Clinical Guidelines

For guidance on hyperlipidaemia treatment guidelines and monitoring patients on lipid lowering therapy please see advice on Remedy

BNSSG Adult Vitamin D Prescribing Guidance

Blood Tests

Urine and Other Tests

Please see these frequently asked questions below to find out more about using North Bristol My Medical Record (MMR). 

Logging in

I have trouble accessing the login page, is there an easy way to access it?

The best way to access MMR is through the link provided on email registration. You can also access My Medical Record by clicking on this link My medical record or by scanning the QR code below:

How do I reset my password?

Can my family or carers log in? How do I do this?

Results

Will I receive notifications when my results are available?

Will I be able to view historical results on My Medical Record?

The dates of my blood results and scans are wrong, what should I do?

How do I book my follow up blood tests or scans?

Other

I have used the message feature, when will I get a reply?

I have changed my mind, am I able to delete my account?

What happens when I reach the end of the MMR protocol?

© North Bristol NHS Trust. This edition published January 2026. Review due January 2029. NBT003855 

Members of the public and staff can attend our Trust Board meetings in public. If you would like to attend, please let us know by emailing trust.secretary@nbt.nhs.uk and we can provide details of the location, and print papers if required. If you wish, you can ask a question to the Trust Board.

Papers are available around one week before the meetings. These papers carry a general and press embargo until after the Board of Directors meeting has been held and no discussion concerning them will be entered into until that time.

2026/2027 meeting dates (meetings in common with the Board of Directors for University Hospitals Bristol and Weston NHS Foundation Trust):

• Tuesday 12 May 2026. This meeting will be held at The Park, Daventry Road, Knowle West, Bristol, BS4 1DQ
• Tuesday 14 July 2026. This meeting will be held at Lockleaze Sports Centre, Off Bonnington Walk, Lockleaze, Bristol, BS7 9XF
• Tuesday 8 September 2025. This meeting will be held at the Trinity Centre, Trinity Road, Bristol, BS2 0NW
• Tuesday 10 November 2025. This meeting will be held at Thornbury Active Lifestyle Centre, Alveston Hill, Thornbury, South Gloucestershire, BS35 3JB
• Tuesday 12 January 2027. This meeting will be held in Seminar Rooms 4 and 5 of the Learning and Research Centre, Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB
• Tuesday 9 March 2027. This meeting will be held in the Garden Room at Ham Green House, Chapel Pill Lane, Bristol, BS20 0HH.

This page contains information about having a contrast-enhanced mammogram (CEM). The information will also be explained by your medical team so if you have any questions or concerns, please let us know.

What is CEM?

A mammogram is an X-ray of the breast. CEM is a technique where a contrast medium (dye) is injected into a vein in your arm before the mammogram is taken. The dye highlights any areas of your breast that we might need to investigate further.

Why do I need a CEM?

CEM is part of your breast assessment. It gives us more detailed information than just using standard mammography as seen below. The image shows the lesions in the breast brighter on the CEM image than a standard 2D mammogram.

What happens during a CEM?

• When you arrive at the clinic you will complete a short questionnaire. This is to check you can have the test. The mammographer will then call you into the X-ray room and explain the procedure to you.
• When you are ready, a small needle attached to a flexible plastic tube (cannula) will be placed into a vein in your arm. The cannula will be used to inject the contrast. This may cause a warm sensation for a short while.
• You will then be asked to undress from the waist up.
  • Deodorant, antiperspirant, and talcum powder may affect the quality of the X-ray, so please do not use them on the day of your appointment. Or you can wash them off before the mammogram is taken.
• The mammographer will position your breasts, one at a time, in the mammogram machine. They will apply some compression and take the X-rays. The compression may be slightly uncomfortable but should not be painful, and is needed to get the best images.
• Mammograms will be taken of each breast from different angles.
• When the X-rays have been taken, can get dressed and return to the waiting room. You will be asked to stay in the department for around 30 minutes to make sure you are safe to go home. We will then remove the cannula from your arm.

How long will the test take?

The test itself should take no longer than 30 minutes. You will be in the department for about an hour.

Will I be able to resume my normal activities right away?

You can eat and drink normally and return to your usual activities straight away. You can continue with your normal medication as usual.

You are advised to drink plenty of fluids after a CEM test.

When can I expect my results?

The image will be reviewed by the radiology team, who may make further recommendations. You might need further tests, for example an ultrasound scan and/or a biopsy. Your consultant will tell you when you will receive the results of any tests you have, and if we need you to attend for any further investigations.

