Critical Folate reagent shortage until mid-July: please only request if
Due to an acute national
reagent shortage, we ask that clinicians please only measure folate where
there is an acute clinical need. Please also consider whether any test
requests for folate could be delayed until reagent supply is restored
(currently anticipated in mid-July).
likely to completely exhaust our reagent supply and require external testing
from mid-June onwards. We plan to send folate
requests to Sheffield Teaching Hospitals Laboratory in this event.
Please note that turn-around
times for folate results may be longer as the test may need to be performed in
batches to conserve reagent. Turnaround times are likely to exceed 24 hours
once samples are being sent to Sheffield for analysis. We apologise for any
inconvenience this may cause.
As an aid, see below a summary
of the indications of where haematinic requesting may be indicated. Please note
this is not exhaustive and for guidance only.
for haematinics requesting:
indications for B12 + Folate:
Unexplained cerebral decline
Anaemia and hypothyroidism
Anaemia and thrombocytopenia or neutropenia
indications for B12 + folate + ferritin:
Unexplained normochromic normocytic anaemia
Anaemia and poor diet
Please contact the laboratory
if you have any further questions.
10/05/2022 – Cortisol assay: cross-reactivity with Prednisolone
Please be reminded that there is significant cross-reactivity in our cortisol assay with many synthetic glucocorticoids, particularly prednisolone. Please be aware that when undertaking any investigations involving measuring cortisol in patients on prednisolone (including dynamic function tests), the measured result will have a significant positive bias and be unlikely to reflect the concentration of the native hormone. Please contact the lab for further advice or discussion
01/04/2022- Critical FT4 reagent shortage: change to test availability and turn-around times
Due to an acute national reagent shortage, FT4 will only be measured on samples with an abnormal TSH from Monday 4 April. FT4 will not be available to request directly from ICE, Meditech or via paper requests, but will be automatically added in the laboratory to samples with an abnormal TSH result.
If there is a strong clinical need for FT4 analysis on your patient, please contact the biochemistry laboratory directly.
Please note that turn-around times for FT4 results will be longer as the test will only be performed at Barnsley laboratory (as of 31.03.22), with weekend samples being batched for one analytical run on Sunday, except for clinically urgent requests
This is a temporary measure and we hope to resume our normal procedure as soon as reagent stocks are back to normal. We apologise for any inconvenience this may cause.
From 20/12/21 we will be
updating our quoted
therapeutic range for digoxin to: 0.7 – 2.0 ug/L.
This revised therapeutic range
brings us in line with the NICE Clinical Guideline for Atrial Fibrillation (https://cks.nice.org.uk/topics/atrial-fibrillation/prescribing-information/digoxin/).
There will be an accompanying
text comment regarding digoxin concentration in patients with heart failure to
reflect the narrower therapeutic window in heart failure:
“Therapeutic target of 0.5-1.0
ug/L in heart failure.”
For patients being treated for
digoxin toxicity, please note that
Digifab interferes with digoxin immunoassays, so there is no clinical
benefit in checking digoxin levels after Digifab administration.
Antimicrobial susceptibility interpretation guidance
from the 11/1/22, the Microbiology department will be reporting antimicrobial
susceptibility results as per the updated guidance released by the European
Committee on Antimicrobial Susceptibility Testing (EUCAST). The new
interpretations are categorised and defined into three susceptibility
- S - Susceptible, standard
dosing regimen: A microorganism is
categorised as Susceptible, standard dosing regimen, when there is a high
likelihood of therapeutic success using a standard dosing regimen of the
- I (High dose)
- Susceptible, increased exposure:
A microorganism is categorised as Susceptible, increased exposure* when
there is a high likelihood of therapeutic success because exposure to the
agent is increased by adjusting the dosing regimen or by its concentration
at the site of infection.
- R - Resistant:
A microorganism is categorised as Resistant when there is a high
likelihood of therapeutic failure even when there is increased exposure.
