS Coagulation supplementary NOC Variable Haemostasis
WFH Haemophilia NOC Quarterly Haemostasis
NEQAS Morphology (Films) JR2, HGH Every 6 weeks Morphology
NEQAS Morphology (Malaria) JR2, HGH Quarterly Morphology
NEQAS Morphology (manual WBC differential) JR2, HGH Quarterly Morphology
NEQAS Digital Morphology JR2, HGH Every 6 weeks Morphology
NEQAS Immunophenotyping (part 1) JR2 Every 2 months Morphology
NEQAS Immunophenotyping (part 2) JR2 Every 2 months Morphology
NEQAS ALL MRD by Flow JR2 Every 4 months Morphology
NEQAS AML MRD by flow (not accredited) JR2 Every 4 months Morphology
NEQAS CSF flow (not accredited) JR2 Quarterly Morphology
NEQAS PNH JR2 Every 2 months Morphology
NEQAS Special Stains (Iron stain only) JR2 Every 6 months Morphology
NEQAS ABO & Rh D testing JR2, HGH Every 2 months Blood Transfusion
NEQAS Antibody screening and identification JR2, HGH Every 5 weeks Blood Transfusion
NEQAS Crossmatching JR2, HGH Every 2 months Blood Transfusion
NEQAS Red cell phenotyping JR2, HGH Every 12 weeks Blood Transfusion
NEQAS Foetal Maternal Haemorrhage JR2 Quarterly Blood Transfusion
NEQAS Extended phenotype (Pilot) JR2 Quarterly Blood Transfusion
NEQAS ABO titration JR2 Quarterly Blood Transfusion
NEQAS DAT (Pilot) JR2, HGH Quarterly Blood Transfusion
DNA diagnostics for Haemoglobinopathies JR2 Every 4 months Molecular Haematology
NEQAS BCR-ABL screening JR2 Quarterly Molecular Haematology
NEQAS BCR-ABL major quantitation JR2 Quarterly Molecular Haematology
NEQAS BCR-ABL minor quantitation (pilot) JR2 Every 6 months Molecular Haematology
NEQAS Lymphoma / Waldenstroms (pilot) JR2 Every 6 months Molecular Haematology
NEQAS Myeloid Gene panel (pilot) JR2 Every 6 months Molecular Haematology
NEQAS Jak-2 JR2 Every 4 months Molecular Haematology
NEQAS Clonality (IgH) JR2 Every 4 months Molecular Haematology
NEQAS NPM-1 mutation analysis JR2 Every 4 months Molecular Haematology
NEQAS SCT Chimerism JR2 Every 2 months Molecular Haematology
NEQAS FLT-3 mutation analysis JR2 Every 4 months Molecular Haematology
GenQA Gastro-Intestinal Stromal tumours JR2 Yearly Molecular Haematology
GenQA Colorectal tumours JR2 Every 6 months Molecular Haematology
GenQA Lung Cancer JR2 Every 6 months Molecular Haematology
GenQA Melanoma JR2 Every 6 months Molecular Haematology
GenQA / Genomics England DNA extraction (pilot) JR2 Annual Molecular Haematology
GenQA GenU data collection pilot JR2 Annual Molecular Haematology
GenQA Next Generation sequencing JR2 Annual Molecular Haematology
GenQA Pathogenicity of Sequence Variants (PSV) JR2 Every 6 months Molecular Haematology
QenQA MCC & Sexting JR2 Every 6 months Molecular Haematology
For the rare tests where there is no external quality assurance scheme available, the laboratory will pursue
alternative means to provide assurance; this will include the use of inter-trust sample sharing schemes to provide
evidence of comparability.
Please note: the schemes marked in the table above as pilot are in development by the EQA scheme;
however, they are currently the “best fit” for the laboratory’s needs.
Measurement of Uncertainty
The department produces results from a wide range of tests, some of which have a measurement of uncertainty
associated with the result. This does not infer an inaccurate test but does highlight that these tests produce a
result that is accurate within certain parameters. This information can sometimes be useful if a specific test has
a target range that may be included in a clinical treatment algorithm. Although not published here, measurement
of uncertainty estimates for tests are available on result from the quality manager (Haematology quality manager
email link )
The Quality Policy of the Department of Laboratory Haematology.
Within the Directorate of Pathology and Laboratories; Oxford University Hospitals NHS Foundation Trust.
The Department of Laboratory Haematology provides a diagnostic and routine monitoring service for the OUH
NHS Foundation Trust; local CCGs and acts as a referral centre for referring hospitals. The analytical profile of
the department includes both routine tests and specialist molecular analysis. In addition, the department
provides blood transfusion support for the trust and certain surrounding hospitals. The department is committed
to providing a service of highest quality and is aware and takes into consideration the needs and requirements
of its users. In order to ensure that the needs and requirements of users are met, the department of laboratory
haematology will:
• Operate a quality management system to integrate the organisation, procedures, processes, and resources
required.
• Obtain and monitor data on user satisfaction and complaints.
• Review the existing services in relation to the needs and requirements using data gathered from the users
of the service in order to achieve continual quality improvement.
• Set quality objectives and plans in order to implement this quality policy and to ensure that it is suitable and
effective.
• Ensure that all personnel are familiar with this quality policy to ensure user satisfaction.
• Commit to the health, safety, and welfare of its entire staff. Visitors to the department will be treated with
respect and due consideration will be given to their safety while on site.
• Uphold professional values and remain committed to good professional practice and conduct.
• Comply with any relevant environmental legislation.
• Where such appropriate controls exist, comply with any relevant or appropriate national or international
product storage legislation.
The Department of Laboratory Haematology will comply with the requirements of ISO 15189:2012; other
relevant national and international standards and where appropriate, other regulatory bodies and is committed
to:
• Staff recruitment, training, development, and retention at all levels sufficient to provide a full and effective
service to its users.
• Ensuring that all staff are familiar with the contents of the Quality manual and all procedures relevant or
appropriate to their work.
• The correct and proper procurement and maintenance of such equipment and other resources as are
needed for successful provision of service.
• The collection, transport, and handling of all specimens where appropriate in such a way as to ensure the
correct performance of laboratory examinations and where appropriate in compliance with relevant
legislation.
• The selection and use of examination procedures that are fit for purpose and provide the highest achievable
quality of all tests performed.
• Reporting results of examinations in ways that are timely, confidential, accurate and clinically useful.
• The assessment of user satisfaction, in addition to internal audit and external quality assessment, in order
to produce continual quality improvement.
This policy is a controlled document and is reviewed annually within the department. Signed copies will be
displayed within the laboratory.
Working Hours
• JR & Horton sites: core services are available 24 hours per day, 7 days a week
• Molecular Haematology on the JR site: routine service is available Monday to Friday 08:30 – 17:00
• OHTC on NOC site: routine service is available Monday to Friday, 08:30 – 17:00, with a limited emergency
service available out of these hours (please see below for information).
• Lab Med lab on Churchill site: routine service is available Monday to Friday 08:00 – 19:00
While the Routine laboratories are open for the receipt of samples and processing the most common tests some
of the more specialist work will only be available when the more specialist staff in individual sections are on
duty.
There is only one qualified Biomedical Scientist on duty at the following times:
JR2 site Horton site Churchill site NOC site

Saturday 20:30 hr – 8.30 hr 08:30 hr – 08:30 hr N/A See notes below
Sunday 20:30 hr – 8.30 hr 08:30 hr – 08:30 hr N/A
Monday –Friday 17:00 hr – 08:30 hr 8:00-10:30 hr
17:00 – 19:00 hr
The OHTC unit offer an on-call service, available outside of routine opening hours, if this service is required;
please contact the on-call Haemostasis consultant via switchboard to discuss your requirements before taking
any samples from patients.
Specialist units:
Staffed 08:30-17:00 Monday to Friday:
• Oxford Haemophilia and Thrombosis Centre, NOC

