NEUROIMMUNOLOGY LABORATORY SOUTHERN GENERAL HOSPITAL USER HANDBOOK

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Marshall Webster
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1 NEUROIMMUNOLOGY LABORATORY SOUTHERN GENERAL HOSPITAL USER HANDBOOK UNCONTROLLED COPY IF PRINTED Page 1 of 7

2 NEUROIMMUNOLOGY LABORATORY HANDBOOK Contents CONTACT DETAILS Director 3 Laboratory Manager.. 3 Departmental Secretary 3 Laboratory Enquiries 3 Postal Address 3 Normal Laboratory Working Hours. 3 Costs 3 SAMPLES/REQUESTS/RESULTS Sample Identification Requirements 4 High Risk Samples. 4 Sample Dispatch....4 Packaging 4 Reports and Results 5 Requests for additional tests.5 SAMPLE BOTTLES AND VOLUMES..5 Neuroimmunology Tests 6 In House Tests.6 Referred Tests Feedback..7 Page 2 of 7

3 CONTACT DETAILS Director of Neuroimmunology Laboratory Professor Hugh J. Willison / Laboratory Manager Ms Jan Gairns Laboratory Secretary Mrs Denise Marshall Telephone FAX Laboratory Enquiries /9023 Postal Address Glasgow Neuroimmunology Laboratory Level 1B, Laboratory Medicine & Facilities Building Southern General Hospital 1345 Govan Road Glasgow G51 4TF Normal Laboratory Working Hours to Monday to Friday There is NO out of hours service COSTS The Neuroimmunology Laboratory currently charges 38 per assay for sample requests from NHS laboratories out with Greater Glasgow and Clyde and associated NHS laboratories. Private laboratory requests are charged at 70 per assay. All assays are charged at the same rate. Billing is by quarterly invoice in arrears to the hospital or institutional finance department or, if preferred, to a named individual within the requesting department. Page 3 of 7

4 SAMPLES/REQUESTS/RESULTS Assays carried out by the Neuroimmunology laboratory are NOT available on Trakcare. Please complete our laboratory request form, available on website We cannot process samples unless we can be sure about the patient s identity, the test(s) required and where to send the result. Sample Identification Requirements SAMPLES MUST HAVE patient s full name (or proper coded identifier) date of birth and hospital or CHI number date and time of sample. REQUEST FORMS MUST HAVE patient s full name (or proper coded identifier) date of birth AND CHI number name of requesting hospital/laboratory destination for report name of patient s consultant tests required date and time of sample relevant clinical information DESIRABLE name and contact/bleep number of requesting clinician Pre-printed adhesive labels (addressograph labels) should be used if available. Samples where the information on request form and sample label (or if sample label is left blank) do not match will not be tested. High Risk Samples These include samples from patients known or thought likely to have infectious diseases eg Hepatitis B or C, HIV infection, Creutzfeldt-Jacob disease and those to whom radioactive materials have been administered therapeutically (not for investigation). The nature of the hazard should be indicated and both the form and specimen(s) must be marked with the yellow Danger of Infection labels. Sample Dispatch Serum and CSF samples do not need to be sent frozen if they are clean, not haemolysed and arrive within two days. Serum samples for anti Myelin Associated Glycoprotein antibodies should be sent immediately and if frozen MUST be despatched by courier on dry ice. Samples for antibodies to Tysabri MUST be brought to the lab within 60 minutes to allow the samples must be spun and frozen. CSF samples should be clear with no red blood cells and include a report on condition if the sample has been centrifuged in the requesting laboratory, Local samples should be sent by hospital transport or taxi. Samples from the UK should be sent by first class mail. Samples from out with the UK should be sent by courier. Packaging Packaging must meet the requirements of relevant UN3373 and postal regulations. Put all specimen tubes into a secondary leak proof container; include absorbent material to absorb any spillage. Page 4 of 7