*Exposure is a function of how the
mode of administration, dose, dosing interval, infusion time, as well as
distribution and excretion of the antimicrobial agent will influence the
infecting organism at the site of infection
refer to the antimicrobial policy for further information. Alternatively,
contact the microbiology department or senior clinical pharmacist if further
guidance is required.
Communication: eGFR and KFRE
2021 NICE published an updated “Chronic kidney disease: assessment and
management” guideline (NG203). This includes two new considerations for users
of Blood Sciences at BRILS who request tests of renal function:
Removing adjustment for ethnicity from eGFR
guidance to adjust for ethnicity when calculating the estimated glomerular
filtration rate (eGFR) in people from Afro-Caribbean ethnic groups is no longer
deemed to be valid.
Committee agreed that adding an ethnicity adjustment to eGFR equations for
different ethnicities is not supported by evidence from available studies, and,
because the muscle mass varies widely between individuals within the same
ethnicity, the adjustment may not be accurate for all individuals within any
given ethnic group
addition, NICE reiterated that eGFR creatinine may be less reliable in certain
situations such as acute kidney injury; pregnancy; oedematous states; muscle
wasting disorders; in those who are malnourished, have higher muscle mass, use
protein supplements or those who have undergone amputation. (Please note
that although not specifically mentioned in NICE guidance, sports supplements,
especially those containing creatine may also make eGFR creatinine
interpretation less reliable.)
Failure Risk Equation (KFRE)
an update related to assessing the risk of patients with known CKD progressing
to require renal replacement therapy.
suggest that adults with CKD are provided with a risk score, calculated
using the 4-variable kidney failure risk equation (KFRE). The equation
uses patient age, gender, eGFR and urinary Albumin to Creatinine ratio to
calculate the kidney failure risk. The recommendation is that patients are
referred for specialist assessment, should their 5 year risk from the
calculation be greater than 5%.
current version of our laboratory information management system (LIMS) is
unable to calculate this score, but while we are addressing this, we will
provide on ICE and the pathology website a link to the risk calculator on the
NICE website. Please use this calculator where appropriate, according to
As a result of these updates, from the 29th of
November the comment appended to eGFR results on lab reports will be as
longer recommend any correction to eGFR for ethnicity. Please interpret with
caution in patients with extremes of muscle mass, or other confounding factors.
For more info see https://tinyurl.com/4hjbeaac”
will also be additional code linked to UEs results with the following comment:
calculator refer to: https://www.nice.org.uk/guidance/ng203/resources
or a link on ICE.”
23/11/2021- Communication: Sample Transportation Reminder
all users of BRILS please note that timely transport of samples to the
laboratory is important in ensuring sample integrity and subsequent patient
results. Can all GP and community users please ensure that samples are
transported on the next available collection. Refrigeration of samples prior to
collection can also affect sample integrity and may lead to spurious results so
please do not store samples in a fridge prior to transport. Please see our user
webpage for further information: https://www.barnsleyhospital.nhs.uk/pathology/pathology-general/transport-spceimens-laboratory/
Communication: Reminder- Phlebotomy Outpatients
Phlebotomy service is now appointment only and appointments can be booked by
telephoning 01226 433969 between 8:00 and 16:50 Monday to Friday. Please
note that the appointment line is very busy and often patients will have to try
multiple times to get through. We are aware of the difficulties and a
solution is being looked into to improve the appointment system. We apologies
for any inconvenience caused.
21/10/2021- Communication: Changes to
repeat Biochemistry requests for slightly haemolysed samples
blood sciences laboratories replaced their automated analysers in Autumn 2020.
As a result of feedback from users about the impact that increased detection of
slightly haemolysed samples is having on repeat biochemistry requests,
especially for potassium, we are changing the haemolysis level at which a
repeat sample is advised for certain tests. This will not have any impact on
the clinical validity of results.
1st November 2021, you should see fewer repeat requests in slightly haemolysed
samples for the following biochemistry tests:
• Creatine Kinase (CK)
• Uric acid (urate)
contact Cat Dibden if you have any queries about
Published on Wednesday 30 May 2022 by Jayshree Sisodia