What are the risks of having a CEM?

• Radiation - All X-rays involve radiation. A mammogram uses very small doses of radiation but the benefit of detecting breast cancer at an early stage outweighs the risk of harm from the radiation exposure. The radiation dose from a CEM is slightly higher than a standard mammogram but is still well within the accepted safety guidelines.
• Allergic reaction - the contrast is safe and usually has no after-effects. A small number of people can have an allergic (anaphylactic) reaction or other side-effects. This can happen as soon as the contrast is injected or up to a day later.
  • Reaction to the contrast dye may include, nausea (feeling sick), vomiting, headache, a rash, and itchy skin. You may also feel lightheaded or faint, breathing difficulties, wheezing, a fast heartbeat (tachycardia), clammy skin, swelling, abdominal pain.
  • The mammographers are trained to recognise these reactions. We will check whether you have had any allergic reactions in the past before we give you the injection. If you are concerned you are having a reaction after leaving the department, please seek urgent medical advice or attend A&E.
• The dye we use for the test can affect the kidneys. This is uncommon, affecting less than 1 in every 100 people. To reduce the chances of this happening, we will not offer you the test if you have any of the risk factors listed below:
  • You are pregnant.
  • You are allergic to iodine.
  • You have renal (kidney) failure.
  • You have diabetes and/or take metformin.

After CEM

• Please drink plenty of fluids.
• Be aware of signs of allergic reactions detailed above. If you are worried you are having a reaction after leaving the department please seek urgent medical advice or go to the Emergency Department.

Who can I contact for further information?

If you have any further questions about anything covered on this page, please contact the breast admin team on:

• 0117 414 7000 (09:00 and 17:00, Monday to Friday)

They will be able to connect you with someone who can answer your question.

© North Bristol NHS Trust. This edition published January 2026. Review due January 2029. NBT003818

Infection Sciences Information

The Department of Infection Sciences is a collaboration between the North Bristol NHS trust and UK Health Security Agency to provide a hospital-based service for the laboratory diagnosis and clinical management of microbial diseases for patients both in hospital and the community, together with advice on the control of infection.

Laboratories participate and perform well in national quality assurance schemes and is fully accreditied. They are accredited for training with the Institute of Biomedical Science and registration with the Health Care Professions Council and the Royal College of Pathologists.

Medical microbiologists are available, both during the day and out-of-hours, to give advice concerning the diagnosis, treatment, and monitoring of infectious diseases. Where appropriate, preliminary reports and results are phoned to the clinician concerned. Ward rounds are conducted daily to review and offer advice on the management of inpatients with serious infections.

An active Infection Control Team is available at all times to help with matters relating to the control and prevention of infection.

UKHSA Terms and Conditions for the supply of goods and/or services Terms and conditions for the supply of goods and/or services - GOV.UK.

Useful Documents

Mycology Reference Laboratory service user handbook

User Survey:

This information will help you prepare for your Pelvic Health Physiotherapy appointment. Thank you for your patience waiting to access this service. 

What to expect

Your appointment will be in a private treatment room. During your session, your physiotherapist will:

• Ask questions to understand your concerns, symptoms, and what matters most to you.
• Discuss your medical history, recovery, and daily life.
• Explore symptoms such as pain; leaking of wee, wind or poo (incontinence); or heaviness/ bulge.
• Decide if it may be helpful to check your pelvic floor and do an examination. You may need to undress for this, but you don’t need to wear any special clothing to your appointment.
• Support you to return to activity and exercise.

Internal (vaginal or rectal) examination

This is where we check the inside of the vagina or rectum (bottom). Your physiotherapist may offer an internal examination to: 

• Check healing of any stitches or tears.
• Assess how your pelvic floor muscles are working (by doing “squeeze” and “relax” exercises).
• Look for any areas that may need further support or treatment.

Important information

• You do not have to have an internal exam.
• You can say no or change your mind at any time.
• Your physiotherapist will explain everything clearly and answer your questions.
• You can attend if you are on your period (menstruating).

Chaperones and support

You can have a chaperone during any physical exam if you would like. 

Chaperones can:

• Provide reassurance and support.
• Witness ongoing consent – that you agree to each part of the exam as it happens.
• Assist the physiotherapist if needed.

Chaperones can be formal or informal:

• A formal chaperone is a trained health professional or member of staff. Please tell us in advance if you would like a formal chaperone.
• An informal chaperone can be a partner, friend, or family member you can bring with you.

Attending with children

Babies and children are welcome. If you have an internal examination you may need to bring another adult to support or look after your child during this part of the session.

