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
This section of the website provides information about the Trust’s Haematology laboratories and how to use the haematology laboratory service. It is by no means exhaustive and should further information, clinical advice or result interpretation be required, please contact a member of the haematology staff using the contact numbers listed below.
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 |
Specimen Container |
Comments |
|
Ascitic Fluid |
? cirrhotic or malignant |
Albumin Total protein Cholesterol Triglycerides LDH |
Plain universal |
Serum albumin should be simultaneously measured for comparison. |
|
? SBP
|
pH
Total protein |
See comment
Plain universal |
For rare instances pH should be collected anaerobically with heparin and then measured in a blood gas analyser using clot filter. |
|
|
? pancreatic fistula ?pancreatitis |
Amylase |
Plain universal |
Serum amylase should be measured. |
|
|
? tubercular |
Glucose |
Fluoride oxalate (grey top) |
|
|
|
Chest Drain Fluid |
? chylothorax |
Chylomicrons Cholesterol Triglycerides |
Plain universal |
|
|
CSF |
? bacterial meningitis |
Protein
Glucose
|
Plain universal
Fluoride oxalate (grey top) |
|
|
? Subarachnoid haemorrhage |
Xanthochromia |
Plain universal protected from light |
Do not use pod system to send sample to lab. Serum total protein and bilirubin should be measured simultaneously. |
|
|
?congenital disorder ?cerebral ischaemia |
Lactate |
Fluoride oxalate (grey top) |
Sent to BCH Biochemistry. |
|
|
?brain metastases |
AFP, HCG, placental ALP |
Plain Universal |
Sent to Charing Cross for analysis. |
|
|
Diagnosis/investigation of inborn errors of neurotransmitter metabolism |
Neurotransmitters |
See comment |
Specific collection requirements – contact Duty Biochemist on ext. 16543 well in advance of arranging test. Sent to Neuroimmunology lab, London. |
|
|
?narcolepsy with cataplexy |
Orexin/Hypocretin |
Plain Universal |
Sent to Immunology, Oxford. |
|
|
?neurosarcoidosis |
ACE |
Plain Universal |
CSF total protein also required for interpretation. Sent to Neurometabolic unit, London. |
|
|
Cyst Fluid |
?thyroid tissue/met |
Thyroglobulin |
Plain universal |
Requires discussion with laboratory prior to request (contact Duty Biochemist on ext. 16543) |
|
Drain Fluid |
? contains urine |
Urea Creatinine |
Plain universal |
Comparison of fluid urea and creatinine with serum will identify significant contamination with urine |
|
?biliary fistula Post surgery |
Amylase Bilirubin |
Plain universal |
|
|
|
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
|
? Ca pancreas |
CEA CA 19-9 Amylase Glucose |
Plain universal
Fluoride oxalate (Grey top) required |
|
|
Pleural Fluid Four types of fluids can accumulate in the pleural space:
|
? transudate or exudates
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. |
Total Protein LDH
|
Plain universal |
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: Ratio of fluid protein to serum protein is >0.5 Ratio of fluid LDH to serum LDH is >0.6 Pleural fluid LDH is > 2/3rds the upper reference limit for plasma LDH.
Measure serum protein and LDH simultaneously |
|
? infected |
pH
|
See comment |
This is part of British Thoracic Society’s guidelines for differentiating infective from non-infective pleural effusions, can only be measured on fresh specimen collected anaerobically using a dedicated blood gas analyzer. This analyser can be found on W513 (respiratory). |
|
|
? chylothorax |
Chylomicrons Cholesterol Triglyceride |
Plain universal |
|
|
|
? pancreatitis |
Amylase |
Plain universal |
Patient's serum amylase should be measured for comparison. |
|
|
? rheumatic cause |
Glucose |
Fluoride oxalate (grey top) tube required. |
|
|
|
Nasal Fluid |
? CSF |
Tau protein |
Plain universal |
Sent to Immunology, Sheffield. |
|
Salivary Cortisol |
?Cushing’s ONDST |
Salivary Cortisol |
Salivette or Plain universal |
Saliva specimens should be collected using a Sarstedt cortisol salivette (these can be requested from Chromatography). Saliva collected into a plain container by passive drool is also acceptable. |
|
Synovial Fluid |
Refer to Microbiology |
N/A |
|
N/A. |
|
Urine pH |
?cause of metabolic acidosis |
pH |
Plain universal |
In patients with a metabolic acidosis and suspected renal tubular acidosis, urine pH measurement is indicated. |
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.
UHB, Department of Laboratory Haematology (Including Transfusion), Blood Bank
Biochemistry
Haematology and Transfusion
Clinical Microbiology (Including Virology)
Cellular Pathology
General Information
Immunology
Molecular Pathology