Anaesthesia allows you to be pain free and comfortable during your operation. Sometimes this involves a general anaesthetic which is a state of controlled unconsciousness controlled by medication during which you will not feel pain or remember anything. This is often referred to as ‘going to sleep’ for your operation. However, anaesthesia does not always mean that you have to be unconscious as modern anaesthetic techniques can numb certain parts of your body such that you will not feel any pain whilst still being able to remain awake. These techniques can numb a small part of your body (local anaesthesia), an entire arm or foot (nerve block) or the lower part of your body from the waist down (spinal or epidural anaesthesia). There are lots of benefits to having a procedure done in this way and for some orthopaedic operations, such as hip and knee replacements, these have become the most common types of anaesthetic. They can often be accompanied by sedation if required for your comfort. Sometimes however these techniques are not the best option for you and a general anaesthetic will suit you better or indeed the operation cannot be done without you having a general anaesthetic.
You will hear more about the anaesthetic options for your intended operation when you attend your pre-operative assessment. Please ensure you pick up a copy of any relevant information leaflets and take time to read through them. You may also be given the opportunity to watch a video prior to your operation if you are having a knee or hip replacement.
Your preferences are important and you will be given the opportunity to discuss the risks and benefits of the anaesthetic options available to you. In some instances you may be asked to attend the hospital specifically to see an Anaesthetist if the specialist nursing staff in the pre-operative assessment clinic feel this would be of benefit to you, but in most cases you will meet your Anaesthetist on the day of surgery.
Details about what to expect and the potential side effects and complications of the different Anaesthetic options are outlined in the document link below ‘Anaesthesia: What you need to know’. Please take the time to read it so you are better prepared for the day of your surgery.
If you are unable to make your own way to your hospital visit due to a medical condition or mobility issue and require ambulance transport to get to your healthcare appointment then please click on the link below which will take you to our Patient Hospital Transport page which gives you all the relevant information on how to arrange this.
If you have been advised by the medical team caring for you that you may benefit from having a hip or knee replacement then the following information and associated links will help ensure you are as prepared as you can be for your surgery and recovery.
Most total hip and knee replacements take place at Glasgow Royal Infirmary. If you are having a Uni-compartmental knee replacement (‘Half-knee’) then you may be advised that you can have your operation carried out at Stobhill hospital if the surgeon feels this would be appropriate for you. If this applies to you then please follow the Stobhill Hospital information where relevant.
[ Given the current unprecedented pressures on our NHS and orthopaedic services at Glasgow Royal Infirmary, we would like to offer you the possibility of remote support via the NHS Joint School App for detailed information on your condition, planned procedure and ways of managing your symptoms whilst awaiting your surgery.]
Your Joint Replacement Pathway
Pre-Op Assessment
You will be invited to attend the pre-operative assessment clinic before your operation. You will meet one of the specialist nurses who will ask you questions about your health and arrange appropriate tests such as blood tests and an ECG (heart tracing).
If any issues are identified that may require further investigation or advice the pre-assessment nurses will then speak to an Anaesthetist. You will be advised of any changes or further tests following this and may be asked to come back for a second appointment to meet an Anaesthetist in clinic. This is generally to explore your health further and discuss the anaesthetic options or risks in more detail. Occasionally an issue is identified that warrants further investigation or treatment before you proceed to surgery. If this is the case the nursing staff will explain what is required and how to let them know when this has been done and you are ready to move forward to surgery.
This process is designed to make sure you are as physically ready for surgery as possible and also gives you information about what to expect so you can take time to think about whether you still want to go ahead.
Please bring your medication with you to the pre-operative assessment clinic or a complete list of these with your prescription. Most medications should be taken as normal up to and including on the morning of surgery. There are a few specific medications that may need to be stopped prior to surgery or not taken on the morning of surgery. These are usually ‘blood thinning’ medications such as clopidogrel, warfarin, and aspirin. Your pre-operative assessment nurse will give you specific instructions.
