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19. Dried Blood Spot (DBS) testing, Instructions & Support

Dried Blood Spot identifiers -18/05/16

In order to comply with UKAS medical laboratory accreditation (ISO15189:2012) standards, with immediate effect, dried blood spot sample cards received without each of the following identifiers ON THE DBS CARD:

  1. Name
  2. Date of birth
  3. CHI or NHS number

Will NOT be tested. These samples will be stored and a report returned with the following comment.

"There were insufficient identifiers to match the DBS sample with the patient request card.  This sample has not been tested.  Please note we require patient name, date of birth and NHS or CHI number before the sample can be processed" 

Pharmacy locations offering Dried Blood Spot testing for HIV, HBV & HCV in NHS GG&C:

  • Abbey Chemists 144 Trongate Glasgow G1 5EN 0141 552 2528
  • Boots Pharmacy Queen Street Station, Dundas Street Glasgow G1 2AF 0141 332 5870
  • Dickson Chemists 1024 Tollcross Road Glasgow G32 8UW 0141 531 9412
  • Hughes Chemist 16-18 Admiral Street Glasgow G41 1HU 0141 429 4131
  • L G Pharmacy 476 St Vincent Street Glasgow G3 8XU 0141 221 3690
  • Rowlands Pharmacy 210 Springburn Way Glasgow G21 1TU 0141 558 5209
  • Glenburn Pharmacy 2-4 Skye Crescent Paisley PA2 8EL 0141 884 4842
  • E R McAnerney 182 Dunlop Street Greenock PA16 9DP 01475 722 805
  • Still Chemist Unit 1a, 6 Cumberland Walk Greenock PA16 0UD 01475 636 396

The way we test dried blood spots (DBS) changed in September 2014.  We moved to a fully automated system for HCV, HBV and HIV screening.  This improves quality and accuracy of testing for HCV antibody, HBV surface antigen, HBV core antibody and HIV antigen/antibody.

We require 5 full DBS spots per card.  Four full spots will be required for the new automated screening process (regardless of the number of tests requested) and one full spot for PCR testing (if the patient is HCV antibody positive).

      FIVE FULL DRIED BLOOD SPOTS ARE NOW REQUIRED

DBS2.jpg

      WITH BLOOD SOAKED THROUGH FROM FRONT TO BACK

DBS1.jpg

PLEASE NOTE THAT THE REQUIREMENTS FOR DBS HAVE CHANGED, FIVE SPOTS ARE NOW REQUIRED - please see the letter to users

Dried Blood Spot (DBS) testing sampling instructions - suitable for printing

Pharmacy blood-borne virus testing support

Assistance is available from the West of Scotland Specialist Virology Centre (WoSSVC), please call 0141 201 8722, if your question is not answered below.

Antibody is a large protein produced by the immune system, used to identify and neutralise specific pathogens including viruses. The presence of a specific antibody indicates infection in the past, it does not indicate current infection. Further testing is required to identify whether the patient is currently infected.

Antigen is a part of a viral protein, presence indicates current infection. HIV screening tests detect both antibody and antigen simultaneously and indicate current infection if detected.

Ribonucleic acid (RNA) is the genetic code of HCV and HIV detected by RT-PCR (the type of test which detects the presence of viral genes).

HIV antibody/antigen and HCV antibody tests are undertaken on the Architect in the WoSSVC.

WoSSVC photo_Architect i2000SR.jpg

Abbott Architect testing platform at the WoSSVC

HIV antibody/antigen and HCV antibody test results are reported as:

HIV antibody/antigen Not detected by Architect

or

HIV antibody/antigen DETECTED by Architect 

and

HCV antibody            :Not detected by Architect

or

HCV antibody            :DETECTED by Architect

"DETECTED by Architect" is a positive result and "Not detected by Architect" is a negative result. This represents the absence (Not detected by Architect) or the detection of the presence of antibody or antibody/antigen (DETECTED by Architect) by the Abbott Architect testing platform.