• Molecular Haematology, JRH
• Immunophenotyping Service, JRH
• Ante-Natal and Neonatal Screening Services, JRH
General Enquiries please see appendix II

Transfer of Specimens to the Laboratory
In the majority of clinical areas at John Radcliffe, Churchill and Horton Hospitals, samples may be sent to the
laboratory in the Pneumatic tube system. Staff are encouraged to use the Air Tube system were available for
all relevant samples. Use of the Air Tube system is covered by OUH policy, a copy of which is available on the
OUH intranet site:
Portering services on the 4 hospital sites are marginally different and local policies should be followed but while
there are some routine collections of samples from the retained estate of the Churchill Hospital in most areas
there is no routine collection of samples and a portering job needs to be logged with the helpdesk on each
occasion.
Transfer between the sites of the Trust during routine hours is by vehicles operated by the South-Central
Ambulance Service (SCAS). A vehicle operates at xx:10 from Laboratory Medicine on the Churchill site via the
NOC and arriving at the John Radcliffe laboratories at xx:45, between the hours of 8:10 and 17:45 Monday to
Friday. Most Haematology samples generated at the Churchill are processed on the Churchill site, but some
specialist work will be sent to the John Radcliffe, all of the routine NOC workload will be sent to the John
Radcliffe.
Between 7pm and 8am, Monday to Friday, and all-day Sat, Sun and Bank Holidays a Commercial Courier
“CitySprint”, provides an hourly service between Churchill, and NOC receptions and the Labs at the John
Radcliffe. Acute clinical areas at the Churchill site can book additional CitySprint collections direct from the
clinical areas and staff working there should make themselves familiar with the local process.
SCAS provides 4 routine collections from the Horton Laboratories at 8:00, 10:35, 14:25, and 16:30 to bring
specialist work to the JRH. If necessary, the Laboratory Staff can organise additional deliveries using a local
Taxi firm. Most Haematology samples generated at the Horton site will be processed at the Horton site, but
specialist work will be sent to the JRH
A twice a day service from most Oxfordshire G.P.’s operates for collection of samples and delivers to both the
laboratories at the JRH and the Horton.
All samples that are transported by these services must be appropriately packaged and labelled. Transport of
all samples should be such to guard against unauthorized access to specimens. These are examples of the
approved transport boxes currently in use. The green bags (of varying size) are used to transport samples from
GP surgeries into the labs and also to transport samples around the various Trust sites. There are other coloured
bags in use. Please note the dark blue bag is for internal use, transporting samples from JR site to the Horton
site and return.
Samples sent by either Royal Mail or other courier services are the responsibility of the sender until the arrival
in the Laboratory. It is their responsibility to ensure packaging meets the standard for the transport of
specimens through the post. Royal Mail Group plc will accept Category B diagnostic specimens provided they
are packaged to Packaging Instruction 650 requirements. Full details may be accessed on the Royal Mail
website: (Royal Mail track and trace )
Specialist Samples:
Most samples can be sent by the best available means to arrive in the Laboratories as quickly as possible, but
some will be required to be processed in specialist areas of the laboratory which may not provide a 7-day service
and may not be able to be stored. In most cases it is strongly advised that requesters contact the relevant
section before sending the sample.
Examples include but are not limited to:
• Platelet Investigations including those linked to potential Non-Accidental Injury investigation, these samples
must be tested within 2 hours of being bled. Please contact the laboratory (01865 2) 25311 in routine
hours, or contact Duty SpR, via switchboard, before taking the samples. In some cases, arrangements
can be made to bleed the patient at the OHTC.
• Cold Agglutinins testing in Blood Transfusion must arrive while still at 37OC, and only between 08.30 and
13.00 Mon-Friday. Contact laboratory on (01865 2) 20339 if sending sample.
• Pre-Natal diagnosis in NHRL or Haemophilia. Contact the laboratory IN ADVANCE, on (01865 5) 72769,
safe details to provide results must be provided. Technically should be: `Pre-natal diagnosis (PND) for Non-
Malignant Haematology. Contact the laboratory in advance to book in using safe details to provide
results. For haemoglobinopathy/Rare anaemia PND referrals email oxford.molecularhaem@nhs.net or
phone (01865 5) 72769. For Haemophilia PND referrals email orh-tr.dutyscientist.oxfordgen@nhs.net or
phone 01865 226001. If you want to include the link to these contact details it is :Contact Oxford
Genetics Laboratories - Oxford University Hospitals (ouh.nhs.uk).’
Requesting of Tests
Blood should be correctly collected into vacutainers if at all possible (including children). The anticoagulant /
sample tube required is listed in the section on normal ranges at the end of this handbook. Samples that have
been damaged by poor phlebotomy technique may not be processed if excessively haemolysed. Please
remember to fully label samples with the following as a strict minimum
• Full Name (first name and surname)
• Date of birth or another unique numerical identifier (e.g., NHS number)
Samples that do not meet these criteria will not be routinely processed.
(Blood Transfusion samples will require a higher standard of patient Identification please see the relevant
section of this handbook, and there is a Trust “Blood Transfusion Policies and Procedures”, a copy should
be available on all wards or from on the intranet:
Blood Transfusion pages on OUH intranet
You must make yourself familiar with it if you need to request blood for transfusion.)
Date and time of collection should be provided on all samples (or associated request card if used) as certain
assays can only be performed on fresh samples.
Please use the patient's hospital number (MRN) or NHS number and give a location for the report and relevant
clinical details. It is most important that requests for immediate investigations are reserved for those that are
truly urgent; we will prioritize investigation of samples using information from request forms. Hospital In-patients
are given priority followed by some outpatient clinics.
OUH Requests
The OUH Trust routine method of ordering tests is via Cerner Millennium EPR. The Trust has almost completed
implementation of the EPR system, samples requested using this method do not require request cards. When
implementation is complete, only samples requested via EPR will be accepted from OUH users.
Use of Cerner Millennium is therefore strongly recommended where possible.

Please do not use paper forms if EPR is available, paper requests are manually entered into the laboratory
LIMS system and these requests are therefore at greater risk of data entry errors.
Information about correct positioning of these labels can be found on the reverse of the specimen bags.
• Always check patient identification before labelling samples.

• Only put specimens from a single patient in each primary bag.
• Stick the specimen label directly over the tube label.
• Labels should be straight, vertical and as close to the cap as possible.
• If using paper forms, please ensure that on each request form, the individual collecting blood, signs the
form.
If Cerner cannot be used: a fully completed request form must accompany all samples (please see Appendix
III, Examples of Haematology Request forms). Please ensure that the correct form is used. Information about
the service and sample collection is printed on reverse of request form. It is very important to complete the
request form fully and correctly. The use of Addressograph labels on request forms is encouraged, but all
samples should be handwritten. Samples labelled with addressograph labels are unlikely to be processed, due
to technical difficulties with the analytical equipment in use in the department.
Oxfordshire CCG GP Practices:

Locations are equipped to use the GP electronic requesting system (Sunquest-ICE). The system will identify
which bottles are required for each test and produce labels suitable for use on the requests bottles and a larger
label to go on the request card including eye-readable information in case of an IT-Link failure and eye readable
clinical details. The date and time the patient was bleed should be added on each occasion.
Use of this ordering system is strongly recommended.
It is CCG and OUH policy that all requests should include a valid NHS number.
All other locations (including referrals from other trusts):

Each request should be accompanied by a fully completed request form see Appendix III for examples. Patient
demographics should include:
• Full name (first name and surname)
• Date of Birth
• Hospital Number
• NHS Number (or CHI number for Scottish requests)
• If your referral site expects the laboratory number to be reflected back to them, it must be included at this
point.
• If your Trust has a policy of demanding Purchase Order Number for all external work, it must be included at
this point.
• Relevant clinical details
Use of addressograph labels on request cards is encouraged, but is strongly discouraged on bottles, as some
designs of larger labels will interfere with the automated flow of samples through the analysers, and some
referral sites (NHSBT) will only accept handwritten samples.
Sample Requirements
Tube Colour Anticoagulant Used

Trisodium Citrate: for all routine coagulation analysis
Potassium EDTA: for routine Haematology analysis and transfusion

investigations
Serum: for Haematinic analysis
Sample Types for Commonly Requested Tests.

