N-terminal pro Brain Natriuretic Peptide for Inpatients and ED Patients


Sunquest Code:NTBNPI  
Epic Code:LAB106Epic Name:NT PROBNP Inpatient
Synonyms:Natriuretic Peptide; NT-proBNP; N Terminal
Methodology:Chemiluminescence
CPT Code:83880
Turnaround Time:Performed and reported 24 hours/day.


Collection Instructions

Specimen:Blood
Optimal Volume:2.5 mL
Minimum\Peds Volume:0.6 mL
Container:Green (lithium heparin, gel) (Green (lithium heparin) on ICE, Green (sodium heparin, no gel), Green (sodium heparin, no gel) on ICE, Purple (EDTA), Purple (EDTA) on ICE, Red (no gel), Red or gold (gel))
Causes for Rejection:Hemolyzed samples.
Contraindications:Large doses of biotin (10 mg or more per day) may cause clinically significant interference in N-Terminal pro brain natriuretic peptide levels. If interference is suspected, it is strongly recommended that biotin is discontinued for at least one week prior to retesting.


Processing and Shipping

Specimen Processing:Centrifuge and aliquot 1.25 mL, 0.2 mL minimum. Store in refrigerator.
Shipping Instructions:Ship at refrigerated temperature to arrive within 72 hours. Alternatively, ship on dry ice.
Test Performed at or Referral Lab Chemistry  (Fairview Range - FRMC, UMMC-East Bank, Fairview Lakes - FLMC, Fairview Ridges - FRH, Fairview Northland - FNMC, Fairview Southdale - FSH, UMMC/UMMCH-West Bank, Grand Itasca GICH)


Interpretive

Reference Range:
Pediatric Reference Range  
Age pg/mL
0-2 days 0-13,000
3-30 days 0-6,500
1-11 mo 0-1,000
1 y 0-680
2-5 y 0-330
6-17 y 0-240
GICH: All ages less than 100 pg/mL

Establishing a baseline value for each individual patient  is useful for future follow-up. Suggested inpatient cut points for confirming the diagnosis of CHF:
Inpatient (acute) Cut Points (pg/mL)
18-49 y Greater than 450
50-75 y Greater than 900
76 y and older Greater than 1800


An inpatient or emergency department patient NT-pro-BNP of less than 300 pg/mL effectively rules out acute congestive heart failure. The outpatient non-acute reference range for ruling out CHF is:
Outpatient (non-acute) pg/mL
18-74 y 0-125
75 y and older 0-450
 
Use:B-Type Natriuretic Peptide (BNP) protein is classed as a cardiac neurohormone and originates from the myocytes of the atrium and ventricles of the heart. It is secreted under conditions of myocardial stretching, volume overload, and increased ventricular filling pressures. ProBNP, the immediate precursor of BNP cleaves to form BNP and NT-proBNP in a 1:1 ratio. NT-proBNP concentrations are higher because the half-life is one to two hours, compared to 22 minutes for BNP. NT-proBNP is used to differentiate heart failure from pulmonary disease in patient presenting with symptoms of dyspnea and shortness of breath. Marked elevations of NT-proBNP may be observed in states other than left ventricular congestive heart failure, including: acute coronary syndromes, right heart strain/failure (including pulmonary embolism and cor pulmonale), critical illness, renal failure, as well as advanced age. Falsely low NT-proBNP in congestive heart failure patients may be observed with increasing body mass index.


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