Hotlines: +233-243-407-809 / +233 - (506) 210458

Central Laboratory Services

About us

 

Introduction

The Central Laboratory Service of the Korle-Bu Teaching Hospital, together with its satellite laboratories forms the Lab SUB BMC. It is a well-equipped modern diagnostics facility located at the centre of the hospital bounded by the Gynaecology Department, the Department of Medicine (Medical block), the Maxillofacial and Haematology blocks as well as wards G and E. The facility is run by highly trained personnel made up of Biomedical Scientists, Technicians, Residents, Consultants and Support Services personnel. Together, they provide a comprehensive analytical, diagnostic and advisory service in Chemical Pathology, Haematology, Microbiology and Immunology.

The Biomedical Scientists with the assistance of Medical Laboratory Technicians provide expert analytical services in all departments of the laboratory. The Consultants are assisted by Residents to fulfil both clinical and laboratory roles within the hospital. Based on their specialty, they are organised into clinical teams to fulfil the special needs of patients which include interpretation of lab results.

The department operates a 24-hour service all days of the week, including public holidays on three shifts.

During the service hours of 08:00 to 17:00 hours a laboratory Officer/Client Services Officer (CSO) is at post and from whom information regarding test availability, advice and general information relating to operational procedures may be obtained.

Investigations of an urgent nature must always be made known to the Officer (CSO)prior to or when the sample is brought to the laboratory.

In the event that an urgent investigation is required outside of the regular working hours of 08:00 to 17:00 hours, the Biomedical Scientist(BMS)on duty in the department concerned should be first contacted.

By its nature, this handbook is unable to cover all the anticipated change in services that will be offered by the lab. However, senior members of the department are always happy to discuss the changing needs of users and to advice on the most appropriate choice of tests. This manual will be reviewed with the approval of laboratory management yearly.

Vision
To become a centre of excellence in Laboratory Diagnostic services and the most preferred point/ facility in Medical Laboratory Services within the West African Sub region.

Mission
Working in a team with other SUB BMCs to provide the highest quality of timely and efficient lab services and to ensure excellence in teaching and research with highly competent and well-motivated staff.

 

Units

Profile of SUB-BMC
The Laboratory Sub BMC is made up of the following units offering services related to the underlisted specialties:

- Microbiology
- Chemical Pathology
- Haematology
- Immunology

Department/Units
- The Laboratory Sub-BMC has the Central Laboratory as the main Department with other Satellite laboratories or Units. The Units or Satellite Laboratories include the following;
- Child Health Laboratory
- Maternity Laboratory
- Fevers Units
- Chest Clinic

 

Senior Clinical, Academic, Administrative, Scientific & Technical Staff

Names Positions
Dr. Sylvester Y. Oppong Ag.Head, Lab SubBMC/Head  Chemical Pathology Dept.
Dr. Ahmed Mashud Laboratory  Manager
BMS. Opuni Aseidu Quality Assurance Manager
BMS. Michael Amo Omari Health and Safety Officer
Ms. Bernice Nortey Client Service Officer (CSO)
Ms Kafui Dometi Accountant
Dr. Theophilus .Adiku Head, Microbiology Dept./Head,Immunology Dept.
Dr. Edeghonghon  Olayemi Head, Haematology Dept.
BMS David Anafu Technical Supervisor, Haematology Dept.
BMS George  Kpentey Technical Supervisor, Chemical Path.Dept.
BMS Augustine .O. Sowah Technical Supervisor, Microbiology Dept.
BMS Yunusah Osman Technical Supervisor, Microbiology Dept.
BMS.Victor A. Degenu Dep.Tech. Supervisor, Haematology Dept.
BMS. Ignatius .A. Awinibuno Dep.Tech. Supervisor, Chemical .Path.Dept
BMS. Yaa Serwaa Addai Dep.Tech. Supervisor, Immunology Unit.
BMS. Thomas Dankwah Dep.Tech.Supervisor, Microbiology  Dept.
Dr. Sandra  Crabbe Specialist Chemical Pathologist.

