CDT Testing - People Losing Their Jobs?

[ExpatBrat]

A while back EK instituted this new policy of CDT tests at the annual medicals. This is a carbohydrate deficiency test that can imply a problem with alcohol. I heard the other day that something like five people have since lost their jobs for failing that test. Which is a rumour. And this is a rumour network so....

But what I didn't understand is, if you knew your medical was coming up, wouldn't you lay off the sauce for a couple weeks? Why take the chance, or are they doing this test as part of the random drug and alcohol tests at EGHQ now too?

[kipper the dog]

If you were a full on alcoholic, then maybe it's not that easy to just lay off the sauce for a couple of weeks..? My understanding was that they only do the CDT test if they suspect there might be a problem, could be wrong though.

Kipper

[The Zohan]

it takes a doctor 10" of liver palpation to see if you need to be tested or not...

wouldn't you lay off the sauce for a couple weeks?

it takes up to six months of virgin mojitos to show an improvement on your CDT results...

hic..!

tz

[Emma Royds]

The one thing that remains vague are the CDT limitations that EK and the GCAA are using for one to fall foul of this test. There is no information that I could see on the GCAA website, in relation to this.

If used properly, then CDT testing is designed to highlight individuals with a persistent drinking problem, who quite frankly need help. To achieve the elevated CDT levels that are often used as benchmarks by other organisations, quantities such as a whole bottle of sprits would need to be consumed on most days to sustain the prolonged elevated high CDT levels.

If EK have set their criteria a lot lower than is commonly used, then that is unfair and not how CDT testing should be used. We can only guess....

[VLS with ice]

Heard that somebody is taking the company to court for this....

[Chewthecrude]

CDT values <1.7 are counted as non positive

Results reater than 1.6 are therefore used as a marker for alcohol abuse (not alcoholism). It is used in risk assessment to assess whether an individual would turn up to fly with alcohol in their system. In the UAE (specifically EK as the small "dr" who has driven it works there) it is used inappropriately in a way no other CAA inc the FAA does.

However Dr FR wrote her letter regards this as no doubt she and all the other western Drs don't agree with its application. However on the other side a high CDT result does give some indication as to the amount and regularity of an individuals drinking. If your reading is +3 then something is pretty much amiss. But once again it has to be cross referenced with GGT & MCV plus a couple of other blood results (CDT,GGT & MCV should not be used as the three stand alone results).

When FR mentioned that if you go on holiday and 'let your hair down' for the two weeks that are really your own to do what you like then come back and get tested for whatever reason they decide to test you for this week then there is a possibility that your CDT may be above the limit.

You WILL be sent for an assessment. You WILL be found to have abused alcohol. You WILL be dismissed. There are no second chances to be helped in the UAE anymore.

There are several individuals who have, in the past, got help when they needed it. There are several individuals who got help that didn't need it. And are still being 'helped'

[Snake man]

Excellent post, Cewthecrude

This smacks of finding a problem to the solution.
Personalities have replaced programs, and lives are being wrecked in the process.

SM

[fatbus]

Can you refuse to have it done?
This could become a thing of the past soon .

[kipper the dog]

Refuse to have it done? Ha! Yeah right, they just gonna fire you instead - no employment laws here.

[Dune]

Perhaps some useful information?

Wikipedia:

Carbohydrate-deficient transferrin (CDT) is a laboratory test used to help detect heavy ethanol consumption.[1]

Physiology[edit]

Transferrin is a serum protein that carries iron through the bloodstream to the bone marrow, where red blood cells are manufactured, as well as to the liver and spleen. Structurally, transferrin is a polypeptide with two N-linked polysaccharide chains. These polysaccharide chains are branched with sialic acid residues. Sialic acid is a monosaccharide carbohydrate.

Various forms of transferrin exist, with differing levels of sialylation. The most common form is tetrasialotransferrin, with four sialic acid chains. In persons who consume significant quantities of alcohol (usually more than 4 or 5 alcoholic beverages a day for two weeks or more), the proportion of transferrin with zero, one, or two sialic acid chains is increased. These are referred to as carbohydrate-deficient transferrins. These carbohydrate-deficient transferrins can be measured in the bloodstream, and are an important marker for alcohol abuse.

