IENFD for Small Fibre Neuropathy
In May 2021, the Department of Clinical Neuropathology became part of an NHS/industry joint venture. The laboratory operations are now under the management of Synnovis LLP (a partnership between Guy’s and St Thomas’ and King’s College Hospital NHS Foundation Trusts, and SYNLAB UK & Ireland).
The department receives more than 200 cases per year for Intra-Epidermal Nerve Fibre Density (IENFD) analysis using 3mm punch biopsies of skin. The technique provides a highly sensitive and specific tool for the diagnosis of a common subtype of neuropathy called small fibre neuropathy.
Please note that the protocol below is for sending skin biopsy samples for IENFD analysis. Please call the laboratory on 020 3299 1957 for instructions when sending samples for other investigations (e.g. Lafora Body histology).
1. Phone us in advance
The department is able to provide a special PLP fixative solution kit. Other fixatives are not suitable for IENFD analysis. Should you require a fixative kit please contact the Neuropathology Laboratory at King’s College Hospital on 020 3299 1957 at least two days before performing the biopsy. If there is no answer, then phone the department office on 020 3299 1955 and leave a message. The department is open from 8.30am to 5pm, Monday to Friday. Kits are sent by Royal Mail Special Delivery to arrive by 1pm the next day.
Please phone the department as soon as possible to notify them of any changes or cancellations.
2. How to take biopsies
Unless specifically indicated/contra-indicated by the patient’s condition, the 3mm punch biopsy of the skin should be obtained from the leg (10cm above the external malleolus). Immediately immerse the biopsy into freshly prepared 2% PLP fixative in a universal container and prepare the sample for urgent transportation, preferably by courier, to the laboratory to be refrigerated. The tissue should spend no longer than 24 hours in the fixative, as extended or warm fixation can affect the analysis. Please note that the department is closed at weekends.
3. How to package and transport the sample
Clinical details, plus any other useful information, must accompany the sample. A request form will be provided.
Samples must be packed carefully to meet legal requirements. Fixed human tissue can be classed under the category of non-pathogenic or inactivated human tissue and can be transported as ‘Exempt Human Specimens’. The packaging must consist of:
- a primary receptacle
- a leak-proof secondary packaging
- an outer packaging with minimum dimensions of 100x100mm and marked ‘Exempt Human Specimens’.
It is the sender’s responsibility to comply with these regulations. PLP Fixative kits which include suitable packaging are available on request.
Mark the package as:
‘Urgent sample from for Department of Clinical Neuropathology, 1st Floor, Academic Neuroscience Centre, King’s College Hospital, Foundation NHS Trust, Denmark Hill, London SE5 9RS. Telephone: 020 3299 1957’
Tell the courier that the Academic Neuroscience Centre is located on Denmark Hill. There is a buzzer entry system and they will need to press the button marked ‘Clinical Neuropathology’. The secretary will then direct them to the laboratory on the first floor. Please phone the laboratory on 020 3299 1957 when the courier has left your hospital. If the courier has difficulty finding the department, or nobody answers the buzzer, they should phone the laboratory for local directions or so someone from the laboratory can meet them at the entrance to the building.
If you have any difficulties or questions, in the first instance contact Peter Bannister on 020 3299 1957. Alternatively, phone Lawrence Doey, Laboratory Manager, on 020 3299 1951.