Education and Training

Continuing Education and In-Service Training
There were Continuing Education Programmes for staff towards W.H.O. Accreditation of the Laboratory, Review of the Laboratory's Organogram, Customer Care and Quality Control. The education programmes were aimed at improving the quality of services at the Laboratory.
Residents Doctors, Medical Students and Allied Health Science Students went through the department, for their practical training.

 

 

Research Activities

Research Activities
Various research projects were undertaken at the Central Laboratory and jointly supervised by our staff. These included student projects, as well as portions of other major projects by staff of the University of Ghana Medical School and other institutions.

Operational Hours

Routine Analytical Service
The departments offer 24-hour service for all routine tests.
To ensure same day reporting, reports for routine requests received from out patients before 12.00 will be available on the same day. For in patients however, results will be made available on the same day. 80% of routine requests are processed within 3 hours of receipt by the laboratory. Patients should present their receipt of payment at the result collection point to collect their test results.

Routine analytical service covers in excess of 80% of the workload of the laboratory and represents those analytes measured on a daily basis which will normally be reported on the day the sample is received. Details of such analytes are listed in Appendix A.

Batched Analytical Service
Much of the remaining analytical work out in the laboratory is done on a batched basis. By batched basis we mean that samples are pooled and run on specific days. Specimens are dealt with in order of receipt and included in the next available batch for assays. Estimates of likely delays in analysis can usually be given for these analytes. Where adequate reasons can be given, samples can occasionally be included in an earlier batch or the timing of a particular batch run changed to expedite processing. Details of such analytes are given in Appendix B.

Urgent Analytical Requests
The lab offers a 24-hour service for all urgent cases. This service complements the routine procedures during regular laboratory hours. The urgent requests may be for routine analytes (Ref: Appendix A) or batched analytes (Ref: Appendix B).

All requests for urgent analysis must be made through the Officer/CSO when the request or specimen is brought in between the hours of 8.00 and 17.00 or the BMS on duty between the hours of 17.00 and 8:00. Arrangements during public holidays may vary. The laboratory should be contacted for specific details.

Urgent requests are handled individually as soon as the sample reaches the laboratory and the clinician telephoned when results are ready or sent via the Laboratory attendant or relatives of the patient.

Urgent requests are extremely demanding of the laboratory resources and so in order not to delay the truly urgent requests, the department operates the following strict policy for requests marked urgent.

Call Request For Stat Analysis
Where the requesting clinician has notified (in the form of a written note) and agreed with the Laboratory Officer/CSO a STAT request, the laboratory will process the request and inform the clinician as soon as the results are available. To facilitate this process, the request form must be properly and completely filled with the required details


All Other Requests For Stat Analysis:
Where the requesting clinician has not notified nor agreed on the request with the Laboratory Officer even where the request form is marked *Urgent* in any way, the laboratory will process the request in a routine mode with a probable turnaround time for routine test of up to 3 hours barring all unforeseen circumstances. The Laboratory will not phone to inform that the results are ready. They will be subject to the usual computerized checking procedures. Critical results from such specimens may be brought to the attention of the Laboratory Officer at whose discretion such results may be phoned to the requesting physician.
The laboratory defines an Urgent Request as analysis required for immediate in-patient management.


Specimen Collection
It is important that persons responsible for collecting specimens ensure that all specified collection conditions are met particularly in relation to timing, fasting conditions and drug given.


Major sources of analytical variation can be introduced by failing to adhere to recommended collection conditions. Such analytical variation may often not be apparent to the laboratory and can generate misleading results.


It is in the interest of all concerned to ensure that specimens are taken appropriately and delivered promptly to the laboratory; in particular, attention is drawn to the following in order to obtain valid results:
- Always avoid prolonged stasis when taking blood.
- Always avoid contamination of the sample with IV fluids.
- Never mix blood from one specimen container with another.
- Always keep timed urine collections cool during the collection period.
- Always label specimens clearly with Name, Date, Time and tests. Inadequately labelled specimens will not be analysed.
- Always fill in the sample collection details on the request form.
- Always, use birthdays to distinguish between patients with similar names on the ward.
- Always send samples to the specimen collection point of the laboratory without delay.
- Always send samples to the laboratory in individual biohazard bags if available, with the request form in the separate pocket.
- Request forms accompanying samples should be filled with Patient name, Age, Gender, clinical information, clinicians name and contact number.
- Never send a sample to the laboratory in a syringe and needle or in a syringe only.

