Specific IgG Testing

Information for patients

Anticoagulant Services are provided at both Bournemouth and Poole Hospitals. If you are being referred for the first time you will receive an appointment to be seen in the Anticoagulant Clinic where one of the Anticoagulant Practitioners will explain all about anticoagulation. You will normally be sent an appointment letter in the post with some information on these drugs. If you prefer the clinic can provide this counselling by a video or telephone consultation.

There are 5 main anticoagulant drugs Apixaban, Dabigatran, Edoxaban, Rivaroxaban and Warfarin used by the clinic.

When you attend the clinic you will normally have a blood test just prior to your appointment. In the clinic you will be given information on the drugs which are suitable for you. Where possible the practitioners will give you the choice of which anticoagulant will be right for you. Don't worry they will help you choose the drug that is right for you.

The practitioners will explain how the drug works, how to take it, what to do if you forget to take it, take too much and what side effects that are possible. You will be given written information on the drug and given an alert card and you will normally be given a prescription for months supply of your new medication.

Normally you won't have to be seen in the hospital again and the practitioners will write to your GP to inform them which drug you have started.

Warfarin Patients

If warfarin is the most suitable drug for you then your follow up will normally be with the clinic. Warfarin needs regular blood test monitoring to adjust how much warfarin you need. The blood test is called International Normalised Ratio (INR).

The Anticoagulant Service uses a dose and post service this means you will receive a letter in the post after each blood test telling you how much Warfarin to take and the date for your next blood test. If there is an immediate change in your warfarin dose we will normally try to phone you to advise the changes. If you prefer we can send your dose instructions automatically as an email. This email is usually sent the same day.

Blood tests can be at the Pathology Department at Bournemouth, Christchurch or Poole Hospital please let the clinic know which hospital you prefer and they can arrange an appointment and further appointments will automatically be made for you. If you are unable to attend one of the three hospitals ,blood test are also available at some GP surgeries please contact your GP surgery.

How do I take my Warfarin?

Take your anticoagulant once a day in an evening, at about the same time, preferably on an empty stomach and washed down with a full glass of water.

If you miss a dose, or take the wrong dose by mistake, make a note on your anticoagulant blood form which will be sent to you each time you have a blood test. Take your normal dose the next day. If the dose you took in error greatly exceeded your normal dose please contact your anticoagulant clinic. You may be given a number of different strength tablets to make up your dose, and it is important that you become familiar with the different strengths and colours that you need to take.

In the UK, the colours of Warfarin tablets are:

• 0.5mg (500 micrograms) – white
• 1mg – brown
• 3mg – blue
• 5mg – pink

The Trust Anticoagulant Service does not tend to use 5 mg tablets. You may need a mixture of different coloured tablets to make up your dose. Other anticoagulants may come in different strengths and colours. Do not confuse the dose in mg with the number of tablets that you take.

Repeat prescriptions

If you are on warfarin

It is important that checks are performed each time you request and receive a supply of oral anticoagulants. This should include reviewing your blood test results and dose information, and ensuring that it is safe to supply you with more tablets. When you request a repeat prescription you should be asked to provide information about your INR test results and current dose of oral anticoagulant, which you will have collected and kept in your anticoagulant folder.

Your community pharmacist will also ask to see this information when they dispense your prescription. If you cannot request or collect the prescription yourself, make sure that the person representing you has this information with them. For prescription delivery services, the pharmacist dispensing the prescription should contact you to confirm your INR and current dose. Make sure that you do not run out of tablets and always have at least a week's supply.

If you are on Apixaban, Dabigatran, Edoxaban or Rivaroxaban

The anticoagulant clinic will normally provide your first month of anticoagulant after which you need to obtain your anticoagulant prescription from your GP.

Serious side effects

The most serious side effect of anticoagulants is bleeding.

• prolonged nosebleeds (more than 10 minutes)
• blood in vomit
• blood in sputum
• passing blood in your urine or faeces
• passing black faeces
• severe or spontaneous bruising
• unusual headaches

for women, heavy or increased bleeding during your period or any other vaginal bleeding. If you cut yourself, apply firm pressure to the site for at least five minutes using a clean, dry dressing. Seek immediate medical attention if you

• are involved in major trauma
• suffer a significant blow to the head
• are unable to stop bleeding

If you are on warfarin and experience any of the following, seek medical attention and have an urgent INR test.