The trust supplies BD Vacutainer tubes for the collection of adult samples, these contain a variety of different
additives, either to stabilize an analyte, or to make a sample suitable for testing. It is very important that the
correct tube is taken for the correct test requested. In almost all cases, if the wrong tube is received, the
laboratory cannot provide a correct result. The table below displays the commonly encountered sample tube
types.
Sample Type Tube lid Colour (BD Tube lid Colour (BD
Vacutainer tubes) Vacutainer tubes)
EDTA
Citrate
Clot
Heparin
If possible, please use BD vacutainer tubes for the collection of all samples, regardless of patient age. If this is
not possible, there is a selection of paediatric tubes available, these may have different lid colours to the adult
tubes, so some degree of care is needed in selection. As with adult tubes, please send correctly filled samples
for clotting studies.
Paediatric tube types in use.
Sample Tube Lid Sample Tube Lid

Type Colour Type Colour
EDTA Red Clot Clear
Citrate Green Heparin Orange
Please note we still receive a number of paediatric EDTA tubes with Heparin lids on them, care must
be taken not to mix up the red and orange lids.
These samples will be rejected as unsuitable to process.

General Haematology Tube requirements
For FBC, the department requires an EDTA sample, if possible, this should be in a properly filled, well-mixed
purple top vacutainer; 4.5- and 1.8-ml tubes are available for use. For paediatric use, there is a 1.3 ml screw
top sample tube available. Please send full samples, if possible, this allows for supplementary requested tests
to be performed on the same sample. For other commonly requested tests please see the normal range section
of this document.
The laboratory does not have the facility to process larger (6 ml or 10 ml) EDTA tubes for routine Haematology
investigations. Any larger samples like this will be rejected and not processed.
As part of the Full Blood Count profile, results will be produced and reported for:
• White Blood Cell Count

• Haemoglobin
• Haematocrit
• Red Cell Count
• Mean Cell Volume (MCV)
• Mean Cell Haemoglobin (MCH)
• Mean Cell Haemoglobin Concentration (MCHC)
• Platelets
• Nucleated Red Cell Count
There is no need to request these tests in addition to a Full Blood Count.
As part of the Full Blood Count profile the aim will be to produce a 5-part White Cell Differential.
• Neutrophil
• Lymphocyte
• Monocyte
• Eosinophil
• Basophil
In most cases an accurate differential will be produced and reported by the analyser, in a minority of cases
either the analyser will not produce a differential or will produce a report suggesting the presence of other cells
in the circulation. In these cases, a Blood Film will be produced and examined by microscopy. There is no need
to request a Blood Film to receive a White Cell Differential.
There are circumstances were examining a Blood Film will add value to the report if so, please include clinical
circumstances and why the Film is requested.
Examples which would generate a Film request regardless of FBC result would include:
• ? Sezary Cells
• ? DIC
• ? Haemolysis
• ? Haemolytic Anaemia
• Persistent/ Unexplained Anaemia
• Persistent/ unexplained Thrombocytopenia
General Coagulation Tube requirements
• For a coagulation screen request PT and APTT or "Coagulation screen" in EPR or if EPR is not available
on form
• For patients anticoagulated with warfarin request an INR
• For patients anticoagulated with unfractionated heparin request an APTT
• Patients anticoagulated with LMW heparin do not normally need monitoring
Please take care with ordering on EPR and select the correct test, as due to the way electronic orders are
handled in the lab, errors may not be spotted prior to processing of samples.
Coagulation citrate samples (blue top) need to be correctly filled due to the nature of the anticoagulant used.
Partially filled, clotted or overfilled specimens will not be processed.
For patients that are difficult to bleed paediatric (1.3 ml) or short draw (1.8 ml) vacutainers tubes are
recommended. Please ensure that all samples are adequately labelled. Please see figure below for correct
filling.
Some conditions where it is appropriate to request a coagulation screen
• Unexplained bleeding or bruising

• Personal or family history of bleeding disorder
• Liver disease
• Prior to anticoagulant therapy
• Conditions associated with DIC e.g., septicaemia
• Massive transfusion
• Suspected non-accidental injury
Coagulation screens before surgery or invasive procedures

In 2008 the British Committee for Standards in Haematology (BCSH) published guidance on the assessment
of bleeding risk prior to surgery
(Chee et al Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures
These recommendations can be summarized as follows:
• Indiscriminate coagulation screening prior to surgery or other invasive procedures for prediction of bleeding
risk is not recommended
• A comprehensive bleeding history should be taken in all patients prior to surgery and invasive
procedures
• If the bleeding history is negative, no further coagulation testing is indicated
• If the bleeding history is positive or there is a clear clinical indication (e.g., liver disease), a comprehensive
assessment guided by the clinical features is required
Some reasons not to request coagulation screen

The use of coagulation screens has increased over recent years as a routine screen for haemostatic
abnormalities. The tests were not designed for this purpose and their use in this manner is inappropriate for
several reasons:
1. By definition, 2.5% of normal healthy subjects will have prolonged clotting times. This is likely to be higher
in the patient population. A large proportion of such results will require further investigations, causing
delayed operations, unnecessary anxiety to the individual, and unnecessary and expensive laboratory
investigations. There are also occasions when this can erroneously precipitate the use of blood products.
2. All inherited bleeding disorders (and many acquired ones) have low prevalence. Indiscriminate screening
results in low positive predictive value, and a high number of false positives.
3. The coagulation screen is insensitive to factor XIII deficiency, mild von Willebrand disease (the commonest
congenital bleeding disorder in Caucasians) and platelet disorders and may give false reassurance.
4. Some factor deficiencies causing prolongation of the APTT are clinically irrelevant, e.g. factor XII deficiency.
This and the lupus anticoagulant may suggest a bleeding risk when none exists, causing unnecessary
postponement of surgical procedures.
5. Evidence in the literature shows that coagulation tests have both low sensitivity and specificity to predict
bleeding.
6. 95% of potentially clinically significant abnormalities of coagulation or haemostasis in medical and surgical
patients can be detected through a comprehensive history and physical examination.
7. Despite a large number of abnormal results being generated through indiscriminate use of the coagulation
screen, studies have shown that patient management is rarely altered.
Requests for specialized bleeding investigations (especially those in patients where there is a suspicion of non-
accidental injury) should be discussed with the clinical staff at the OHTC before taking the samples. The
majority of these samples need to be reasonably fresh (<4-6 hours) in order to process, so should be sent direct
to the OHTC on the NOC site.
Samples delayed in transit outside of this time may not be processed.
Specialist Coagulation testing
Who to test for heritable thrombophilia?
Patient
• Consider testing those with a strong family history of unprovoked thrombosis
• Women planning a pregnancy who have had a VTE due to a provoking factor should be tested and
considered for antenatal prophylaxis if a thrombophilia is found
Relative of patient
• Consider testing asymptomatic relatives in selected thrombosis-prone families with high-risk thrombophilia
(antithrombin, protein C or protein S deficiency). May be particularly helpful for counselling female
relatives regarding COC and HRT.
• Women planning a pregnancy who have a family history of venous thrombosis should be tested if an
event in a first degree relative was unprovoked, or provoked by pregnancy or COC exposure
In patients, if testing is indicated it is usually performed one month after discontinuing anticoagulation with
Warfarin. We do not recommend testing in the acute phase or when anticoagulated with warfarin.
Who to test for antiphospholipid antibodies?
• Patients with unprovoked or recurrent VTE who are stopping anticoagulation.