 

Chemical Pathology Dept

For blood
PLAIN BOTTLE WITH GEL(GOLD TOP)/ LITHIUM HEPARINIZED TUBE (GREEN TOP)is required for MOST ROUTINE ASSAYS carried out by this section of the lab.
BLOOD GLUCOSE TEST requires FLUORIDE OXALATE TUBE (GRAY TOP).
BLOOD for GLYCATED HAEMOGLOBIN(HBA1C) requires an EDTA TUBE(PURPLE TOP)
In the event that a different tube is introduced; the wards will be appropriately communicated to.
Do not apply a tourniquet when drawing blood for CALCIUM analysis
OGTT
This test is a provocation test to examine the efficiency of the body to metabolise glucose

Preparation of the Patient
At least three days of unrestricted, carbohydrate rich diet (≥150g of carbohydrates daily)
Unrestricted physical activity prior to day of test.
- As much as possible, there should be no medication on the day of the test. If medication cannot be avoided, then it must be recorded.
- 8-14 hours overnight fast prior to the test, during which water may be drunk.
- No smoking is allowed prior to and during the test.
NOTE
The OGTT is affected by metabolic stress from a number of clinical conditions. These include
- Major surgery
- Myocardial infarction, stroke, infections etc.
Other factors affecting OGTT are
- Rate of absorption for e.g. Malabsorption
- Rate at which glucose is cleared from the blood
- Drugs (steroids, thiazides, phenytoin, oestrogens, thyroxine)
- Stress e.g. ( patient on admission)
- nausea
- Caffeine, smoking
Blood for analysing SB (Serum Bilirubin) should be wrapped with paper to reduce exposure to light and sent immediately to the lab.
24 hour urine sample test instructions are available at the front desk of the lab, however they are briefly reproduced below:

24-hour urine collection procedure
The first urine passed in the morning is discarded. All subsequent urine for the next 24 hours is collected into the receptacle. On rising the next morning the patient empties the bladder again, 24 hours after the first specimen, and this final specimen is added to the bottle. Collection from 08:00 is recommended and the bottle should preferably be kept cool (refrigerated if possible).

The laboratory however does not provide urine containers for 24-hour urine test. The client is expected to bring along for the preservative a clean plastic container with a secured lid large enough to contain urine collected over a 24 hour period.

Since some receptacles may contain corrosive materials patients must always be advised to avoid skin contact and splashes while using the receptacles and that on no account should any liquid in the bottle be tipped out of the bottle before use.

Cerebrospinal Fluid (CSF)

CSF for GLUCOSE ANALYSIS is required in FLUORIDE OXALATE BOTTLE (GRAY TOP). 

Tests Tube Sample Vol
Blood Glucose Fluoride oxalate(gray top) *2mL-4 mL
CSF Fluoride oxalate(gray top) ≤1 mL
General Chemistry Plain(gold top)/heparin tube(green top) *2mL -5 mL
HBA1C EDTA tube(purple top) 2mL -5 Ml

*Provisions are made for paediatric samples

 

Haematology Dept

EDTA TUBE (PURPLE TOP) is required for FBC, BF, Hb, BLOOD FILM FOR COMMENTS, SICKLING, Hb ELECTROPHORESIS tests.
HEPARIN TUBE (GREEN TOP) is required for G-6PD.
SODIUM CITRATE TUBE (BLUE TOP) is required for COAGULATION TESTS and blood should be 1.8mL in volume.

Blood volume required for ESR tests should be at least 2mL.

Tests Tube Sample Vol
FBC EDTA TUBE (PURPLE TOP) 1mL
ESR EDTA TUBE (PURPLE TOP) 2mL
SICKLING, BF EDTA TUBE (PURPLE TOP) 1 mL
BLOOD FILM COMMENT EDTA TUBE (PURPLE TOP) 1 mL
Hb ELECTROPHORESIS EDTA TUBE (PURPLE TOP) 1mL
G-6PD HEPARIN TUBE (GREEN TOP) 3mL
COAGULATION SODIUM CITRATE TUBE (BLUE TOP) 1.8mL
     

Parasitology Unit

BLOOD is required in an EDTA TUBE (PURPLE TOP)for MICROFILARIA TESTS. The sample should be taken between the hours of 22:00 and 2:00.

