Urgent Samples

Policy Statement on Urgent Samples

Including ANCA and anti-GBM antibody (Goodpasture's Syndrome)

Our aim is to send results back to the requestor in an appropriate timely manner. The definition of an urgent sample is one where the result is likely to affect management of a patient before the time when a normal sample would be reported (i.e. usually around 24 hrs).

Although the time taken to carry out urgent requests is relatively small, they can have a considerable effect on the normal routine of the laboratory, resulting in unnecessary delay to hundreds of other tests. This is particularly unfortunate on a Friday when we are trying to complete and report all outstanding tests before the weekend.

Policy on GBM and ANCA Requests

GBM - Normal procedure

Samples arriving through the normal portering system will be assayed by the Bioplex 2200. This assay is run daily and takes up to 1h 30min. Results are entered onto Telepath for validation. The results are filtered into the Urgent authorization list (IM05) so that they can be released onto the results server as soon as possible. If the result is positive (new patient/change in result) the result will be telephone to the requesting clinician.

GBM - Urgent samples

Urgent requests which have been requested by telephone (by a consultant or on his/her specific instruction) and where special transport has been arranged by the requestor will be assayed as soon as possible. A contact name and number should be clearly identified on the request form.

If the sample arrives before 4pm the routine Bioplex 2200 assay will be performed.

If the urgent sample arrives after 4pm (or in the rare case of a request out of hours or where special arrangement has been made), anti-GBM will be assayed by a Quickcard assay which takes around 10-15 minutes.

The result of the assay (positive or negative) will be entered onto Telepath and the validation staff should be informed so that the results can be validated as soon as possible and reported by telephone to the requestor.

Results obtained by Quickcard will be confirmed by Bioplex 2200 at the first opportunity.

ANCA - Normal procedure

Samples arriving through the normal portering system will be assayed by indirect immunofluorescence using fixed neutrophils. These assays which are set up each morning, take approximately 3 hours. Results are entered onto Telepath for validation that day. No further action is required for negative results unless discussed with a senior member of staff. Positive ANCAs will be tested for anti-PR3 and anti-MPO on the Bioplex 2200, usually on the same day the ANCA IIF is performed, and the samples are also tested for ANA (also using Bioplex 2200). Upon validation, anti-MPO/-PR3 antibody results will go out with the positive ANCA result that day. Any new anti-PR3 or anti-MPO antibodies that are thought to be clinically significant are brought to the attention of the requestor by the Clinical Scientist Duty Officer.

ANCA - Urgent samples

Urgent requests made by telephone (by a consultant or on his/her specific instruction) and where special transport has been arranged by the requestor, will be assayed as soon as possible. A contact name and number should be clearly identified on the request form.

If the sample arrives before the routine immunofluorescence test has been set up (i.e. in the morning) or with enough time for a second run to be set up in the afternoon it will be assayed by this method and reported within 3-5 hours. Anti-MPO/-PR3 antibodies will be also be tested as soon as possible, and on the day of request if it is received by the laboratory by 4pm.

If the urgent sample arrives after 4pm (or in the rare case of a request out of hours or where special arrangement has been made), anti-MPO/-PR3 can be assayed but the result may not be reported until the following morning.

Policy with respect to other urgent sample requests

The main criterion for accepting samples as urgent is whether the results will definitely or most likely affect the immediate management of the patient. For most immunological tests this is not the case. In rare cases where the outcome of other tests is likely to affect treatment the tests will be done but only when requested by a Consultant treating the patient and when sanctioned by a consultant in Immunology or the laboratory manager.


Page updated: 23/09/14 | Updated by: Anna McHugh