• Ischaemic Stroke < 50 years
• Three consecutive spontaneous abortions < 10 weeks
• Foetal death > 10 weeks
• Premature birth due to (pre-)eclampsia or placental insufficiency
Samples required
• Hereditary thrombophilia - 4 citrate samples and 1 EDTA

• Antiphospholipid antibodies - 1 citrate and 1 clotted
• Both - 4 citrate samples, 1 EDTA and 1 clotted
Platelet Function Assays (including those that form part of a non-accidental injury investigation)
These are not routine tests and require medical discussion before sample collection and testing. These need to
be performed on fresh samples arriving at the Haemophilia centre (NOC site) within ideally 2 hours of collection
(maximum 4 hours); as such it is essential that clinical areas contact the laboratory before bleeding the patient.
In routine working hours (Monday – Friday) please phone OHTC on (01865 2) 25311
Outside of this please bleep the on-duty Haematology Specialist Registrar via switchboard (0300 3047777)
Samples referred to the laboratory for Haemostatic or Thrombotic investigations

Samples should be sent to:
Haemophilia and Thrombosis Centre (OHTC)
NOC, Windmill Rd, Headington,
Oxford OX3 7HE
• Samples originating from external laboratories should be sent direct to the address above.
• Unless they can be delivered within 4 hours of collection, samples will need to be centrifuged to produce
platelet poor plasma which should be separated.
• Plasma should be frozen in 2 ml freezer vials with screw cap lids and labelled with -70oC freezer proof
labels. Be aware samples will be thawed at 37oC in a water bath and labels must also be resistant to this.
• Samples to be sent should packed frozen in manner that will maintain this state for the transport time. Dry
ice is strongly recommended to keep the samples frozen.
• Same day or overnight direct door to door courier services are recommended to ensure sample stability
• Samples should be accompanied with a suitable request card and covering explanation letter if there are
complex clinical details. If no local SLA is in place a purchase order number should be included
• The laboratory reserves the right not to process any samples that have been transported inappropriately or
insufficiently labelled.
Samples referred to the laboratory for platelet function investigations
Samples should be sent to:

Haemophilia and Thrombosis Centre (OHTC)
NOC, Windmill Rd, Headington,
Oxford OX3 7HE
• All requests for investigations involving platelet function must be discussed with the laboratory before
samples are taken. The laboratory may be unable to process samples of this nature if prior contact has not
been made.
• Samples for platelet nucleotides must be pre-prepared before being frozen as a platelet extract on dry ice.
Please contact the Haemophilia and Thrombosis Centre beforehand to discuss the preparation proceed
and to receive a copy of the SOP if necessary
• Samples for platelet function testing (chronolog, platelet aggregation etc.), must be fresh (ideally <2 hours
from collection, maximum 4 hours from collection), it is the responsibility of the sending laboratory to use a
transport process that will fulfil this requirement. Samples should be accompanied with a suitable request
card and covering explanation letter if there are complex clinical details. If no local SLA is in place a purchase
order number should be included
• The laboratory reserves the right not to process any samples that have been transported inappropriately or
insufficiently labelled.
Specialist Haematology including Molecular Haematology
The Oxford University Hospitals NHS trust’s department of Haematology provides a comprehensive molecular
diagnostic service for a range of haematology and oncology disorders. The services offered are divided into 2
main areas: -
1. Haemato-oncology: An integrated phenotypic (immunophenotyping) and molecular service for the

management of haematological malignancies
2. Solid tumours: Integrated pathology and genomics. CE marked diagnostics of response prediction and
cancer gene mutation panel utilising next generation sequencing
In addition, the laboratory also provides a technical NGS service for disorders of haemostasis and
haemochromatosis and other aspects of non-malignant haematology; however, this testing is organised via the
genetics laboratory on the Churchill site; please see their website for further details:
www.ouh.nhs.uk/geneticslab
General Information
• Address for sending results

o Molecular Haematology, Level 4, John Radcliffe Hospital, Headington Oxford, OX3 9DU
• Enquiries and information:
o (website) link to oxford genetics laboratories
o E-mail (general): - mail to: oxford.molecularhaem@nhs.net
o E-mail (haemoglobinopathy laboratory support service) mail to: lab.support@nhs.net
o Phone number: 01865 572769
Reporting of Results
Oxford University Hospital Foundation Trust Users

All results will be sent to the Cerner Millennium EPR System
What you need before you start

A computer that has been set up to connect to the EPR either from the OUH virtual desktop, or directly from a
web page short cut on your desktop. You need to ensure that your smartcard has been properly enrolled and
provisioned to give you access to Trust systems and that you have an Oxnet (hospital network) account.
Login process
You will need an NHS Smartcard and passcode; it is your responsibility to obtain this and a log-in before working
your first shift, (even for locum staff!).
Tap&Go
For clinicians, most of the time, you will access clinical systems via the OUH Citrix workspace virtual desktop,
using your NHS smartcard to activate the proximity sensor attached to the PC, by gently tapping it with your
card. This takes you to a desktop from where you can launch EPR simply by entering your passcode. You can
secure your session by tapping the sensor again, and this allows you to retrieve your session at any other
machine running Workspace (with a proximity sensor attached). After a pre--‐determined time should you not
return to your session the EPR will time--‐out, and you will have to launch it again when you re--‐connect to your
session.
• Always secure your session before leaving the PC.
• Never share your card or passcode – you would be in breach of the Data Protection Act.
Launching Millennium
• To launch Millennium, click on the TRUE icon in the task bar or double--‐click the icon on the desktop: Either
will open the browser page:
• After single--‐clicking the Power Chart icon (the middle one of the Applications) the login window
• Your Smartcard number is entered automatically by the single sign--‐on system – then enter your Millennium
passcode (this can be set--‐up to be the same as your Smartcard passcode – a minimum of 4 digits like a
bank PIN), and press enter key or click OK
Forgotten your smartcard or it has stopped working?

• The Tap&Go infrastructure addresses a number of hardware usability and security issues that make the
system easy for busy clinicians to use – faster login, fast user switching, without losing your active
Millennium EPR session, secure session roaming, all using the NHS Smartcard with proximity sensor to
automate the login process.
• However, if your Smartcard fails (nothing happens when you tap the sensor) or you forget it at home, then
you can log in to your Citrix workspace e desktop by using your OUH network username and passcode
entered into the Windows login window. This is the same process you would use if you accessed Citrix
workspace from the web portal.
All Results should be endorsed (signed) on receipt
• You can endorse results even if you have not requested them; you are part of a team and can sign
results if you are tasked to check them.
• Endorsement ensures you have signed and if necessary, actioned a result.
• This is all about Patient Safety
• It is Trust Policy that ALL results must be endorsed.
• NB Results for FBC and Coagulation Screens will be released prior to final authorisation and
may be subject to change
• Once Results reviewed click Endorse Results button
Please remember: the Haematology laboratory does not manage EPR and is not responsible for training or the
repair of equipment associated with EPR. Assistance with EPR should be directed towards OUH trust IM&T
services on ext 22822.
Oxfordshire ICB GP Practices
Results are transmitted to relevant Practice IT systems after the result is authorised. Results are transmitted at
04:40, 07:50, 10:50, 12:50, 13:50, 14:50, 16:50, 17:50, 19:50 and 22:50 and would be available for collection
by the practice IT after that time.
If there are any problems in receipt of results, please contact the Directorate IT team on (01865 2) 20463.
Contact Details: Kevin.paddon@nhs.net
Oxford Haemato-Molecular Diagnostic Service