BLOOD is required in an EDTA TUBE (PURPLE TOP) for TROPHOZOITE COUNT. Blood can be sampled at any time.

URINE receptacles (containers) for Routine Examination and special tests are obtained directly from the reception/front desk at all hours in the lab. Urine required should be at least 20 mL in volume. Urine specimen should reach the lab within an hour of collection

STOOL containers for routine examination can be obtained directly from the reception/front desk at all hours in the lab. A spatula full of stool is required for the tests. Stool specimen should reach the lab within an hour of collection

Stool for occult blood
Please adhere to the following instructions.
Patient should abstain from the following foods and drugs for 3 days before producing stool sample. Green vegetables, beans, folic acid, blood tonic, red meat, fresh fish

Swab Sticks: Sterile swabs can be obtained at the front desk of the central lab. Dry swabs would not be accepted.

Skin Snip: Patient should present to the laboratory on the day of testing. No preliminary preparation is required.

 

Bacteriology Unit

BLOOD for CULTURE AND SENSITIVITY (C/S) should be put into

- PAEDIC PLUS BOTTLE (PINK TOP) FOR PATIENTS/CLIENTS 12 YEARS AND BELOW;
- AEROBIC AND ANAEROBIC BOTTLES (ASH AND ORANGE TOPS) FOR PATIENTS/CLIENTS ABOVE 12 YEARS.
- For clients with ANY SUSPICION OF IMMUNOSUPPRESSION, blood should be put in the AEROBIC, ANAEROBIC and MYCOTIC BOTTLES (Ash, Orange, and Lime green tops) respectively.

Urine
Receptacles for culture and sensitivity tests can be obtained from the reception of the lab. Midstream specimen is required. Where suprapubic tap is used to obtain urine, it should be stated clearly on the request form. Urine specimen should reach the lab within an hour of collection.

Stool
Containers for culture and sensitivity tests can be obtained directly from the reception/front desk at all hours in the lab. A SPATULA FULLof stool is required for the tests. Stool specimen should reach the lab within an hour of collection.

Skin scrapping
Patients would be directed from the reception/front desk to the appropriate lab for an appointment and instructions regarding the test.

Other fluids
Sterile universal containers of appropriate size are available at the front desk of the lab for aspirates and fluids which require culture and sensitivity tests. Such samples are not acceptable in syringes.

Cerebrospinal fluid (CSF):
Sterile Universal Containers of an appropriate size are preferred and available at the front desk of the lab for the collection of CSF for cell count and or culture and sensitivity test

Sputum
Sterile containers are available at the front desk of the lab. Sputum is required and not saliva

 

Immunology and Cell Biology Unit

- PLAIN BOTTLE WITH GEL (GOLD TOP) is required for MOST ROUTINE ASSAYS carried out by this section of the lab
- CD4 COUNT, HIV VIRAL LOAD requires EDTA TUBE (PURPLE TOP).

In the event that a different tube is introduced; the wards will be appropriately communicated to.

Semen for Analysis
Samples are received at the lab between the hours of 8am and 12 noon on Mondays, Wednesdays and Fridays only. Samples should be received within one hour of sample production. Patient should have abstained from sex for at least 3 days and at most 7 days prior to producing specimen. During the period of abstinence, patient should neither drink alcohol nor smoke. Masturbation is the recommended method for producing the specimen.

DNA tests for paternity testing and karyotyping.
Requesting for the DNA test
A request for a DNA test can be made in two main ways, namely:
1. Legally through a written request from a legal practitioner, the court of law, or a practicing medical officer.
2. By a walk–in (Here the client must be willing to sign the consent form; however the result cannot be presented in the court of law)

Appointments
Once a request is received, an appointment is given to the client for sampling. This appointment is confirmed by the laboratory three clear days before the appointed day. On the day of sampling the following items are required.
- Each person to be tested must provide two recent passport size photos showing your full face and wearing no hat and dark glasses
- Each person tested must provide one piece of original ID that can be checked to confirm identity when sampling. Acceptable IDs are Passport, Driver’s License, Voter’s ID, National ID, NHIS card.
- Certified copy of birth certificate for children to be tested.


