Lab report Sexual Health Screening

Labreport
The Newsletter of The Doctors Laboratory
Test Update
SPRING 2007
PROFILE OF 7 PCR TESTS FROM ONE SAMPLE
Test
Code
Sexual Health
Screening
DL12
DL12
7 tests by PCR* from ONE
of four different sample types
OR REQUEST SINGLE TESTS
Test
Code
Urine*
PCR Swab
Cytyc Vial
Semen
• First Catch Urine
• Semen
• Thin Prep Vial
• PCR Swab
N.gonorrohea
Chlamydia trachomatis
CT/NG combined
Mycoplasma genitalium
Ureaplasma urealyticum
Trichomonas vaginalis
Gardnerella vaginalis
Herpes Simplex I/II
CGON
CPCR
CCG
MGEN
UGEN
TVPC
GVPC
HERD
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
* Polymerase chain reaction (PCR) is a molecular technique that
allows a small amount of DNA to be amplified exponentially.
Chlamydia trachomatis: the most common sexually
transmitted infection, with Neisseria gonorrhoeae
being the second most common bacterial STI in the
UK. These two infections are well recognised and
documented. The prevalence is highest in young
sexually active adults, especially women ages 16
to 24 years and men ages 18 to 29 years.
Most infections are asymptomatic, with a large
proportion remaining undiagnosed. Untreated genital
chlamydial infection may have long-term
consequences, especially in women in whom it is a
well-established cause of pelvic inflammatory
disease (PID), ectopic pregnancy and infertility.
Mycoplasma genitalium: has been very difficult to
culture from genital tract specimens known to be
positive by PCR and has been shown to be
associated with nonchlamydial, nongonococcal
urethritis, epididymitis and prostatitis. When men
present to a clinic for treatment of persisting or
recurrent urethritis after a course of doxycycline,
nearly half are infected with M. genitalium.
In women M. genitalium can be detected in the
upper genital tract, as well being as a cause for
cervicitis and urethritis – and in those with infected
male partners. Ureaplasma urealyticum is similiarly
identified as the most common cause of
Sample Type
1
OR 1
OR 1
OR 1
x
x
x
x
Turnaround Time
First Catch Urine Sample
PCR Swab
Thin Prep Vial
Semen Sample
4 working days
Turnaround Time
2
2
2
4
4
4
4
4
working
working
working
working
working
working
working
working
days
days
days
days
days
days
days
days
*First catch random urine - If requesting urine for m/c/s please ensure this is clearly requested as a separate test.
symptomatic nongonococcal and nonchlamydial
urethritis. (* Sex Transm Infect 2006;82:276-279)
Vaginitis due to Trichomonas vaginalis is a very
common sexually transmitted disease causing an
offensive vaginal discharge, associated with vulvar
itching, burning, redness and swelling. Testing by
PCR will outperform culture. It is pathogenic to the
genitourinary tract – 50% of women are asymptomatic carriers and the other 50% are symptomatic.
Bacterial vaginosis (BV) formerly known as nonspecific vaginitis, is the most common cause of
vaginitis and is characterised by an increase in
vaginal discharge and overgrowth of certain
bacteria in the vagina, including Gardnerella
vaginalis. The incidence of BV increases with the
number of recent and lifetime sexual partners or
new sexual partners. G. vaginalis is predominantly
identified in women. Male partners are usually
asymptomatic and rarely develop infections with G.
vaginalis – but men whose sexual partners have
symptoms of BV may present with urethral
colonisation of the same strain of G. vaginalis.
There is sufficient data to support infection as
causative agents of chronic prostatitis in men and
chronic pelvic pain syndrome in women. These
patients are not infrequently found to have a wide
variety of bacterial infection identified by PCR
testing despite previous negative cultures.