The integrated Bone Marrow Reports are available to colleagues in neighbouring partner hospitals by access to
a secure website. If registered to access the Integrated Reports Website, please click
on: http://oxfordir.oxnet.nhs.uk. NB. It only works from an NHS networked (N3) computer.
To apply for access contact Dr A Timbs mail to: Adele.Timbs@ouh.nhs.uk
RAID Anticoagulant Dosing Service

Results are posted direct to patients using First class post. Results which require a Recall test of the patient in
less than 7 days will be phoned to the patient by the Nurse Specialist team.
All other users

Results will be produced hard copy and sent by second class mail.
NPEX
National Pathology Exchange, The National Exchange for the UK NHS. The OUH is registered and has been
since 2015. We are receiving requests and samples and sending reports to a variety of users by this route, to
use this route please contact Mr Kevin Paddon, kevin.paddon@ouh.nhs.uk initially.
Retrospective Testing
In accordance with local policies, the department stores specimens for a period of time post analysis in
conditions suitable for retrospective or additional test requests. With certain analysis there is a time limit outside
of which the stored sample is likely to unsuitable for processing. The following table will give information on such
time limits for commonly encountered tests. For any tests that are not on this list, please contact the department
for advice. Outside of the times stated on this list new samples will be required.
Test Availability Storage comments
FBC All sites Samples are suitable for processing up to 48 hours from
collection. Samples however are retained by the
department for 24 hours post analysis, so may not be
available for use
ESR Horton and JR Samples if available are suitable for testing up to 24

sites hours post collection
Plasma Viscosity JR site Samples if available are suitable for testing up to 7 days
post collection, however samples are only stored for a
minimum time period so may not be available for use
Glandular Fever Screen Horton and JR Serum samples, if available, are suitable for testing up to
sites 72 hours post collection.
EDTA samples, if available, are suitable for testing up to

24 hours post collection.
G6PD assay Horton site EDTA samples if available are suitable for testing up to 5
days post collection.
Malaria RDT screen Horton and JR Samples are suitable for testing up to 48 hours post
(usually performed with sites collection, on a suitable EDTA sample
blood films)
Blood Films / Malaria Film Horton and JR Samples are suitable for testing up to 24 hours post
sites collection, on a suitable EDTA sample
Flow Cytometry JR site Samples if available are suitable for testing up to 72

hours post collection, on a suitable EDTA sample
Sickle Test Horton and JR Samples if available are suitable for testing up to 4 days
sites post collection.
Haemoglobinopathy Screen JR & Churchill Samples if available are suitable for testing up to 4 days
site post collection.
PT / INR All sites, Samples are suitable for testing up to 24 hours post
collection
APTT All sites, Samples are suitable for testing up to 8 hours post
collection
Thrombin Time All sites Samples are suitable for testing up to 8 hours post
collection
Fibrinogen All sites Samples are suitable for testing up to 8 hours post
collection
D-Dimers All sites Samples are suitable for testing up to 24 hours post
collection
Factor Assays OHTC sites Samples are suitable for testing up to 8 hours post
collection, however fresh samples (<4 hours old) are
strongly recommended
Platelet function testing OHTC site Unspun citrate samples required, these must be fresh
(<4 hours old max, ideally < 2), older samples cannot be
tested. Contact the OHTC before collecting samples.
Haematinic Assays Horton and JR Samples if available are suitable for testing up to 72
(including Red Cell Folates) sites hours post collection.
Haptoglobins Horton site Samples if available are suitable for testing up to 72

hours post collection.
DAT Horton and JR Samples if available are suitable for testing up to 72 hours
sites post collection.
Molecular processes JR2 Samples are suitable for testing up to 72 hours post
involving RNA testing collection, on a suitable EDTA sample
Molecular processes JR2 Samples if available are suitable for testing for an
involving DNA testing unlimited period post collection, however samples are
only stored for a minimum time period
Sample Analysis Turnaround times
This document provides information on turnaround times for commonly encountered assays offered by the
department. During routine processing, the department will endeavour to process samples to within these stated
time limits. In situation of reduced staffing or unexpected analyser failure, processing times may be longer. The
times stated are in-laboratory turnaround times and do not take any account of delivery of sample to department
or delivery of report to final location. For any process not covered and for samples stated as urgent, we will
attempt to process them as rapidly as practical, within operational constraints.
Analysis Urgency Turnaround (unless stated this refers to 95% of samples

being processed in the given time period)
Routine FBC: Out-patient 98% <12 hours
Haematology / GP
FBC: In-patient 3 hours
FBC: A&E 95% < 60 minutes 5
ESR 4 hours
Routine Plasma 72 hours

Viscosity
G6PD 3 days, batches run twice a week
Pyruvate Kinase 7 days 6

(send away test)
Urgent Sickle 2 hours

screen
Glandular Fever 24 hours

screen
Morphology Malaria Screen 7 hours
Routine Blood 12 hours (Mon – Fri)

Film
CSF Cytospin 2 days
Coagulation Pre-op 4 hours

coagulation
screen
Urgent 95% < 1 hour 5

coagulation
screen (A&E)
Urgent INR 1 hour

(Warfarin Control)
Urgent APTT 1 hour

(Heparin control)
INR (GP only) 98% < 24 hours 1

Urgent D-Dimer 1 hour
(DVT screen)
Direct Thrombin 4 hours

Inhibitor screen
Urgent Factor 5 hours

deficiency
investigation
Factor deficiency 1 week

Investigation
Von Willibrands 2 weeks

factor
Thrombophilia 3 weeks
Screen
Molecular For molecular all molecular test TAT available

TAT, at: https://www.ouh.nhs.uk/services/referrals/genetics/genetics-
laboratories/turnaround-times/
Immunophenotyping Leukaemia Formal report within 1 week