How to prepare

To get the most from your appointment we recommend you:

• Think about why you were referred.
• Consider what’s important to you about your symptoms.
• Bring a list of current medications.
• If you have bladder symptoms, please complete a bladder diary and bring it with you. Please tell us if you cannot print this yourself or need help understanding it. Some people prefer to write things down on paper or in a note on their mobile phone.
• Have a look at our information on the Pelvic Health Physiotherapy Service website including:
  • Information and videos in other languages.
  • A printable bladder diary on our What to expect page.

After the assessment

Your physiotherapist will discuss the findings and agree a template plan with you. This may include: 

• Advice and education.
• Exercises for recovery.

You will have time to ask questions.

If you need to cancel or reschedule

Your appointment is important. Please call 0300 555 0103 as soon as possible if you need to cancel.

• Note: If you cancel twice or don’t attend without telling us, you may be discharged from the service.

We look forward to seeing you and supporting your recovery. 

© North Bristol NHS Trust. This edition published January 2026. Review due January 2029. NBT003852

Aciclovir

Amikacin

Bedaquiline

Benzylpenicilin (Penicillin G)

Chloramphenicol

Ciprofloxacin

Colistin

Cycloserine

Daptomycin

Ethambutol

Flucloxacillin

Fluconazole

Flucytosine

Ganciclovir

Gentamicin

Isavuconazole

Isoniazid (+ N-Acetyl-Isoniazid)

Itraconazole

Levofloxacin

Linezolid

Meropenem

Moxifloxacin

Posaconazole

Rifabutin

Rifampicin

Streptomycin

Sulphamethoxazole in (Co-trimoxazole)

Teicoplanin

Tobramycin

Trimethoprim in (Co-trimoxazole)

Vancomycin

Voriconazole

Leukaemia and Non-Hodgkin Lymphoma Diagnosis and Monitoring

The laboratory provides a comprehensive service in the investigation of Leukaemia and Non-Hodgkin Lymphoma. Immunophenotyping provides additional information to morphology and cytogenetics in the diagnosis, classification and monitoring of these disorders.

HIV Monitoring
Immunophenotyping is used serially to monitor CD4 levels.

Investigation of Cellular Immunodeficiency Disease
Wrong choice of tests, especially in the paediatric setting, can mean rare cases of immunodeficiency are missed. Vital information includes type and site of infections, family history, other pathology results, X-rays and clinical features. Please refer to the Clinical Immunologists: ward or clinic referral is the ideal.

• Immunophenotyping identifies numerical defects in lymphocyte subsets, inherited or acquired, and are indicated in cases with recurrent viral, fungal or mycobacterial infection.
• PNH Testing performed on peripheral blood samples looking for the absence of GPI-linked proteins on neutrophils, monocytes and red blood cells.
• Functional Leucocyte Assays

These assays are technically complex and require prior discussion with the laboratory. Abnormalities are rare, most commonly due to poor sample quality, testing during drug therapy or intercurrent infection.  Abnormal findings should always be confirmed on a second sample.  True abnormalities may need further, more specialised tests to specify the disorder.

• Lymphocyte function studies are indicated in cases of recurrent viral, fungal and mycobacterial infections in whom no numerical lymphocyte defect has been defined. The investigation provides a measure of lymphocyte activation. Lymphocytes are cultured for 5 days with mitogens which mimic antigen activation.
• Neutrophil function studies screen for defects in the metabolic burst and adhesion molecules and are indicated in cases with recurrent fungal or bacterial infection with a normal neutrophil count (>1x109/1).A normal result excludes major defects in neutrophil function.

Quantiferon Assay

The QuantiFERON-TB test is an interferon gamma release assay (IGRA) used for the diagnosis of latent Tuberculosis (TB). The assay requires special blood tubes and has specific sample handling requirements. The laboratory can issue guidance and sample tubes to requestors. Interpretation of the result needs to be in the context of clinical history and other laboratory and clinical investigations.  The antigens used in the test are absent from all BCG vaccine strains of TB and from most known non-tuberculoid mycobacteria, it is possible to have a reactions to M. kansasii, M. szulgai and M. marinarum.  If such infections are suspected, alternative testing should be sought.

The QuantiFERON-TB test (and other TB IGRAs) may give false negative results in immunosuppressed patients. The laboratory provides a positive control tube for all tests to ensure the validity of results. Where the positive control fails (indeterminate result) the laboratory may suggest alternative testing. Please see guide below for interpreting indeterminate results.