Herpes Simplex Virus I/II has the characteristics
of a viral, not a bacterial infection, for which there is
no cure. Prevention is inherently dependent on
behaviour, not treatment. Two types exist: type 1
(HSV-1) and type 2 (HSV-2). Both are closely related
but differ in epidemiology. HSV-1 is transmitted
chiefly by contact with infected saliva, whereas
HSV-2 is transmitted sexually or from a mother's
Continued on page 2
IN THIS ISSUE
TDL FRONT PAGE
• Sexual Health Screening
STD Diagnoses at GUM clinics in the UK 1996 – 2005
NEWSLETTER INSERT
Total of 1.8 million attendances at GUM clinics in the UK in 2005 – more than double the
number recorded in 2002.
• TDL FrostBox Service
• The Body – Tumour markers at a glance
TDL ANDROLOGY
Year
Syphilis
Gonorrhoea
Chlamydia
Herpes
All Diagnoses
1996
137
12579
35840
16811
4955151
2005
2814
19392
109958
19837
790443
TDL GENETICS
60%
• Amplichip CYP450 Test
% change
▲
2,054%
▲
54%
▲
207%
▲
18%
▲
Since 1996, there has been a substantial increase in diagnoses of most Sexually Transmitted Diseases (STDs)
in the UK, and reports of two of the most common STDs have shown massive rises. Cases of uncomplicated
gonorrhoea increased by 54% between 1996 and 2005, while genital chlamydia increased by 207%.
Chlamydia has been the most commonly reported sexually transmitted disease since 2001, overtaking genital
warts. This is the first time that a bacterial infection has held this title.The rapid increase in reports of bacterial
STDs is probably in part due to a general deterioration in sexual health amongst young people and men who
have sex with men. However, the greater acceptability of using GUM services and new campaigns to encourage
testing have also made a contribution.
UK Health Protection Agency, November 2006.
• Male Infertility
TEST UPDATES
• PCA3 • Liver Fibrosis • HPV and Anal Cancer
• Non Alcoholic Fatty Liver Disease (NAFLD)
SERVICE UPDATES
• TDL FrostBox Service
TDL CONTACT
• Who to ask for help
Sexual Health Screening continued
genital tract infection to her newborn. Clinical
diagnosis may be difficult as patients do not always
present with lesions. Cultures are helpful if the
patients presents early enough but viral shedding
only lasts a few days and often the lesion has crusted
or disappeared by the time the patients is seen.
Thus, a negative culture would not definitely rule out
herpes. Measuring HSV DNA by PCR assay is more
sensitive for detecting HSV in a lesion than a viral
culture and will distinguish between HSV-1 and
HSV-2.
Tests can be requested as single assays, or as a
group of 7 in TDL Profile DL12. ■
TDL Andrology
Male Infertility
I
n some cases, a diagnosis of male infertility may
be successfully treated allowing a couple to
conceive naturally or with minimal medical
assistance but some patients may have more
significant disease. Treatments will continue to
progress as an increasing number of couples seek
fertility services.
Infertility evaluation is usually considered for a
couple with a history of unprotected intercourse for
at least 12 months without a pregnancy. This is
relevant even for couples who have had a successful
first pregnancy but are unsuccessful establishing a
second pregnancy.
A full screening evaluation for the male partner
incorporates a complete medical, sexual, family and
social history, together with a physical examination,
laboratory evaluation and possibly up to two or more
semen analyses. Semen profiles can show
considerable variation from one sample to the next.
If one test gives poor results, it is essential to carry
out a second test between 1 and 3 weeks later. It is
well recognised that patients presenting with a
subfertile semen analysis may later show parameters
within the normal reference range on a subsequent
test, thus averting an incorrect diagnosis of infertility.
Alternatively, men who have had a very satisfactory
semen analysis more than 6 months previously, but
who are finding it difficult to conceive, may benefit
from a repeat test as conditions such as primary
testicular failure or seminoma may manifest with a
dramatic loss in sperm concentration. ■
•
•
•
•
Test Update
PCA3
The first molecular diagnostic
assay that can contribute to the
diagnosis of prostate cancer.
