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Laboratory Medicine

Immunology

Click here to view Immunology test information

Click Here for Advice for Requestors and Information Regarding Service Delivery

Click Here for Information Regarding: Issues with the Coeliac Disease Antibody Screening Test:  February 2024

The Immunology Laboratory sits within the Scarborough, Hull and York Pathology (SHYPS) network, a clinically led pathology service that incorporates a range of laboratory disciplines across Hull Royal Infirmary (HRI), Castle Hill Hospital, York Hospital and Scarborough Hospital.

The department is accredited by UKAS under ISO15189:2012 standards and participates in all relevant National Quality Assurance Schemes.

The laboratory offers advice and tests for the investigation and monitoring of immunodeficiency, autoimmune disease and allergy.  Note, allergy testing is currently performed within the Biochemistry Department at York.

Laboratory Opening Times

9.00 am to 5.00 pm Monday to Friday.

Contacts for the Immunology Service

For result and specimen enquiries Click Here

Key Contacts:

Name

Position

 

Tel

Immunology Laboratory

 

hyp-tr.immsend@nhs.net

01482 607768

H Dassanayake

Chief Biomedical Scientist

hiruni.dassanayake@nhs.net

01482 607775

Dr M Hajjawi

Blood Sciences Laboratory Manager

mark.hajjawi@nhs.net

01482 607802

Dr A McHugh

Consultant Clinical Scientist

anna.mchugh@nhs.net

01482 607710

K Emsell-Needham

Senior Clinical Scientist

kristina.emsell1@nhs.net

01482 607813

Dr P Gordins and Dr S Khan

Consultant Immunologist

pavels.gordins@nhs.net

sujoy.khan@nhs.net

01482 461397//461444

 

Non-urgent clinical advice can also be obtained via Advice and Guidance for allergy and immunology advice via eSR.  Also see referral documentation for Immunology and allergy at Referral Documentation - Immunology and Allergy | Hull University Teaching Hospitals NHS Trust (hey.nhs.uk)

Urgent Requests

The York/Scarborough Blood Sciences laboratory must be informed via phone of any urgent requests for immunology testing.

The requesting clinician, location and contact details (full phone number and nhs.net email address) MUST be provided on the request form to ensure timely reporting of the results.

The Immunology laboratory at Hull does not provide an out of hours service – the laboratory is open 08.30 – 17.00 hrs Monday – Friday therefore samples received in York or Scarborough after 2pm will be tested on the next working day.

Test information

This is a brief overview of the most commonly requested tests and is not an exhaustive list of tests available. Please discuss other requirements with the laboratory. For detailed specimen requirements and testing frequency please Click York and Scarborough Teaching Hospitals NHS Foundation Trust - Test Directory (yorkhospitals.nhs.uk)or contact the laboratory.

 Overview of test repertoire

Autoantibodies

Autoantibodies Associated with Connective Tissue Disorders

  • Requests for Anti-Nuclear antibodies (ANA) receive a multiplex automated screen (Werfen Aptiva) comprising of:
    • Extractable nuclear antigens (ENA) and related antigens – Ro52, Ro60 (SSA), La (SSB), RNP, Sm, Scl 70, Jo-1, centromere B, ribosomal P, dsDNA antibodies
    • Requests for patients under 18 years automatically have ANA performed by IIF (indirect immunofluorescence).
  • CCP
  • Rheumatoid factor
  • Cardiolipin antibodies and beta-2-glycoprotein I antibodies for investigation of possible antiphospholipid syndrome (APS).  A test for lupus anticoagulant should also be requested from Haematology when investigating possible APS

Liver Associated Antibodies – performed by IIF & immunoblot

  • Screen performed by indirect immunofluorescence (liver/kidney/stomach/HEp2 tissue substrates). For investigation of suspected autoimmune liver diseases
  • Additional tests are added by the laboratory as needed, depending upon the results of the IIF and the provided clinical details
    • Autoimmune liver disease antigens (M2, LKM1, LC1, SLA/LP)