diagnosis
Blood Transfusion Routine Group & 24 hours 2

Antibody Screen
Urgent Group & 3 hours 2

Antibody Screen
Routine Antenatal 48 hours 3

Serology
Routine Post 36 hours

Natal Rh
Negative testing
Urgent 1 hour 2
Crossmatch
request
2Turnaround times are only achievable on patients with no special transfusion requirements and a negative
antibody screen.
3This excludes any samples that require further investigations
4 Depending on the complexity of the investigation
5 Locally agreed in laboratory TAT with ED (January 2010)
6 as this is a sendaway test, extra time may be needed to cover postal services and weekends.
Key Factors known to affect result quality
Although all analytical methods used by the department are appropriately controlled by internal and external
quality assurance methods, there are some factors that can affect the specific analytical methods. This
document will cover the factors affecting the most common tests; information on other tests is available from
the relevant sections on request.
• Correct sample collection, storage, and transport to the laboratory: can minimize sample degradation pre
analysis. For any analysis that requires whole (EDTA) blood, samples which contain clots are unlikely to be
suitable for processing.
• Correct sample volume:
o for certain tests (e.g., Coagulation screens) this is essential as the tubes contain a liquid
anticoagulant.
o For other tests, there will be a minimum amount of sample required for correct analysis. Samples
that do not contain this will not be processed.
o Other samples such as for ESR have significant volume requirements, so sending partially filled
bottles may result in the laboratory being unable to process.
• Sample age: in general samples should be transported without delay to the laboratory post collection.
However, with some tests the delay is more critical than with others. Please refer to the retrospective testing
table for information on this.
• Haemoglobin: this test includes a spectrophotometric process, so excessive jaundice and lipaemia may
affect the result. This can be detected in the laboratory and corrected for before releasing results.
• Platelet clumping: this is a non-specific immunological process that can lead to a falsely low platelet count.
The current analysers used in the department check for this and the laboratory will amend results
appropriately
• Clotting tests: may be affected by the presence of anticoagulants; however, this affect will depend on the
specific test and the specific anticoagulant. More information is available from the OHTC on ext 25311
• Certain clotting tests include a spectrophotometric end point detection process. Therefore, as with
Haemoglobin, the laboratory may not be able to process any samples that are excessively haemolysed or
jaundiced.
• Certain clotting tests (especially platelet function analysis) cannot be transported to the department using
the trust air tube system. In addition, these samples need to be as fresh as possible (less than 4 hours from
collection), so please contact the OHTC on ext. 25311 before samples are taken.
• Haemoglobinopathy screens:
o Results will be affected by the patient receiving recent blood transfusions or Bone marrow
transplant. This should be discussed with the section before sending the sample as it may be
prudent to defer testing for a period of time.
o HbA2 levels: can be lowered in severe iron deficiency, clinical advice should be sought before
testing.
• Sickle Screening:
o Results obtained from neonates (< 6 months old) may be unreliable because of the low percentage
of HbS and the high percentage of HbF.
o Abnormally high levels of plasma protein (e.g., Myeloma) may cause false positive results.
o The kit may not reliably produce a positive result in patients who have an HbS level of less than
20%.
o Samples that have Hb less than 60 g/l are deemed grossly anaemic, and the sickle screen results
may be affected due to the larger plasma: red cell ratio.
• Glandular Fever (infectious mononucleosis screen):
o False positive result may occur in serum samples from patients with a recent infection of
cytomegalovirus, leptospirosis, hepatitis A and parvovirus.
o Some patients do not develop heterophile antibodies (<20% adults and 50% children), so will
consistently produce a false negative result
• Malaria RDT test
o This is a screening test, as such it may not detect all very early parasite infections, so a negative
result does not exclude Malaria in the presence of relevant clinical symptoms and patient history.
o Currently no Malaria RDT test can consistently identify all cases of P.Knowlesi in isolation.
• G6PD assay
o This assay may be affected by a high reticulocyte count, as reticulocytes contain a high level of
G6PD. It is recommended that G6PD assays are not performed if the patient is undergoing acute
haemolysis.
o The gene for G6PD is on the X chromosome, female carriers should demonstrate approximately
50% normal red cell G6PD activity, however due to mosaicism, activity will vary depending on the
population of red cells expressing the gene (lyonization), as such this assay cannot be used to
determine heterozygous state in females
• Molecular testing for somatic mutations will be affected by undeclared bone marrow transplants; clinical
advice should be sought before testing.
• Molecular testing for somatic BRAF mutations may be affected by the presence of endogenous melanin in
FFPE samples and lead to an invalid test result.
• Blood transfusion samples: results obtained from these samples may be affected if the patient has recently
received a blood transfusion or bone marrow transplant. Because of this, it is very important to ensure that
the blood bank is aware of this information.
Blood Transfusion
Requests for Blood and Blood Products for Transfusion

There is a Trust “Blood Transfusion Policies and Procedures”, a copy should be available on all wards or
from on the intranet: Welcome to Blood Transfusion website
You must make yourself familiar with it if you need to request blood for transfusion.
When trained and deemed competent, doctors, nurses, phlebotomists and medical students may take blood
specimens for grouping and crossmatching. Staff who are untrained are not permitted to take blood samples for
transfusion.
Particular attention must be paid to positive identification of the patient based on interrogation of the
patient where possible, a wristband and the patient's hospital notes.
As a further safeguard, in addition to patient's name and other relevant information on the specimen and request
card, BloodTrack Tx system must be used. This is an electronic system for which ensures that the patient
sample is labelled correctly. It uses bar-coded wristbands in combination with a handheld computer to ensure
positive patient identification and produce an on demand printed patient identification label. These labels are
suitable for labelling a blood transfusion sample (NOTE: an addressograph label is not suitable). The laboratory
will not proceed with any incorrectly or inadequately labelled specimens.
There is an expectation that samples will be accompanied by an electronic EPR request. Only in
exceptional circumstances will samples be accepted with a completed signed request card.
Please note that a routine group and crossmatch will take a minimum of 3 hours. For planned transfusions
including pre-planned surgical procedures, the specimen should arrive at the laboratory a full working day
before the blood is required. Routine specimens received in the laboratory after 20:00 hours may not be
processed until the following day in this case blood will be available by 10:00 if no atypical antibodies
are present.
Patients with atypical antibodies

If you require blood for a patient with known red cell antibodies, please ensure the laboratory are given as much
notice as possible. Although red cells suitable for most commonly occurring antibodies are kept in stock, for
more unusual antibodies/combinations blood will need to be ordered from the NHSBT. For some combinations
obtaining suitable red cells is difficult and there will be a considerable delay.
Emergency Transfusion including Massive Haemorrhage

The trust has a Massive Haemorrhage Protocol (MHP) which is available at OUH Major Haemorrhage Protocol
There is an expectation that clinical staff will be aware of how to activate the protocol and where a copy can be
located.
Activation is by calling switchboard on 4444 – use the term activate the Major Haemorrhage Protocol and clearly
state your site and location.
Other blood products

• 5% or 20% Human Albumin Solution
• Platelets
• Fresh Frozen Plasma
• Cryoprecipitate
• Prothrombin Complex concentrate (Octaplex)
• Prophylactic Anti-D
These are available on a named patient basis from the laboratory upon discussion with the staff on duty.
• FFP and Cryoprecipitate should only be ordered if it is to be used immediately.
• The department will not thaw out FFP and Cryoprecipitate on a “standby basis”, although FFP may be
available already thawed from within the laboratory.
Blood Ordering Schedule

The Trust has implemented a comprehensive system of remote blood issue in most of the theatre suites.
This ensures that blood is available on request directly at the point of need for most operations. As
such we no longer use a Blood Ordering schedule in its traditional sense.
Transfusion Sample Requirements
These are adult (> 7 years old) sample volume requirements, for children under 7 years old a minimum of 1.5
ml is required for group save and crossmatch. More may be required for patients requiring complex antibody
investigations.
Tube Colour Investigation
Group and Save (Full, 4.5 ml EDTA) 2 x EDTA if patient known to have antibodies.
Crossmatch Request (Full, 4.5 ml EDTA) 2 x EDTA if patient known to have antibodies
Antenatal Serology: Full, 4.5 ml EDTA on mother. Other samples may need to be sent
if haematology and haemoglobinopathy screening is required.
Kleihauer test (2 ml EDTA)
Routine samples on Rhesus negative mothers at delivery (2 ml EDTA on mother and

baby)
Direct Antiglobulin Test (DAT) (2 ml EDTA)
Cold Agglutinins (Clot delivered to laboratory at 37°C in thermos flask, discuss the test
with laboratory staff prior to collecting a sample)
Samples for Antenatal Testing:

