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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)

    7

    Daily

    ANCA Screen (MPO + PR3)

    6

    Daily

    ANCA Indirect Immunofluorescence

    6

    Daily

    Beta 2 Glycoprotein

    7

    Daily

    Cardiolipin Autoantibodies

    7

    Daily

    Anti CCP antibody

    7

    Daily

    Coeliac IgA Autoantibody Screen

    7

    Daily

    Coeliac IgG Autoantibody Screen

    7

    Daily

    Crithidia DNA Autoantibodies

    9

    Bi-Weekly

    Endomysial Antibody (IgA)

    12

    Weekly

    Endomysial Antibody (IgG)

    12

    Fortnightly

    Specific Microbial Antibody Studies

    16

    Fortnightly

    Glomerular Basement Membrane Antibody

    6

    Daily

    Intrinsic Factor Antibodies

    7

    Daily

    Liver Antibodies (blot)

    14

    Weekly

    Liver Associated Antibodies (LKS by IIF)

    12

    x4 Weekly

    Myositis Antibody Profile

    12

    Weekly

    Rheumatoid Factor

    6

    Daily

    Skin Autoantibodies

    14

    Fortnightly

     

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

     

     


    Web Page 59 Last Reviewed: 12/02/2025

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