Biochemistry

Latest news from the Biochemistry department

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

29
May
2014

Laboratory Information System Migration

Laboratory Information System Migration
In order to bring systems in line with the restructured laboratory services the Laboratory Medicine directorate will be migrating to new Laboratory Information System Databases for Blood Sciences and Microbiology.
 
The migration is due to commence at 8am Monday 2nd June.
 
No downtime is anticipated but there may be some temporary disruption as the migration progresses.
 
The Blood Sciences System will replace what is currently the separate disciplines of Chemistry, Haematology and Immunology as a single department. As such the ICE Reporting System will display reports as Blood Sciences (Orange highlighting).

Categories: Blood Sciences, Microbiology, Cellular Pathology, Haematology, Immunology, Biochemistry, General

14
February
2014

Important Notice re PTH analysis

Abbott Diagnostics withdraws PTH assay with Immediate Effect

Important Notice re PTH analysis
Dear Colleague,

Product Recall: Parathyroid hormone (PTH) test

Abbott Laboratories who supply our major laboratory biochemistry analysers and the reagents for the majority of the tests we run on these machines, have issued a global product recall for their parathyroid hormone (PTH) test. We received an initial warning of this recall by phone on 13th February and written confirmation and further details this morning. We have been instructed to stop using their PTH assay immediately and destroy our current stocks of reagent.

Written by: Craig Webster 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

29
May
2014

Change to Thyroid requesting

Change to Thyroid requesting

As of 27th May 2014 TSH only will be the frontline test for investigating Thyroid function. If the TSH is <0.35 mU/L or >4.9 mU/L a fT4 will be automatically added on to the request. If the TSH is <0.1 mU/L fT3 will also be added. The reason for this is to encourage more appropriate use of the thyroid tests. If you have any queries or concerns please contact the duty biochemist (bleep 2506).

Written by: Craig Webster Categories: Blood Sciences, Biochemistry

04
March
2014

PTH Update

PTH Update

From 27th February 2014 we will be resuming a PTH service from Heartlands using the Roche intact PTH assay (iPTH).  It is difficult to directly compare results determined from the previous Abbott assay to the Roche assay as the Abbott method had a significant positive bias with respect to Roche, therefore you should expect slightly lower results now.  The reference range for iPTH on the Roche assay is 1.6-6.9 pmol/L. 

 

Analysis will be batched daily, Monday-Friday.  As previously plasma from EDTA samples is the preferred sample type.  If there is a need for an urgent PTH the current process of contacting the duty biochemist/duty consultant will continue and the urgent pathway implemented. If there are any queries clinicians should contact the duty biochemist/duty consultant.

Written by: Craig Webster Categories: Blood Sciences, Biochemistry

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