Samples sent to the laboratory for antenatal testing should comply with the labelling requirements indicated
above. In addition, if a patient is not yet registered with the Trust and for whom there is no NHS number available,
the laboratory will accept the patients FULL address as a patient identifier (this will not be acceptable on samples
for compatibility testing)
Appendix I Normal Ranges (Adult, 13 years+, apart from ESR: 17 years +)
FBC – EDTA sample
Haemoglobin (Hb) Male 130 - 170 g/l
Haemoglobin (Hb) Female 120 - 150 g/l
12
Red cell count (RBC) Male 4.5 - 5.5 x10 /l
12
Red cell count (RBC) Female 3.8 - 4.8 x10 /l
Haematocrit (Hct) Male 0.40 - 0.50 l/l
Haematocrit (Hct) Female 0.36 - 0.46 l/l
Mean Cell Volume (MCV) 83 - 101 fl
Mean cell Hb (MCH) 27 - 32 pg
Mean cell Hb concentration (MCHC) 315 - 345 g/l
Red Cell Distribution Width (RDW) 11.5 – 16.0 %
Reticulocytes percentage (RET) 0.5 - 2.5 %
Reticulocytes absolute (RET) 0.04 – 0.12 x1012/l
Ret-He 28.7-37.6 pg
Nucleated RBC percentage (NRBC) 0 – 0.2 %
Nucleated RBC absolute (NRBC) 0 – 0.5 x109/l
White cell count (WBC) 4.0-11.0 x109/l

Neutrophil count 2.0 -7.0 x109/l
Lymphocyte count 1.0 -4.0 x109/l
Monocyte count 0.2 - 1.0 x109/l
Eosinophil count 0.02-0.5 x109/l
Basophil count 0.02-0.1 X109/l
Immature Granulocytes (IG) 0 – 0.1 x109/l
Platelets (Plt) 150-400 x109/l

Immature Platelet Fraction (IPF) 2.3 – 12.7 x109/l
Mean Platelet Volume (MPV) 9 – 12.1 fl
Plasma Viscosity at 25°C (EDTA) 1.50 - 1.72 MPa/s

Glandular fever screen (Monospot) (EDTA / Clot)
Erythrocyte Sedimentation Rate (ESR) - EDTA sample

ESR Male 17-69years <14 mm /hr
ESR Male >70 years <30 mm/hr
ESR Female 17-69 years <20 mm/hr
ESR Female >70 years <35 mm/hr
COAGULATION- Citrate sample

Prothrombin time (PT) 9.0 – 12.0 sec
Activated Partial Thromboplastin Time (APTT) 20.0 - 30.0 sec
International Normalised Ratio (INR) 2.0-4.0*
(*Discuss with anticoagulation nurse specialist) sec
Thrombin time (TT) 14.0-19.0 sec
Reptilase Time 16.0 – 22.0
Fibrinogen (Fib) 1.5-4.0 g/l
D-Dimers < 500 g/l FEU
Protein C 0.70 – 1.40 IU/ml
Protein S Free (Male) 0.70 - 1.50 IU/ml
Protein S Free (Female) 0.55 – 1.35 IU/ml
Antithrombin (AT) 0.80 – 1.20 IU/ml
Dilute Russell’s Viper Venom Tests (DRVVT) ratio 0.80 - 1.20
Actin FSL ratio 0.70 – 1.30
ADAMTS 13 activity 60.6 – 130.6 IU/dl
ADAMTS 13 Inhibitor 0 – 12.0 IU/ml
Anti-Xa assay (Peak treatment dose given BD) 0.50 - 1.00 U/ml
Von-Willebrand Factor (AG & activity & CBA) 0.50– 2.00 IU/ml
Factor VIII / IX 0.50 – 2.00 IU/ml
Factor II, V, VII & XII 0.50 – 2.00 IU/ml
Factor XI 0.70 – 1.30 IU/ml
Factor XIII 0.70 – 1.40 IU/ml
2-Antiplasmin 0.80 – 1.30 IU/ml
Plasminogen 80 - 120 IU/dl
PFA : Collagen/ADP 55 – 112 Sec

PFA : Collagen / Epinephrine 79 - 164 Sec
Platelet Nucleotides (ATP) 25-60 x109/l plt

Platelet Nucleotides (ADP) 20-40 x109/l plt
Platelet Nucleotides (Ratio) 0.8 – 2.2 Ratio
Chronolog Thrombin 1u/ml 0.5 – 2.0 nmole

Chronolog Collagen 2ug/ml 0.5 – 1.7 nmole
Chronolog Collagen 5ug/ml 0.9 – 1.7 nmole
HAEMOGLOBINOPATHY (EDTA sample)

Thalassaemia screen (EDTA)
HbF < 1.0 %
HbA2 2.0 - 3.2 %
RED CELL ENZYMES (EDTA sample)

Glucose-6 Phosphate Dehydrogenase (G6PD) 5.8-18.8 u/gHb
Pyruvate Kinase (PK) (send away test) 6.2-14.2 u/gHb
Ranges updated: 09/06/2022. Ranges Reviewed 09/06/2022

Codes used in reference range list –
Although other samples may be useable, this is the preferred sample type
EDTA – Purple topped EDTA anticoagulated tube
Citrate – light blue topped Sodium Citrate anticoagulated tube
Clot – Yellow / Gold topped non anticoagulated clotted sample
Reference range source

Ranges have been derived from a number of reputable sources.
1. Adult Normal FBC & ESR Ranges derived from Practical Haematology; 11h edition Dacie & Lewis 2012;
checked and verified as part of new equipment implementation 2015.
2. Haemoglobinopathy ranges derived from Practical Haematology; 11th edition Dacie & Lewis 2012.
3. Coagulation and Haematinic ranges derived from manufacturers recommendations, but checked and
amended as part of new equipment verification 2015
4. PT range amended as part of new batch change September 2018
5. PK range supplied by external referral laboratory
6. G6PD range supplied by manufacturer of assay and verified by laboratory September 2017
7. Haptoglobin reviewed and updated as part of a formal verification of method in 2017, but with reference
to Practical Haematology, 11th edition, Dacie & Lewis 2012.
8. IPF range adapted from Haematology reference intervals for established and novel parameters in
healthy adults. J.M.Pekelharing et al, checked with local study in 2019.
Please note
• Ranges for patients below the age of 13 are available on request from the quality manager
(Andrew.platt@ouh.nhs.uk) or 01865 857663.
• There are no formal ranges available for the ESR test for patients <17 years, if needed clinical advice on
the interpretation of results is available from HaematologyRegistrarEnquiries@nhs.net .
Due to ethical issues surrounding generation of internal ranges, reference ranges for children are derived from
published sources
1. Practical Haematology; 12th edition Dacie & Lewis 2017

2. Diagnosis in Paediatric Haematology: 1st Edition Harry N Smith 1996
3. Pediatric Hematology: 2nd Edition J S Lilleyman et all 1999
Appendix II, Departmental Telephone Numbers
General Enquiries Ext

Combined Haematology / Biochemistry office (JRH) (01865 2) 20336
Haematology / Coagulation (Horton) (01295 2) 29369
Oxford Haemophilia & Thrombosis Centre (01865 2) 25311
Blood Transfusion Laboratory (JR2 & Churchill) (01865 2) 20339 / 20340
Blood Transfusion (Horton) (01295 2) 29236
Molecular Diagnostics (JRH) (01865 5) 72769
Immunophenotyping Laboratory (JRH) (01865 5) 72827
Medical Assistance – Monday to Friday 8:30-17:00 only

Blood Transfusion Duty Registrar (01865 741166) Bleep 6888
Haemostasis Duty Registrar (01865 741166) Bleep 5529
Haematology Duty Registrar (01865 741166) Bleep 1836
Duty Registrar outside of core hours ask Switchboard to bleep duty JRH Switch 0300 3047777
Haematology Registrar.
For non-urgent clinical enquiries please email HaematologyRegistrarEnquiries@nhs.net

For general Molecular enquiries please email: oxford.molecularhaem@nhs.net
For all National Haemoglobinopathy Laboratory Support Service lab.support@nhs.net
queries
For Haemoglobinopathy screening queries please hbopathy.screening@nhs.net
Staff contact details

