Coagulation Laboratory

The Coagulation Laboratory service is comprised of the National Coagulation Laboratory and Haemostasis Molecular Diagnostics (HMD) Laboratory is part of the LabMed Directorate and it supports the National Coagulation Centre (NCC) at St James’s hospital.
The laboratory is the national referral laboratory for adult patients with bleeding and thrombotic disorders in Ireland. The department’s work involves the laboratory diagnosis and monitoring of treatment of haematological conditions including bleeding disorders such as Haemophilia and Von Willebrands Disease and thrombotic disorders. It provides a comprehensive blood testing service to the hospital and to general practitioners and hospitals nationwide. It is the largest such department in the Republic of Ireland.
Laboratory testing includes both phenotypic and genotypic assessment of both heritable and acquired disorders of coagulation. There is a wide repertoire of tests available for the diagnosis and monitoring of patients with bleeding and thrombotic disorders. Laboratory testing for patients on anticoagulant therapy is performed in the Coagulation Laboratory.

The critical phone limits for Coagulation can be accessed at this link Critical phone limits for Coagulation
The laboratory is accredited by INAB to ISO Standard, 15189:2012 Medical Laboratories – requirements for quality and competence. It is a recognised in-service training laboratory for students of the Biomedical Science degree course at the Technological University Dublin (TUD). It promotes further post-graduate education of its staff, is involved in ongoing research and development activities and in international scientific collaborations. It also provides laboratory support for many clinical trials being conducted at St James’s hospital.

The primary source of information for users is the LabMed User Guide. The guide includes a database of laboratory investigations, specimen requirements, turnaround times & biological reference intervals.
We operate the HealthLink electronic system for General Practitioners; this facilitates electronic ordering and transmission of results to the Practice Management system.
Samples from GPs and external hospitals should be received in the laboratory before 15:00 Monday to Friday.
Test results
The laboratory cannot give results directly to patients. Patients should contact their referring doctor with all queries regarding laboratory tests.

Dr Kevin Ryan, Consultant Haematologist, (01) 416 2141 kryan@stjames.ie

Ms Mary Byrne, Chief Medical Scientist, (01) 428 4346 mbyrne@stjames.ie

Thrombophilia testing
Thrombophilia testing can only be performed in cases that meet the laboratory guidelines for thrombophilia testing. There are laboratory testing guidelines and specific request forms for thrombophilia (including Lupus Anticoagulant) testing.  Please see the Thrombophilia Testing Guidelines for more information.

A fully completed Thrombophilia screen request form must be sent along with the samples for testing. All requests for thrombophilia testing are reviewed by the Coagulation Consultant Haematologist. Full clinical information and evidence of informed patient consent should be included on the request form. Requests where full clinical information or evidence of consent is not provided will be held in the laboratory pending receipt of same. 
Evidence of informed patient consent is required for prothrombotic molecular testing (Factor V Leiden / Prothrombin gene mutation / APCR testing) this can be done via the Thrombophilia mutation analysis consent form

Heparin Induced Thrombocytopenia (HIT) testing
The specific request form for HIT testing  must be sent with all samples for HIT testing. This includes the assessment of the pre-test probability score for HIT. The request form should be completed in full by the requesting clinician.

Haemostasis Molecular Diagnostics (HMD) laboratory
The HMD laboratory carries out molecular analyses for variants associated with bleeding and thrombotic disorders (other than Factor V Leiden and Prothrombin G20210A variants). Refer to the LabMed User Guide for a complete list of available genetic tests and sample requirements. In addition, a specific HMD request form must be sent with the samples for testing. Contact the laboratory for further information.

For further information regarding sample requirements, links to testing guidelines and specific request forms, turnaround times, availability, relevant notes and reference ranges for all coagulation tests please refer to the LabMed User Guide.
All samples received must be labelled correctly with the minimum number of patient identifiers as per laboratory policy. Samples received must be in the correct anticoagulant and received within the correct timeframe. Coagulation samples that are inadequately labelled, clotted, haemolysed, under-filled or over-filled are not suitable for analysis.

1. For add-on D-dimer and fibrinogen requests, samples should be less than 24 hours old.
2. If an add-on APTT or APTT Ratio is required, a fresh sample should be sent to the laboratory without delay.
3. Additional diagnostic tests such as factor assays, Lupus Anticoagulant, etc. performed in the National Coagulation Laboratory (NCL) may be requested on stored samples (if available) within one year.
4. Platelet Aggregation Studies must be performed on the day of collection and cannot be stored.
5. For all other tests or any additional information contact the laboratory at (01) 416 2908 (Routine Coagulation) or (01) 416 2049 (National Coagulation Laboratory)

If frozen samples are being sent from the referral laboratory, sample aliquots must be stored in the appropriate sample vial. Please contact the laboratory for details of acceptable storage vials. Samples must remain frozen at all times; samples that are thawed on receipt will be unsuitable for testing. Frozen samples must be sent in the appropriate frozen container and remain in this frozen container for the duration of the transfer. They must not be removed and placed in a freezer in the courier van.

Clinical advice for service users is available from the Coagulation Registrar or Coagulation Consultant on call. Advice is available by contacting the National Coagulation Centre at (01) 416 2141 during routine hours (9am to 5pm Monday to Friday) or through the hospital switchboard at (01) 410 3000 outside routine hours.