Test for alcohol consumption[edit]

Carbohydrate-deficient transferrin is elevated in the blood of heavy alcoholism but raised levels can also be found in a number of medical conditions. The limitations of the assay depend upon the methodology of the test. HPLC (High Performance Liquid Chromatography) can detect certain genetic variants and potential liver diseases affecting CDT.

Used with other tests, such as gamma glutamyl transferase (GGT), aspartate aminotransferase (AST), and alanine aminotransferase (ALT), carbohydrate-deficient transferrin can be a useful tool in identifying problem drinking, such as alcohol abuse or alcoholism. However, it is less sensitive than phosphatidylethanol (PEth) in detecting current regular alcohol consumption.[2]

CDT is measured by taking a sample of a patient's blood. Apparently healthy individuals with no or low reported alcohol consumption and a negative Alcohol Use Disorder Identification Test will have a %CDT <1.7% (95th percentile for the social drinking population). Elevated levels of CDT suggest recent alcohol abuse, especially if other liver-associated enzymes (such as γGT) are elevated. Although recent heavy alcohol use is most commonly associated with elevated CDT, certain rare liver disorders can also increase levels of CDT. CDT levels are less useful for detecting alcoholism in patients with other liver diseases.[3]


Phosphatidylethanol

Phosphatidylethanols (PEth) are a group of phospholipids formed only in the presence of ethanol via the action of phospholipase D.[1] Levels of phosphatidylethanols in blood are used as markers of previous alcohol consumption.[2][3] For this purpose, PEth is more sensitive than carbohydrate deficient transferrin (CDT), urinary ethyl glucuronide (EtG) and ethyl sulfate (EtS).[4]

Chemically, phosphatidylethanols are phospholipids carrying two fatty acid chains, which are variable in structure, and one phosphate ethyl ester.



MUSC Health Institute of Psychiatry

%dCDT Frequently Asked Questions

Disialo carbohydrate-deficient transferrin (%dCDT) is a blood test for heavy alcohol use that can be very useful in evaluating medical symptoms and predicting complications after surgery. It is based on the fact that an average daily consumption of more than 60g of alcohol (about 5 standard drinks) during the previous 2 weeks increases the percentage of transferrin that has a deficient carbohydrate content. A positive %dCDT test result is 1.7% or higher and may change up or down with increased or decreased drinking.

Does a high %dCDT mean that a person is an alcoholic?

No, not at all. Alcoholism is a clinical diagnosis that can only be made with a more complete assessment. There are many people who might be drinking heavily enough to elevate %dCDT who do not meet criteria for alcohol abuse or dependence.

Does a high %dCDT indicate harmful alcohol use?

The fact that %dCDT is elevated most likely means that a person is drinking too much. %dCDT is an indication that alcohol is disrupting the normal chemistry of the liver cell. While it does not mean that there is liver damage per se it does indicate that alcohol is having a negative effect. It also means that alcohol may be affecting other organs besides the liver and playing a harmful role in the patient’s medical or social functioning.

How sensitive is %dCDT?

It has been established that %dCDT can increase after about 2-3 weeks of steady alcohol consumption of about 4-6 drinks a day (this is equivalent to a bottle of wine, 5 cans of beer, or ½ pint (8 oz.) of hard liquor). The longer a person drinks at this level (or perhaps binge drinks) the more likely %dCDT will be positive. Men seem to be more sensitive than women. In many studies, chronic heavy drinking leads to a sensitivity of 60-80%.

How specific is %dCDT – do other diseases or drugs affect it?

Actually, %dCDT is quite specific for heavy alcohol use. There are a few inborn errors of glycoprotein metabolism that may cause elevated %dCDT in about 1-5% of the population. Also, very severe liver disease may lead to false positives. There are no medications that are known to elevate %dCDT. The new %dCDT test is capable of identifying genetic variants that might cause false positives and negatives as well as unique patterns due to liver disease related to heavy alcohol use.

How long does %dCDT stay elevated once a person stops or moderates drinking?