Registrars (JR)* 01865 (2) 20367 or bleep 1836
Registrars (Churchill)* 01865 (2) 35884 / 35885 or bleep 1836
Laboratory Manager - Mr. D Smith (Dan.smith@ouh.nhs.uk ) 01865 (2) 20337
Quality Manager – Mr. A Platt (Andrew.platt@ouh.nhs.uk ) 01865 (8) 57663
Blood Bank Manager – Miss J Staves** 01865 (2) 20334
Morphology Senior Staff – Mr K Leyden, Mr Ashley Cooper, Miss 01865 (5) 72827
Joana Silva**
Coagulation Contact – Mr. P Baker** 01865 (8) 57096
Horton lead (combined with Biochemistry) – Mrs E Siggs** 01295 (2) 29243
Automated Haematology contact – Mr M Jacobs 01865 (2) 21125
(Michael.Jacobs@ouh.nhs.uk )
Laboratory secretary 01865 (5) 72824
Dr Pavord’s Secretary 01865 (5) 72824
*For non-urgent clinical enquiries please use the dedicated Haematology registrar email
HaematologyRegistrarEnquiries@nhs.net . This will be checked on a daily basis only, for urgent
enquiries please phone or bleep.
** These contacts should be used if there is a non-routine issue with a specific department otherwise, please
use the general enquiries number or email address.
Appendix III, Examples of Haematology Request forms
Please note it is expected that the majority of requests made to the department will be made
on either Cerner EPR (inpatients / outpatients) or via Sunquest ICE (GP). If available in your
clinical areas the laboratory would urge you to use these systems instead of using paper
forms.
If using paper forms, please ensure that on each request form, the individual collecting
blood, signs the form.
Haematology / Biochemistry Joint Requesting form (in use from January 2007)
This form has replaced both JR and Horton Haematology & Biochemistry forms; this form is to be
used, only if EPR ordering is not available
1. Please fill in the patients’ full name & Date of Birth; insufficiently labelled samples or cards will
not be tested. If available, it is acceptable to use addressograph labels on request forms.
2. Please use either NHS or Hospital number on all requests; it enables the department to merge
results with previous records on the patient.
3. Clinical information is very important, especially for some Biochemistry requests. Please do
not leave this blank.
4. Please include a patient location on all request cards, it will enable the laboratory to telephone
the results if abnormal or if the sample is unsuitable for testing. For GP patients, please
remember to give the requesting GP’s name and location.
5. Please list the tests required, for Haematology & Biochemistry. For information on sample
requirements, please refer to section in laboratory handbook. Please ensure that you have
taken sufficient blood in suitable tubes for the required tests. If the sample is urgent, please
make this clear on the form.
6. Please fill in date and time of sample collection.
Blood Transfusion Form: This form is being used on all sites not using EPR ordering
1. Patient’s full name must be on the form and on the sample, not the one that the patient “likes to
be known by”. The correct hospital number or NHS number and date of birth must be on sample
and form. If they are missing or do not match, the sample will not be processed. The use of
addressograph labels on request forms (not samples) is encouraged.
2. If the SafeTx system is being used, there is no need to use the Red label system. Please ensure
that a SafeTx label is on the request card and sample. If using the Red Label system, the red label
must be on the form, sample, and patient’s wristband and in the patient’s notes. If the red label is
missing from any of these, new samples will necessary. Incorrectly labelled forms will not be
processed
3. All forms must be signed, at least by the doctor requesting the transfusion: no signature, no
processing of sample. It is important that we can work out who you are, so please write clearly!
4. It is essential to the blood bank that this section is filled in as completely as possible. It is of
particular importance if the patient is thought to have red cell antibodies or has been transfused
in another hospital.
5. Finally, tell us what you want, when you want it and where you want it. If blood is truly required
urgently then telephone the department to let us know that the sample is coming.
JR & Horton Blood bank Antenatal Request form.
As of January 2007, all antenatal (AN) samples will be processed on the JR site, please use this
form for such samples
1. Please ensure that you put the following information as a minimum on the form in this section:
a. NHS number (Hospital number is acceptable)
b. Full patient name.
c. Date of birth
2. Please enter the applicable ethnic code.
3. Please ensure that the following information is included on this form:
a. Midwife location code
b. GP name
c. GP location
d. Midwife name and contact details
e. Date (and time) sample taken
4. Please ensure that all the questions are answered in this section
5. Please send sufficient samples for the requested tests. Current departmental policy does not
allow samples to be shared for FBC and Blood grouping:
a. Blood Group & Antibody Screen – 1x EDTA
b. FBC / Sickle / Thalassaemia screen – 1 x EDTA
c. Please make sure that a family origins questionnaire is included with all requests
for Sickle or Thalassaemia screens.
6. If the sample is from a partner of an antenatal patient (AN), it is very important that the AN
patient details are completed in this section. The majority of partner sample request forms will
be labelled with a yellow sticker.
In addition to this information, please ensure that you read the back of the request form.
Please note: Family Origins questionnaire can be completed electronically via the ICE system
(request via Antenatal Haemoglobinopathy screen set) if this facility is available.
Molecular Haematology: a variety of specialist Request forms are downloadable from the
specialist website Oxford Molecular Diagnostics centre forms

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THE DEPARTMENT OF LABORATORY HAEMATOLOGY HANDBOOK

About the Oxford University Hospitals NHS Foundation Trust (OUH)

The John Radcliffe Hospital

This service includes the following:

Business Continuity and Contingency Plans

Phone Enquiry Policy (SOP Gen 001)

• Laboratory Manager: Dan Smith (email to Dan.smith@ouh.nhs.uk ) 01865 220337

Making a Formal Complaint

Critical Values for FBC include:

Critical Values for Coagulation testing include:

• Each specimen must be sealed in a double plastic bag.

Referral of Tests to another Laboratory

• FBC (including Retic)

• Clotting screen / INR / D-Dimer

• FBC (including Retic)

• FBC (including Retic)

Update: June 2022.

Schemes we participate in as of June 2022 include:

Scheme Site Frequency Section

JR2 site Horton site Churchill site NOC site

• Oxford Haemophilia and Thrombosis Centre, NOC

General Enquiries please see appendix II

Examples include but are not limited to:

Use of Cerner Millennium is therefore strongly recommended where possible.

• Always check patient identification before labelling samples.

Oxfordshire CCG GP Practices:

All other locations (including referrals from other trusts):

Tube Colour Anticoagulant Used

Potassium EDTA: for routine Haematology analysis and transfusion

Serum: for Haematinic analysis

Sample Types for Commonly Requested Tests.

Paediatric tube types in use.

Sample Tube Lid Sample Tube Lid

Citrate Green Heparin Orange

These samples will be rejected as unsuitable to process.

• White Blood Cell Count

There is no need to request these tests in addition to a Full Blood Count.

Some conditions where it is appropriate to request a coagulation screen

• Unexplained bleeding or bruising

Coagulation screens before surgery or invasive procedures

These recommendations can be summarized as follows:

Some reasons not to request coagulation screen

Samples delayed in transit outside of this time may not be processed.

Specialist Coagulation testing

Who to test for heritable thrombophilia?

Who to test for antiphospholipid antibodies?

• Patients with unprovoked or recurrent VTE who are stopping anticoagulation.

• Hereditary thrombophilia - 4 citrate samples and 1 EDTA

Samples referred to the laboratory for Haemostatic or Thrombotic investigations

Samples referred to the laboratory for platelet function investigations

Samples should be sent to:

1. Haemato-oncology: An integrated phenotypic (immunophenotyping) and molecular service for the

• Address for sending results

Oxford University Hospital Foundation Trust Users

What you need before you start

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• Once Results reviewed click Endorse Results button