Clinical Advice

  • Haematinic Guidelines

    HEFT Pathology Guideline Investigation and Referral Pathways for Anaemia in Primary Care

    Produced by:

    Dr Sukhbir Kaur (Senior Clinical Biochemist)

    Approved by:

    Dr Kartsios Charalampos (Consultant Haematologist)

     

    Dr Marcus Mottershead (Consultant Gastroenterology)

    This guidence covers the following areas

    1. Anaemia Testing in Adults

    2. Iron Deficiency Anaemia Testing in Adults

    3. Iron Deficiency Anaemia Treatment and Monitoring Advice

    4. Vitamin B12 Deficiency Testing, Treatment and Monitoring

    5. Folate Deficiency Testing, Treatment and Monitoring Advice

    6. Renal Anaemia Testing in Adults

    Read more

  • Clinical Decision Limits

    Phoning limits for biochemistry tests are as follows:

    Decision limits for phoning

      Below Above Units
    Sodium 120 150 mmol/L
    Potassium 3 6.5 mmol/L
    Urea   30 mmol/L
    Creatinine   500 umol/L
    Glucose 2.5 20 mmol/L
    Calcium adjusted 1.8 3.5 mmol/L
    Magnesium 0.4   mmol/L
    Phosphate 0.3   mmol/L
    AST   700 U/L
    ALT   400 U/L
    Total CK   500 U/L
    Amylase   600 U/L
    TBA   20 umol/L
    Iron   70 umol/L
    Total bilirubin   225 umol/L
    Carbamazepine   25 ug /mL
    Digoxin   2.5 ng/mL
    Theophylline   45 mg/L
    Phenytoin   20 mg/L
    Phenobarbitone   70 mg/L
    Lithium  <0.2 >1.5 mmol/L
    Valproate   100 mg/L
    Cyclosporin A   200 ug/L
    CRP  

    300

    phoned with other abnormal results

    mg/L
    Salicylate   20 mg/L
    Paracetamol   10 mg/L
    Ammonia All phoned    
    Lactate All phoned    
    beta-HCG All phoned    
    progesterone All phoned    
    CSF glucose All phoned    
    CSF protein All phoned    
    NNU results All phoned    

    Read more

  • Tumour Marker Use in Primary Care

    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 https://pathways.nice.org.uk/pathways/ovarian-cancer

    PSA link https://www.gov.uk/guidance/prostate-cancer-risk-management-programme-overview

    For symptoms and referral guidelines of other malignancies see the NICE Suspected Cancer Recognition and Referral guidelines. http://pathways.nice.org.uk/pathways/suspected-cancer-recognition-and-referral

    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

    CEA

    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

    CA19-9

    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.

    CA125

    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

    CA15-3

    Monitoring breast cancer

    Lung, colon, ovary

    Raised in benign liver, breast, ovarian disease

    AFP

    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

    PSA

    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

    hCG

    Diagnosis and monitoring of germ cell tumours and gestational trophoblastic neoplasia

    Lung

    Raised in pregnancy

    Transiently elevated with cannabis use

    LDH

    Diagnosis and monitoring of germ cell tumours

     

    Elevated in cardiac disease and benign liver disease

    Elevated in some anaemias relating to non-malignant disease

    Read more

Clinical Protocols

Investigation Protocols

Read more

Pathology Phone Limits

Read more

PREDNISOLONE METABOLISM TEST

Read more

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Tests not appearing on this scope are either under consideration or in the process of accreditation and so currently remain outside of our scope 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.

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