HbA1c is routinely measured for this purpose. The assay is run daily on weekdays and requires an EDTA plasma sample (purple top). Fructosamine can be used as an alternative when HbA1c is not appropriate. Fructosamine reflects blood glucose over two weeks rather than 2 to 3 months as it reflects glycation of albumin rather than haemoglobin. Fructosamine is performed on serum (yellow or red top) and run daily.
Conventionally diabetes mellitus was diagnosed by high fasting or random blood glucose concentrations, or an abnormal oral glucose tolerance test (OGTT) whilst haemoglobin A1c (HbA1c) was used to monitor longer term glycaemic control in patients with known diabetes mellitus.
In 2011, the World Health Organisation (WHO 2011) recommended that HbA1c measurements should also be used to diagnose diabetes in the majority of asymptomatic individuals, and this recommendation has been agreed in the UK (NHS Diabetes 2011).
An HbA1c of 48 mmol/mol or more is consistent with diabetes. If the patient has no symptoms then a second HbA1c result must be obtained within 2 weeks, and if it remains ≥48 mmol/mol diabetes mellitus is confirmed.
HbA1c values of 42 to 47 mmol/mol suggest a high risk of future diabetes. Such individuals should be offered structured lifestyle education and support to delay/prevent development of diabetes, and have an annual HbA1c test.
HbA1c must be measured in an accredited laboratory undertaking recommended quality assurance procedures. Near patient testing is not appropriate when HbA1c is used for the diagnosis of diabetes.
HbA1c is now the preferred method to diagnose diabetes, except in the following situations where this test would be unreliable, and in whom the traditional methods of diagnosis with blood glucose concentrations remain the method of choice:
Despite this new approach, if an individual has abnormally high random or fasting blood glucose levels or abnormal OGTT, which would be consistent with diabetes on the traditional criteria, then that patient should be considered to have diabetes irrespective of their HbA1c value. Without symptoms of diabetes two abnormal tests of the same type (two high fasting/random blood glucoses or a diabetic OGTT) are required to confirm diabetes mellitus.
UHB, Clinical Chemistry, Clinical
Haematology and Transfusion Department
Click here for the list of Haematology and Transfusion UKAS accredited Assays
8784
The Haematology Department is a fully UKAS accredited clinical laboratory service providing a comprehensive range of haematology analyses on blood and other bodily fluids to support high-quality patient care. Across University Hospitals Birmingham NHS Trust, our haematology laboratories receive over 1.5 million samples annually.
The laboratory is Training accredited by the HCPC and IBMS for registration and specialist portfolios and an established military training facility.
The Haematology, Coagulation and Blood Transfusion laboratories offer a routine service at all sites with an extended repertoire at the Heartlands and Queen Elizabeth sites. Good Hope, Heartlands and Queen Elizabeth sites provide a 24-hour service with Solihull providing an extended day service with out of hours cover provided from the Heartlands site.
The Queen Elizabeth site is a nominated coagulation laboratory for the West Midlands Regional Haemophilia comprehensive care service and a designated transfusion trauma centre.
Should you require any urgent full blood count or coagulation specimens to be analysed in the laboratory during core hours at QEH, you must telephone the routine laboratory prior to dispatch of the sample to obtain a specimen reference number (0121 371 6920 or ext 16290). This ‘urgent specimen’ number must be written on the request form as must the correct location of the patient. This will facilitate its processing and ensure that the results are returned directly to the requesting source. It is important to do this in order that we identify urgent specimens and provide easy identification for the laboratory staff on arrival within the department.
The following tests are available out-of-hours:
For urgent special coagulation assay information click Here
The following locations are already prioritised:
|
Location |
Turnaround time (from receipt of specimen) |
|
ED, CDU, WAMU, WACT, WACB, WACE, WAST W620 WCCA, WCCB, WCCC, WCCD, WADM, WAMB, Oncology, W622, QCCU, QSSU, St Mary’s Hospice and GP samples marked urgent. |
1 hour
|
|
All Trust inpatients |
4 Hours |
All Turnaround times for inpatients are monitored for FBC, PT, APTT and D-Dimer.
Please note that at times of high demand or if there are instrument malfunctions we may not be able to achieve these turnaround times.