Autoantibodies Associated with Gastrointestinal Disease

  • Coeliac screen (IgA anti-TTG). All patients are automatically screened for IgA deficiency. Additional tests are added by the laboratory as needed (IgG anti TTG, and IgA/IgG anti-endomysial antibodies as appropriate). If IgA deficiency is present IgG, IgA and IgM levels are reported
  • Gastric parietal cell antibodies
  • Intrinsic factor antibodies

Autoantibodies Associated with Vasculitis and Renal Disease

  • Glomerular basement membrane antibodies (GBM)
  • Anti-neutrophil cytoplasmic antibodies (ANCA).  Screened using PR3/MPO-ANCA with confirmation by IIF-ANCA

Other Autoantibodies Performed In-House

  • Skin antibodies for bullous skin diseases (pemphigus and pemphigoid)

 

Allergic Disease

Total and Specific IgE levels

·         Total IgE is required for all patients to aid in the interpretation of the specific IgE results.

·         Specific IgE requests should be selected based on the clinical presentation as outlined below.

·         Note the NICE guidance on investigation of allergy in young people http://guidance.nice.org.uk/CG116 which includes guidance for parents and carers

 

 

Tryptase

·         Tryptase is used in the investigation of systemic allergic reactions. Samples are taken at 1 hour, 3 hours and 24 hours following the reaction. The first 2 samples are to demonstrate raised levels the last to establish the patient’s normal baseline level.

·         Tryptase is also used in the investigation of systemic mastocytosis.

 

Immunodeficiency (*Note these tests are currently referred to Leeds via the Haematology Laboratory)

Specific antibodies

IgG antibodies to Haemophilus, Pneumococcus and tetanus toxoid. Used to assess vaccine responses in patients with suspected immunodeficiency. Pre and post (>6 weeks) vaccination levels are required.

Lymphocyte subsets *

A number of subsets may be quantified. CD4 counts for HIV monitoring in accordance with national and local guidelines. T and B lymphocyte subsets in the investigation of immunodeficiency. These tests are referred to Leeds.

Neutrophil function tests

By prior arrangement only, for the investigation of possible chronic granulomatous disease or carrier status.

 

Test Turnaround Times

Immunology tests are performed Monday to Friday 8.30am-5.00pm, excluding public holidays.

Turnaround time is the time between sample receipt and issue of an electronic or paper report. This includes weekends, e.g. a test taken on Friday and reported on Monday would have a 3 day turnaround time recorded. This is why some ‘Daily’ tests have a longer turnaround target than might be expected.

 

Note that some tests are only performed in response to a positive result in another test, e.g. Crithidia is added to a positive dsDNA result from the Antinuclear Ab screen. Turnaround time is measured from the date/time of receipt of the original request. This also contributes to why some ‘Daily’ tests have a longer turnaround target than might be expected.

 

Autoantibodies

Test Name

Target Turnaround Time

(for 90% of results)

Frequency of

testing

Antinuclear Ab (includes dsDNA ENA)

3

Daily

ANCA Screen (MPO + PR3)

3

Daily

ANCA Indirect Immunofluorescence

4

Daily

Beta 2 Glycoprotein

3

Daily

Cardiolipin Autoantibodies

3

Daily

Anti CCP antibody

3

Daily

Coeliac IgA Autoantibody Screen

3

Daily

Coeliac IgG Autoantibody Screen

4

Daily

Crithidia DNA Autoantibodies

7

Weekly

Endomysial Antibody (IgA)

10

Weekly

Endomysial Antibody (IgG)

14

Fortnightly

Specific Microbial Antibody Studies

16

Fortnightly

Glomerular Basement Membrane Antibody

3

Daily

Intrinsic Factor Antibodies

3

Daily

Liver Antibodies (blot)

10

Weekly

Liver Associated Antibodies (LKS by IIF)

7

x4 Weekly

Skin Autoantibodies

14

Fortnightly

 

Turnaround times for tests sent to external laboratories are available on request.

 

 


Web Page 59 Last Reviewed: 15/02/2024

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