Latest News

  • 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:
    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)

  • Apixaban & Rivaroxaban

    Apixaban & Rivaroxaban

    Item Author Mark Hill

    Haematology are now offering assays to measure the new oral anticoagulant drugs Apixaban and Rivaroxaban. Both drugs are direct factor Xa inhibitors. Apixaban is recommended by the National Institute for Health and Clinical Excellence for the prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation and at least one of the following risk factors: prior stroke or transient ischemic attack, age 75 years or older, diabetes mellitus, or symptomatic heart failure. Apixaban and other newer anticoagulants (dabigatran and rivaroxaban) appear equally effective as warfarin in preventing non-hemorrhagic stroke in people with atrial fibrillation and are associated with lower risk of intracranial bleeding. For further information please contact the laboratory on 0121 424 0908 (internal ext 40908) or for clinical advice please contact the On Call Haematologist via switchboard.


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. 


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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Tumour Marker Use in Primary Care

Written by Craig Webster on .

In the last 5 years requests for tumour marker tests from Primary Care have more than doubled. This high use in Primary Care is worrying because the majority of tumour markers (eg. CEA, CA19-9) are neither specific nor sensitive enough for use in the diagnosis of malignancy. See this link for a summary of the main tumour markers, their uses and limitations.

The main use for tumour markers is in monitoring disease progression, treatment or recurrence of a histologically diagnosed cancer. A recent audit of Primary Care requests for tumour markers found that only 9% of CEA and 4% of CA19-9 were requested for these reasons; the rest being for non-specific symptoms.

In contrast to the above, CA125 and PSA do have use in diagnosis of their related cancers, however it should also be noted that these are still only a diagnostic aid and should be used with caution as both can be raised in a number of other benign conditions (see table). Please click the relevant links below of links to guidelines relating to their use in Primary Care.

CA125 link

PSA link

For symptoms and referral guidelines of other malignancies see the NICE Suspected Cancer Recognition and Referral guidelines.

You can also use the search bar or test database on this website to find more specific information on the use of each tumour marker.

Tumour marker

Main application

Other tumour elevations

Other limitations


Monitoring colorectal adenocarcinomas

Breast, lung, gastric, mesotheliomas, oesophageal and pancreatic

Raised in smokers

Raised in other benign renal, liver, lung or GI disease

Poor sensitivity in early disease and may be absent/low in poorly differentiated tumours


Monitoring pancreatic carcinoma


Raised in obstructive jaundice, cholestasis, cirrhosis, pancreatic hepatitis and non-malignant GI disease.

Not present in those negative for the Lewis blood group determinant.


Monitoring ovarian carcinoma


Raised in patients with ascites, pleural effusions or free fluid in the pelvis

Raised in patients with congestive heart failure

Raised in benign renal and liver disease and other adenocarcinomas

Mildly raised in menstruation and the first two trimesters of pregnancy

Can be raised in endometriosis


Monitoring breast cancer

Lung, colon, ovary

Raised in benign liver, breast, ovarian disease


Diagnosis and monitoring of hepatocellular carcinoma and germ cell tumours

Gastric and other GI (oesophageal, pancreatic)

Raised in pregnancy and neonates

Raised in benign liver disease


Diagnosis and monitoring of prostate carcinoma


Also elevated in benign prostatic conditions

Increases with age (as prostate size increases)

Elevated in UTI, catheterisation, prostatitis or other prostate manipulation


Diagnosis and monitoring of germ cell tumours and gestational trophoblastic neoplasia


Raised in pregnancy

Transiently elevated with cannabis use


Diagnosis and monitoring of germ cell tumours


Elevated in cardiac disease and benign liver disease

Elevated in some anaemias relating to non-malignant disease