Biochemistry

Latest news from the Biochemistry department

10
May
2018

Notification of Assay Change: CA19-9

In light of the recent merger between Heart of England Foundation Trust and University Hospitals Birmingham, and in order to consolidate the tests we provide as a trust, CA19-9 samples will now be analysed at the Queen Elizabeth Hospital pathology laboratory.

There is no change to specimen handling instructions or reference ranges. Serum separator tubes (SST) is the recommended sample type.

For further information please do not hesitate to contact us: Duty Biochemist: Telephone: 01214242193 or Bleep: 2506

Categories: Biochemistry

01
March
2018

Changes in Renin and Aldosterone Service

Due to difficulties in obtaining sufficient kit supplies for our Renin workload, it is with regret that we will no longer be able to offer the measurement of Renin, and subsequently Aldosterone , from this laboratory.

We have been working closely with our colleagues at University Hospital Birmingham (UHB) and will be sending work there from the 28/2/2018. The Renin assay provided by UHB is an Immunoassay method (IDS iSYS) for renin mass with reference ranges comparable to the ones used at Heartlands.  See attached information.  The aldosterone method is a comparable assay by LC/MSMS.

The UHB laboratory is a UKAS accredited laboratory.  The aldosterone assay is already UKAS accredited and the Renin immunoassay will be assessed by UKAS as part of their next extension to scope application.

The aldosterone assay is in essence identical to the one used at Heartlands. It is a mass spec method and should have the same characteristics. The http://www.heftpathology.com/item/aldosterone.html information should be applicable.

There will be a slight change in the ratio cut offs used to take into account the renin method. We will be using the Endocrine guidelines ranges and use the 91 cut off with and Aldosterone greater than 750 as a “screen” positive interpretation. This is taken from the Endocrine guidelines on the investigation of Conns. https://academic.oup.com/jcem/article/93/9/3266/2596343

From a sample processing point of view continue to send the samples to Heartlands and we will  transport the samples to UHB.

Please contact the lab or duty biochemist if you have any queries

Categories: Biochemistry

27
September
2017

Notification of change: Measurement of Methotrexate

From Monday 2nd October samples for Methotrexate measurement will be analysed in the Department of Clinical Chemistry at Heartlands Hospital rather than sent away to UHB.

By bringing this test in house we hope to provide better support for our clinical colleagues by turning around these very urgent samples within 4 hours.

Methotrexate analysis will be available 24 hours a day, 7 days a week. Please contact the laboratory (41185 / 0121 424 1185) and ask to speak to a biomedical scientist or biochemist before sending a specimen to ensure that your sample is dealt with promptly.

**** There will be no change to specimen type or volume required***

The new assay is awaiting accreditation and will be assessed by UKAS against ISO 15189 standard at our next  inspection in October.

Categories: Biochemistry

09
January
2017

Notification of Assay Change: Vitamin D

We are changing our Vitamin D method to the Abbott Total 25OH-Vitamin D method from Monday 16th January 2017. This is to allow us to process more rapidly the very large number of requests for vitamin D.

Reference ranges and specimen requirements will not change.

The circulating form of vitamin D is hydroxylated colecalciferol (vitamin D3). Most patients with vitamin D deficiency are also treated with vitamin D3, but a small number of patients are given ergocalciferol (vitamin D2) instead. Since the Abbott method cannot detect vitamin D2 in equimolar concentrations (up to 50% under-recovery), those given ergocalciferol will require their serum vitamin D levels to be measured using the mass spectroscopy method.

The mass spectrometry method can be requested for patients on D2 using ICE requesting. If ICE requesting is not available, please use the clinical details section to document this or alternatively request “VITDMS” in the tests request section.

All paediatric samples will be run on the mass spectrometer due to the smaller sample volume requirements on this method.

The new abbott Vitamin D assay is awaiting accreditation and will be assessed by UKAS against ISO 15189 standards at our next annual inspection.

For further information about vitamin D and the methods we offer please visit the test database. If you have any queries relating to this notice, please do not hesitate to contact us: Duty Biochemist: 0121 424 2000 (Bleep 2506)

Categories: Biochemistry

17
October
2016

Faecal Calprotectin and Local IBS Guidelines

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.