Guide to interpretation

•    Negative: A negative result indicates that latent infection with M. tuberculosis is NOT likely. This result does NOT exclude active TB infection. The investigation of suspected active TB requires clinical, radiological and microbiological assessment.
•    Positive: A positive result is consistent with latent or active TB. This result may be due to exposure to M.tuberculosis complex (except M. bovis BCG), M. kansasii, M. szulgai or M. marinarum.  IGRA should not be used for the investigation of suspected active TB. The investigation of suspected active TB requires clinical, radiological, and microbiological assessment.
•    Indeterminate: The likelihood of the patient having M. tuberculosis infection cannot be determined from the blood sample provided. Please see the guide to interpreting indeterminate results below.

Quick guide to interpreting INDETERMINATE and EQUIVOCAL QuantifFERON-TB results

INDETERMINATE RESULTS

An indeterminate result from the QuantiFERON-TB assay means that the likelihood of the patient having M. tuberculosis infection cannot be determined from the blood sample provided.

The majority of indeterminate results are caused by a low T lymphocyte response to mitogen stimulation (reported as mitogen tube failure).  
This can be caused by:

•    An insufficient number of T lymphocytes in the blood sample. Is the patient immunosuppressed?
•    A functional inability of the patient’s lymphocytes to generate Interferon-gamma (IFN-γ) in response to mitogenic stimulation, for example if they are taking drugs that supress their immune system.
•    Reduced lymphocyte function due to improper sample handling.

Ideally repeat the QuantiFERON-TB test once with a fresh blood sample. If a mitogen tube failure is reported a second time, there is no value in repeating the QuantiFERON-TB test again until the underlying cause has been identified and resolved. 

Rarely a high background in the negative control (Nil) tube generates an indeterminate result. 
This can be caused by:

•    Excessive levels of circulating IFN-γ or the presence of heterophile antibodies in the sample. Stimulating the cells further as part of the QuantiFERON-TB test does not produce a further IFN-γ response.

Ideally repeat the QuantiFERON-TB test once with a fresh blood sample. If a high background is reported a second time, there is no value in repeating the QuantiFERON-TB test again until the underlying cause has been identified and resolved.

Other causes of indeterminate results can include:

•    Incorrect filling/mixing of the Lithium Heparin or QuantiFERON-TB tubes.
•    If the time between venepuncture and sample incubation in the laboratory is greater than 16 hours.

These indeterminate samples should be repeated using the correct sampling and handling procedures.

For further information please see:

https://www.qiagen.com/gb/tb-testing/what-is-quantiferon/how-does-qft-work/quantiferon-tb-test-result-interpretation

EQUIVOCAL RESULTS

An equivocal reference range of 0.2 – 0.7 IU/mL is now applied to the Q-TB results generated when subtracting the negative control tube value (NIL) from the TB1 and TB2 tube results: TB1-NIL and TB2-NIL.

Where both TB1-NIL and TB2-NIL results are within the equivocal range (0.2 – 0.7), or where one result is equivocal (0.2 – 0.7) and one is true negative (<0.2) the Q-TB results will be reported as EQUIVOCAL with the following interpretation applied:

The significance of this result is uncertain. The risk of progression to active TB disease is likely to be different when compared to patients with clear positive (>0.7) or clear negative (<0.2) results. Suggest repeat testing if clinically indicated; approximately one third of patients with equivocal results will revert to either a clear positive or clear negative result when a fresh blood sample is analysed within six months.

Why have we implemented an equivocal reference range?

Reversion and conversion of low positive (TB-NIL: 0.35 – 0.7) and high negative (TB-NIL: 0.2 – 0.34) Q-TB results on repeat testing is a well-recognised phenomenon. To address this issue, multiple European centres have proposed an equivocal range of 0.2 – 0.7 IU/mL [1-7]; conversion to true positive results have been shown to occur most frequently when the first Q-TB result is between 0.2 – 0.35 IU/mL, and reversions to a true negative result have been shown to occur more frequently when the initial result is between 0.35 – 0.7 IU/mL [5].

The Royal Free hospital in London has implemented this equivocal range in line with other low-incidence TB European settings [6].  Data from the Royal Free lends support to the use of the equivocal range for the reporting of Q-TB results; ~1/5th of their results that fell just below the 0.35 cut-off were positive when repeated on a fresh blood sample, and half of those just above the 0.35 threshold were negative when repeated on a fresh blood sample. This data strongly implies that relying on results within the equivocal range could result in either over-treatment or under-treatment of patients.