Other medicines

If you are on warfarin many medicines can interact. If, during your course of anticoagulants, you are also starting or stopping another medication, the prescriber may advise that you should have an INR blood test within five to seven days of starting the new medication. This is to make sure that your INR remains within the desired range. Please contact the anticoagulant clinic for further advice.

If you are planning to buy over-the-counter medicines, including alternative remedies, tell the pharmacist that you are taking an oral anticoagulant and show them your anticoagulant alert card. They can then advise you on medicines that are safe for you to take.

With all anticoagulants yIf you are on warfarin ou should not take aspirin unless it has been specifically prescribed by your GP. It is also advisable to avoid other non-steroidal anti-inflammatory drugs like diclofenac or ibuprofen.

Please note that some of these can be bought over the counter in pharmacies with names such as Nurofen®. Paracetamol and codeine-based painkillers are acceptable, although be aware that some paracetamol 'plus' products contain aspirin.

Diet

It is important to eat a well balanced diet. Consult your doctor or practice nurse if you need to diet to lose weight. Any major changes in your diet may affect how your body responds to your anticoagulant medication.

If you are on warfarin foods rich in vitamin K may affect your INR result. Such foods include green leafy vegetables, chick peas, liver, egg yolks, cereals containing wheat bran and oats, mature cheese, blue cheese, avocado and olive oil. These foods are important in your diet but eating them in large amounts may lower your INR result.

Try to take the same amount of these foods on a regular basis. It is the change in the vitamin K intake that affects your INR result. Drinking cranberry juice can also affect your INR and so should be avoided altogether if possible. If your diet changes greatly over a seven-day period, you should have an INR test.

Alcohol

It is recommended that you do not exceed the national guidelines. These are up to three units a day for men, and up to two units a day for women.

One pint of beer is two units; one pub measure of a spirit is one unit; and one pub measure of wine is one unit. It is dangerous to 'binge drink' while taking anticoagulants.

Pregnancy

Oral anticoagulants can affect the development of a baby in early pregnancy.

Women who are on oral anticoagulants should discuss plans for future pregnancy with their doctor before trying to conceive, wherever possible.

Women who think they have become pregnant while on anticoagulants should seek a pregnancy test as soon as possible and, if this is positive, an urgent appointment with a doctor.

You may breast feed while taking warfarin but not other anticoagulant medication.

Periods

Women may experience heavier periods while they are taking oral anticoagulants and may wish to discuss this with their GP, anticoagulant nurse or pharmacist.

Going to the Dentist

You can still go to your dentist as usual. In the majority of cases your dental treatment can go ahead as normal without your anticoagulant being stopped or the dose being adjusted. Do inform your GP you are on an anticoagulant. If you are on warfarin your dentist may need to see a recent INR test result to ensure that it is safe to provide treatment.

Your dentist will be able to provide you with a leaflet which explains this and give you some additional advice. You should contact your dentist before your appointment in case they need you to have an extra blood test.

Anticoagulation video

Click here to watch a video, produced by the Wessex Academic Science Network.

Immunology

Immunology laboratory based in Royal Bournemouth Hospital in Pathology Hub, provides a comprehensive clinical and laboratory service for investigation of patients with allergy, autoimmune disorders , vasculitis, immunodeficiency and other related diseases, for Bournemouth, Christchurch, Poole and Dorchester hospital, as well as the associated GP networks.

Our service is based upon the principles of good laboratory practice.

All investigations are governed by standard operating procedures and are performed in the strictest confidence by qualified personnel.

Bournemouth and Southampton laboratories are UKAS accredited, subscribe to the UK National Quality Assurance Scheme (NEQAS), and perform continual internal quality assessments.

Consultant advice is available for all aspects of the Immunology service.

Cytology

Key Contact Details

• You can view our cytology and histology contact information here

Location of Cytology

The Poole laboratory is situated in the orange zone level 1 next to the microbiology department; ring the bell in microbiology reception (located on the left hand side on the wall) for assistance. The Bournemouth laboratory is located on the first floor of the Pathology Hub Building; report to pathology central reception at the main entrance of the hub building if assistance is required.

