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Hi Gifford Our laboratory (in New Zealand) reports blood lead in umol/L but animals in ug/dL as well as umol/L and the problem to guard against is the flagging of abnormal results (yes we do have a reference range for animals). Assuming the laboratory analyses all results as umol/L and if you treat the reporting of blood leads in umol/L and ug/dL as separate tests you run in to the problem of flagging one result as abnormal in one unit and normal in the other unit due to the calculation rounding at the cut off point. We guard against this having the result in umol/L controlling the flagging of the abnormsl results in both units. I would also report the results both in umolL and ug/dL as when the sample is received you don't know whether the sample is occupational or non occupational or whether the receivers of the reports are interested in the occupational or non occupational exposure. There is also the risk to the treatment of patient in the collating of blood lead results from a mixture of units and corresponding miss translation of the results. In many casea samples we receive are occupational but adult samples we receive from GP's could be occupational or non occupational. As for A1c I am assuming the you will be reporting one result and two comments rather than the laborartory deciding whether it is diagnostic or monitoring. Hope this helps. Trevor Walmsley Canterbury Health Laboratories New Zealand ________________________________ From: Clinical biochemistry discussion list [[log in to unmask]] on behalf of GIFFORD BATSTONE [[log in to unmask]] Sent: 19 June 2014 03:35 AM To: [log in to unmask] Subject: Issues re reporting Blood lead and HbA1c Dear Collective Brain The maintenance and updating of the Pathology Bounded Code List (PBCL) is overseen by the Pathology Catalogues Executive Team (PCET) at the College - more can be found on the College website. Last week PCET discussed two issues about naming and reporting but wish to have a wider review before finalising our recommendations. There is a legal requirement to report blood lead concentrations as ug/dl rather than SI units - The Control of Lead at Work 2002 and yet for clinical purposes most labs will use SI units. The PCET proposed mitigation is that blood lead requests could be differentiated as being associated with the monitoring of lead workers eg Blood Lead (Occupational) reported in ug/dL and for other clinical purposes Blood Lead (Clinical) in umol/L. This creates two report items for the same assay but avoids two sets of units for the same assay. The second issue was raised by GPs in relation to HbA1c being used both for monitoring glycaemic control and in the diagnosis of diabetes. The use of NICE guidance as action indicators with HbA1c reports hides elevated values when the same assay is being used for diagnostic purposes. Elevated values may be considered ‘satisfactory’ when in fact they are indicating a new diagnosis of diabetes. The proposed PCET mitigation is to create two report items in PBCL Glycated haemoglobin (monitoring) and Glycated haemoglobin (diagnostic). This will allow appropriate interpretive comments to be made for both purpose of use of the assay. Your views on these proposals will be very welcome Regards Gifford Dr Gifford Batstone MBBS, BSc, FRCPath, MSc Chair PCET ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/ ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/