Download our specific Covid related Pre-Op Self-Isolation Advice leaflet here
Preparing for Your Surgery
If you can improve your general fitness, strength and well-being prior to surgery you will find that your recovery is easier and quicker. It may also reduce the risk of complications. A hip or knee replacement is a major surgical procedure that places physical demands on your body during the surgery and anaesthetic and during the healing process. It also requires effort on your part to recover well and get maximum benefit from your new joint such as performing regular physiotherapy-guided exercises.
Watch the video to see what you can do to prepare for surgery.
Click here for more videos on how to improve your fitness before and after surgery.
If you are Overweight
Reducing your weight will reduce many of the risks of having an anaesthetic. Importantly, it will also reduce the load carried by your hip or knee and can reduce the pain in the joint even prior to surgery. It will make your recovery and physiotherapy easier after surgery too. There are multiple sources of information and local groups to help you learn about healthy eating and lose weight.
The NHS inform website can provide a useful starting point – Food and Nutrition . Your local GP surgery may be able to point you in the direction of nearby groups or services if you wish.
If you Smoke
Giving up smoking as far in advance of the surgery as possible will reduce the risk of breathing problems both during and after your anaesthetic and reduce the risk of problems such as a chest infections. If you need help or advice with this from a trained advisor please contact Quit Your Way on 0800 84 84 84. Lines are open Monday to Friday 8.00am until 10.00pm and Saturday to Sunday 9.00am until 5.00pm. You can also visit the Quit Your Way website to find a local Quit Your Way Pharmacy Service.
Eating and Drinking the day before surgery
Please follow the advice below.
Note: ‘Clear fluids’ includes water, black tea or black coffee (no milk).
If you are asked to come to the hospital for morning surgery
Eat your evening meal as normal on the day before surgery Have a snack in the evening if you want Do not eat anything after midnight Drink only clear fluids after midnight Drink clear fluids when you are thirsty until 0600 Have a drink of around 300ml of clear fluid at 0600 to help stop you getting thirsty and improve your comfort while you wait. If you are asked to come to the hospital for afternoon surgery
Have a light breakfast before 0700 on the day of surgery to keep you feeling comfortable during the day ahead Do not eat anything after 0700 Drink clear fluids when you are thirsty until 1100 Have a drink of around 300ml of clear fluid at 1100 to help stop you getting thirsty and improve your comfort while you wait. The exact time of your surgery may not be confirmed until on the day as you will be part of a theatre list with other patients. We ask more than one patient to arrive for the start of the day to help ensure flexibility if there are last minute changes and to allow the theatre staff to see you before the surgical session begins. If there will be time for you to have a further drink of clear fluid on arrival at hospital the nursing team will be able to advise you of this on the day.
Your Anaesthetic for Joint Replacement Surgery
Anaesthesia allows you to be pain free and comfortable during your operation. In some cases, especially knee replacement surgery, your anaesthetist may place a longer lasting local anaesthetic around other nerves in your leg to help reduce the discomfort for a little longer after surgery. This is known as a “nerve block”. They will discuss this with you on the day of your operation.
There are occasions where, for medical or surgical reasons, a spinal anaesthetic is not suitable and your anaesthetist will be able to discuss the options with you. This often includes a general anaesthetic. Your preferences as to the type of anaesthetic you receive are also important so please take the time to consider these and ask your anaesthetist for advice. In some instances you may be asked to attend the hospital specifically to see an anaesthetist if the specialist nursing staff in the pre-operative assessment clinic feel this would be of benefit to you. In most cases you will meet your anaesthetist on the day of surgery.
You can download this patient information leaflet – Anaesthesia: What you need to know and watch this short video by your anaesthetist.
Your Anaesthetist
For further information https://www.nhsggc.org.uk/your-health/health-services/orthopaedics/anaesthesia/
Enhanced Recovery After Surgery [ERAS]
The ‘Enhanced Recovery After Surgery Programme’ simply refers to the processes that are in place to ensure you are prepared for your surgery and receive the care required to get you back to the comfort of your own home as quickly as possible.
Evidence tells us that a huge part of improving a patient’s recovery after surgery is making sure they have a good understanding of what to expect before coming into hospital. This website together with information leaflets and appointments with the staff in the hospital are all opportunities to find out about what will happen when you come into hospital and how to prepare.
