Laboratories
Please click one of the
laboratories below for more information.
Blood
Counts Laboratory I Anticoagulant Clinic I
Coagulation Laboratory I
Regional Haemophilia Centre I
Blood Transfusion I
Haematinic Laboratory I
Haemolytic Laboratory I
Leukaemia Laboratory I
Molecular
Diagnostics Centre
Blood
Counts Laboratory
The Blood Count laboratory is housed within the Auto-Lab facility
of CSBII. The laboratory provides a 24 hour service analysing
specimens from all hospitals located on the Central Manchester
Health Site (Manchester Royal Infirmary, St. Mary’s Hospital,
Manchester Royal Eye Hospital and The University Dental Hospital)
along side specimens from General Practitioners and primary care
trusts. An Out-of Hours service is also being provided for the
Christie Hospital.
The laboratory is currently equipped with SYSMEX instrumentation
for Blood count analysis, smear preparation and staining. A stand-alone
XE2100 analyser is utilised for processing “urgent”,
Clinic and Paediatric samples. Whilst a Twin XE-2100 is stationed
on an HST system along with an SP100 slide maker and an automated
ESR system (InteRRLIner Vi-Tech scientific). These analysers are
handling a typical workload in the order of 1,000 analyses per
day. A high percentage of which will be “abnormal blood
counts” requiring further investigation and review, by experienced
Biomedical Scientists who, where necessary, examine and differentiate
the blood cells by microscopy. For example the laboratory provides
an essential aid to the detection and diagnosis of leukaemia as
well as routine analysis for the large neonatal department.
The laboratory is also responsible for processing bone marrow
specimens which are examined under a microscope after the cells
have been stained. Bone marrow specimens are stained together
with blood film samples using Romanowsky dyes and then, where
necessary, by various cytochemical techniques.
The laboratory also supports teaching and training of both laboratory
and medical staff in collaboration with Manchester Universities
and medical school.
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Anticoagulant Clinic
An anticoagulant clinic is held every working day in the out-patients
department at Manchester Royal Infirmary, with an average patient
attendance of 80 - 90. Patients attending the clinic include both
long term anticoagulant users with mechanical heart valves and
patients on short term treatment for thrombosis.
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Coagulation Laboratory
The coagulation section in housed next to Blood Counts within
Autolab. It deals with both routine blood samples from within
the Central Manchester Health Site as well as offering a specialized
coagulation service, which is also available to other regional
hospitals in the North West of England.
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Regional Haemophilia Centre
The Haemophilia Centre at Manchester Royal Infirmary is a comprehensive
care centre. It is the major centre for the treatment of patients
with Haemophilia and Von Willebrand's Disease in the North West
of England.
There are 450 patients registered with Haemophilia of which about
150 are treated in any one year. Other registered patients include
150 with Von Willebrand's Disease, 100 Haemophilia carriers, and
a small number of patients with other disorders of haemostasis.
Most of the severely affected Haemophiliacs (80) have home treatment
programmes that are supervised by the centre.
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Blood Transfusion
The busy Blood Transfusion laboratory within haematology, handles
between 100 - 200 requests for blood and blood products on most
week days. The laboratory is located immediately adjacent to Autolab,
and provides a 24 hour continous service to all of the hospitals
within the Central Manchester Site, for both routine operations
and emergency requests.
This laboratory is responsible for carrying out both routine
tests such as blood grouping and screening of patients blood for
irregular blood group antibodies, as well as compatibility testing
between a donor unit of blood and the patient. The laboratory
is also responsible for the compatibility testing and issue of
other blood components, such as platelets, plasma, human albumin
and coagulation factor concentrates.
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Haematinic Laboratory
Investigations carried out in this laboratory may be partitioned
into two areas, consisting of in-vitro tests and In-vivo studies.
The in-vitro investigations constitute mainly vitamin B12, folate
and ferritin assays carried out as part of the diagnosis of anaemia.
The following in-vivo analyses are also performed.