UHB, Department of Laboratory Haematology (Including Transfusion)
Read more: Laboratory Haematology
|
Fluid type |
Clinical Indication |
Analyses available |
Sample Container |
Comments |
|
|
|
|
|
|
|
Ascitic Fluid |
? cirrhotic or malignant |
Albumin Cholesterol Triglycerides LDH |
Plain universal |
Serum albumin should be requested simultaneously measured for comparison. |
|
? chylous ascites |
Chylomicrons Cholesterol Triglycerides |
Plain universal |
||
|
? SBP (spontaneous bacterial peritonitis) |
Total protein pH |
Plain universal See comment |
pH cannot be performed in a plain universal tube. Sample must be collected anaerobically into a lithium heparin tube and analysed on a blood gas analyser using a clot filter. |
|
|
? pancreatic fistula ? pancreatitis |
Amylase |
Plain universal |
Serum amylase should be measured simultaneously for comparison. A high ascitic:serum amylase ratio is suggestive of a pancreatic origin. |
|
|
? tubercular ascites/ tuberculous peritonitis
|
Glucose |
Fluoride oxalate (grey top) |
||
|
|
|
|
|
|
|
Chest Drain Fluid |
? chylothorax |
Chylomicrons Cholesterol Triglyceride |
Plain universal |
|
|
|
|
|
|
|
|
CSF |
? bacterial meningitis |
Total protein Glucose Lactate |
Plain universal Fluoride oxalate (grey top) |
|
|
? Subarachnoid haemorrhage |
CSF bilirubin and oxyhaemoglobin (Xanthochromia) Total protein |
Plain universal (protect sample from light) |
Do not use pod system to send sample to lab. Samples must be received protected from light as light will cause degradation of bilirubin in the sample. Serum total protein and bilirubin should be measured simultaneously to support interpretation in equivocal cases. |
|
|
? congenital disorder ? cerebral ischaemia |
Lactate |
Fluoride oxalate (Grey top) |
Raised levels of CSF lactate may occur with severe cerebral hypoxia or genetic lactic acidosis, intracranial haemorrhage, bacterial meningitis and epilepsy. |
|
|
? brain metastases |
AFP, HCG, LDH |
Plain universal |
These analyses are not performed in-house and will be referred to Charing Cross Hospital. Turnaround may be up to 7 days. |
|
|
? neurosarcoidosis/ monitoring |
ACE |
Plain universal |
These analyses are not performed in-house and will be referred to Queen’s Square Neurometabolic Laboratory. Turnaround may be up to 10 days. Please note, this test has not been clinically validated for diagnosis and monitoring of neurosarcoidosis and is therefore not UKAS accredited. This utility of this test should therefore be considered before requesting. Activity may be increased if blood-brain barrier impairment leads to passage of serum proteins (including serum ACE) or blood contamination. |
|
|
? Alzheimer’s Disease ? neurodegeneration |
Beta-2-transferrin Amyloid Beta42 and Amyloid Beta40 ratio Total Tau Phospho-Tau181 S100B Neurofilament light chain |
Polypropylene tube |
These analyses are not performed in-house and will be referred to Queen’s Square Neuroimmunology Laboratory. Turnaround may be up to 15 days. The Duty Biochemist must be contacted via This email address is being protected from spambots. You need JavaScript enabled to view it. at least 1 day prior to sample collection. Polypropylene tubes must be collected from the Duty Biochemist in advance. Each individual test requires at least 500 µL sample, therefore discussion regarding sample volume needed is essential. |
|
|
Diagnosis and monitoring of inherited neurotransmitter disorders |
CSF Neurotransmitters |
Specialist neurotransmitter tubes |
These analyses are not performed in-house and will be referred to Queen’s Square Neurometabolic Laboratory. Turnaround may be up to 35 days. Please contact Duty Biochemist (This email address is being protected from spambots. You need JavaScript enabled to view it.) at least 1 week prior to the sample being collected. Specialist tubes must be ordered from the referral lab and samples must be frozen on dry ice at the bedside. Requests must be accompanied by a specific referral lab form (in addition to the UHB request form) which be requested along with the tubes. A paired serum prolactin level may be useful. Patients should ideally be off any L-DOPA medications for 7 days prior to CSF collection. |
|
|
? narcolepsy with cataplexy |
Orexin/Hypocretin |
Plain universal |
These analyses are not performed in-house and will be referred to Oxford for analysis. Turnaround may be up to 42 days. |
|
|
|
|
|
|
|
|
Nasal/Ear Fluid |
? CSF leak (rhinorrhoea/ otorrhoea) |
Tau protein (Beta-2-transferrin) |
Plain universal |
These analyses are not performed in-house and will be referred to Sheffield protein reference unit. Turnaround may be up to 10 days. |
|
|
|
|
|
|
|
Cyst Fluid |
? thyroid tissue/ metastatic thyroid cancer |
Thyroglobulin |
Plain universal |