The operation itself and healing process place high physical demands on your body. In the weeks and months before your operation you can take actions to improve your health and fitness in preparation for surgery. If you do this then you will be back to your normal self much more quickly and hopefully gaining the benefits of your new hip or knee as soon as possible.
We also aim to make sure all patients get the same high level of care during their anaesthetic and surgery and afterwards on the ward so we can get you back on your feet as soon as possible. Getting out of bed with the help of the physiotherapists and nursing staff soon after surgery, eating and drinking normally, getting dressed into your own clothes and getting home as soon as possible have all been shown to get your recovery off to the best possible start and do not increase the risk of any complications.
Evidence tells us that the sooner you can get your new hip or knee moving and back on your feet the better the result from your surgery. It also helps reduce the discomfort in your new joint. We will ensure you have plenty of medication available to help ease the pain when you need it. In most cases the discomfort significantly improves after only a few days.
You will be told how long your hospital stay is likely to be when you come into hospital so you know what to expect. The planned duration of stay will vary depending on the specifics of your operation and which hospital you are attending. You will be assessed regularly after your surgery to check how you are progressing and to monitor for any complications. You will be discharged home when you are ready even if this is earlier than the planned date. If you need a little more help don’t worry, you will not be discharged until you are ready.
Click here (https://www.nhsggc.org.uk/your-health/health-services/orthopaedics/hipknee-replacements/exercise/) for some videos on how to improve your fitness before and after surgery
Our Fracture Clinics/Trauma Pathway
virtual fracture clinic
fracture clinic
nurse led clinics
contact information
Virtual Fracture Clinic
After your visit to the Emergency Department you may be initially referred to our Virtual Fracture Clinic. As the name implies this is a virtual clinic and patients do not need to attend.
An Orthopaedic Consultant and Nurse will look at your notes and x-ray and contact you with advice. You may be asked to physically attend our Fracture Clinic or you will be given advice over the phone and discharged with the option to call back anytime for further advice or an appointment.
It is helpful if you give the staff in the Emergency Department your most up-to-date phone number and remember the call may come from a 0800 number.
Following assessment you may be sent a letter with one of the following leaflets:
Following the Virtual Clinic outcome, you may be given an appointment to attend one of our Fracture Clinics in the Gatehouse Building (Castle Street). An orthopaedic doctor will look at your notes, x-rays and talk to you about your injury. The clinics are split up into different body parts on different days of the week (see chart below). The patients attending this clinic are usually people who have had an accident so there can be lots of patients at the same clinic. The nurses will keep you up to date if waiting times are longer than expected. It is helpful if you have something to eat before you come and take your normal medicines. It is also helpful if you bring a list of any medication you are currently taking.
Fracture Clinic Schedule
Monday: Foot and Ankle Morning Clinic
Tuesday: Elbow/Shoulder Morning Clinic/Hand and Wrist Afternoon Clinic
Wednesday: Hip Morning Clinic
Thursday: Knee Morning Clinic
Friday: Frame Clinic Morning Clinic
Nurse Led Clinic
After an injury or in some cases after an operation you may be asked to attend to one of our Nurse Led Clinics. These clinics are held daily Monday to Friday and are run by our specialist nurses who are very experienced and have had training in orthopaedic injuries and operations. If a doctor is needed the nurse can contact one to see you.
Additional Information
If you have been asked to attend the Fracture Clinic and wish to cancel or rearrange your appointment please call 0141 201 3105 or 0141 201 3114
These lines are staffed from 8.00am until 5.00pm Monday to Thursday and 8.00am until 4.00pm on Fridays (excluding public holidays).
Should you require any additional advice from medical staff, the specialist nurses can be reached on 0141 201 6417 or 0141 201 6416 during normal office hours.
for further information on your patient journey select from the boxes below
When you attend your clinic appointment to see the Specialist Clinician you may be given a selection of leaflets about your condition to read. Please select the correct body part to find the appropriate leaflet.
You will also find our Virtual/Fracture Clinic leaflets for self-management which will be posted out to you following attendance at A&E and assessment by our Orthopaedic Specialist Clinicians.
Select the body part below for further information.
