This is a brief introductory guide to the role and function of the Laboratory. The Regional Laboratory for Toxicology is concerned with applying "state of the art" techniques to the analysis of body fluids and tissues for drugs and chemical poisons. It also has a major interest in the investigation of the relationship between such findings and the signs and symptoms of human toxicity following acute or chronic poisoning.
The Laboratory was designated as a Regional Scientific Speciality in 1972, and has been part of the U.K. Supraregional Assay and Advisory Service for trace element analysis since 1974. The Laboratory became part of the Directorate of Pathology at City Hospital with the establishment of the NHS Trust in 1994. Because of the specialist nature of the work, the Laboratory continues to provide a service to registered medical practitioners from any health region within the UK. The Laboratory also has a close relationship with the National Poisons Information Service (NPIS), the Centre for Chemical Incidents and West Midlands Poisons Treatment Unit at City Hospital.
The full range of specialist laboratory services are provided for clinicians within the West Midlands Region and beyond.
All analytical work is performed to the highest standards of laboratory practice, and the Laboratory participates fully in all relevant UK and international external quality assessment schemes.
The Regional Laboratory for Toxicology is situated close to the Pathology Department and the Sheldon Block on the City Hospital site. There is direct access to the Laboratory from the Western Road entrance to the Hospital. The Laboratory is in a purpose-built building (opened in 1981) and is relatively well-equipped with modern instrumental techniques, which include: immunoassay (enzymic, polarised fluorescent and radioisotopic labelling); gas-liquid chromatography; high performance liquid chromatography; mass-spectrometry; atomic absorption spectrometry; UV-, visible- and fluorescence-spectrophotometry.
The current organisational structure of the Laboratory is shown in Figure 1. The Laboratory has a total of 19.5 wte’s ("whole time equivalents"), which includes Clinical Scientists, Medical Laboratory Scientific Officers (MLSO’s), Medical Laboratory Assistants (MLA’s) and Secretarial staff. The Laboratory is headed by a Consultant Clinical Scientist and there are two principal clinical scientists who act as deputy heads of department. There is also a quality management section and a separate business manager. The operational side of the Laboratory is divided into 3 sections which have individual team leaders who report to either of the two deputy heads of department.
The Laboratory has close links with the University of Birmingham and the World Health Organisation (WHO) International Programme on Chemical Safety (IPCS). Specialist teaching and laboratory based training is also provided to undergraduate and post-graduate students of pathology, toxicology and medicine of the University of Birmingham. The Laboratory also has links with the Universities of Bath, Wolverhampton and Coventry.
Description of Current Service
Specialist laboratory services are provided for clinicians within the West Midlands Region and beyond. Approximately 85% of the workload of the Laboratory originates from outside of City Hospital NHS Trust, with more than 60% of the workload originating from the greater Birmingham area. Specialist laboratory services that are provided include:
Analytical Toxicology (Laboratory Diagnosis of Poisoning)
The Laboratory provides a comprehensive analytical service with 24 hour cover for the diagnosis of poisoning. Most investigations are carried out on specimens of blood and urine. Screening for an ‘unknown’ drug or poison makes extensive use of both immunoassay and chromatographic techniques. Compounds that are commonly detected in cases of acute poisoning include analgesics (salicylate, paracetamol), alcohols (ethanol), antidepressants (amitriptyline, dothiepin), benzodiazepines (diazepam, temazepam), anticonvulsants (carbamazepine, phenytoin), amphetamines (amphetamine, "ecstasy"), opioids (methadone, dextropropoxyphene) and opiates (morphine, codeine, dihydrocodeine). Important chemical poisons that can be investigated include: carbon monoxide, solvents, cyanide and paraquat. Prior consultation is advisable in all cases requiring ‘unknown’ drug/poisons screening, particularly when dealing with medicolegal or complex cases.
Therapeutic Drug Monitoring (TDM)
Therapeutic drug monitoring is of value for a limited number of drugs whose concentrations in plasma correlate with therapeutic effect better than drug dosage.
The Laboratory currently offers a same day service for the measurement of the following drugs in plasma:-
Anticonvulsant drugs: carbamazepine, ethosuximide, gabapentin, lamotrigine, phenobarbitone, phenytoin, valproic acid, vigabatrin Cardioactive drug: digoxin Respiratory stimulants / Bronchodilators caffeine, theophylline
The Laboratory provides an extensive screening and confirmatory service for common drugs of abuse, and this is also available for the clinical management of patients in drug misuse cases.
Current Routine Repertoire Performed for Drugs of Abuse Screening
Alcohol
Amphetamines (e.g. amphetamine, methamphetamine)
Barbiturates (e.g. amylobarbitone, phenobarbitone)
Benzodiazepines (e.g. temazepam, diazepam)
Cocaine
Cannabis
Chlormethiazole
Dextropropoxyphene
Ecstasy (MDMA) and related drugs (MDA, MDEA)
Ketamine
Methadone
Opiates (heroin, morphine, codeine, dihydrocodeine)
Pethidine
Specialist confirmatory procedures using gas chromatography (GC) or GC-mass spectrometry (GC-MS) are used routinely, particularly in the case of amphetamines and opiates. The Laboratory also has a developing interest in the investigation of heroin abuse and anabolic steroids.
The Laboratory also offers a full pre-employment and employment screening service for drugs of abuse.
Trace Element Analysis (SAS Service)
The Laboratory is a designated Supraregional Laboratory for trace element analysis and an analytical and advisory service are provided for a wide range of both essential and non-essential trace elements. Complementary investigations such as erythrocyte zinc protoporphyrin (ZPP) are also provided by this section. The main analytical technique used for the analysis of most trace elements is electrothermal atomic absorption spectrometry (ETAAS). It is hoped to introduce even more advanced techniques such as ICP-Mass spectrometry in the near future.
Trace Element and associated assays provided by the Laboratory (SAS Service)
| Element | Specimen Matrix |
| Aluminium | Plasma, Water, Urine, Bone, Dialysate |
| Arsenic | Blood, Urine |
| Barium | Plasma, Urine |
| Cadmium | Blood, Urine |
| Chromium | Blood, Urine |
| Copper | Plasma, Urine |
| Lead | Blood, Urine, Water |
| Lithium | Plasma, Urine |
| Mercury | Blood, Urine |
| Nickel | Urine |
| Selenium | Plasma, Urine |
| Thallium | Blood, Urine |
| Zinc | Serum |
The Laboratory is able to provide a service for occupational physicians and Health and Safety Advisors concerning monitoring of occupational exposure to hazardous chemicals, also workplace testing for drugs of abuse. The main services provided include:-
The Laboratory offers an extensive service for the investigation of deaths due to drugs or other poisons. Analyses are carried out on specimens of post-mortem fluids and tissues. Most investigations are carried out on behalf of the Coroner, although some are cases which involve criminal proceedings and the senior staff are experienced in giving evidence in Crown court. The Laboratory also has experience in the investigation of non-accidental poisoning in children.
Current research interests include:
Within 'normal' laboratory hours (08.00-17.00) weekdays
There will be a surcharge applied to all urgent/emergency requests for quantitative investigations and a further charge in the case of 'unknown' drug or poisons screening.
Outside 'normal' laboratory hours, weekends and public holidays
There will be an additional surcharge for all urgent/emergency requests for quantitative analyses and a further charge in the case of 'unknown' drug or poisons screening.
Last modified: April 13, 2005
Copyright © [Regional Laboratory for Toxicology] 1999. All rights reserved.