Requires discussion with Duty Biochemist. Please email This email address is being protected from spambots. You need JavaScript enabled to view it. or phone 0121 371 6543. |
|
|
|
|
|
|
|
Drain Fluid |
? contains urine |
Urea Creatinine |
Plain universal |
Comparison of fluid urea and creatinine with serum will identify significant contamination with urine |
|
?post operative pancreatic fistula |
Amylase Bilirubin |
Plain universal |
A high amylase and bilirubin in drained fluid suggests a leak of pancreatic fluid e.g. after pancreatic resection. |
|
|
|
|
|
|
|
|
Gastric Aspirate |
? reflux ?achlorhydria |
pH |
Plain universal |
Occasionally gastric pH may be requested in patients suspected of intestinal reflux or achlorhydria. Normally the fasting gastric pH is about 1-2. |
|
|
|
|
|
|
|
Pancreatic Cyst Fluid |
Differentiation of pancreatic cysts types |
CEA CA 19-9 Amylase Glucose |
Plain universal Fluoride oxalate (grey top) |
Pancreatic CEA may be useful in aiding differentiation between benign cysts and mucinous pancreatic cysts with an increased risk of malignancy. Please note, tumour markers are non-specific and should be used in conjunction with cytology and imaging. |
|
|
|
|
|
|
|
Pleural Fluid Four types of fluids can accumulate in the pleural space:
|
? transudate or exudates
|
Total Protein LDH (measure serum protein and LDH simultaneously) |
Plain universal |
A transudate fluid is produced through pressure filtration without capillary injury while exudate is "inflammatory fluid" leaking between cells. Most common causes of pleural exudates are bacterial pneumonia and malignancy. Most common causes of pleural transudates are left ventricular failure and cirrhosis. TP <25g/L indicates transudate TP>35g/L indicates exudate Light’s criteria applies to pleural fluid TP between 25 and 35g/L. A fluid is an exudate if any of the following apply:
|
|
? infected |
pH
|
Lithium heparin (green top) |
This is part of British Thoracic Society’s guidelines for differentiating infective from non-infective pleural effusions. pH can only be measured on a fresh specimen collected anaerobically using a dedicated blood gas analyser. At QE, this analyser can be found on W513 (respiratory). Suggest contact the POCT team to discuss prior to sample collection. |
|
|
? chylothorax |
Chylomicrons Cholesterol Triglyceride |
Plain universal
|
Visual inspection for chylomicrons required. |
|
|
? pancreaticopleural fistula/oesophageal rupture/malignancy |
Amylase |
Plain universal |
Serum amylase should be measured for comparison. A level that is higher in pleural fluid compared to serum will aid differential diagnosis. |
|
|
? parapneumonic effusion/tuberculosis/ malignancy/rheumatoid arthritis. |
Glucose |
Fluoride oxalate (grey top) |
Pleural fluid glucose is not solely diagnostic but may be useful in aiding differential diagnoses. A low pleural fluid glucose may suggest exudative effusions such as infections, tuberculosis, rheumatoid arthritis or malignancy. |
|
|
|
|
|
|
|
|
Saliva |
? Cushing’s syndrome/ Overnight dexamethasone suppression test |
Salivary Cortisol |
Sarstedt salivette (preferred)/ Passive drool into plain universal |
Saliva specimens should be collected using a Sarstedt cortisol salivette (these can be requested from the Specialist testing laboratory by contacting the Duty Biochemist). Saliva collected into a plain container by passive drool is also acceptable. Recommend collection of late night salivary cortisol on two different occasions to aid initial diagnosis of Cushing’s syndrome. |
|
|
|
|
|
|
|
Synovial Fluid |
N/A |
N/A |
|
Refer to Microbiology |
|
|
|
|
|
|
|
Urine pH |
? cause of metabolic acidosis |
pH (UPH) |
|
In patients with a metabolic acidosis and suspected renal tubular acidosis, urine pH measurement is indicated. Please note, the reliability of a single spot urine pH measurement is limited. An early morning sample or testing after an acid load is more accurate. Urinary tract infections may also mimic distal RTA by causing a high urine pH. Measurement of serum bicarbonate alongside urine pH is most useful for interpretation. |
By law blood bank is required to document evidence of the fate of every blood component received by the Trust. If blood or blood components are administered to a patient, it is the clinical areas responsibility to record this evidence in PICS or the area’s blood registers/transfusion record. All blood components that are not transfused must be returned to blood bank as soon as possible with appropriate documentation (form WNP 0606; authority to collect/return blood or blood components). The law requires 100% traceability and Blood Bank audits, reports and monitors compliance on a continuous basis. Issues of non-compliance are reported to the Trust’s Hospital Transfusion Committee on a quarterly basis and to the MHRA in an annual return.