Note: Patients are not expected to attend Virtual Clinic appointments.
The Orthopaedic Consultant and Nurse will look at your notes and x-ray(s) and contact you with advice. This might be an appointment to come to the clinic or phone advice and discharge with the option to call back anytime for further advice or an appointment.
It is helpful if you give the staff in the Emergency Department your most up-to-date phone number and remember the call may come from a 0800 number.
Following assessment you may be sent a letter with one of the following leaflets:
Very simply, Patient Focused Booking (PFB) puts patients at the heart of the booking process by engaging them in dialogue about their appointment. Previously, patients would be sent an appointment letter, with the date and time of their appointment, no matter how far ahead in time that may have been. When the appointment day came, patients may have no longer required the consultation, may have forgotten to turn up or booked clinics may have been cancelled.
With PFB, patients are sent an invitation letter, inviting them to telephone or email the hospital to arrange a suitable date and time for an appointment within current guarantee time guidelines. The process is complemented by a policy that prevents a clinic being cancelled with less than six weeks’ notice. Therefore, when the patient phones or emails, the appointment options are limited to only those clinics scheduled in the next few weeks (non-routine patients are clinically prioritised to by-pass this process and will always be seen first).
The call operator offers a choice of dates and times and the patient chooses the most convenient to them. After a period of 7 days, if the patient fails to phone a reminder letter will be sent, after checking contact details, if the patient fails to respond to the reminder letter after a period of 7 days a further letter is sent to the patient and their GP, explaining that they have been removed from the waiting list.
Glasgow Royal Infirmary Attend Anywhere Helpline: 0141 201 3105/3114 (Glasgow Royal Infirmary/Stobhill Orthopaedics ONLY)
In order to gain access to the video consultation service you must have a previously arranged appointment which you will be informed of via the orthopaedic outpatient service. There is currently no drop-in service available via video.
Before Your Appointment:
Please ensure you are using Chrome as you main internet browser.
Click on an analyte name below for further information:
Adrenocorticotrophic Hormone (ACTH)
Adrenocorticotrophic hormone (ACTH) is a 39 amino acid peptide hormone secreted by the anterior pituitary, under the control of the hypothalamic peptide, corticotrophin-releasing hormone (CRH). ACTH secretion is pulsatile and exhibits diurnal variation, with highest plasma concentrations around 8am and lowest levels at midnight. It stimulates glucocorticoid (cortisol) production in the adrenal cortex.
ACTH measurement is only useful as a second line investigation following the finding of either cortisol deficiency or excess.
In cortisol deficiency due to primary adrenal failure, ACTH will be raised due to lack of negative feedback. ACTH will be low in adrenal insufficiency secondary to pituitary failure (hypopituitarism).
Excessive production of cortisol accompanied by suppressed ACTH may be seen in Cushing’s syndrome due to adrenal tumours/hyperplasia, and with exogenous glucocorticoid administration. Cortisol excess with raised ACTH may be seen in ACTH-producing tumours of the pituitary (Cushing’s disease) or other tissues e.g. lungs (ectopic ACTH production).
NB. ACTH secretion may be increased by stress.
Sample Requirements and Reference Ranges
Sample Type: Plasma
Container: EDTA
Precautions: Separate and freeze plasma within 4 hours of sample collection. Transport frozen. Timing of collection important. Avoid stress. Haemolysed specimen unsuitable.
Minimum Volume: 1 mL
Reference Range: Not applicable
Turnaround Time: 7 days
Method: Siemens Immulite
Quality Assurance: UK NEQAS
Anti-Mullerian Hormone (AMH)
Anti-Mullerian hormone (AMH) is a protein produced by granulosa cells of the ovaries in females and by Sertoli cells of the testes in males.
In women serum AMH concentration increases with age up until the mid-twenties, after which it begins to decline. AMH correlates well with the number of follicles in the ovary (as measured by ultrasound) in women over the age of 25 and its measurement is used to individualise fertility treatment.
In men serum AMH concentration tends to be high in childhood, then declines through puberty to low levels in adulthood. It is used in the investigation of cryptorchidism and anorchidism.
