Had a couple of good Oestradiol levels recently in two patients on HRT.
Patient 1.
Previous Oestradiol levels around the 300-400 pmol/L level, this time, level was 5340 pmol/L.
Checked QC and repeated this and others, all OK. Then checked with GP.
Patient was on HRT patches but had been just prescribed nasal spray "Aerodiol" by consultant with provisio to "just take a couple of puffs as required".
Guess what, patient was taking 6 puffs a day, and had the blood sample taken after 4 puffs. Manufacturer's data warns against taking blood samples within 4 hours of doseas high levels may be found.
Patient 2.
On HRT gel, levels around 500 pmol/L, then suddenly increased to 2000, and finally 4500.
GP when asked admitted patient had been told recently to put gel on her arm, and guess which arm the blood was taken from, so we were getting neat Oestradiol before it had time to equilibrate into the blood volume adequately.
With these two delivery systems now being used for a number of drugs, I would suggest caution on any high levels detected until you can exclude this as a cause.
-- Never take a no from someone not empowered to give you a yes --
Gary Mascall
Clinical Biochemistry Department
Kidderminster Hospital
Worcestershire Acute Hospitals NHS Trust
Bewdley Road
Kidderminster, Worcs, UK
DY11 6RJ
Tel : 01562 823424 extn 3465
Fax : 01562 513030
email : [log in to unmask]
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