What is expected during sampling
On the day of sampling to ensure test results are legally acceptable, a neutral third party, usually a medical officer would collect and authenticate the DNA samples ensuring their integrity. Such a person known as sampler is responsible for verifying the identity of the parties being tested and their subsequent samples.
The sampler will endorse the passport–sized photos as follows:
1. [SAMPLERS NAME ] certify that this is the true likeness of [ CLIENTS NAME]
2. Samplers signature
3. Date
All these processes are adhered to, to ensure a strict chain of custody to make the results admissible and defensible in the court of law.

Payments for tests
Clients are expected to make the Full payment before sampling is done on the appointed day.

Sample used
Blood is required for the DNA tests

Results
As a result of batched testing, results are given out within a 30 day period to the requesting client. Depending on the peculiar situation, results are either delivered through mail or picked up by clients.

Dna tests for paternity testing and karyotyping. Requesting for the dna test

Tests Tube Sample Vol
General Serology Plain tube with gel(Gold Top) 3mL blood
CD4/CD8 count EDTA Tube(Purple Top) 3mL blood
Urine Pregnancy Test Clean container 10mL urine
* Viral load(HBV/HIV) EDTA Tube(Purple Top) 3mL blood

*Paediatric samples should be sent to the child health lab and that for adults should be sent to the fevers unit lab.

Order- of-draw for multiple blood collection
The following order-of-draw, which is recommended when drawing several specimens during a single venepuncture, is based on pragmatism. Its purpose is to avoid possible test result error due to cross contamination from tube additives. This procedure should be followed for both evacuated tubes, and syringe transfer of blood to multiple tubes.

A. BLOOD CULTURE OR BLOOD CULTURE BOTTLE (rotate tube 8-10 times)
B. COAGULATION TUBE (BLUE TOP) (rotate tube 3-4 times)
C. Other Additive and non-additive tubes:
- GEL SEPARATOR or CLOT ACTIVATOR TUBE (GOLD TOP WITH GEL) (rotate tube 8-10 times)
- HEPARIN TUBE(GREEN TOP)(rotate tube 8-10 times)
- EDTA TUBE (PURPLE TOP)(rotate tube 8-10 times)
- FLUORIDE-OXALATE TUBE(GRAY TOP)(rotate tube 8-10 times)
D. For syringe draws, the order of draw is the same, except the Blood Culture bottle or tube is always sampled first, and if two syringes are used in the draw, the Coagulation bottle (blue top) must be sampled from the 2nd syringe.

Disclaimer
The lab reserves the right to discard any specimen incorrectly collected. The lab does not provide specimen containers to be used for tests by other labs. Where request forms are incorrectly or illegibly completed, the laboratory reserves the right to reject such requests. Unlabelled or mislabelled samples will not be accepted.

Requests for lab investigations

Requests for lab investigations

Request forms and clinical information

Four Request forms are available for use and have been colour coded  each representing one of the departments. Red is for Haematology, Blue for Chemical Pathology, Green for Microbiology and Yellow for Immunology. In all cases the form must be correctly and legibly completed with patient NAME, AGE, GENDER, CLINICAL DETAILS and REQUESTING DOCTOR’S NAME, SIGNATURE and DATE. Tests for different departments should be requested on their respective forms and not put together on one form. Tests required should be clearly indicated and where any test is not listed it should be clearly written on the request form. The Requesting DOCTOR'S CONTACT should be quoted.

Where all information is provided appropriately the speed of processing of request, and the results of the tests are influenced positively, leading to a more rapid turnaround of report. Also it will allow the department to correctly interpret results and provide follow-up tests where appropriate.

Phlebotomy service
For the convenience of Out-Patient Clinics, phlebotomy services are currently available at the Central Laboratory, Child Health department, Fevers Unit, and Obstetrics and Gynaecology department of the hospital. The last four facilities above are usually open Mondays to Fridays between the hours of 08:00 and 16:30.