AMH is elevated in the majority of patients with granulosa cell tumours and may be used to monitor disease progression or recurrence. AMH is also useful in the investigation of disorders of sex development as a marker of testicular activity.
Sample Requirements and Reference Ranges
Sample Type: Serum
Container: SST
Precautions: Separate serum and send via first class post. If there will be >48 h before sending store the specimen at -20°C. Sample can be sent at ambient temperature.
Minimum Volume: 2 mL
Reference Range:
Females: <50 pmol/L in young adults (falls steadily towards menopause where it becomes undetectable)
Males (Levels fall at puberty. These ranges were derived from a study where stage of puberty was not determined):
0-1yr 390-1300 pmol/L
1-4yr 300-1700 pmol/L
5-8yr 260-1200 pmol/L
9-12yr 100-1000 pmol/L
13-16yr 40-560 pmol/L
17-20yr <520 pmol/L
Adults <100 pmol/L (literature value)
Turnaround Time: 14 days
Method: Beckman Access
Quality Assurance: UK NEQAS
Growth Hormone (GH)
Growth hormone (GH) is a peptide hormone secreted by the anterior pituitary. Its main action is to stimulate the production and release of insulin-like growth factor 1 (IGF-1) by the liver. Excessive secretion causes acromegaly, while deficiency causes failure of growth in children and metabolic problems in adults.
The secretion of GH is very episodic, so random measurement is rarely useful diagnostically.
Failure of GH to suppress during a glucose tolerance test is diagnostic for acromegaly.
Stimulation tests, such as an insulin tolerance test (NB. potentially dangerous, should only be carried out in centres experienced in it) or stimulation with arginine, GHRH/arginine or glucagon, can be carried out to test for insufficiency. GH deficiency may occur as part of a more general deficiency of pituitary hormones, so other hormones are often measured at the same time.
Sample Requirements and Reference Ranges
Sample Type: Serum
Container: SST
Precautions: None
Minimum Volume: 2 mL
Reference Range:
Random GH:
> 10 μg/L excludes GH deficiency
< 0.4 μg/L excludes acromegaly
Severe Growth Hormone Deficiency:
Adults Peak GH during ITT < 3 μg/L
Adults Peak GH with GHRH/Arginine < 5 μg/L
Children Peak GH during provocation < 5 μg/L
GH Excess:
Failure to suppress during OGTT < 1 μg/L
Mean integrated 24hr GH > 1.7 μg/L
Turnaround Time: 7 days
Method: IDS iSYS
Quality Assurance: UK NEQAS
Insulin-like Growth Factor 1 (IGF-1)
Insulin-like growth factor 1 (IGF-1) is a peptide hormone, very similar to insulin. It is a major growth factor, which is synthesised by most cells and tissues. Circulating IGF-1 is produced by the liver in response to growth hormone (GH). IGF-1 concentration is increased in acromegaly, decreased in growth hormone deficiency and altered in systemic illness and malnutrition.
It is often measured along with growth hormone in the investigation of disorders of GH secretion. It is also used to monitor patients with acromegaly and those on growth hormone therapy.
Sample Requirements and Reference Ranges
Sample Type: Serum
Container: SST
Precautions: None
Minimum Volume: 2 mL
Reference Range:
Age (yr) Males (μg/L) Females (μg/L)
<2 15 – 157 17 – 151
2 – 4 28 – 247 25 – 198
5 – 7 46 – 349 39 – 272
8 – 10 67 – 442 59 – 371
11 – 13 89 – 503 82 – 465
14 – 16 104 – 510 97 – 502
17 – 25 105 – 410 96 – 417
26 – 39 81 – 249 72 – 259
40 – 54 63 – 201 57 – 197
55 – 65 49 – 191 43 – 170
65+ 39 – 186 35 – 168
Turnaround Time: 7 days
Method: IDS iSYS
Quality Assurance: UK NEQAS
Insulin
Insulin, produced by pancreatic beta cells, regulates glucose uptake and utilization and is involved in protein synthesis and triglyceride storage. It is often measured alongside C-peptide.
Clinical uses of insulin measurements:
Evaluation of possible insulinoma: In cases of hypoglycaemia, diagnosis of insulinoma relies on proving inappropriate secretion of insulin during a hypoglycaemic episode.