Services Provided

The cytology department provides a number of non-gynaecological cytology diagnostic services and ancillary tests.

The non-gynae service assists in clinical sample collection and Rapid on Site Evaluation and aims to provide a diagnostic report within the following turnaround targets:

80% of all requests within 7 days

90% of all requests within 10 days

Please use the contact details to arrange for cytology assistance within the hospital.

The laboratory is currently UKAS ISO15189 and has been approved by the IBMS as a training laboratory in the pre-registration of Biomedical Scientists.

Gynae Cytology

In 2016, the UK National Screening Committee recommended that the HPV test should replace cytology as the first (primary) test in cervical screening and by December 2019 primary HPV has fully rolled out across England. Commencing from the 25th November 2019 onwards, all local cervical screening HPV samples are processed at Berkshire and Surrey pathology services at the St. Peters hospital, Chertsey site. All enquiries can be made via 01932 726622 or This email address is being protected from spambots. You need JavaScript enabled to view it.

Opening Times

Monday - Friday 08:00-17:00

Out of Hours Service

The laboratory does not provide an out of hours service.

Samples taken out of hours should be refrigerated on the ward and submitted to the lab during opening hours

Sample collection

Please ensure the correct sample container is used for the collection of all cytology samples. A separate sample should be collected for cytology analysis and not added to another sample request for biochemistry or microbiology.

Samples Taken at or Sent to Poole Hospital

The cytology laboratory at Poole hospital now processes all Diagnostic Cytology samples for UHD. All samples need to be clearly labelled and forwarded to the pathology department for dispatch and processing

The department examines a variety of samples including sputa, urines, fluids and fine needle aspiration samples. To avoid delay in processing please use blue non gynae cytology request forms available from the laboratory.

Forms must be properly completed or requests will be returned to the originator.

Fine needle aspiration - Tips for getting a fast, efficient service

Please write the telephone number/Bleep on the request form so we can phone the surgeon with the diagnosis.

The ideal specimen consists of one air dried slide, one wet fixed slide and a needle washing collected into cytolyt solution.

• You can view more information on Fine needle aspiration here

Sputum Cytology

Sputum cytology is only indicated in patients who are not fit for bronchoscopy

Three pre-breakfast samples should be taken on consecutive days and sent fresh to the laboratory

Please label with surname, forename, NHS or registration number and date of birth.

Urine Cytology

30ml of Sample should be collected mid-morning and taken from the initial stream to maximise cell yield

Must NOT be mid-stream urines

Must NOT be mid-stream urines

Place in plain sterile pots and sent fresh to the laboratory

DO NOT send in boric acid as these cannot be processed on our equipment.

Label with surname, forename, NHS or registration number and date of birth

Cerebral spinal Fluid

Ensure sample is split for flow cytometry (The link to the correct form is located below)

Use a small universal container and send to the laboratory as soon as possible after collection to prevent cell degradation

Ensure sample arrives by 4pm or give prior notification to laboratory if it will be after hours

Label with surname, forename, NHS or registration number and date of birth.

Other Fluids (breast cyst fluids, pleural fluids, ascitic fluid etc)

All other fluids for cytology should be put in a small universal and sent to the laboratory with a request form.

Ideally the sample should be over 50ml to allow for further testing however the laboratory will not accept quantities of fluid greater than 200 ml

Label with surname, forename, NHS or registration number and date of birth.

Fine Needle Aspirates

Submitted to the laboratory as prepared slides

The patient's surname, plus any two of the following: hospital number, NHS number, forename, date of birth must be printed on the frosted end of the glass side using lead pencil

If the sample is from the breast, the side ie ‘Left’ or ‘Right’ must also be written, in full, on the form and (L or R), initial only may be used on slides

For any bilateral organ the side (left or right) and area (upper, middle, lower) from which the sample has been taken should be identified in this way

Bronchial Brushings

Submit to the laboratory as prepared slides fixed in alcohol or spray fixed or entire brush head (including 4-5 cm sheathing) cut off into CytoLyt solution

Patient's surname, plus any two of the following: hospital number, NHS number, forename, date of birth must be printed on the frosted end of the glass side using lead pencil

Breast Implant fluid suspicious of BI-ALCL

Please note very important: Two samples need to be taken; One for Cytology and one for RBH Molecular Biology. Please stick to the time scale detailed below as the accuracy of flow cytometry is unknown on specimens after 24 hours.