 

Categories: Clinical Advice, Blood Sciences, Biochemistry

26
October
2015

PTH Update (From 21st December 2015)

From Monday 21th Decemeber we will no longer be provide dual reporting of PTH results. HEFT will provide PTH measurements using the Abbott Architect assay only. Please take note of the new method specific reference range for PTH.

Reference Interval (Abbott): 1.6 – 7.2 pmol/L

 

Note: There will be no change to specimen handling instructions. EDTA plasma is still the recommended sample type.

If you have any queries or comments please contact Craig Webster (Clinical Lead for Blood Sciences) by email or the Duty Biochemist on Bleep 2506.

Note re accreditation status. This PTH assay is currently not on our UKAS accreditation scope.

Tests not appearing on this scope are either under consideration or in the process of accreditation. However, these tests have been validated to the same high standard as accredited tests and are performed by the same trained and competent staff. 

Written by: Craig Webster Categories: Clinical Advice, Biochemistry

15
September
2015

Update on Vitamin D analysis

update: 15/09/2015

Update on Vitamin D analysis

The vitamin D equipment is now fixed and operational. We have now started working through our backlog. We estimate that our backlog is approx 28 days. If you require any further infomation, please contact the laboratory.

Written by: Craig Webster Categories: Blood Sciences, Biochemistry

10
June
2014

Notification of changes to CA19-9

On Wednesday 11th June the method for the CA19-9 assay at HEFT will change from the Siemens Immulite assay to the Roche assay. Our comparisons have shown that the results are comparable in most cases; however, there were some samples which did show a poor correlation.  We are therefore going to dual report results for a period to allow transition of serially monitored patients to the new CA199 assay.

Further more detailed information is available on request. If you have any queries or comments please contact Craig Webster (Clinical Lead for Blood Sciences) by email or ext 42930.

Written by: Craig Webster Categories: Blood Sciences, Biochemistry

17
April
2018

Notification of change: New NT-ProBNP assay

Firstly we would like to apologise for any delay in results you have recently experienced for NT-Pro-BNP. We have had ongoing issues with your current assay.

Abbott Laboratories, who supply our major laboratory biochemistry analysers and reagents, have released their new Alere NT-ProBNP assay. After careful evaluation, we have confirmed that the Alere NT-ProBNP assay is fit for purpose and we will move to measure NT-ProBNP on Wednesday 18th April 2018 .

Due to the assay being continuously available on the routine platform, there should be a dramatic increase in the turnaround times for these results.

There will be no change to reference ranges, with Chronic Heart Failure: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care: Partial Update (2010) still being used (see below).

>400 but <2000 ng/L: Refer for heart failure specialist assessment and echo (within 6 weeks)

>2000 ng/L: Refer urgently for heart failure specialist assessment and echo (within 2 weeks)

Note: there is no change to specimen handling instructions. Serum separator tube (SST) is the recommended sample type. Further information will be available on the test database

Categories: Blood Sciences, Biochemistry

02
November
2017

Delay in Renin Analysis

Dear Colleague,

Ref: Notification of delay in measurement of Renin mass

We have been experiencing supply and quality issues with the kits we use for the determination of Renin Mass. This has led to a back log of samples. Therefore, there will be a delay in reporting of results.

After working with our supplier, we have kits on order that should allow us to work through this backlog and we should be able to start reporting results by the end of next week (10th Of November)

We have samples stored safely and if any are required urgently we can prioritise analysis or send on to another laboratory.

Please accept our apologies and If you would like any further information please contact Craig Webster or Joanne Duffy

 

Best Wishes

Categories: Blood Sciences, Biochemistry

09
January
2017

Notification of change in service for the diagnosis of H Pylori Infections

Notification of change in service for the diagnosis of H Pylori Infections

The laboratories at HEFT are changing the way we diagnose H. pylori infections. Urease breath tests (UBT) and blood tests (helicobacter serology) will no longer be available from our laboratories with immediate effect. These tests are being replaced with a Stool Antigen Test (SAT).