Hypoglycaemia of infancy due to hyperinsulinaemia.
Diagnosis of factitious hypoglycaemia together with measurement of C-peptide.
Discrimination of type 1 and type 2 diabetes mellitus: Insulin and C-peptide concentrations are generally low in patients with type 1 diabetes mellitus, and either normal or elevated in early type 2 diabetes, and decreased in later stages.
Sample Requirements and Reference Ranges
Sample Type: Plasma
Container: Lithium heparin
Precautions: Collect after overnight fast or during symptomatic hypoglycaemia, together with glucose sample. Separate and freeze plasma within 4 hours of sample collection. Transport frozen. Haemolysed specimens unsuitable. For hypoglycaemic screen, only measure when hypoglycaemic (glucose <2.6 mmol/L).
Minimum Volume: 2 mL
Reference Range: Not applicable
Turnaround Time: 7 days
Method: Abbott Alinity
Quality Assurance: UK NEQAS
Insulin C-peptide
Insulin C-peptide (connecting peptide), a 31 amino acid polypeptide, represents the midportion of proinsulin. During insulin secretion it is enzymatically cleaved from proinsulin and co-secreted in equimolar proportion with mature insulin. The half life of C-peptide is significantly longer than insulin, so it is detectable in higher concentrations and the level less variable. C-peptide is often a more reliable marker than insulin. In addition, insulin is destroyed by proteases in haemolysed samples, while C-peptide is not.
Clinical uses:
Insulinoma: Elevated C-peptide levels from increased beta-cell activity.
Covert self-administration of insulin: Can be virtually ruled out as cause of hyperinsulinaemia by finding elevated C-peptide.
Type 1 diabetes mellitus: Low C-peptide levels due to diminished insulin secretion, or suppressed as a normal response to exogenous insulin. Patients on insulin can develop anti-insulin antibodies which can interfere with insulin assay, so C-peptide can be used instead to check residual beta-cell activity.
Sample Requirements and Reference Ranges
Sample Type: Plasma
Container: Lithium heparin
Precautions: Collect after overnight fast. Separate and freeze plasma. Transport frozen.
Minimum Volume: 1 mL
Reference Range: Not applicable
Turnaround Time: 7 days
Method: Siemens Immulite
Quality Assurance: UK NEQAS
Macroprolactin
Prolactin exists in various forms including the monomeric biologically active form (23kDa) and a higher molecular weight form, bound most commonly to IgG, known as macroprolactin (>100kDa). Macroprolactin lacks biological activity but can interfere in standard prolactin immunoassays and is a “common” cause of hyperprolactinaemia (overall prevalence 1.5%). Its presence is determined by recovery of prolactin following precipitation with polyethylene glycol (PEG screening test).
Macroprolactin should be requested in cases of persistently raised prolactin >700 mU/L (on two or more occasions) in euthyroid patients and after excluding drug associated hyperprolactinaemia. PEG screening can identify macroprolactin and determine the concentration of monomeric (bioactive) prolactin, as both may coincide.
Sample Requirements and Reference Ranges
Sample Type: Serum
Container: SST
Precautions: None
Minimum Volume: 2 mL
Reference Range:
Macroprolactin is reported as positive or negative based on percentage recovery of monomeric (bioactive) prolactin after PEG precipitation to remove macroprolactin:
Post-PEG recovery <40% – macroprolactin detected
Post-PEG recovery >60% – macroprolactin negative
Post-PEG recovery 40 – 60% – equivocal recovery
Turnaround Time: 7 days
Method: Polyethylene glycol (PEG) precipitation to precipitate macroprolactin followed by Abbott Alinity immunoanalyser to quantify monomeric prolactin.
Quality Assurance: UK NEQAS
Parathyroid Hormone (PTH)
Parathyroid hormone (PTH), a polypeptide containing 84 amino acids, is secreted by the chief cells of the parathyroid glands. It has a molecular weight of 9.4 kDa. PTH should be measured in the investigation of unexplained hypercalcaemia or hypocalcaemia. PTH should always be interpreted in light of the serum adjusted calcium concentration and the patient’s renal function.
