Guidelines for the prioritisation of laboratory genomics services during the Covid-19 pandemic - click to read

On 26 March 2020, NHS England and NHS Improvement wrote to all NHS Genomic Medicine services in response to COVID-19 to provide advice on the prioritisation of work to ensure the continued delivery of urgent and essential genomic testing and to enable the release of genomic laboratory capacity to support COVID-19 testing, where needed.

Until further notice, services should be directed to those groups of patients with urgent needs. This will include:

  • pregnant women undergoing prenatal diagnosis;
  • patients needing urgent advice on carrier testing relating to pregnancy, examples include cystic fibrosis, thalassaemia; 
  • those with abnormal fetal scans; critically ill neonates and children requiring assessment and those for whom the rapid PICU/NICU Whole Exome Sequencing (WES) is appropriate;
  • conditions where rapid genetic testing may alter clinical treatment or decision making especially in patients with cancer; 

Please see table 1 below which provides details of those services that have been prioritised by NHSE.

We will continue to process and test all samples received for urgent testing (Green and Amber in table 1). If possible, please avoid sending non-urgent (Red) samples to the laboratory until further notice. Any non-urgent samples received will be processed (DNA/RNA extraction or cell culture) and stored and are unlikely to be tested for some time.

Clinicians must notify the lab when sending a sample from a known or suspected COVID-19 patient; such samples should be clearly labelled with a ‘Danger of Infection’ or ‘High Infection Risk’ sticker. Failure to do so will put the laboratory staff at increased risk.

We can only accept buccal or saliva samples in exceptional circumstances until further notice (i.e. where there is an urgent clinical need and an alternative sample is not possible). In these circumstances please contact the laboratory prior to sending the sample bwc.genetics.lab@nhs.net .

We would like to take this opportunity to thank our service users for their patience and continued support during this challenging time.

Table 1. NHSE prioritisation of genomic testing during COVID-19 pandemic.

Key to RAG rating

Green

Continue

Amber

Partial stop

Red

Only continue if there is laboratory resource available over and above that required to support   COVID-19 testing

Cancer somatic genomic services

RAG rating for pandemic

Rationale for RAG

Further details

All clinically appropriate testing to inform diagnosis

Green

Urgent cancer service

 

All clinically appropriate testing to inform therapy choice and patient management

Green

Urgent cancer service

 

Urgent minimum residual disease monitoring e.g.  acute leukaemias

Green

Urgent cancer service

 

Other minimum residual disease monitoring e.g. non urgent chronic myeloid leukaemia

Amber

Cancer service

When clinically safe to do so, consider reducing frequency of testing or extending turnaround times

Chimerism testing for stem cell transplant monitoring

Amber

Cancer service

Testing for myeloproliferative neoplasms

Amber

Cancer service

When clinically safe to do so, consider extending turnaround times

Rare disease genomic services

RAG rating for pandemic

Rationale for RAG

Further details

All prenatal diagnosis

Green

Urgent diagnostic service

 

Urgent carrier testing relating to pregnancy; e.g. cystic fibrosis, thalassaemia etc.

Green

Urgent diagnostic service

 

Testing to inform urgent management, transplantation or therapy e.g. neonatal diabetes and congenital hyperinsulinism testing, BRCA testing to inform chemotherapy options etc.

Green

Urgent diagnostic service

 

Rapid exome sequencing for NICU/PICU

Green

Urgent diagnostic service

 

Genomic testing to support New Born Screening Programme e.g. cystic fibrosis, MCADD

Green

Urgent diagnostic service

 

All other rare disease testing

Red

Diagnostic service

Any samples received should be processed and stored appropriately for testing at a later date.

 

COVID-19 buccal swab and saliva sample acceptance update - click to read

During the COVID-19 pandemic we have taken the decision to only accept buccal swab and saliva samples in exceptional circumstances where there is urgent clinical need and there was no option to take an alternative sample type.  For non-urgent testing please consider postponing sample collection or taking an alternative sample type.​

Guidance for genetic testing in haem-malignancy during the COVID-19 pandemic - click to read

West Midlands Regional Genetics Laboratory

We provide comprehensive genetic testing services (many of which are UKAS ISO 15189:2012 accredited) to NHS patients within the West Midlands region, private consultants and hospitals and other healthcare institutions both nationally and internationally. We currently receive in excess of 55,000 samples from patients every year, and this number is growing all the time.

With more than 200 scientific, technical and support staff, we are the largest genetics laboratory in the UK. Using the most up-to-date technologies and equipment, we are able to bring you accurate answers and we work hard to continually improve our reporting times.

Genetics in medicine is rapidly growing with a focus on the translation of information and techniques from cutting-edge research into robust clinical tests. We work closely with our clinical genetics counselling service so that patients receive suitable advice both before and after testing.

The laboratory is aligned with patient pathways, with two over-arching clinical programmes both of which provide integrated cytogenetic and molecular genetics services:

  • Germline Genetics Programme
  • Cancer Genetics Programme

The laboratory performs a comprehensive range of genetic tests ranging from single gene disorders to whole chromosome aneuploidy. Our Germline Genetics Programme provides testing services including prenatal testing for at-risk pregnancies, postnatal testing for conditions such as developmental delay and infertility, and specific testing for a variety of syndromes and single gene disorders. Our Cancer Genetics Programme testing services include blood and tumour cancer diagnosis and prognostic stratification, monitoring of treatment response and surveillance, and post-transplant chimerism monitoring.

Referrals

If you are a clinician looking to make a referral to our service, please use our germline genetic test referral form.

To make a request for a DNA sample to be sent to another laboratory please use our DNA sample export form.

If you are a clinician looking to make a referral for cancer studies, please use our cytogenetic referral and molecular referral forms.

Criteria for the rejection of specimens

In order to provide a high standard of testing, we need to ensure that the specimens we receive into the lab are of an optimal quality. Please read our criteria for the rejection of samples that must be met when a referring centre sends samples to the West Midlands Regional Genetics Laboratory for testing.

Please see the controlled document for criteria for rejection of samples.

Contact details

For further information on any of the services provided please email bwc.genetics.lab@nhs.net.

Videos

Find out about genomics in medicine and how the patient pathway in genomics is organised in the NHS with our Clinical Scientist in Genomics Florentina Sava. 

Find out what our staff love about working in Genetics in this video filmed for Healthcare Science Week 2020: