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  • Troponin testing in suspected ACS patients at HEFT

    Troponin testing in suspected ACS patients at HEFT

    Item Author Craig Webster

    The Trust guidance on Cardiac Troponin testing has been revised in line with the European Society of Cardiology guidance.

    This process will be in place from 10th October 2016 and will be subject to audit. The trust uses gender specific Troponin results – for Males <34ng/l and for Females <16ng/l are considered to be within normal range.

    The main change is that patients with chest pain >6hrs ago, and remaining pain free during their hospital attendance, will only require a single troponin in order to exclude an ACS. If the hs-TnI is undetectable, risk stratification is also favourable and the patient is pain free then the patient can be considered for discharge with arrangements for outpatient investigation if appropriate.

    Paired troponin samples should still be sent at 0h and 3h for patients with onset of chest pain within the last 6 hrs or with ongoing chest pains whilst in hospital.

    The ICE requesting system will incorporate a prompt box to ask clinicians to clearly specify if the request is for a single or paired troponin. There will also be a reminder message on the results screen of the Troponin results.

    The flowchart below summarises this change and is a reminder of the role troponin plays in the suspected ACS pathway. 

    New Flow ChartNew Flow Chart

  • Faecal Calprotectin and Local IBS Guidelines

    Item Author Emma Evans

    Faecal Calprotectin (FCAL) is a protein that is released into the intestines in excess when there is any inflammation. Many people with irritable bowel syndrome (IBS) have unnecessary invasive hospital investigations before their condition is diagnosed. Use of FCAL testing may lead to a reduction in the number of investigations being requested for people with a high likelihood of an IBS diagnosis. This will:

    • Improve the patient experience for those with IBS and reduce the number of patients undergoing invasive procedures within secondary care.

    • Reduce outpatient referrals into secondary care.

    • Increase the numbers accessing rapid diagnosis for IBS/IBD.

    • Improve pathways for the management of IBS.

    • Provide a structured programme to aid decision making in primary care.

    FCAL testing is recommended by NICE as an option to help doctors distinguish between inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis, and non-inflammatory bowel diseases, such as irritable bowel syndrome.

    The new IBS local pathway has two options for a patient i.e. if they are suffering from constipation then they are referred into the IBS pathway 2 (diet, medication physical activity etc). If a patient is suffering from diarrhoea then they will follow the IBS pathway 1 and be tested for FCAL. Only if the FCAL concentration >150 ug/g is the patient referred into the Inflammatory Bowel Disease Clinic (IBD). If the FCAL concentration is <60 ug/g they are referred onto the IBS pathway 2 and if the concentration is between 60 and 150 ug/g then the test is repeated after a 4 week interval. Please see flow charts below.

  • Group and Save - Two Sample Rule

    Group and Save - Two Sample Rule

    Item Author Mark Hill

    With effect from 1st September 2016, Blood Bank are introducing the two sample rule for requests for blood and blood components (blood, fresh frozen plasma, cryoprecipitate, platelets, granulocytes).

    What is the two sample rule?

    Blood Bank need to ensure that there are two distinct samples from a patient that have generated the same blood group from both samples. If Blood Bank have seen the patient before and already have a historic blood group (after 20th October 2015) then you only need to make a request for group and save or X-match as you normally do. If the patient has no previous records in Blood Bank then you MUST repeat the group and save or X-match with a second sample.

    Why is this rule being introduced?

    Wrong blood in tube (WBIT) is a 'never event', it should not happen, however on occasions it does. The consequences of transfusing somebody with blood of the incorrect blood group is very serious and can lead to death. WBIT is a SHOT (Serious Hazards of Transfusion) reportable  incident. The two sample rule is a national guideline to improve patient safety when receiving transfusions.

    How does the two sample rule work?

    If the patient is not known to Blood Bank then the two sample rule is invoked. The two samples must come from separate venepuncture events and ideally should be carried out by two different people. Separate request forms should be completed for each sample. It is NOT acceptable to take two samples at one venepuncture event and send them to Blood Bank on separate request forms. This will not negate the possibility of WBIT. There is no limit on the time between samples as long as Blood Bank have a historic blood group on record after 20th October 2015.

    How will I know if a second sample is required?

    If you are unsure if Blood Bank already have a historic blood group you can check iCare or ICE for requests after 20th October 2015. If you are still unsure then please telephone Blood Bank on 40706 (BHH), 47279 (GHH) or 44527 (Sol).

    What happens in an emergency situation?

    If blood is required in an emergency eg massive bleed procedure invoked, the two sample rule will not apply however a second sample should be sent as soon as possible. Blood will be issued as per the massive bleed procedure and will not be delayed.

     

  • Change to Haematology Reference Ranges

    Change to Haematology Reference Ranges

    Item Author Mark Hill

    Please note from June 1st 2016 the reference ranges for the full blood count will be changing, the most notable of which include haemoglobin, red cell count and neutrophil count.
    New ranges:
    RBC Male 4.3-5.7 *1012/L
    Female 3.7-5.1*1012/L
    Hb Male 133-166 g/L
    Female 110-147g/L
    Neutrophils 1.5-4.7 *109/L

     

    The Erythrocyte Sedimentation Rate (ESR) reference ranges will also be changed from June 1st to reflect the new method used in the laboratory. These are as follows:
    Age
    2-14   2-34
    15-50 (Female) 2-39
    15-50 (Male) 2-30
    51-70 (Female) 2-45
    51-70 (Male) 2-44
    >70 3-55

     


    For more information regarding these changes please  contact the laboratory on extension 40908

     

     

  • Change to Feto-Maternal Haemorrhage (FMH) Anti-D Calculation

    Change to Feto-Maternal Haemorrhage (FMH) Anti-D Calculation

    Item Author Mark Hill

    From 25/04/16 we have adjusted the way Anti-D is calculated in our FMH screen by flow cytometry. The bleed is still reported in millilitres as previously however the suggested dose of Anti-D required to cover the bleed also takes into account the uncertainty of measurement of this technique in our laboratory. This may result in a slightly higher dose than expected but will ensure that bleeds are appropriately covered, especially those requiring multiple injections. For further information click here or contact the laboratory on 0121 42(40704)

Introduction

Written by Craig Webster on .

This handbook encompasses all disciplines of Laboratory Medicine at Birmingham Heartlands, Solihull and Good Hope Hospitals. It has been designed to provide the busy general practitioner and hospital doctor more readily available information regarding our services. 

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You can search or browse our test directory here. This database includes details on all our tests and recommended profiles for the investigation of common presenting complaints.
 

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