Sample Requirements and Reference Ranges
Sample Type: Plasma
Container: EDTA
Precautions: Avoid haemolysis
Minimum Volume: 2 mL
Reference Range: 1.6 – 7.5 pmol/L
Turnaround Time: 1 day
Method: Abbott Alinity
Quality Assurance: UK NEQAS
Renin
Renin, a proteolytic enzyme, is synthesized by the juxtaglomerular cells of the kidney and released in response to decreased blood volume, decreased blood pressure and sodium depletion. Renin stimulates aldosterone release through angiotensin intermediates, resulting in the renal retention of sodium and the excretion of potassium.
Renin is measured with paired aldosterone to calculate an aldosterone/renin ratio in the investigation of hypertension.
Renin measurement may be useful in monitoring response to therapy in patients with Addison’s disease or congenital adrenal hyperplasia (CAH).
Beta blockers, diuretics, ACE inhibitors, angiotensin II receptor blockers, calcium channel blockers, a restricted salt diet and posture can all affect interpretation of renin results.
Sample Requirements and Reference Ranges
Sample Type: Plasma
Container: EDTA (Lithium heparin unsuitable)
Precautions: Do not collect on ice. Separate and freeze plasma within 4 hours of sample collection. Transport frozen. Grossly haemolysed or lipaemic samples unsuitable. Posture and relevant drug therapies (see above) may affect interpretation of results.
Minimum Volume: 500 μL
Reference Range:
Adults (upright): <52 mIU/L
Infants <1 year: <450 mIU/L
Children 1 – 5 years: <380 mIU/L
Children 6 – 15 years: <125 mIU/L
Turnaround Time: 14 days
Method: IDS iSYS
Quality Assurance: UKNEQAS
Sex Hormone Binding Globulin (SHBG)
Sex hormone binding globulin (SHBG) is a large 80-100 kDa glycoprotein that functions to transport sex hormones around the body. It has a high affinity for 17β-hydroxy steroids such as testosterone and oestradiol. Concentrations of SHBG are influenced by many factors. SHBG will be increased by elevated concentrations of circulating oestrogens (including the oral contraceptive pill), hyperthyroidism, liver disease and excess alcohol. SHBG will be decreased by increasing body mass index, polycystic ovarian syndrome and hypothyroidism.
Sample Requirements and Reference Ranges
Sample Type: Serum
Container: SST
Precautions: None
Minimum Volume: 2 mL
Reference Range:
Age Male (nmol/L) Female (nmol/L)
3 – 10 years 45 – 220 50 – 170
10 – 12 years 22 – 188 38 – 129
Adult 13 – 70 20 – 155
Turnaround Time: 1 day
Method: Abbott Alinity
Quality Assurance: UK NEQAS
Anti-Thyroperoxidase (TPO) Antibodies
Anti-thyroperoxidase (TPO) antibodies are present in 90-100% of patients with Hashimoto’s thyroiditis, the commonest cause of autoimmune hypothyroidism. Anti-TPO is measured in patients with subclinical hypothyroidism (TSH 5-12 mIU/L and FT4 within reference limits: 8-21 pmol/L) to identify those at increased risk of developing thyroid failure. The risk of developing hypothyroidism if anti-TPO is positive is approximately 5% per year.
Sample Requirements and Reference Ranges
Sample Type: Serum
Container: SST
Precautions: None
Minimum Volume: 2 mL
Reference Range: <6 IU/L
Turnaround Time: 1 day
Method: Abbott Alinity
Quality Assurance: UK NEQAS
TSH Receptor Antibody (TRAB)
TSH receptor antibody (TRAB) is measured if the cause of thyrotoxicosis is not clear. It is specific for Graves’ autoimmune disease of thyroid but is not present in all cases. It can be used to distinguish Graves’ disease from toxic multinodular goitre and postpartum or subacute thyroiditis. It is also measured in 3rd trimester of pregnancy, if there is a maternal history of Graves’ disease/thyrotoxicosis, to predict risk of neonatal thyroid problems. It may be helpful in cases of possible “euthyroid” Graves’ ophthalmopathy.