D
iagnosis of prostate cancer has relied heavily on
serum Prostate Specific Antigen (PSA), physical
examination by digital rectal examination (DRE) and
biopsy. However all have shortcomings. Nonmalignant conditions (eg prostatitis and benign
prostatic hyperplasia) can cause PSA levels to rise
and the positive predictive value (PPV) for diagnosing
cancer by serum PSA is low. Approximately 75% of
men suspected of having cancer based on PSA
testing actually have non‐cancerous conditions. The
PPV by DRE is even lower (10%). Complications
caused by prostate biopsy are well documented. As
many as 10 – 25% of patients with a negative biopsy
may have prostate cancer.
PCA3 is prostate cancer specific, over expressed
in >95% of malignant tissue, and is significantly
up-regulated (60-100 fold) in prostate cancer.
PCA3 is more prostate cancer specific than PSA
with a positive predictive value to diagnose prostate
cancer being almost twice than of serum PSA.
PCA3 is only expressed in prostate tumour – not in
benign or normal tissue and is not affected by the
size of the prostate.
Testing for PCA3 is from a urine sample. The
urine sample must be collected following a DRE.
The released prostate cells are collected in a first
catch urine after the DRE. Gen-Probe urine sample
collection tubes must be used and there are
important storage and temperature instructions
once the urine sample has been collected. The
PCA3 result is reported as a score; the higher the
score the greater the probability of a positive
prostate biopsy whilst the lower the score the
likelihood of a positive biopsy decreases. The
greatest diagnostic utility occurs at a cut off of 35.
Highly specific to Prostate Cancer
Non-invasive
Improves diagnosis of Prostate Cancer
Helps reduce the number of
unnecessary biopsies
By measuring the expression of mRNA from the
PCA3 gene, this new assay provides greater
accuracy: a positive result may indicate prostate
cancer and the need for an additional biopsy; a
negative result even though accompanied by a PSA
greater than 4 ng/ml suggests a relatively longer
time interval may be acceptable between biopsies.
The routine use of PCA3 in men with raised PSA
levels with negative biopsies would expect to both
enhance the early detection of cancer in these men,
as well as reduce the number of unnecessary
biopsies. The use of PCA3 in combination with
current PSA testing and increased accuracy for
timing of biopsies would also increase the biopsy
yield of positive cancers (UROLOGY.2007;69:532 – 535).
For further information about PCA3, or to order
Gen-Probe PCA3 Urine Specimen Transport Tubes
please contact Annette Wilkinson or Lynn DerbyLewis at The Doctors Laboratory on 020 7307
7373 or by email pca3@tdlpathology.com ■
PCA3 Score
As the PCA3 score
increases the likelihood
for positive biopsy
increases. As the
PCA3 score decreases,
the likelihood for a
positive biopsy
decreases. The greatest
diagnostic utility occurs
at a cut-off of 35.
125
115
105
95
85
75
65
55
45
Increased
Probability
of Positive
Biopsy
35
30
25
20
15
10
9
8
7
6
5
4
Decreased
Probability
of Positive
Biopsy
Sample information – See TDL Laboratory Guide page 56 (Tumour Markers)
Test
Code
Sample Type
Turnaround Time
PCA3
PCA3
1 x Gen Probe PCA3 Sample Transport Tube
5-7 working days
DRE and Urine sample collection is by appointment (020 7307 7383) at Patient Reception, 55 Wimpole Street, London W1G 8YL
Sample information
New Andrology Suite
Test
Code
Instructions for Appointments
Comprehensive Semen
Analysis for Fertility
SPER
Post Vasectomy
PVAS
Semen Analysis Sperm DNA
SEXT
Please make, or ask your patient to make,
an appointment for a semen analysis (Fertility
or Post Vasectomy) on 0207 025 7940 or
020 7307 7373. This will ensure that samples
are assessed within specific time limits.
