Produced by: |
Dr Sukhbir Kaur (Senior Clinical Biochemist) |
Approved by: |
Dr Kartsios Charalampos (Consultant Haematologist) |
Dr Marcus Mottershead (Consultant Gastroenterology) |
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
Decision limits for phoning
Analyte |
Phone results below or equal to: |
Phone results above or equal to: |
Units |
Notes |
Sodium |
120 |
150 |
mmol/L |
|
Potassium |
2.5 |
6.5 |
mmol/L |
|
Urea |
- |
Adults: 30 Paediatrics: 10 |
mmol/L |
Except those on renal wards or under renal consultants. |
Creatinine |
- |
Paediatrics: 200 |
umol/L |
|
eGFR |
Adults: 15 |
- |
ml/min |
|
AKI |
- |
2 |
Not CKD patients (AKI 2 discretionary) |
|
Glucose |
2.5 |
25 |
mmol/L |
|
Calcium adjusted |
1.8 |
3.5 |
mmol/L |
|
Magnesium |
0.4 |
- |
mmol/L |
|
Phosphate |
0.3 |
- |
mmol/L |
|
AST |
- |
600 |
U/L |
|
ALT |
- |
600 |
U/L |
|
Total CK |
- |
5000 |
U/L |
|
Amylase |
- |
500 |
U/L |
|
Digoxin |
- |
2.5 |
ng/mL |
|
Theophylline |
- |
25 |
mg/L |
|
Phenytoin |
- |
25 |
mg/L |
|
Lithium |
- |
1.5 |
mmol/L |
|
Troponin T |
- |
GP only: >14 |
ng/L |
GP only |
Ammonia |
- |
100 |
umol/L |
|
Ethanol |
- |
Paediatrics only: any detectable |
mg/L |
Paediatrics only |
Paracetamol |
- |
10 |
mg/L |
Not ED patients |
Salicylate |
- |
300 |
mg/L |
Not ED patients |
Conj bilirubin (DBIL) |
- |
Paediatrics only: 25 |
umol/L |
Paediatrics only |
Total bilirubin |
- |
Paediatrics only: 225 |
umol/L |
Paediatrics only |
Carbamazepine |
- |
25 |
ug /mL |
|
Iron |
- |
ED only: 70 |
umol/L |
ED only |
Phenobarbitone |
- |
70 |
mg/L |
|
CSF Gluc |
3.3 |
- |
mmol/L |
|
CSF Prot |
- |
0.45 |
g/L |
|
Lactate |
- |
2.3 |
||
CRP |
- |
300 |
||
Total bile acids |
- |
20 |
||
Methotrexate |
Phone all |
umol/L |
Haemoglobin | White Blood Cell Count |
---|---|
<8.0 g/dl normochromic and normocytic | Low result – neutropenia <0.5 x 10 9/L |
<7.0 g/dl microcytic and hypochromic | High result – White cell count >40 x 10 9/L |
<7.0 g/dl macrocytic | or Lymph count > 20 x 10 9/L |
<5.0 g/dl renal patients | Any presence of blast cells |
Platelets | Clotting Studies |
---|---|
Lower limit - <70 x 10 9/L | INR - >5.0 |
Upper limit - >1000 x 10 9/L | PTT - >180 seconds |
Fibrinogen < 1.0g/l |
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 |
Written by Helen Wiggins on . Posted in Protocols
The laboratories at Heartlands Hospital, Good Hope Hospital and Solihull Hospital form part of the services provided by University Hospitals Birmingham and are UKAS (United Kingdom Accreditation Service) accredited to the ISO 15189:2012 standard. For a list of accredited tests and other information please visit the UKAS website using the following link: https://www.ukas.com/find-an-organisation/
Tests not appearing on the UKAS Schedule of Accreditation 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.
For further test information, please visit the test database: http://www.heftpathology.com/frontpage/test-database.html.
Protection of personal information - Laboratory Medicine comply with the Trust Data Protection policy and have procedures in place to allow the Directorate and its employees to comply with the Data Protection act 1998 and associated best practice and guidance.
For further information contact Louise Fallon, Quality Manager, 0121 424 1235