5 Put the leak proof container and a request card with details of the request into an external package strong enough to withstand postal transit. DO NOT PUT PAPER WORK ON THE OUTSIDE OF THE PACKAGE as it may be discarded with packaging. Reports and Results Paper copies of results are sent out by internal or royal mail. All results will be available electronically on Clinical Portal, SCI store (if CHI number is provided) Reference Ranges Reference ranges and/or interpretative comments are available; on printed reports and Clinical Portal. Please contact the laboratory for advice where required. REQUESTS FOR ADDITIONAL TESTS Samples sent for testing to Neuroimmunology are stored at -80 o C for five years. Add on requests may be made within this time-frame, where appropriate. SAMPLE BOTTLES AND VOLUMES Anti Acetylcholine receptor antibodies, AchR, ACR 2ml sample of clotted, gel activated, blood (ochre top), if sending by mail 1ml serum CSF Oligoclonal Bands 1ml CSF (clear no red cells) + 2ml sample of clotted, gel activated, blood (ochre top), if sending by mail 1ml serum. Serum MUST be with CSF. Anti Ganglioside antibodies (IgG and IgM) 5ml sample of clotted, gel activated, blood (ochre top), if sending by mail 1ml serum Anti Myelin associated Glycoprotein antibodies (anti-mag IgM) 2ml sample of clotted, gel activated, blood (ochre top), if sending by mail 1ml serum Anti Paraneoplastic antibodies, Anti neuronal antibodies 2ml sample of clotted, gel activated, blood (ochre top), if sending by mail 1ml serum Anti Interferon Beta Binding antibodies 5ml sample of clotted, gel activated, blood (ochre top). Referred Assays 5-ml sample of clotted, gel activated, blood (ochre top), if sending by mail 2 ml serum If requesting a sample for more than 2 referred tests send 2 x 5ml clotted blood. Page 5 of 7

6 NEUROIMMUNOLOGY TESTS In House Tests Acetylcholine Receptor Antibodies Antibodies to the acetylcholine receptor (anti-achr) are present in a very high proportion of patients with the neuromuscular transmission disorder, myasthenia gravis (MG). Detection of oligoclonal bands in the cerebrospinal fluid and serum Sample Cerebrospinal fluid plus Clotted Blood or Serum The clinical diagnosis of multiple sclerosis can be supported by analysis of cerebrospinal fluid (CSF). In a very high proportion of patients with multiple sclerosis (>90%) the CSF contains oligoclonal bands that are not present in the serum. Anti-Glycolipid Antibody Anti-glycolipid antibodies are found in a significant proportion of patients with a variety of autoimmune peripheral neuropathies. Anti-MAG Antibody Testing A clinically important form of IgM paraproteinaemic neuropathy is associated with antibodies to myelin-associated glycoprotein (MAG). Anti-Neuronal Antibody Testing Anti-neuronal antibodies are present in the serum of patients with paraneoplastic disorders affecting the nervous system. These disorders have a very wide range of clinical presentations and often enter the differential diagnosis of complex neurological problems. Anti Interferon Beta Binding antibodies Anti Interferon Beta Binding antibodies are a useful in screening IFN- treated MS patients for antibodies potentially decreasing the treatment efficacy. Samples positive for IFN- binding antibodies are referred to UCL London for IFN- neutralising antibody assay. Page 6 of 7

7 Referred Tests Antibodies to Voltage Gated Potassium Channels (VGKC) Leucine-Rich Glioma-Inactivated Protein (LGI1) Contactin_Associated Protein 2 (CASPR2) Voltage Gated Calcium Channels (VGCC) Aquaporin, Neuromyelitis Optica (AQUAP4, NMO), Glutamic Acid decarboxylase (GAD65) Glycine receptor antibody muscle specific kinase antibody (MuSK) Low affinity (clustered) AchR or MuSK N-Metyl-D-Aspartate (NMDA) receptor Glutamate receptor antibodies (AMPA 1&2 and GABA) Myelin oligodendrocyte glycoprotein (MOG) antibodies. These assays are referred to The Department of Immunology, Churchill Hospital, Old Road, Heddington, OXFORD, OX3 7JL Antibodies to Basal Ganglia, Beta Interferon (neutralising antibody) These assays are referred to The Neuroimmunology Laboratory, UCLH Institute of Neurology, Queen Square, LONDON WC1N 3BS Antibodies to Gliadin This assay is referred to The Immunology Laboratory, Northern General Hospital, Herries Road, SHEFFIELD, S5 7AU Antibodies to Tysabri (Natalizumab) This assay is performed at Barts and The London, Immunology Department, Pathology and Pharmacy Building, 2nd Floor, 80 Newark Street, Whitechapel, LONDON E1 2ES Feedback Suggestions and complaints Suggestions about our service may be raised by , letter, phone call or by calling personally at the laboratory. All complaints are dealt with in accordance with the NHSGG&C Complaints Policy and the Neuroimmunology complaints document. The laboratory manager will investigate the complaint and issue a response as soon as possible, if a satisfactory outcome cannot be achieved the complaint will be passed to the Clinical Services Manager. A response to the complaint will be issued within twenty days of receipt of the complaint. Page 7 of 7

Test Definition: DEMES Dementia, Autoimmune Evaluation, Serum

Test Definition: DEMES Dementia, Autoimmune Evaluation, Serum Reporting Title: Dementia Autoimmune Eval, S Performing Location: Rochester Specimen Requirements: Container/Tube: Preferred: Red top Acceptable: Serum gel Specimen Volume: 4 ml Additional Information: