| Tau protein | |
| Tau protein, asilotransferrin, beta-transferrin, TAU | |
| Samples suspected to be CSF (e.g. nasal leakage) should be collected into a white universal container | |
|
This test is referred to another centre: Department of Clinical Chemistry Expected turnaround time: 4 weeks |
|
| Used in the investigation of suspected CSF leakage | |
| Contact referral laboratory | |
| Contact referral laboratory | |
| N/A | |
| N/A |
| Thyroxine Binding Globulin | |
| TBG | |
| Serum, Gel tube (brown top tube), refrigerate prior to referral | |
|
This test is referred to another centre for analysis: Department of Clinical Biochemistry Expected turnaround time: 6 weeks |
|
| Used in the investigation of atypical thyroid function tests. | |
| Contact referal laboratory | |
| Contact referal laboratory | |
| N/A | |
| N/A |
| Thyroglobulin | |
| THG | |
| Serum, Gel (brown top) bottle, store refrigerated prior to referral. | |
|
This test is referred to another centre for analysis: Department of Medical Biochemistry Expected turnaround time: 6 weeks |
|
| Used to monitor treatment in some forms of thryoid cancer | |
| Anti-thyroglobulin antibodies may cause an analytical interference and are tested for at the referral centre. Please contact the referral laboratory for more information. | |
| Contact referal laboratory | |
| N/A | |
| N/A |
| Thiopurine metabolite | |
| Thiopurine metabolite, 6-TGN, MMPN, TPMET | |
| Whole blood, EDTA (Red top tube). Upon arrival in the laboratory the sample is refrigerated prior to referral. Do not centrifuge. | |
|
This test is referred to another centre for analysis: Department of Clinical Biochemistry Expected turnaround time: 4 weeks |
|
| Used in the investigation of azothioprine metabolism | |
| Contact referral lab for more information | |
| Contact referral lab for more information | |
| N/A | |
| N/A |
|
Assay |
Thrombotic Screen |
|
Key Words |
Thrombophilia Screen, Protein C, Protein S, Activated Protein C Resistance, APCR, Factor V Leiden, FVL, Antithrombin, AT, Prothrombin G20210A |
|
Specimen Collection |
5x 3.0ml Citrate (Green lid). Equivalent volume with 1.4ml Citrate for paediatric (Green lid) - Discuss with laboratory. Fill to mark. A Lupus Anticoagulant Screen will also be performed as standard, but a Thrombotic Screen may be indicated without one in some circumstances. Discuss with laboratory regarding sample requirements if unsure. Molecular investigations by PCR will be performed if APCR of Thrombotic Screen is abnormal. Samples will be processed up to 24 hours from the time of collection. Due to the nature of the assay, this test cannot easily be added on to routine coagulation requests sent with a single sample, UNLESS the assay is being performed on the day of receipt (which only occurs once every two weeks). Contact the laboratory before requesting this test as an add-on. |
|
Turnaround time |
1 Month |
|
Test indications |
Investigation of inherited thrombophilia or fertility screen. To be requested by consultant general practitioner, or registrar. |
|
Interferences |
Recent thrombosis, lipaemia, haemolysis, anticoagulants, pregnancy and up to 3 months post-obstetric event. |
|
Reference Range |
See table below. Adult reference ranges from reagent manufacturer's package inserts. Paediatric reference ranges from: Williams, M., Chalmers, E. and Gibson, B. (2002). The investigation and management of neonatal haemostasis and thrombosis. British Journal of Haematology, 119(2), pp.295-309. |
|
Minimum retesting interval |
Lupus Anticoagulant Screen requests made within 70 days of a previous request on a patient are intervened. Thrombotic Screen requests made where historic results exist on a patient are intervened. |
|
TEST |
AGE / GENDER |
REFERENCE RANGE |
UNITS |
|
Protein C |
Full term up to 1 day |
26 - 44 |
% |
|
Full term up to 5 days |
30 – 53 |
||
|
Full term up to 1 month |
32 – 54 |
||
|
Full term up to 3 months |
41 – 67 |
||
|
Full term up to 6 months |
48 – 70 |
||
|
6 months - Adult |
70 - 140 |
||
|
Protein S |
Full term up to 1 day |
24 - 48 |
% |
|
Full term up to 5 days |
36 – 64 |
||
|
Full term up to 1 month |
48 – 78 |
||
|
Full term up to 6 months |
70 – 102 |
||
|
Male 6 months - Adult |
74.1 - 146.1 |
||
|
Female 6 months - Adult (affected by pregnancy) |
