Download Purpose of test NICE CG 187 Acute Heart Failure and NICE CG 108

Examination
17696
Purpose of test
Brain naturetic peptide (BNP) (NT-proBNP)
NICE CG 187 Acute Heart Failure and NICE CG 108
Chronic Heart failure currently recommend the use of NTproBNP/BNP as a first line test in ruling out HF and thus
obviating the need for specialist input or Doppler
Echocardiography
- Do NOT request NT-pro BNP in patient with a previous
MI (specialist assessment recommended)
- NT-pro BNP should only be measured once unless there
is a repeat episode of suspected heart failure with a
change in clinical presentation
- The role of NT-pro BNP in HF prognosis and monitoring
is not clear
Should only be measured once per acute episode for
diagnosis. Pre-discharge repeat measurement has
prognostic significance but has not been shown to alter
outcome
Sample
Blood
Sample Tube/Container
Adult- Yellow top or Green top Lithium Heparin Gel
Paediatric- Green top Lithium Heparin Gel
Sample Volume
4ml
Minimum (see calculation of minimum volume)
Special Precautions
No specific requirements
Request Form:
Clinical Chemistry & Haematology Requests
Laboratory
Biochemistry
Biological reference range
Rule out in chronic heart failure < 400ng/L (NICE chronic
heart failure 2010)
The age specific data listed in the additional information
section may be helpful
Rule out in acute heart failure <300ng/L (NICE Acute
Heart Failure 2014)
Clinical decision values
See NICE CG 108 Chronic Heart failure guidelines and
NICE CG Acute Heart Failure guidelines
Factors affecting performance In sample where icterus (bilirubin), haemolysis or lipemia
is indicated by the manufacturer to cause inaccuracy of
>10%, the result will be dashed out or reported with a
disclaimer
In patients receiving therapy with high biotin doses (i.e. >
5mg/day), no sample should be taken until at least 8 hours
after the last biotin administration
Note: Printed documents are not controlled
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In rare cases, interference due to extremely high titres of
antibodies to analyte-specific antibodies, streptavidin or
ruthenium can occur
Obesity or treatment with diuretics, angiotensin-converting
enzyme (ACE) inhibitors, beta-blockers, angiotensin II
receptor antagonists (ARBs) and aldosterone antagonists
can reduce levels of serum natriuretic peptides
High levels of serum natriuretic peptides can have causes
other than heart failure (for example, left ventricular
hypertrophy, ischaemia, tachycardia, right ventricular
overload, hypoxaemia [including pulmonary embolism],
renal dysfunction [GFR <60 ml/minute], sepsis, chronic
obstructive pulmonary disease [COPD], diabetes, age >70
years and cirrhosis of the liver)
Turnaround times:
The Laboratory aims to report 90% of requests within the
stated time from receipt
Urgent - 1 hour
Ward - 4 hours
GP and OPD – 1 working day
Patient preparation
No specific requirements
Instructions for patient
collected sample
No specific requirements
Sample transportation
No specific requirements
Special handling needs
No specific requirements
Patient consent required
Implied consent
Specific rejection criteria
Generic rejection applies
Additional information
Stability 1 day at 15-25 °C
Minimum Retest Intervals- Should only be measured once
unless there is a repeat episode of suspected heart failure
with a change in clinical presentation and the diagnosis of
heart failure has previously been excluded
Age specific reference data
Roche insert quotes the following 97.5 percentiles based
on the circulating NT-proBNP concentration determined in
samples from 1981 blood donors aged between 18 and 65
as well as 283 elderly patients aged between 50 and 90,
both populations without known cardiac risks, symptoms
or medical history
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NT ProBNP
<45yrs
male
female
86 ng/L
130 ng/L
45 - 54
male
female
121 ng/L
249 ng/L
55 - 64
male
210 ng/L
female 287 ng/L
64 -74
male
female
376 ng/L
301 ng/L
>75
male
female
486 ng/L
738 ng/L
Roche insert states that In the paediatric population aged
between 1 and 18 the following NT-proBNP values were
obtained using the Elecsys proBNP II assay
Age (years)
1-3
4-6
7-9
10
11
12
13
14
15
16
17
18
References
NT-proBNP (ng/L)
97.5th percentile
320
190
145
112
317
186
370
363
217
206
135
115
Lab Tests Online
Roche insert 2012-05, V 7 English
WHO use of anticoagulants in diagnostic laboratory
investigations
National Minimum Re-testing Interval Project: A final report
detailing consensus recommendations for minimum retesting intervals for use in Clinical Biochemistry
Note: Printed documents are not controlled
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