British Andrology Society guidelines currently
specify that first appointments for post vasectomy
samples should be at least 16 weeks and 24
ejaculations after surgery.
Important information
It is essential that patients do not abstain for longer than 5 days but not less than 2 days.
If you would like to discuss a patient’s results, or specialist services, (Sperm Preparation for overnight survival
or IUI sperm motility and vitality testing, retrograde ejaculation etc.) or would like further information about
TDL Andrology’s services, please call Dr Sheryl Homa, Head of Andrology, on 020 7025 7940 or 07813 077797
or email andrology@tdlpathology.com.
TDL’s new Andrology Laboratory, with three
dedicated sample collection rooms, is now
located in the same premises as Patient
Reception at 55 Wimpole Street, providing
diagnostic semen analysis and post
vasectomy analysis testing services.
The laboratory is CPA accredited, and
performs to current WHO, Associated
Biomedical Andrologists and British
Andrology Society guidelines for laboratories
undertaking comprehensive semen analyses
for fertility, post-vasectomy semen analyses
and screening of sperm donors. TDL
Andrology contributes to the external quality
assurance scheme UKNEQAS.
TDL Genetics
Amplichip CYP450 Test
Breast Cancer and
Tamoxifen response
T
he Amplichip CYP450 Test (Roche Diagnostics)
has been designed to determine a patient’s
CYP2D6 and CYP2C19 genotype and phenotype.
Genes such as these have a marked impact on
response rates to certain drugs, helping to explain
why some patients respond well, others poorly, and
why some patients need higher or lower doses. The
Amplichip test helps clinicians determine whether
patients process drugs too slowly (poor metabolisers)
or too quickly (extensive or ultrarapid metabolisers)
and enables the most suitable drugs and dosages to
be determined before treatment begins.
Recent studies have shown that Tamoxifen may
not work as well in women with breast cancer who
carry certain variants of the CYP2D6 gene. An
Test Update
HPV and Anal Cancer
H
igh-risk HPV types are implicated in a
substantial portion of anal, penile, and head
and neck precancers and cancers. HPV 16 and 18
are the most common HPV types found in cervical
cancer and are responsible for approximately 70%
of these cancers.
Anal cancer rates in the UK have risen by 2.5 –
5 fold in the last 50 years. They are similar to the
incidence rate of other external anogenital
malignancy but certain subsets of the population
have a high susceptibility to anal cancer:1
• Men and women with HIV infection
• Men who have sex with men
Anal cancer shows many similarities to cervical
cancer: high risk HPV infection being the causative
factor in most cases. Rates of High Risk HPV in anal
cancer specimens are 83% men / 95% women and
with further advances in detection and
Test Update
Liver Fibrosis
L
iver Fibrosis with progression to cirrhosis is a
common outcome in chronic liver disease,
Diagnosis of liver fibrosis and monitoring to identify
the effectiveness of drug treatment is usually made
by histological analysis, the “reference standard”
index of liver fibrosis. Histology can be highly
informative but there are well documented
disadvantages for undertaking biopsies – they are
relatively expensive, and may not always give
accurate results because of difficulties in sampling
or interpretation. Fibrosis is also not evenly
distributed throughout the liver and small amounts
of biopsy material may give a misclassified result.
Repeated liver biopsies are not considered
acceptable, even through the indications for
obtaining a liver biopsy for diagnosis, determining
prognosis, and evaluating the impact of treatment are
estimated 7% to 10% of Caucasian women with
breast cancer carry such CYP2D6 variants,
reducing their ability to metabolise Tamoxifen,
increasing a risk of recurrence and reducing
disease-free survival rates.1
The CYP2D6 enzyme transforms Tamoxifen into
the potent anti-estrogen endoxifen, but certain
CYP2D6 genetic variants and inhibitors of the
enzyme markedly reduce endoxifen plasma
concentrations in Tamoxifen-treated patients.1,2
CYP2D6 metabolism, as measured by genetic
variation and enzyme inhibition, has therefore been
proposed as an independent predictor of breast
cancer outcome in post-menopausal women
receiving tamoxifen for early breast cancer.