54.7 - 123.7 |
||
|
Antithrombin |
Full term up to 5 days |
53 - 80 |
% |
|
Full term up to 1 month |
63 – 93 |
||
|
Full term up to 3 months |
85 – 110 |
||
|
3 months - Adult |
83 - 128 |
||
|
Activated Protein C resistance (APCR) |
Full term up to 6 months |
2.61 - 3.32 |
Ratio
|
|
6 months – Adult |
2.20 - 3.32 |
|
Assay |
Total Protein |
|
Key Words |
TP, TPR |
|
Specimen Collection |
Serum (brown), Plasma (orange) |
|
Turnaround time |
8hrs |
|
Test indications |
Hypoproteinemia can be caused by diseases and disorders such as loss of blood, nephrotic syndrome, severe burns, salt retention syndrome and Kwashiorkor (acute protein deficiency).Hyperproteinemia can be observed in cases of severe dehydration and illnesses such as multiple myeloma. |
|
Interferences |
The total protein assay has an interference from icterus (hyperbilirubinaemia) |
|
Reference Range |
60-80 g/L |
|
1.7% |
|
|
6.7% |
|
|
Minimum retesting interval |
Liver function test requests made within 2 days of a previous result on a patient are intervened |
|
Assay |
Tissue Typing for Bone marrow Transplant |
|
Key Words |
Tissue Typing, bone marrow transplant |
|
Specimen Collection |
Mon-Thu only. 20ml (3x7.5ml) EDTA (for potential recipient 1 gel tube). Please contact Haematology for information. |
|
Referral |
This test is referred to another centre for analysis: |
|
Turnaround time |
21 days from receipt at reference laboratory |
|
Test indications |
HLA compatibility testing for haematopoietic stem cell transplantation |
|
Interferences |
Contact referral laboratory for information |
|
Reference Range |
Contact referral laboratory for information |
|
Minimum retesting interval |
N/A |
| Testosterone | |
| TT, FRTT, free testosterone | |
| Serum (brown), Plasma (orange) | |
| 24hrs | |
|
The determination of testosterone in women is helpful in the diagnosis of androgenic syndrome (AGS), polycystic ovaries (Stein-Leventhal syndrome) and when an ovarian tumour, adrenal tumour, hirtuism, adrenal hyperplasia or ovarian insufficiency is suspected. Testosterone is determined in men when reduced testosterone production is suspected, e.g. in hypogonadism, oestrogen therapy, chromosome aberrations (as in the Klinefelters syndrome) and liver cirrhosis. In both sexes testosterone may be used as part of an indirect assessment of pituitary function (assessing activity of LH). A calculated free testosterone is available upon request, principally for use in the diagnosis of male androgen deficiency. If free testosterone is required, please contact the laboratory via secure email (peh-tr.chemmimm@nhs.net) with information regarding the patient on which free testosterone is required (name, DOB, patient number) and the clinical indications for the request. Free testosterone is calculated from the total testosterone and SHBG. |
|
|
No known common methodological interferences. A strong interaction with Nandrolone (INN international nonproprietary name, WHO) was found. Do not use samples from patients under Nandrolone treatment. In isolated cases, elevated testosterone levels can be seen in samples from female patients with end stage renal disease (ESRD). Due to the diurnal nature or testosterone concentrations results should be interpreted in conjunction with sampling time (preferably 9am). The free testosterone calculation used presumes an albumin concentration of 46g/L, and may be adversely affected by low/high albumin concentrations and/or the presence of other binding proteins or steroids. |
|
|
Total testosterone: Males:
Females:
Free testosterone (male): 0.245-0.785 nmol/L |
|
| 3.3% | |
| 49.6% |
| Thiopurine methyltransferase | |
| Red Cell Thiopurine Methyl Transferase, TPMT | |
| Whole blood, EDTA (Red top tube). Upon arrival in the laboratory the sample is refrigerated prior to referral. Do not centrifuge. | |
|
This test is referred to another centre for analysis: Specialist Chemistry Postal Reception Pathology Department Sandwell General Hospital Lyndon West Bromwich B71 4HJ Tel: 0121 507 5345 Expected turnaround time: 4 weeks |
|
| Used in the investigation of azothioprine metabolism | |
| Contact referral lab for more information | |
| Contact referral lab for more information | |
| N/A | |
| N/A |
| Total Homocysteine | |