Payments
Central Laboratory DOES NOTOFFER FREE SERVICES. All tests requested for must be paid for either with the National Health Insurance Scheme, any other Health Insurance scheme who have subscribed with the Hospital or by upfront payment. Clients should always demand receipts when payments for services are made. These payments must be done at the designated points before specimen bottles are given out. It is the responsibility of in-patients/relations to demand receipts of all payments made on their behalf by lab attendants. In the event where receipts are not given, a formal complaint can be made to the laboratory officer/CSO.

Disclaimer
The Laboratory does NOT BEAR ANY RESPONSIBILITY for payments not made at the designated cash points by out-patients and in-patients/clients WHO WALK INTO the Central lab.

Submission of samples
Samples are to be submitted at the front desk of the Central lab. At no point should the samples be sent to the main lab without passing through the reception. In the event that a sample gets into the lab without passing through the front desk, the Central Lab will not be held responsible for any outcome of the sample.

Criteria for sample rejection
Samples received at the front desk of the lab will be rejected if they fall into the following criteria
1. Generally for all samples with LABELLING ERRORS as follows:
- Unlabelled specimen
- Labelling on specimen and requisition do not tally

2. Generally for ALL UNSATISFACTORY SAMPLES as follows:
- Urine specimen Longer than two-hour lapse before refrigerating or culturing
- Blood specimen of insufficient volume for ESR test(<2mls)
- Semen samples older than one hour
- Whole blood specimens containing clots
- Blood specimens older than 24 hours for haematology tests
- Blood for FBC, BF, Hb, Trophozoite count, Blood Film for comments, Sickling, Hb electrophoresis tests in tubes other than EDTA anticoagulant
- Any dry swab received
- Saliva received instead of sputum
- Obvious mouth wash or food contamination in sputum
- Insufficient quantity or dried specimen for C/S received
- Blood for G-6PD test in tube other than Heparin tube (Green Top
- Blood for Coagulation tests in tube other than Sodium Citrate tube (Blue Top)
- Blood volume more than 1.8mls for coagulation test.
- Samples for culture and sensitivity testing in non-sterile containers
- Samples from patient under 6 months of age for sickling tests
- Unfasting blood samples for fasting tests
- Grossly haemolysed samples
- Blood exposed to light for more than 2 hours for the estimation of bilirubin
- Lipaemic samples as it affects enzymes, electrolytes (Na+) total protein and bilirubin estimation
- Icteric samples as it interferes with assays near the bilirubin absorbance peak

3. Generally for ALL REQUISITION INADEQUACIES as follows:
- Time of collection not noted on requisition
- Improperly filled or incompletely filled requisition
4. Generally for ALL SAMPLES WITH HAZARDOUS HANDLING CONDITIONS as follows
- Any liquid specimen exhibiting container contamination/spillage
- Specimen in syringe only or both syringe and needle
- Specimens submitted in cracked or leaking containers with external contamination of blood/body fluids.
When specimens are rejected, a sample rejection form which indicates the reason for the rejection will be sent to the requesting clinician and a new specimen would be required. When mislabelled or unlabelled irreplaceable specimens such as CSF and certain microbiological specimen are received, the requesting clinician or other approved personnel would have to come to the laboratory to positively identify the specimen, affix the proper label, and complete an unlabelled / mislabelled specimen documentation form.
Also when a physician requires that a procedure be performed on unsatisfactory specimen, s/he will be required to do so in writing. The condition of the specimen will also be noted in the report he will be given.
Please refer to the appendix for a sample of the laboratory rejection form and mislabelled/unlabelled specimen documentation form.

Report collection
Reports are collected at the designated collection point by using the receipts given when payments were made. Days and times for collecting reports are communicated to the client when the samples are received.

Laboratory attendants
In some designated wards laboratory attendants are attached. Their duties include the dispatch of samples and requests from the wards to the main laboratory and results/reports from the main laboratory to the wards. The attendants duties includes transporting blood and blood products to and from the blood bank. Some attendants double as phlebotomist. Their assistance maybe sought when needed. However, the responsibility of their actions or inactions in the line of duty lies squarely on the shoulders of the requesting clinician.

Turn Around Times (TAT)
This indicates how long it will take the lab to run tests and release results.