November 2016 Update on testing
Dr Manning has recently retired – due to problems with the assay they have suspended testing for TMAU for the foreseeable future. This is clearly a huge issue for those wanting to be tested,
Currently Sheffield is (was) the only lab in the UK running this test – the alternatives are labs in the US or Netherlands but I have no idea of prices and whether a GP would fund.
Unfortunately Dr Lachmann will not be able to accept any new referrals at the moment as a result.
New information will be posted on the forum ; Testing Suspended
Disregard the below information, see above, as of November 2016 all testing is suspended
The below is kindly reproduced with the permission of Nigel Manning, Sheffield Children's Hospital;
Sheffield Children's NHS
Department of Clinical Chemistry
Arranging the TMAU test.
Option 1. GP referral. The following metabolic specialists are recommended in the UK.
Dr Robin Lachmann
Charles Dent Metabolic Unit
National Hospital for Neurology and Neurosurgery
London WC1N 3BG
Dr Chris Hendriksz
Adult Inherited Metabolic Disorders Clinic
Salford Royal NHS Foundation Trust
Salford M6 8HD
Dr Tarekegn Hiwot
Consultant in Inherited Metabolic Disorders
Queen Elizabeth Hospital Birmingham
Birmingham B15 2WB
Dr Helena Kemp
Dept. of Clinical Biochemistry
North Bristol NHS Trust
Westbury on Trym
Bristol BS10 5NB
Option 2. GP organises the test sample.
To test for Trimethylaminuria (TMAU) we require a 20ml urine sample and a referral letter or request form
from a GP or local hospital.
TMAU is associated with ingestion of certain foods so it is important to collect this sample at the time of the
odour. For this we recommend a dietary ‘Choline Load’ before sample collection using foods known to
produce the odour eg beans, eggs, liver.
URINE SAMPLE COLLECTION
EITHER - '24 hour' urine collection - during a prolonged period urine is collected into a 2.5 litre container
with approximately 10ml of ‘5M’ hydrochloric acid (available from general hospital laboratories) to acidify the
sample and stabilise the trimethylamine. (This is the same sample collection as for a urine Calcium test)
OR - (for convenience) a single 20ml sample with a small amount of hydrochloric acid (1ml of 1M HCl) to
acidify the sample.
SUGGESTED PROCEDURE: at 13:00 and 19:00 a high choline meal containing (eg 2 eggs + 400g baked
beans / soya beans).
1. Start ’24 hour’ urine collection the day after the choline load and collect urine until the end of the day
or 2. collect a single 20ml sample the morning after the choline load.
Send 10 – 20ml urine to Sheffield Childrens Hospital to measure:
Trimethylamine and Trimethylamine-oxide.
The acidified urine should be sent to the address below by 1st class post at room temperature. We should be
able to return the results with interpretation within 4 weeks of receipt of the sample. The test costs £134 if
GP requires the patient to pay for the test. Most GPs are funded for this test by the NHS so the test is free.
Option 3. Testing via a private company called Smart Nutrition who can start the process without a GP
They work with a company called Biolab Medical Unit who would send the patient the necessary kit to
collect a single 20ml urine sample which is then sent to us. This costs approximately £190 and the report and
advice would be dispatched in approximately 4 weeks.
Principal Clinical Scientist
Dept. Clinical Chemistry
Sheffield Children's Hospital
Sheffield S10 2TH
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