Comments on hepatitis C virus results

1. HCV antibody WEAKLY reactive in the screening test. Results may suggest previous exposure to hepatitis C, but may be a non-specific reaction. Please send a plasma sample to confirm antibody status. In the absence of RNA (by RT-PCR) there is no evidence of ongoing hepatitis C infection.

- Note: Antibody levels decline over time for patients infected with HCV in the past.

2. Confirmed positive for antibody against hepatitis C virus. Please send a repeat specimen for confirmation. In the absence of RNA (by RT-PCR) there is no evidence of ongoing hepatitis C infection.

- Note: Antibody to HCV does not protect against re-infection.

3. Patient remains HCV PCR negative. No evidence of current HCV infection.

- Note: Patient has previously been tested as having been exposed in the past (antibody detected) and remains currently uninfected.

4. A low level of HCV RNA was detected, unable to confirm this result. Please send a plasma sample to confirm HCV PCR status.

- Note: Dried Blood Spots contain significantly less sample than a traditional venepuncture. Some patients have a low concentration of virus in the blood which means that current infection cannot be confirmed (or excluded) without a blood specimen.

5. First diagnosis of ongoing HCV infection at the WoSSVC. Evidence of ongoing HCV infection. Patient should be referred to a specialist HCV unit. An HCV PCR should be carried out as part of the specialist assessment.

- Note: The patient has a current infection which has not previously been identified by the laboratory.

6. Patient is known to have an ongoing HCV infection.

- Note: The patient has a current infection which has previously been identified by the laboratory.

7. Dried blot spot card was submitted with insufficient sample to complete testing. Please send another DBS specimen with completely saturated spots. Please see our website: www.nhsggc.org.uk/virology "19. Dried Blood Spot (DBS) Instructions"

- Note: It is not possible to offer testing if the DBS spots are too small to cut out full spots. Please see the Dried Blood Spot (DBS) testing sampling instructions

8. Dried blot spot card was submitted with insufficient sample to complete HCV PCR testing. Please send another DBS specimen marked clearly "PCR ONLY, PREV. INSUFFICIENT". Please see our website: www.nhsggc.org.uk/virology "19. Dried Blood Spot (DBS) Instructions"

- Note: It is not possible to complete the testing if there are insufficient DBS spots submitted. Please see the Dried Blood Spot (DBS) testing sampling instructions

9. Please send a repeat specimen for confirmation.

- Note: It is necessary to confirm a new infection status due to the significance of a change for the management of the patient.

Comments on HIV results

1. Patient is known to be HIV-1 POSITIVE

- Note: The patient has an HIV-1 infection which has previously been identified by the laboratory.

2. New diagnosis of HIV infection at the WoSSVC. Confirmed HIV-1 antibody POSITIVE. In order to ensure correct identification of patient's sample, please send an EDTA sample now.

- Note: The patient has an HIV-1 infection which has not previously been identified by the laboratory.

3. New diagnosis of HIV infection at the WoSSVC. ***Confirmed HIV-2 antibody POSITIVE*** NOTE this has major implications for patient management. In order to ensure correct identification of patient's sample, please send an EDTA sample now.

- Note: The patient has an HIV-2 infection which has not previously been identified by the laboratory. This is very rare in Scotland, only one previous diagnosis having been made. This information to provide to the patient by the pharmacy is the same as for the diagnosis of HIV-1.

4. Suggestive, but not diagnostic of HIV infection. Please send a plasma specimen for confirmation.

- Note: Dried Blood Spots contain significantly less sample than a traditional venepuncture. Some patients, usually very early in infection, have a low concentration of virus in the blood which means that infection cannot be confirmed (or excluded) without a blood specimen.

This webpage is maintained by Dr Eleri Wilson-Davies. Please contact me with any comments on how it can be improved to support the pharmacy service ([email protected]).