The Trust guidance on Cardiac Troponin testing has been revised in line with the European Society of Cardiology guidance.

This process will be in place from 10th October 2016 and will be subject to audit. The trust uses gender specific Troponin results – for Males <34ng/l and for Females <16ng/l are considered to be within normal range.

The main change is that patients with chest pain >6hrs ago, and remaining pain free during their hospital attendance, will only require a single troponin in order to exclude an ACS. If the hs-TnI is undetectable, risk stratification is also favourable and the patient is pain free then the patient can be considered for discharge with arrangements for outpatient investigation if appropriate.

Paired troponin samples should still be sent at 0h and 3h for patients with onset of chest pain within the last 6 hrs or with ongoing chest pains whilst in hospital.

The ICE requesting system will incorporate a prompt box to ask clinicians to clearly specify if the request is for a single or paired troponin. There will also be a reminder message on the results screen of the Troponin results.

The flowchart below summarises this change and is a reminder of the role troponin plays in the suspected ACS pathway. 

From the 9th of February 2016, ethlene glycol measurement is available 24 hours a day, 7 days a week at Birmingham Heartlands Hospital.

Ethylene glycol is an odourless and highly toxic compound found in various household products. Cases of ethylene glycol poisoning are rare but often fatal unless treated promptly. Early recognition is thus critical for treatment and recovery of patients. Patients with ethylene glycol poisoning typically present in the acute setting with a high anion gap metabolic acidosis, altered mental status and acute kidney injury. Indirect testing of ethylene glycol ingestion (e.g. lactate, osmolar gap & anion gap), although potentially helpful, are not accurate estimators of the presence of ethylene glycol. Urgent, accurate measurement of ethylene glycol should be sought if ingestion is suspected. Measurement of ethylene glycol
has not always been readily available due to specialised methodologies required; and often comes at a prohibitively high price for access to these assays out of normal working hours.

We have therefore implemented a rapid, automated, cost effective assay for the measurement of ethylene glycol which is readily available 24/7.
GC-MS measurement of ethylene glycol and diethylene glycol is still available on specific request. 

Additional Information:
Please contact the laboratory (41185 / 0121 424 1185) and ask to speak to a biomedical scientist or biochemist before sending a specimen.

If you wish to discuss a particular patient please bleep the duty biochemist / toxicologist on 2506 or 3289 in work hours, or the on-call consultant via switchboard (0121 424 2000).

For external users, please send samples urgently via courier to: Pathology Reception, Birmingham Heartlands Hospital, Bordesley Green East, B9 5SS. Couriers should use the Yardley Green Road Entrance to the hospital. At night, vehicular access is limited but access on foot is available via the pedestrian gate.

The vitamin D equipment is now fixed and operational. We have now started working through our backlog. We estimate that our backlog is approx 21 days. If you require any further infomation, please contact the laboratory.

Date of update: 14/9/2015

We are experiencing a short delay in the processing and reporting of Vitamin D requests.

We hope to have this situation resolved in the next week and will be working through our backlog as quickly as possible. We will keep updating the web site with our progress.

This is due to problems with the equipment which we are working to resolve as soon as possible. 

If you would like to discuss this further or expedite the measurement of request please contact the duty biochemist on bleep 2506 or at This email address is being protected from spambots. You need JavaScript enabled to view it.

As of 27th May 2014 TSH only will be the frontline test for investigating Thyroid function. If the TSH is <0.35 mU/L or >4.9 mU/L a fT4 will be automatically added on to the request. If the TSH is <0.1 mU/L fT3 will also be added. The reason for this is to encourage more appropriate use of the thyroid tests. If you have any queries or concerns please contact the duty biochemist (bleep 2506).

From 27^th February 2014 we will be resuming a PTH service from Heartlands using the Roche intact PTH assay (iPTH).  It is difficult to directly compare results determined from the previous Abbott assay to the Roche assay as the Abbott method had a significant positive bias with respect to Roche, therefore you should expect slightly lower results now.  The reference range for iPTH on the Roche assay is 1.6-6.9 pmol/L. 

Analysis will be batched daily, Monday-Friday.  As previously plasma from EDTA samples is the preferred sample type.  If there is a need for an urgent PTH the current process of contacting the duty biochemist/duty consultant will continue and the urgent pathway implemented. If there are any queries clinicians should contact the duty biochemist/duty consultant.

A video of the new laboratory at Birmingham Heartlands Hospital