| Homocystine, HOM | |
| Lithium Heparin (Orange top tube). Specimen must reach laboratory within 1 hour of venepuncture. Store frozen prior to referral | |
|
This test is referred to another centre: Department of Clinical Chemistry Expected turnaround time: 6 weeks |
|
| Used in the investigation of homocystinuria (inborn error of metabolism). Requests for the assessment of stroke/cardiovasular disease and/or Vitamin B12/folate deficiency are not routinely referred unless discussed and approved with the laboratory. | |
| Contact referral laboratory | |
| Contact referral laboratory | |
| N/A | |
| N/A |
| Tacrolimus | |
| TAC, FK506 | |
| Whole blood, EDTA (red top) bottle. | |
| 72hrs | |
| Used in the therapeutic drug monitoring of tacrolimus | |
| No known methodological interferences | |
| 5-10ng/mL (Please note, quoted target therapeutic ranges are trough levels for renal transplant patients, >6 months post-op) | |
| 6.2% | |
| N/A |
|
Assay |
Thyroid Stimulating Hormone |
|
Key Words |
TSH, TFT |
|
Specimen Collection |
Serum (brown), Plasma (orange) |
|
Turnaround time |
8hrs |
|
Test Indications |
TSH is the frontline marker for assessing hypothalamic-pituitary-thyroid axis function. Elevated TSH is usually indicative of hypothyroidism, and low TSH concentrations are usually indicatiove of hyperthyroidism. |
|
Limitations/Interferences |
No known common methodological interferences. |
|
Reference Range |
(Non-Pregnant): • 6 days - 3 months: 0.72-11.0 mIU/L • 3 months - 1 year: 0.73 - 8.35 mIU/L • 1 year - 5 years: 0.70 - 5.97 mIU/L • 6 years - 10 years: 0.60 - 4.84 mIU/L • 11 years - 17 years: 0.51 - 4.30 mIU/L • ≥19 years: 0.30-4.20 mIU/L
|
|
4.6% |
|
|
58.5% |
|
|
Minimum retesting interval |
Requests made within 30 days of a previous result on a patient are intervened |
|
Assay |
TSH receptor antibodies |
|
Key Words |
Thyroid receptor Ab's, TRA |
|
Specimen Collection |
Serum (brown) |
|
Turnaround time |
14 days |
|
Test indications |
The hyperthyroidism of Grave’s disease is caused by the presence of stimulatory IgG antibodies which bind to thyrotrophin (TSH) receptors on the thyroid follicular cells and cause unregulated stimulation of thyroid hormone production. Such antibodies are detectable in the serum of 85% of patients with Graves'. However this test measures binding to TSH receptors only (both blocking and stimulatory) and thus cannot distinguish between stimulating antibodies in Grave’s disease and inhibiting antibodies in myxoedema. In a patient with known hyperthyroidism where an autoimmune aetiology has been demonstrated by the presence of thyroid microsomal antibodies, measurement of TSH-R Ab is of little additional value. Reports suggesting that high titres of these antibodies predicts early relapse after treatment with antithyroid drugs have not been confirmed. Pregnant women with Graves disease, or that have previously been treated for Graves disease are at risk of having a child with neonatal hypothyroidism. |
|
Methodology |
Enzyme Immunoassay |
|
Interferences |
None |
|
Reference Range |
Negative: <2.9 IU/L Equivocal: 2.9-3.3 IU/L Positive: >3.3 IU/L |
|
Analytical error |
Contact laboratory (x8454) |
|
Reference change value |
N/A |
|
Assay |
Tetanus antibodies |
|
Key Words |
Tetanus antibodies, TETA |
|
Specimen Collection |
Serum (brown) |
|
Turnaround time |
21 days This test is referred to another centre: Department of Clinical Chemistry and Immunology Level 4 Addenbrookes Hospital NHS Trust |
|
Test indications |
This trest is used to assess the T cell dependent antibody pathway. Patients should have this test done in the following clinical circumstances: a) Patients, especially children, with recurrent bacterial sepsis; particularly of the upper and lower respiratory tract. b) Patients with invasive disease caused by encapsulated organisms. c) Patients with selective antibody deficiency states and in monitoring immunoglobulin replacement therapy in such patients. d) Immunological reconstitution following Bone Marrow Transplant. e) Patients having haemoglobinopathies or who are due to undergo or who have had a splenectomy should have their levels of antibodies to encapsulated bacteria (i.e. pneumoccocal & Hib) monitored. f) patients with radiographical evidence of bronchiectasis.