Guidance released in 2012 on the management of H. pylori (Management of Helicobacter pylori infection—the Maastricht IV/ Florence Consensus Report) indicates that the SAT is equivalent to UBT in terms of diagnostic performance and does not require a hospital appointment like UBT. Helicobacter serology is also not recommended by updated PHE guidelines for most patients (PHE H. pylori guideline).

The stool antigen is reliable for both diagnosis and post eradication testing, provided the patient has avoided PPIs for 2 weeks and antibiotics for 4 weeks prior to sample collection.

A stool sample is required and samples must arrive in the laboratory within 48 hours of collection. Patients should be advised to bring the properly labelled stool sample in a blue topped sample pot (picture below) to the GP surgery or laboratory reception as soon as possible after collection, ideally same day or next morning.

If you have any queries relating to this notice, please do not hesitate to contact us:

Duty Biochemist:

Telephone: 0121 424 2000 (Bleep 2506)

Categories: Biochemistry

26
October
2016

Troponin testing in suspected ACS patients at HEFT

Troponin testing in suspected ACS patients at HEFT

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. 

 

Categories: Biochemistry

23
February
2016

24/7 Provision of Ethylene Glycol Measurement at Heartlands Hospital

24/7 Provision of Ethylene Glycol Measurement at Heartlands Hospital

From the 9th of February 2016, ethlene glycol measurement is available 24 hours a day, 7 days a week at Birmingham Heartlands Hospital.

Ethylene glycol is an odourless and highly toxic compound found in various household products. Cases of ethylene glycol poisoning are rare but often fatal unless treated promptly. Early recognition is thus critical for treatment and recovery of patients. Patients with ethylene glycol poisoning typically present in the acute setting with a high anion gap metabolic acidosis, altered mental status and acute kidney injury. Indirect testing of ethylene glycol ingestion (e.g. lactate, osmolar gap & anion gap), although potentially helpful, are not accurate estimators of the presence of ethylene glycol. Urgent, accurate measurement of ethylene glycol should be sought if ingestion is suspected. Measurement of ethylene glycol
has not always been readily available due to specialised methodologies required; and often comes at a prohibitively high price for access to these assays out of normal working hours.

We have therefore implemented a rapid, automated, cost effective assay for the measurement of ethylene glycol which is readily available 24/7.
GC-MS measurement of ethylene glycol and diethylene glycol is still available on specific request. 

Additional Information:
Please contact the laboratory (41185 / 0121 424 1185) and ask to speak to a biomedical scientist or biochemist before sending a specimen.

If you wish to discuss a particular patient please bleep the duty biochemist / toxicologist on 2506 or 3289 in work hours, or the on-call consultant via switchboard (0121 424 2000).

For external users, please send samples urgently via courier to: Pathology Reception, Birmingham Heartlands Hospital, Bordesley Green East, B9 5SS. Couriers should use the Yardley Green Road Entrance to the hospital. At night, vehicular access is limited but access on foot is available via the pedestrian gate.

Categories: Biochemistry

05
October
2015

Update on Vitamin D Analysis 5/10/2015

Update on Vitamin D Analysis 5/10/2015

The vitamin D equipment is now fixed and operational. We have now started working through our backlog. We estimate that our backlog is approx 21 days. If you require any further infomation, please contact the laboratory.

Written by: Craig Webster Categories: Biochemistry

14
September
2015

Delay in Vitamin D Analysis

Delay in Vitamin D Analysis

Date of update: 14/9/2015

We are experiencing a short delay in the processing and reporting of Vitamin D requests.

We hope to have this situation resolved in the next week and will be working through our backlog as quickly as possible. We will keep updating the web site with our progress.

This is due to problems with the equipment which we are working to resolve as soon as possible. 

If you would like to discuss this further or expedite the measurement of request please contact the duty biochemist on bleep 2506 or at This email address is being protected from spambots. You need JavaScript enabled to view it.

Written by: Craig Webster Categories: Blood Sciences, Biochemistry

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