1. Torres Costa J, Silva R, Sa R, et al. Serial testing with the interferon-gamma release assay in Portuguese healthcare workers. Int Arch Occup Environ Health 2011; 84: 461–469.
2. Schablon A, Harling M, Diel R, et al. Serial testing with an interferon-gamma release assay in German healthcare workers. GMS Krankenhhyg Interdiszip 2010; 5: Doc05.
3. Schablon A, Diel R, Diner G, et al. Specificity of a whole blood IGRA in German nursing students. BMC Infect Dis 2011; 11: 245.
4. Ringshausen FC, Schablon A, Nienhaus A. Interferon-gamma release assays for the tuberculosis serial testing of health care workers: a systematic review. J Occup Med Toxicol 2012; 7: 6
5. Nienhaus A, Ringshausen FC, Costa JT, et al. IFN-gamma release assay versus tuberculin skin test for monitoring TB infection in healthcare workers. Expert Rev Anti Infect Ther 2013; 11: 37–48.
6. Brown J, Kumar K, Reading J, et al. Frequency and significance of indeterminate and borderline Quantiferon Gold TB IGRA results. Eur Respir J 2017; 50: 1701267
7. Hermansen TS, Lillebaek T, Langholz Kristensen K, et al. Prognostic value of interferon-gamma release assays, a population-based study from a TB low-incidence country. Thorax 2016; 71: 652–658.

Blood Transfusion

Telephone: 0117 4148350
On-Call Haematology BMS via bleep 9433

Autolab heldesk

Telephone: 0117 4148383
On-Call Haematology BMS via bleep 9433

Medical Staff

Dr A Whiteway
Consultant Haematologist
Head of Clinical and Laboratory Haematology
Via Haematology secretaries - Telephone: 0117 4148401

Dr Michelle Melly
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Dr M Kmonicek
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Dr Samreen Siddiq
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Dr Sophie Otton
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Dr Jaroslaw Sokolowski
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Dr Surenthini Salmon
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Dr Kiri Dixon
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Laboratory Staff

Mrs Allison Brixey
Blood Sciences Manager
Telephone: 0117 4148416

Mr Tim Wreford-Bush
Lead BMS Blood Transfusion
Telephone: 0117 4148363

Dr Karen Mead
Specialist Practitioner of Transfusion
Telephone: 0117 4148358

Mrs Grace VanDerMee
Lead BMS Haematology
Telephone: 0117 4148356

Mrs Halina Collingbourne
Quality Manager
Telephone: 0117 4148354

Anticoagulation Monitoring Service

Please note that this service has moved to Pharmacy.

Llinos Jones
AMS@nbt.nhs.uk
Telephone 0117 4148405
Contactable from Mon-Fri 09:00 - 17:00

Secretaries Office

Telephone: 0117 4148401
Email: HaematologySecretaries@nbt.nhs.uk

The clinical service is staffed with 8 Consultant Haematologists for interpretation and advice.  The technical and clinical service is provided by Biomedical Scientists (BMS), Clinical Scientists (CS), Associate Practitioners (AP) and Medical Laboratory Assistants (MLA).  In 2024 the laboratory processed 600,000 full blood counts, 250, 000 HbA1Cs & 100,000 clotting requests, with 10% growth each year. Haemoglobinopathy testing is also undertaken, including sickle cell and thalassaemia (SCT) screening for the antenatal and newborn programmes.

The Blood Transfusion laboratory issued over 13,000 blood components and processed 50,000 group and save samples. It also supports the Adult Major Trauma Centre at NBT and provides blood components to two air ambulances for the prehospital setting.  

The department has been approved for BMS training by the IBMS and our Trainee BMS staff are trained in accordance with the IBMS and HCPC regulations. Our qualified staff (CS and BMS) are required to be registered with HCPC. The department is also accredited to train staff undertaking the STP and HSST programmes with the National Science Healthcare school.  There is active encouragement for staff to follow further education courses, such as MSc (Haematology) and management qualifications.

The Department has a dedicated Quality Manager who is responsible for maintaining accreditation and compliance to ISO 15189 and BSQR (https://www.nbt.nhs.uk/severn-pathology/quality/pathology-accreditation-status) . The department participates in all appropriate External Quality Assurance Schemes accredited to ISO 17043 (https://www.nbt.nhs.uk/severn-pathology/quality/external-quality-assurance) for which performance is closely monitored.

Clinical Head of Service
Dr Alastair Whiteway

Blood Sciences Manager
Mrs Allison Brixey