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Haemoglobin A1c assay: optimised clinical service and reduced costs

Consolidation of HbA1c testing on a Siemens chemistry analyser has had a significant impact on staff usage and turnaround time at St George’s Hospital in London. St George’s Healthcare NHS Trust in London has recently consolidated all glycated haemoglobin (HbA1c) testing on its routine Siemens Healthcare Diagnostics ADVIA Chemistry 2400 systems. The move to consolidate a traditionally ‘esoteric’ test into the automated routine chemistry environment resulted from a drive to increase efficiency. Incorporating specialist HbA1c analysis into the routine chemistry laboratory testing environment has delivered significant cost savings. In addition to savings made by eliminating purchasing and maintenance costs involved for a dedicated HbA1c high-performance liquid chromatography (HPLC) system, St George’s has liberated a dedicated operator to provide this service and reduced turnaround time from an average of two days to two hours.

For many years, St George’s routinely processed over 100 patient samples a day for HbA1c on a dedicated Bio-Rad VARIANT II TURBO HPLC system. The system was situated in a specialist laboratory and was run by dedicated operators. The HbA1c service is now delivered through ADVIA Chemistry 2400 systems that reside in the clinical blood sciences laboratory where methods are easily accessible 24 hours a day, seven days a week.
 St George’s experience of the ADVIA Chemistry Haemoglobin A1c (A1c) automated pretreatment method highlights the following points:
* excellent agreement with the Bio-Rad VARIANT II TURBO HPLC method, confirming that the assay produces accurate results in the presence of HbS and HbC variants
* fast, precise and easy-to-use, liberating operator time
* allows consolidation of testing for HbA1c into routine workflow, resulting in cost savings to the laboratory and an improved turnaround time (from an average of two days to two hours).

Accurate results in the presence of HbS and HbC variants
The ADVIA Chemistry Haemoglobin A1c (A1c) automated pretreatment method is precise and shows excellent agreement with the Bio-Rad VARIANT II TURBO HPLC method (Fig 1). St George’s serves a local population with a high percentage of people of Asian, Caribbean and African origin who have a high prevalence of haemoglobinopathies. Some immunoassay techniques for measuring HbA1c can produce erroneous results when haemoglobin variants are present. St George’s evaluated ADVIA Chemistry Haemoglobin A1c levels in 105 HbS and 20 HbC patients, and the ADVIA Chemistry Haemoglobin A1c levels were compared with the Bio-Rad VARIANT II TURBO HPLC method.
 The results (Figs 2 and 3) confirm that patient samples that contain haemoglobin variants (HbS and HbC) can be assayed accurately on the ADVIA Chemistry for HbA1c. This is achieved by incorporating a protease in the reagent to liberate the same glycated pentapeptide regardless of the haemoglobin variants present in whole blood.

Specialist testing on high-throughput systems
“Processing HbA1c samples on ADVIA Chemistry systems does not require any specialist expertise or training,” explains Irena Houssein, chief biomedical scientist at St George’s Healthcare NHS Trust. “The ADVIA Chemistry reagents are ready to use and have excellent reagent and calibration stability. The combination of this and the automated pretreatment make the method very simple, fast and easy-to-use.

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