If the specimen is taken at Poole Hospital: the sample must reach the lab before 13:00 in order to be put on van for RBH.

If the specimen is taken at Bournemouth Hospital: Samples MUST reach molecular biology by 2pm

For the Molecular Biology sample: 20mls in standard white top universal container

Send with a molecular biology form for flow cytometry (SIHMDS form) with the following clinical details on form.

Suspected BI-ALCL

For the Cytology sample: 20ml in standard white top universal cytology container

Send with a cytology form with the following clinical details

Other Brushings

These are collected into a Cytolyt. Please ensure vial is within date and labeling guidelines are followed. Please contact the laboratory for any assistance tel ext 2793

Risk of Infection

SARS-COV-2- For all suspected/diagnosed COVID specimens please write on front of form

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Histology

Key Contact Details

• You can view our cytology and histology contact information here

Location of Histology

The laboratory is situated in the orange zone level 1 next to the microbiology department; ring the bell in microbiology recepton (located on the left hand side on the wall) for assistance.

Opening Times

The laboratory is staffed by BMS on rotation with Bournemouth and MLA's between the hours of:

Monday - Friday: 08:15-17:00

Weekend/Bank Holiday: Closed

Out of Hours: By prior arrangement

If no-one is available, please direct any enquiries to the Poole Histology secretaries (2211), Bournemouth Histology Secretaires (4832) or the Cytology Department (2793).

The secretarial offices hours are:

Monday - Friday: 08:00-17:00

Weekend/Bank Holiday: Closed

There is currently no out of hours service for Poole.

Request Form Completion

All samples for Histological examination should arrive with an appropriately signed request form and clearly labelled sample pot with a maximum of four samples per request form. Left and Right samples also need to be on separate request forms.

They need to contain:

• Patient's Surname - Hospital and GP samples
• Patient's Forname - Hospital and GP samples
• Date of Birth - Hospital and GP samples
• Hospital Number - Hospital samples
• NHS Number - Hospital and GP samples
• Source - Hospital and GP samples
• Consultant and or GP - Hospital and GP samples
• Specimen Type/Site - Hospital and GP samples
• Clinical Details - Hospital and GP samples

Any form or sample that does not match or fails to reach the above criteria will be error logged and returned to source for completion

Incomplete information will delay results.

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Frozen Section Requests

It is important that frozen sections are booked with a minimum of 24 hours advance notice where possible. This is to ensure that technical and pathologist staff are available to process and report the sample when it arrives. To book a frozen section call or e-mail the laboratory or the Poole Histology office; (extensions 8081, 2211 or 2283) or Bournemouth Histology office; (extension 4832).

Alternatively email requests to:

If Poole -  This email address is being protected from spambots. You need JavaScript enabled to view it.

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If Bournemouth - This email address is being protected from spambots. You need JavaScript enabled to view it.

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Guidelines for Specific Sample Types

The majority of samples are received in the laboratory at room temperature in 10% Neutral buffered Formalin at least 10-15 times greater than tissue volume to ensure adequate fixation. Fixation is a chemical process, and at least 24 hours is needed for the process to complete. Although "over fixation" can be detrimental, under-fixation can be a significant problem and may be responsible for inappropriate results. Samples in formalin should not be placed into the fridge as this slows the chemical process of fixation and will affect the interpretation of results

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Certain samples require a deviation from this standard approach which includes:

Fresh Lymph node: Fresh

Samples for Referral for Genetic Studies: Fresh

Samples for T Cell Gene Rearrangement: Fresh or Normal Saline

Muscle Biopsies: Fresh

Skin samples for Immunoflourecense: Michel's fluid

Renal biopsies for Glomerulonephritis: Fresh

Tissue for sensitive disposal (RPOC's): Formalin with consent form

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Fresh Lymph Node

Samples are sent dry straight to the laboratory and staff informed immediately. If no staff available during working hours please take to cytology department. Any sample taken out of routine hours must be fixed in conventional way.

Referral for genetic studies

These include samples of skin, placenta, cord and RPOC for various genetic tests.