Determination of CYP2D6 genotype may also be of
value in selecting adjuvant hormonal therapy and it
appears CYP2D6 inhibitors should be avoided in
Tamoxifen-treated women. The effects of reduced
metabolism appeared greatest in poor metabolisers,
with a greater than threefold higher risk of
recurrence compared to extensive metabolisers.
In light of this recent evidence the FDA was
advised, by its own panel of experts, to consider
changing the Tamoxifen label to include a reference
to CYP2D6 and the risk associated with certain
metaboliser phenotypes.
The results of a patient’s genotype and predicted
phenotype (poor, intermediate, extensive, ultrarapid)
are presented in her report and may improve the
choice of optimal hormonal therapy for the
treatment of estrogen receptor positive cancer. ■
1. Goetz et al J Clin Oncol. 2005;23(36):9312-8.
2. Jin Y et al: J Natl Cancer Inst 97:30, 2005
Sample information
Test
Code
Sample Type
Turnaround Time
Roche Amplichip
CHIP
EDTA whole blood
1-2 weeks
For further information please contact Dr Lisa Levett, TDL Genetics: lisa.levett@tdlpathology.com or 020 7307 7409.
classification, this may increase. Type16 is the
most frequent HPV type detected followed by
Type18, regardless of gender. The types being
identified (16, 18, 31, 33, 45) are identical to the
subtypes found in cervical cancer2 Smokers (men
and women) are at particularly high risk for anal
cancer, independent of age and other risk factors3.
Anal cytology is the candidate test for screening
for prevention of anal cancer. Inspection and clinical
examination includes cytological, perianal and intraanal PAP smear sampling. Simultaneous HPV DNA
by PCR testing increases the sensitivity of anal
cytology andby using Liquid Based Cytology both
cytological examination and HPV testing can be
undertaken. Test values and screening performances
are well documented5,6. Triage of atypical cytology
can be performed according to gynaecological
cancer screening procedures.
If HPV infection is identified, identifying low from
high risk subtypes is helpful. Biopsy, excision and
examination especially for HPV lesions is
recommended. Follow up testing of HPV DNA by
PCR will identify whether there is clearance or
persistence of the virus. Persistence of HPV infection
is, like cervical cancer, indicative of an increased
risk of recurrence4. ■
1
2
3
4
5
6
Science to Community Clinical #3
J Clin Pathol 55:244 – 255
Cancer. 2004 Jul 15;101(2):270-80
AIDS 1998;12:495-503
Cancer Epidemiol Biomarkers Prev 2003;12:638-42
Colorectal Dis (2006) 21: 135 – 142
Sample information
Test
Code
Sample Type
Turnaround Time
Anal Pap Smear
HPV 20 subtypes* DNA by PCR
APAP
HP20
1 x Cytyc Thin Prep Vial
1 x PCR Swab or 1 x Thin Prep Vial
48 hours
4 days
*Each of the 20 DNA subtypes are reported individually as Positive or Negative (5 Low and 15 High Risk).
This test is appropriate for male or female patients.
important. Whether the damage is caused by
alcohol, fat or virus the effect is much the same - long
term inflammation causing scar formation or fibrosis
– with scar tissue eventually obstructing blood flow.
This is cirrhosis. Many chronic liver diseases can now
be diagnosed without resorting to biopsy, with the
assessment of liver inflammation made by using
blood tests. Because Enhanced Liver Test Function
(ELF TM) test uses a blood sample rather than a biopsy,
and it can be used repeatedly for the same patient
helping monitor progression or reduction of fibrosis.