* The Schilling test is carried out as a confirmatory investigation
for Pernicious Anaemia.
* Measurements of Red Cell Volume and Plasma Volume are carried
out on patients presenting with an elevated Red Cell Count and
Haematocrit value.
* Determination of red cell survival together with scanning
procedures, are performed to determine the degree of red cell
destruction and to detect sites of red cell pooling or sequestration.
All of the above in-vivo tests involve the administration of
radio-isotopes to patients. The laboratory is strictly controlled
with reference to the quantity of isotope administered and the
individual to which it may be given.
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Haemolytic Laboratory
This laboratory is responsible for investigations of anaemia
due to red cell haemolysis. In the majority of cases these include
investigations for disorders of both hereditary (intrinsic) red
cell disorders of the membrane, metabolism and haemoglobin, along
with acquired (extrinsic) red cell disorders.
The majority of the laboratories workload is taken up by the
screening and diagnosis of hereditary disorders of haemoglobin
synthesis, collectively termed haemoglobinopathies. The two most
commonly encountered are Sickle Cell disorders (Haemoglobin S)
and Thalassaemia. A variety of tests are performed, such as High
Performance Liquid Chromatography (HPLC) and isoelectric focusing.
Haemoglobinopathies are found principally in certain ethnic populations.
Sickle Cell disorders are most commonly found amongst Afro-Caribbeans
and West Africans, and to a lesser extent in those of Eastern
Mediterranean and Asian origin. Thalassaemia is found mainly in
individuals originating from the Mediterranean, Asia, the Middle
East and to a lesser extent Africa.
Since Haemoglobinopathies affect such a large population and
encompass a wide spectrum of language, culture and social aspects,
the laboratory works closely with the haematology clinicians as
well as counsellors from the Manchester Sickle Cell and Thalassaemia
Centre.
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Leukaemia Laboratory
Leukaemia Laboratory has both a service and an R&D element.
The service laboratory provides for Bone Marrow (BM) and Peripheral
Blood Progenitor Cell (PBPC) processing, cryopreservation and
return, which is crucial to the haemopoietic stem cell transplant
programme in Clinical Haematology. These transplants may be either
autologous (patients own cells) or allogeneic (matched related
or matched unrelated donors). Over the past year (to March 2004)
we have processed 150 BM/ PBPC collections and 70 transplants
have been performed.
We are currently working towards DoH accreditation for tissue
banks.
The R&D side currently has a number of major themes contained
within the umbrella of diagnosis and treatment of haematological
malignancies.
One of the major problems of leukaemia for example is that although
patients may enter remission after chemotherapy a large proportion
subsequently relapse with their disease. One novel approach is
the use of immunotherapy to stimulate the patient’s own
immune system to recognise and attack their disease. Disease could
be brought under control using chemotherapy then immunotherapy
could stimulate the immune system to attack any residual disease
thus prolonging the remission period and possibly eradicating
the leukaemic cells totally. We are currently investigating the
production of dendritic cells (central to the generation of a
specific immune response) and ways to stimulate T cells to recognise
and destroy leukaemic cells. We hope to carry this forward to
Phase 1 clinical trial.
Another area of interest includes in vitro work on specific antibodies
conjugated to a toxin which can bind to leukaemic cells, be internalised
and prevent the cell from dividing and the effectiveness of combining
the antibody with low dose chemotherapy.
We regularly accommodate and supervise various students ranging
from 4 week Medical Student placements to 1 year Salford University
work experience through to longer term MSc, MD and PhD project
students.
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Molecular Diagnostics Centre
This facility was recently opened to help the detection and diagnosis
of various genetic blood disorders. This new facility is able
to offer a molecular diagnostics service to hospitals throughout
the North West of England.
The centre is able to offer tests of genetic risk factors for
Thrombophilia and Haemochromatosis . The laboratory also provides
a genetic carrier and prenatal diagnostic service for families
with Haemophilia and eventually Thalassaemia.
The laboratory has research interests in the fields of haemostasis,
thrombosis and molecular oncology.
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