Referral information

A fully completed referral form should accompany each sample. Please find the referral forms below:

Haemato-oncology Test Request Form

Solid Cancer Test Request Form

If a sample is a known infection risk, please ensure this is recorded on the referral form. Indicate the risk with as much detail as possible and contact the department in advance. See High Risk Samples section for containment levels.

Clearly stating the referring clinician and the referral centre is necessary to ensure the report is sent to the correct location. Failure to provide this information may delay testing or result in the report being sent to the incorrect location. This information is also essential to ensure that referral centres are invoiced for the correct tests.

Clearly stating the identity of the person collecting the sample is necessary to aid investigation of any sample labelling issues.

Haemato-oncology Sample Requirements

Clinical Indication	NGTD Code	Genomic Test	Sample Requirements
Myeloproliferative Neoplasms (MPN)	M85.14	JAK2 V617F hotspot	3mL EDTA (DNA)
	M85.16	CALR exon 9 hotspot
	M85.11	Diagnostic BCR::ABL1	3mL EDTA (RNA)
Acute Myeloid Leukaemia (AML)	M80.18/M80.21	FLT3 ITD/TKD hotspot	5mL EDTA (DNA/RNA)
	M80.22	NPM1 exon 12 hotspot
	M80.42	RUNX1::RUNX1T1 RT-qPCR
	M80.43	CBFB::MYH11 RT-qPCR
	M80.23	IDH1 mutation hotspot
	M80.24	IDH2 mutation hotspot
	M80.10	PML::RARA RT-qPCR
Acute Lymphoblastic Leukaemia (ALL)	M91.8	Diagnostic BCR::ABL1	3mL EDTA (RNA)
Chronic Myeloid Leukaemia (CML): Diagnostic	M84.1	Diagnostic BCR::ABL1	3mL EDTA (RNA)
Chronic Myeloid Leukaemia (CML): Monitoring (MRD)	M84.2	MRD BCR::ABL (p210 only)	9mL EDTA (RNA)
Monitoring of haematopoietic stem cell transplant (STR)	M118.1	Chimerism	3mL EDTA (DNA)

Solid Cancer Sample Requirements

Minimum of 50μm FFPE tissue sectioned at 10μm (5x10 μm):

Samples with <20% neoplastic nuclei: Send unstained slide-mounted tissue sections on uncoated slides with a marked-up H&E.
Samples with ≥20% neoplastic nuclei: Send unstained tissue sections as scrolls in a clean universal with a H&E.

Sample Labelling

All samples should be labelled with at least three patient identifiers which should match the details on the referral form. For example:

• Patient's name
• Date of birth
• NHS number/hospital number/address
• Date sample taken

Sample containers must be sterile and clearly labelled. For sample labelling criteria please see sample requirements section.

A referral form (see above tab) must accompany each sample. Please ensure that the sample containers are securely sealed and the sample along with the referral form is kept in a waterproof packet. For blood/bone marrow samples, please ensure the referral form is kept separate to the vessel in case of any leakage during transport.  

If sending diagnostic samples by post, courier or taxi, they must be packaged for transportation according to the requirements of UN packaging instructions: For guidance to the packaging and transportation of biological specimens by road please see Department of Transport Guidance for Transport of Infectious Substances.

The packaging of blood/bone marrow samples should consist of three components:

• A primary receptacle.
• Secondary packaging with sufficient absorbent material to absorb any fluid in case of leakage or breakage.
• Outer packaging sufficient to protect the secondary packaging and contents from damage whilst in transit.

The outer packaging should be clearly marked with the UN3373 diamond and diagnostic specimen. 

Blood and bone marrow samples that require an RNA-based test should be sent to the laboratory within 72 hours of the sample being taken. Delays in sample receipt can significantly impact the quality of test results.

If dispatching samples just before the weekend or a bank holiday, you may wish to store the sample in a fridge (please DO NOT FREEZE) before dispatching the next working day. This reduces the risk of the sample being undelivered or stored at room temperature for several days. 

All genetic testing requires consent. It is the responsibility of the referring clinician to obtain appropriate consent from the patient for genetic testing. The laboratory assumes that, on receipt of a clinical sample and a completed referral form, consent has been obtained by the referring clinician. Verbal test requests can be made to activate testing on stored samples but must be supported by written confirmation of the request to enable the laboratory to commence testing.

If a sample received does not comply with the sample requirements (see above) for the test requested, or the referral form is inadequately filled, it may lead to the rejection of the sample. For referrals that are not easily repeatable, processing may be attempted, and the issued report will include details concerning sample labelling or why a sample was suboptimal.

Blood and bone marrow samples that require an RNA-based test should be sent to the laboratory within 72 hours of the sample being taken. Delays in sample receipt can significantly impact the quality of RNA based test results.

High risk samples will be rejected if they cannot be handled at our containment level. See high risk samples section (tab below) for further information on containment levels.

Samples will be processed and archived if the reason for referral is not specified or at clinical request.

If a sample has an infection risk please ensure this is recorded on the referral form. If the name of the organism is not recorded, the referring centre will be contacted for this information and this may cause delays in processing the sample.

The laboratory only has appropriate containment facilities for specimens with a known infection risk at hazard group 2 plus the following three infections from hazard group 3: HIV, Hepatitis B and Hepatitis C.

Hazard Group 2: Specimens with a known infection risk at hazard group 2 can be processed by the department.

Hazard Group 3: Samples known to be at risk of hepatitis B or C or HIV can be processed by the laboratory with additional precautions. Please inform the laboratory so that appropriate measures can be taken. Specimens known to be at risk of other hazard group 3 pathogens, including mycobacterium tuberculosis, cannot be accepted by the department.

Hazard Group 4: The department cannot accept any hazard group 4 pathogens.

Please also refer to the HSE Approved List of biological agents.

Page updated 19/06/2024. Please note that if printed, information is only valid on the day of printing.

 

Please contact the laboratory via e-mail to coordinate the transfer of molecular monitoring for patients outside of Nottingham University Hospital. Please include all technically relevant information with the referral to ensure accurate and timely transfer of their care; including a copy of the most recent molecular results and/or molecular monitoring target e.g. BCR::ABL1 transcript type.