The Enhanced Liver Fibrosis (ELF TM) test combines
three direct serum markers and employs a
proprietary algorithm* based on the measurement of
three key markers: hyaluronic acid, TIMP-1 and
PIIINP. The algorithm measures each of these
markers by immunoassay, to create an ELF TM score
able identify patients with little or no fibrosis, from
clinically significant hepatic fibrosis. ELF TM testing
can be used to monitor disease progression and
response to therapy and can be used in many chronic
conditions, including alcoholic liver disease, primary
biliary cirrhosis, and hepatitis. ■
* Non-invasive markers of liver fibrosis tested in different forms
of chronic liver disease showed variable diagnostic performance,
but accuracy was rarely above 75%-80%. Results obtained
when markers are combined (the set of algorithms that combine
sequentially indirect non-invasive markers of liver fibrosis) achieve
90%-95% diagnostic accuracy. The accuracy of this algorithm
is similar when compared to three expert liver pathologists
working independently.
Sample information
Test
Code
Sample Type
Turnaround Time
Enhanced Liver Fibrosis (ELF) Test
ELF
2 x Gold/SST
7 days
This test employs an algorithm based on the measurement of three key direct liver markers: hyaluronic acid, TIMP-I and PIIINP*.
This serum sample needs no special handling. Postal packs are routinely provided on request by The Doctors Laboratory.
Test Update
Non Alcoholic Fatty Liver
Disease (NAFLD)
W
ith an estimated prevalence as high as 30%
in Western countries, NAFLD is emerging as
one of the commonest causes of abnormal liver
function. The effect of obesity in affluent countries
means that it has overtaken alcohol and viral
infection as the main cause of liver disease. The
effects of excess fat has only recently started to be
recognised. Although its true prevalence is
unknown, some estimates suggest it may already
affect up to one-third of adults.
Diagnosis is not easy. Most subjects with NAFLD
are asymptomatic but it has a well-established
capability of leading to cirrhosis and end-stage liver
disease in affected patients.
It is not clear why an excess of fat harms the liver
– most people with liver disease do not look like they
have liver disease. Because liver biopsy remains the
gold standard for grading and staging (ie,
recognition of inflammation and fibrosis), a critical
issue in management is whether individual patients
should undergo biopsy to detect progressive
disease. Biopsies have inherent drawbacks – they
are invasive, relatively expensive, and small
amounts of biopsy material may not be
representative – and for this reason referral for liver
biopsy is likely to be considered only after a
thorough, non-invasive serologic and radiographic
evaluation have failed to confirm a diagnosis of
cirrhosis; the benefit of biopsy outweighs the risk;
and it is postulated that biopsy will have a favorable
impact on the treatment of chronic liver disease.
Based on available evidence, it can be
anticipated that non-invasive markers of liver
fibrosis and their combined use will become a most
useful tool in the clinical management of many
forms of chronic liver disease. However, their
implementation will not completely eliminate the
need for liver biopsy.
The Enhanced Liver Fibrosis (ELFTM) test is
validated as highly accurate across all stages of
disease severity in HCV, HIV, HCV/HIV co-infection,
primary biliary cirrhosis and non alcoholic fatty
liver disease. ■
Sample information
Test
Code
Sample Type
Turnaround Time
Enhanced Liver Fibrosis (ELF) Test
ELF
2 x Gold/SST
7 days
This test employs an algorithm based on the measurement of three key direct liver markers: hyaluronic acid, TIMP-I and PIIINP*.
This serum sample needs no special handling. Postal packs are routinely provided on request by The Doctors Laboratory.
Service Update
Sample information
TDL FrostBox Service
S
ome tests need special handling or need to be
frozen at the time of sample taking. Without
regular deliveries of dry ice, making arrangements
for same day deliveries are expensive and time
consuming.
The TDL FrostBox Service is a one price solution
for anyone within the UK who wants to arrange
regular, or ad hoc, shipments for one or more
frozen samples. We provide a simple, cost
effective, door to door total service at the times you
need it.