Knowledge of vaccine history is imperative for correct interpretation. Specific clinical symptoms are also advantageous. If a poor response if found, patients will be required to be vaccinated and retested 4 week post. Specific interpretation is given for each patient result |
|
Methodology |
Enzyme immunoassay |
|
Interferences |
Contact referral centre |
|
Reference Range |
Minimum protective level 0.1 IU/mL Optimum protective level >1.0 IU/mL |
|
Analytical error |
Contact referral centre |
|
Reference change value |
N/A |
|
Assay |
Tissue transglutaminase (TTG) antibodies |
|
Key Words |
Tissue transglutaminase IgA antibodies , TTGA |
|
Specimen Collection |
Serum (Brown) |
|
Turnaround time |
5 days |
|
Test indications |
IgA anti-tTG antibodies are indicated as a screening test for Coeliac disease. As per NICE guidance (https://www.nice.org.uk/guidance/ng20/chapter/Recommendations) patients must have commenced a normal diet (eating some gluten in more than one meal every day) for at least 6 weeks before testing. The presence of IgA antibodies to tTG closely correlates with the detection of endomysial antibodies detected by indirect immunofluorescence but have the advantage that they are reported quantitatively. All newly positive anti-tTG results will be confirmed by endomysial antibodies. In known coeliac patients anti-tTG concentrations may predict recovery of villous atrophy as concentrations have an inverse relationship with adherence with a gluten free diet. As patients with IgA deficiency (found in up to 1/500 of the normal population) can cause false negative results, all likely low/deficient patients will automatically have total IgA and anti-IgG tTG measured. False positive anti-tTG results have been described in patients with liver disease. False negative results can be found in patients with IgA deficiency (but unlikely to occur with testing strategy in place). The gold standard diagnosis is duodenal biopsy and histological confirmation.
Please see new guidelines from ESPGHAN for the diagnosis of Paediatric Coeliac disease. https://www.espghan.org/knowledge-center/publications/Clinical-Advice-Guides/2020_New_Guidelines_for_the_Diagnosis_of_Paediatric_Coeliac_Disease |
|
Methodology |
Enzyme immunoassay |
|
Interferences |
No known methodological interferences |
|
Reference Range |
IgA and IgG TTG
Negative : <7 U/mL
Equivocal: 7-10 U/mL
Positive: >10 U/mL |
|
Analytical error |
Contact the laboratory (x8454) |
|
Reference change value |
NA |
|
Minimum retesting interval |
Requests made within 30 days of a previous request on a patient are intervened. |
|
Assay |
Tryptase |
|
Key Words |
Mast cell tryptase, TRYP |
|
Specimen Collection |
Serum (brown) Post Mortum: 20mL universal using blood from a femoral source. |
|
Turnaround time |
5 days This test is referred to another centre: Department of Clinical Chemistry and Immunology
|
|
Test indications |
Tryptase is released from mast cells during anaphylaxis. It has a half-life of approximately 3 hours, and serum levels peak at approximately 2-4 hours after systemic anaphylaxis, and usually return to normal by 24 hours. Persistently elevated levels may be seen in mastocytosis and urticaria pigmentosum. Tryptase measurements are particularly helpful in patients with suspected atypical allergic reactions, and in anaphylaxis during general anaesthesia. It is reasonable to take a sample 3 and 24 hours post reaction, occasionally intermediate samples may also be helpful. Anaphylaxis samples are required at immediately post event, 1-2hrs and > 24 hours post reaction. The time should be stated on the request. This is in line with BSACI guidelines for the investigation of suspected anaphylaxis during general anaesthesia Clinical & Experimental Allergy, 40, 15–31. For mastocytosis one sample is required, if positive a second will be requested. |
|
Methodology |
Enzyme immunoassay |
|
Interferences |
No known methodological interferences |
|
Reference Range |
2.0 – 14.0 ng/mL |
|
Analytical error |
Contact referral laboratory |
|
Reference change value |
N/A |
|
Assay |
T & B Subsets |
|
Key Words |
T and B subsets, Lymphocyte, T cell, B cell, immunodeficiency |
|
Specimen Collection |
3.4ml EDTA (Red lid). 1.3ml EDTA for paediatric (Red lid). Do not refrigerate & must be less than 24 hours old on receipt (this is due to white cell degradation).