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DO NOT PUT THESE BIOPSIES IN FORMALIN AT ANY STAGE.

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All specimens must be put in dry containers, or in transport media (supplied by Wessex regional Genetics Laboratory, Salisbury) correctly sealed and ideally sent to the laboratory the next working day. If there is a delay, store at 4°C.

Referrals for T cell Gene Rearrangement

These skin samples must be sent in NORMAL SALINE to the laboratory as soon as possible. If out of hours please store at 4°C and send as soon as possible. Ideally, the lab should be given notice from the requesting clinician when fresh specimens for TCR analysis are being sent. Fresh specimens should not be sent to the PGH lab after midday on Fridays as it cannot be guaranteed that staff will be present to receive/store specimen appropriately over the weekend.

Muscle Biopsies

Please inform secretarial staff at least three days prior to removal. All samples must be received fresh and sent to the laboratory straight away. The type of investigation required, whether morphological or myopathic disorder must be clearly written on the request form. The majority of these samples will be referred to Southampton.

Skin Samples for Immunoflourecense.

These samples need to be sent to the laboratory as soon as possible in Michel's fluid or transport medium. Please contact Immunology laboratory for sample containers at least three days in advance. (Refer to link Specimen requirements) If out of hours please store at 4°C and send the next day.

Renal biopsies for Glomerulonephritis

These need to be sent fresh to the laboratory as soon as possible or sent direct to Southampton Hospital Neuropathology department for Electron Microscopy.

Tissue for Sensitive Disposal (RPOC)

Products of conception (POC) specimens that require cremation after processing need to be accompanied by a cremation consent form entitled 'Sensitive disposal of foetal remains' form. The legislation surrounding this is very stringent, and the forms need to be signed and completed with care. The processing of these samples will be delayed until the consent has been received and if no consent form is received with the sample, it will be returned to source.

Identification of High Risk Samples

All samples received fresh or in formalin are regarded as potential high risk. Samples known to be high risk from patients with Hepatitis B, C, HIV and TB must clearly be marked on the request and sample as HIGH RISK and identified with a yellow "danger of infection" label.

Specimen Transport

Containers of formalin should be securely closed wrapped in the absorbent pad and placed with the request form into the clear transport bag and sealed by person taking the sample. Formaldehyde vapour is a well-recognized respiratory irritant, and skin contact with formalin solution should be avoided, as repeated exposure may cause dermatitis in some individuals. Samples are collected twice daily from within the hospital by the portering service and GP samples are collected on a daily basis by Dorset Ambulance Trust. Samples from the Harbour Hospital are delivered via their portering staff. Urgent samples can be brought direct to the laboratory, if no staff are available please take to cytology department.

Referral of Samples

We occasionally require expert or secondary opinion on more complex samples these are referred to:

Availability of results

For patient confidentiality we need to establish the caller's identity before giving results over the telephone. We are unable to give results directly to patients or their relatives. In general, results are not available on EPR until they have been authorized by the reporting Consultant Histopathologist. In exceptional circumstances preliminary results may be available directly from the Consultant Histopathologist.

The time taken for a result to be available varies depending upon the type, size and complexity of the specimen and whether a referral is required. These are available to view via EPR only for GP's, for requesting Consultants a paper report is also sent. More rapid processing of very urgent small specimens can be arranged following discussion with the appropriate pathologist.

Department Reporting Times

The Department has decided to adopt the creation of a 4-category division of work that is clinically prioritized.

Specimens are categorised into 4 streams of work (A, B, C, D) This involves Category A being the most clinically urgent, through to category D, the least clinically urgent.

It is therefore important that the clinical details provided are as accurate as possible in order that specimens can be categorised appropriately for reporting. This should ensure that high priority cases, for example suspected cancers, are reported promptly.

We aim to maintain our reporting times within the follow turnaround time targets;

• 90 % of all specimens shall be reported within 10 days
• 100 % of all specimens shall be reported within 20 days

Occasionally more complex samples will need to be referred for expert opinion and these may take longer.

Complaints Procedure

If you feel the service provided by the laboratory falls short of addressing the needs of the patient, please use the hospital complaint policy:

• Patient Experience: Complaints
• or the Patient Advice and Liasion Service (PALS):