Laboratory sciences

Laboratory Sciences cover the specialisms of Haematology and transfusion, Clinical Chemistry, Cellular Pathology and Microbiology.

Haematology and Transfusion

The Haematology Department comprises haematology automation, morphology, coagulation and blood transfusion sections.

Automation deals with the analysis of Full Blood Count Samples (FBC) to diagnose conditions relating to red cells (anaemia), white cells (infection and leukaemia) and platelets (clotting issues). The analysis uses automated analysers that measure various cell population numbers and sizes. A Biomedical Scientist interprets these results to aid clinicians in the diagnosis of disease or treatment monitoring. This may involve other tests such as blood film morphology. The automation section analyses approximately 3,000 samples per day.

Morphology is a subsection of Haematology. If an abnormal result is detected in the Automation section, a blood film of the sample is made and stained. This allows the Biomedical Scientist to look at the cells for changes in number, size and general characteristics. This can help to narrow down the diagnosis. Approximately 150 blood films are viewed each day.

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Coagulation involves the analysis of samples to detect problems in the clotting mechanism that can lead to a patient either being at risk of excessive bleeding or excessive clotting (thrombosis). The samples are analysed on automated machines and the results are interpreted by a Biomedical Scientist. Any abnormal result will require specialist coagulation tests to identify the specific cause of the abnormality and enabling tailored treatment.  Between 700-800 routine coagulation samples are analysed each day, with approximately ten specialised bleeding tests and 80 specialised thrombosis tests processed every fortnight.

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Blood transfusion deals with the identification of a patient’s blood group (A, B, AB or O) and other antibodies testing. Biomedical Scientists are responsible for ensuring donor red cells are compatible with the patient’s blood (cross matching), and also for the safe issue of other blood components such as fresh frozen plasma and platelets. Red cells and other blood products may be required during certain surgical procedures or in emergency situations, such as road traffic accidents, where patients have lost a lot of blood. Most red cells are required for the treatment of anaemia, which is secondary to a number of medical conditions. The blood transfusion section processes roughly 300 blood groups tests each day, while the numbers of crossmatches can vary. During 2018, more than 14,000 blood products were issued here at NNUH.

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Clinical Biochemistry

Automation is a section of Clinical Biochemistry which looks at the various chemicals, enzymes, vitamins and hormones in the blood and urine to provide information on health and disease as well as monitor the effectiveness of treatment. Tests are grouped to assess the function of various organs such as the liver, heart, kidney, thyroid and pancreas. Automation receives approximately 7,000 samples each day.

Immunology helps diagnose diseases like leukaemia by looking at the proteins on the cell surface. They also provide allergy and autoimmune testing. Immunology receives about 500 samples a day.

Endocrinology specialises in testing proteins as well as various hormones. It also carries out Maternal Serum Screening investigations. The department works with the University of East Anglia to provide a specialised Metabolic Bone Service. Endocrinology receives about 500 samples a day.

Toxicology is a specialised area of clinical biochemistry that provides a drug monitoring service for both therapeutic drugs and substance abuse or drug overdose testing. Toxicology also provides a service to coroners and occasionally tests for other medico-legal purposes. Toxicology receives approximately 200 samples a day.

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Cellular Pathology

Histopathology is the study of disease in tissue, with the aim of making a diagnosis on which clinicians can base treatment. The role of the Histology lab is to turn biopsies (small tissue samples) or samples from resections (larger tissue samples or whole organs) into microscope slides for Consultant Pathologists to examine under a microscope. The Histology lab receives approximately 250 cases each day and creates approximately 250,000 microscopy slides per year.

Description and dissection of specimens received in Histology has traditionally been done by consultant pathologists. Now, dissection of simple specimens is increasingly done by Specialist Biomedical Scientists. Similarly, some experienced Biomedical Scientists are training in more complex specimen dissection and even diagnosis.

Diagnosis by examination of tissue sections on slides relies on chemical dyes used to stain the tissue to make it visible. This kind of staining remains a routine part of the work. However, pathologists are increasingly relying on immunohistochemistry (using antibodies to target specific proteins involved in disease) or molecular techniques (analysing DNA and RNA). These are techniques that will increasingly contribute to the future of personalised medicine.

Microbiology

Medical Microbiology is the study of micro-organisms which cause infections. These include bacteria, viruses, fungi and parasites. The Microbiology department undertakes diagnosis of infections to ensure accurate treatment and the prevention of their spread. Microbiology receives approximately 2,000 sample requests each day.

The department uses various techniques to establish evidence of infection. This includes the use of culture media to support the growth of micro-organisms, microscopy, biochemical tests and the detection of antibodies and genetic material.

They specialise in testing specimens such as urine, faeces, blood, tissues and swabs for evidence of infection caused by micro-organisms.

Point of care testing

Point of care testing (POCT), also known as extra-laboratory testing or Near Patient Testing (NPT), refers to any analytical test performed for a patient, by a healthcare professional, outside the conventional laboratory setting.

Biomedical scientists in the POCT Team, offer support for all departments using POCT instruments across the Norfolk & Norwich University Hospitals NHS Foundation Trust.

The POCT team support many different healthcare professionals to perform a wide range of pathology tests throughout the hospital in a wide range of areas including ED, critical care, the wards and outpatients to enable results to be obtained quickly so decisions on care can be made, including:

• Blood glucose testing and HbA1c testing for diabetes
• Blood gas analysis on patients with breathing difficulties
• Blood clotting measurements on patients on blood thinners
• Measuring blood haemoglobin levels for patients in theatre
• Urine analysis (such as sugar and protein content) to monitor or diagnose conditions such as diabetes, kidney failure and urinary tract infections
• Swab analysis to identify viruses (Flu/common cold virus/Covid-19) to ensure patients can be moved safely to an appropriate ward to prevent cross infection of patients
• Testing for blood infections (sepsis)
• Pregnancy tests
• Tests for problems during pregnancy (pre-eclampsia) and estimating expected delivery of babies (fFN).

The number of POCT glucose tests run daily within the Trust is in excess of 1000.

The POCT service includes:

• Advice on the selection and procurement of POCT equipment.
• Implementation and network connection of new POCT devices.
• Providing training and training material to new locations acquiring POCT devices.
• Organising and providing refresher training to current users.
• Troubleshooting and liaising with external organisations (companies) to resolve any issues arising with the devices.
• External quality assurance (EQA) schemes for all POCT tests to ensure the result obtained is correct.