Samples arriving on Friday or on a weekday that preceeds a Bank Holiday must arrive in the laboratory before 12pm or it will NOT be processed |
|
Turnaround time |
3 working days |
|
Test indications |
Suspected immunodeficiency, in conjunction with immunoglobulin profile. |
|
Interferences |
Haemolysis, clotted samples |
|
Reference Range |
See tables below. Adult reference ranges from: Jentsch-Ullrich, K., et al. (2005). Lymphocyte subsets' reference ranges in an age- and gender-balanced population of 100 healthy adults—A monocentric German study. Clinical Immunology, 116(2), pp.192-197. Paediatric reference ranges from: Shearer, W., et al. (2003). Lymphocyte subsets in healthy children from birth through 18 years of age. Journal of Allergy and Clinical Immunology, 112(5), pp.973-980. |
|
Minimum retesting interval |
T & B Subset requests made within 14 days of a previous request on a patient are intervened. |
|
Additional information |
This test is currently UKAS accredited. |
|
Age |
Cells per microlitre (% of cells) |
||||
|
CD3+ |
CD3+ CD4+ |
CD3+ CD8+ |
CD19+ |
CD3- CD16+ 56+ |
|
|
0 – 3 months |
2500-5500 |
1600-4000 |
560-1700 |
300-2000 |
170-1100 |
|
(53-84) |
(35-64) |
(12-28) |
(6-32) |
(4-18) |
|
|
3 – 6 months |
2500-5600 |
1800-4000 |
590-1600 |
430-3000 |
170-830 |
|
(51-77) |
(35-56) |
(12-23) |
(11-41) |
(3-14) |
|
|
6 – 12 months |
1900-5900 |
1400-4300 |
500-1700 |
610-2600 |
160-950 |
|
(49-76) |
(31-56) |
(12-24) |
(14-37) |
(3-15) |
|
|
1 – 2 years |
2100-6200 |
1300-3400 |
620-2000 |
720-2600 |
180-920 |
|
(53-75) |
(32-51) |
(14-30) |
(16-35) |
(3-15) |
|
|
2 – 6 years |
1400-3700 |
700-2200 |
490-1300 |
390-1400 |
130-720 |
|
(56-75) |
(28-47) |
(16-30) |
(14-33) |
(4-17) |
|
|
6 – 12 years |
1200-2600 |
650-1500 |
370-1100 |
270-860 |
100-480 |
|
(60-76) |
(31-47) |
(18-35) |
(13-27) |
(4-17) |
|
|
12 – 18 years |
1000-2200 |
520-1300 |
330-920 |
110-570 |
70-480 |
|
(56-84) |
(31-52) |
(18-35) |
(6-23) |
(3-22) |
|
|
Male |
750-2240 |
450-1240 |
190-940 |
140-600 |
70-680 |
|
(52-77) |
(27-52) |
(11-40) |
(8-24) |
(4-27) |
|
|
Female |
750-2750 |
620-1990 |
210-820 |
140-450 |
60-570 |
|
(64-82) |
(33-56) |
(15-36) |
(9-20) |
(3-24) |
|
|
Male + female |
670-2180 |
480-1670 |
120-830 |
30-450 |
80-730 |
|
(54-88) |
(36-66) |
(9-41) |
(2-19) |
(6-32) |
|
Translate Page