Test
Code
Instructions
Next day delivery & collection
TDL Frostbox
FBOX
Telephone 020 7307 7380
or email frostbox@tdlpathology.com
£97.00
If you have an on-site freezer, take your sample,
prepare and freeze at your convenience – store as
frozen until your FrostBox arrives. If you do not
have a freezer wait until your Frost Box arrives
before taking and preparing the sample. Label
samples with their three unique identifiers, include
the request form(s) or work sheets in the sample
bag(s) and surround with dry ice. Handle dry ice in
accordance with health and safety guidelines. Dry
ice should not be put into food or drinks. ■
1
4
Deliver
at TDL on
Wednesday
3
24 hour Telephone (Main Switchboard for all services) 020 7307 7373 Fax 020 7307 7374
David Byrne
david.byrne@tdlpathology.com
Group Laboratory Director
Rob Joyce
rob.joyce@tdlpathology.com
Director of Sales/Service
Annette Wilkinson
annette.wilkinson@tdlpathology.com
Director of TDL Genetics
Dr Lisa Levett
lisa.levett@tdlpathology.com
Heads of Support Departments
Quality Management
Cyril Taylor
cyril.taylor@tdlpathology.com
Customer Service Manager
Rochelle Fakhri
rochelle.fakhri@tdlpathology.com
Patient/Doctor Invoices
Spencer Jack
spencer.jack@tdlpathology.com
Courier Control
Steven Sykes
steven.sykes@tdlpathology.com
Patient Reception/Home Visits
Michaela Rackham
michaela.rackham@tdlpathology.com
Pathology Supplies
Ken Roberts
supplies@tdlpathology.com
Service Support Sample Handling
Jacqui Dehaney
help@tdlpathology.com
Call Centre
Adrian Worley
adrian.worley@tdlpathology.com
IT
Alan Stevens
alan.stevens@tdlpathology.com
TDL
FrostBox
2
Arrive
Tuesday
Pick up
Tuesday
TDL Contact: Who to ask for help
CEO
Order
from TDL
on Monday
The TDL Frostbox process:
• Your FrostBox will arrive by 10.00am
• Your FrostBox will be collected by
4.00pm on the same day.
• Your FrostBox will be delivered to
Sample Reception at TDL by 9.00am
the following day.
Order your TDL FrostBox by telephone:
020 7307 7380 or by email:
frostbox@tdlpathology.com, giving details of:
• Who you are
• Where the TDL FrostBox needs to be delivered
Heads of Laboratory Departments
Sample Handling and Data Entry
Kathleen Frost
kathleen.frost@tdlpathology.com
Referrals
Lynn Derby-Lewis
lynn.derby-lewis@tdlpathology.com
Haematology
Letisha Brukman
letisha.brukman@tdlpathology.com
Biochemistry
Barbara Vale
barbara.vale@tdlpathology.com
Microbiology
Massimo Bonaiti
massimo.bonaiti@tdlpathology.com
Andrology
Dr Sheryl Homa
andrology@tdlpathology.com
Cytology
Nick McClenaghan
nick.mcclenaghan@tdlpathology.com
Immunology/Virology
Nalin Shah
nalin.shah@tdlpathology.com
Molecular Genetics
Dr Stuart Liddle
stuart.liddle@tdlpatholog.com
Cytogenetics
Terry Ballard
terry.ballard@tdlpathology.com
TDL Trials
Abraham Roodt
abraham.roodt@tdlpathology.com
TAP506/24-04-07/V7
• Who is your contact person
• Your direct telephone number
• Which day/date you want your FrostBox to be
delivered (TDL FrostBoxes can be delivered
and collected on Mondays within the M25
only). Orders for a Friday FrostBox, for return
delivery to the laboratory on Saturday morning
will incur an additional charge of £20.00)
• Please order by 2.00pm for a next day delivery
The charge for this service is £97.00 and will
be invoiced with your pathology.