The haematology laboratory service provides an essential service for the Royal Free London NHS Foundation Trust and many local GP practices. The department is staffed by several consultant haematologists supported by Health and Care Professions Council (HCPC) registered biomedical scientists and medical laboratory assistants.
The laboratory performs over 500,000 blood tests every year which are processed by one of the five different sections within the laboratory: diagnostic haematology, blood transfusion, special haematology, immunophenotyping and molecular diagnostics. The laboratories work to nationally agreed standards as set out by Clinical Pathology Accreditation (CPA) UK Ltd, Medical Healthcare product Regulatory Agency (MHRA) and the Blood Safety and Quality Regulation (BSQR) 2005.
he types of tests performed vary greatly from routine tests such as full blood count to more specialist tests including the diagnosis and classification of leukaemia. The laboratory is closely linked with colleagues in the molecular cytogenetics laboratory in the department of academic haematology (see the University College London website for more information).
The diagnostic laboratory generates thousands of results every day, all of which are accessible to medical staff via the hospital computer system.
The laboratory is open 9am-5.30pm Monday to Friday. An out of hours shift services operates outside these hours for blood transfusion and diagnostic haematology departments only.
The diagnostic haematology laboratory provides a 24hr service consisting of a variety of analytical tests including full blood counts, reticulocytes, erythrocyte sedimentation rate, blood and bone marrow morphology, malarial parasite and infectious mononucelosis diagnosis.
The department has a HST track system comprising of 2 x XE-2100 analysers and a SP-1000i slide maker stainer. There is also a standalone XE-2100 analyser, an ESR Autocompact analyser and 3 x XS-1000i analysers, one based at the ancillary site of the Royal National Orthopaedic Hospital.
All the analysers are connected in a bi-directional interface to the Winpath information system providing clinicians with a comprehensive results service within specified turn around times.
The department provides a comprehensive service to outpatients, day wards and in-patients including all aspects of clinical haematology and bone marrow transplants. The laboratory uses automated blood grouping and electronic blood issue systems. In excess of 50,000 blood group and save tests are processed per year.
The blood transfusion laboratory is responsible for issuing blood for transfusion and providing other blood products such as platelets and plasma.
The department provides a service for the Royal Free Trust 24 hours an day, 7 days a week.
The special haematology section processes 11,000 patient requests per year from within the trust, community other NHS centres and private institutions within the UK and overseas.
The section provides a primary haemoglobinopathy screening service using a Bio Rad Variant II HPLC system and is supported by the National Haemoglobinopathy Reference Laboratory in Oxford for the further investigation of rare and unusual haemoglobin variants and Thalassaemias . The section undertakes a range of investigations for the diagnosis of non-immune haemolytic anaemias resulting from metabolic and membrane disorders including enzyme assays and flow cytometric analysis of blood cells for paroxysmal nocturnal haemoglobinuria and hereditary spherocytosis. The section is also responsible for the clinical validation of haematinic assays (vitamin B12, folate, iron TIBC and ferritin) performed on the Roche Diagnostics E170 analyser based in the clinical biochemistry department. Enquiries regarding these results and interpretation should be initially addressed to the special haematology laboratory.
In addition to these general tests the section is an international referral centre for the assay of transcobalamins and tissue iron (liver and cardiac) and is always interested in being of assistance with regard research projects where time and resources allow.
This laboratory provides a leukaemia/lymphoma diagnostic service right across the North London Cancer Network. Flow cytometric immunophenotyping has revolutionised the diagnosis of acute leukaemia by generating increasingly detailed and prognostically significant phenotypes. Some new therapies use agents that target antigens expressed by leukaemic blasts, such as anti-CD33, anti-CD20 and anti-CD52. Response to therapy, residual disease post-therapy and early relapse is all readily assayed by flow cytometric immunophenotyping.
The laboratory uses two BD FACSCanto II 8 colour analysers to process the samples. The patient's cells are stained with monoclonal antibodies specific to both surface and intracellular antigens, in order that a diagnosis is obtained in accordance with World Health Organisation (WHO) guidelines.
In addition to leukaemia/lymphoma immunophenotyping, the laboratory performs prognostic ZAP 70 testing for CLLs, and TCR-V Beta assays to determine the presence of a T-cell clone. A variety of cytochemical stains can be performed on bone marrow aspirate slides, such as Sudan Black, Dual Esterase and iron stain, which are reported in conjunction with the patient's morphology.
The laboratory consultant is Dr Christopher McNamara (ext. 33260, bleep 71-2421) and because multi-parameter approaches to both diagnosis and therapy are essential, the laboratory works closely with histopathology, molecular biology and the cytogenetics departments. The immunophenotyping laboratory processes in excess of 2,000 requests a year. All bone marrow aspirate/trephine investigations must be requested by prior arrangement with a haematology clinician (laboratory SpR bleep 71- 1775 ext 33267).
To ensure sample acquisition on the same day all samples must be received in the immunophenotyping laboratory before 3:30pm. Urgent referrals (diagnostic acute leukaemia) will be authorised within 24 hours of sample receipt. All samples are reported within a clinically appropriate turn-around time.
Molecular diagnostic unit
Over the years, a strong research programme within the haematology departments has supported medical care at the Royal Free London NHS Foundation Trust using the latest molecular techniques to diagnose and classify disease and monitor response to treatment.
Many of these molecular techniques have now been merged into a molecular diagnostic unit with dedicated facilities and staff providing an international service as well as a
service across the North London Cancer Network.
A range of molecular tests for the diagnosis, prognosis and monitoring of the haematological malignancies are undertaken and are listed below:-
- BCR-ABL and PML-RAR analysis
- JAK2 and cKIT mutation analysis
- TcR and IgH analysis
- VH mutation analysis
- FLT3 and NPM1 analysis.
- HFE mutation analysis
The section also provides a diagnostic and treatment monitoring service for lysosomal storage diseases offering a range of fluorimetric enzyme assays and DNA mutational analysis.
The assays used for molecular analysis are usually not sample age sensitive but samples over 24 hours old may result in poor data.
DNA/cDNA/RNA samples are stored for a minimum of 4 weeks post completion of analysis, except DNA samples which have been taken for the purpose of familial genetic testing which are stored for a minimum of 30 years in accordance with RCP G031 - The Retention and Storage of Pathological Records and Specimens (4th edition 2009). Additional tests
may be requested within this time frame providing that sufficient material is available.
The unit is registered with the UK-NEQAS for quality control assessment and processes over 2000 requests each year.
Over 95% of results are available within 14 days of sample reception with some more complex DNA sequencing assays being available within 30 days.
The section works closely with cytogenetics and immunophenotyping.
Any questions regarding the molecular analysis of haematological conditions should be addressed to the section lead, Dr Steve Hart (ext 34472) or the laboratory consultant, Dr Panos Kottarides (ext. 35713, bleep 71-1990).
The laboratory is situated in Room 1/495, opposite blood transfusion on the first floor.