In most people, an elevated %dCDT will return to normal during several weeks of alcohol abstinence. It will also decrease if a person substantially reduces drinking.

Can %dCDT be used to monitor how well people are doing in moderating their alcohol intake?

Most definitely. Data show that a 30% reduction in %dCDT is consistent with a substantial reduction in alcohol intake. %dCDT then has characteristics similar to hemoglobin A1c, cholesterol and other blood tests that change based on diet or pharmacological intervention. If %dCDT goes up again, once it has been reduced, this could be an indication that the person has returned to heavy drinking.

What if a person admits to drinking heavily but %dCDT is not elevated?

There could be several explanations for this. Since %dCDT begins to “normalize” within a few days, if a person has not consumed alcohol for four days or more prior to testing, the %dCDT may have fallen sufficiently to read within the normal range. However, it is well known that a person can have a %dCDT within the normal range and still experience a 30% reduction if followed over time while maintaining abstinence. Also, not everyone is a %dCDT responder/elevator. That is why a good clinical history as well as the utilization of GGT may be useful.

Why assess GGT as well as %dCDT?

GGT and %dCDT are independent markers of heavy drinking. Alcohol may elevate one, the other or both in different people. It usually takes heavier and more chronic drinking to elevate GGT but in some people, especially women, GGT seems to be more sensitive to sub-acute heavy alcohol use. Also, GGT may increase secondary to other illnesses (ex. hepatic, biliary, obesity) and medications (ex. hormones, anticonvulsants). So if an isolated GGT is abnormal one might need %dCDT to confirm or disconfirm that the elevation is due to alcohol use.

What do I tell the patient if %dCDT is elevated?

Of course clinical judgment and other signs and symptoms should guide the response. However, a non-confrontational approach such as “it appears that the amount of alcohol you are drinking (not being accusatory of drinking too much) may be affecting how your body functions – we have evidence that alcohol may be disrupting your liver metabolism which also means it may be affecting your other symptoms (fill in the blank as necessary). So… lets see if a reduction in drinking (perhaps in conjunction with other treatments that I might prescribe) may be useful in helping with your problem. Lets make another appointment. Between now and then try to keep a diary of how much you drink each day so we can discuss it more thoroughly.” An appointment for reassessment can be made, the use of a questionnaire (like the AUDIT [see enclosed pamphlet] which takes a few minutes for the patient to fill out) can be considered, and a retest of the %dCDT undertaken. If a person exhibits persistent heavy alcohol consumption, a referral for counseling might be considered).

Is %dCDT covered by third party payers?

%dCDT is covered by Medicare and Medicaid. Most insurance companies follow the lead of government payers and should cover the expense of testing within the limits of their policies. Even if not covered, the costs of a misdiagnosis of heavy alcohol use are costly to patients and medical personnel.

How quickly can I expect to get the results of %dCDT testing?

It is anticipated that results will be available within 24 to 48 hours of the serum sample reaching our laboratories during Monday through Friday business hours.

[lfrk]

NPA No. 18 /2014 CAAP 19: AEROMEDICAL (https://www.google.fr/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CCkQFjAB&url=https%3A%2F%2Fwww.gcaa.gov.ae%2Fen%2FePublication%2F_lay outs%2FGCAA%2FePublication%2FDownloadFile.aspx%3FUn%3D%2Fen% 2Fepublication%2Fadmin%2FLibrary%2520Pdf%2FNotice%2520of%252 0Proposed%2520Amendment%2520%2528NPA%2529%2FNPA%252018-2014%2520CAAP%252019%2520-%2520AEROMEDICAL.pdf&ei=HxcDVcm6Go2zabeWgOgP&usg=AFQjCNFbgTe-EKtWt7xhhzziQMqagkVPbA&bvm=bv.88198703,d.d24&cad=rja)

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:ugh::ugh::ugh:

Basically 4/5 drinks per day for 2 weeks or more (eg:during leave) + full blood test CDT... = Bye bye UAE.
It's for all UAE operators not only EK, quite hard yes but it's there and will stay there.

Then when do you get CDT checked? as per FR email, after an incident, maybe during your yearly medical or because a 19y/o GR2 report you.

Simple, :rolleyes:
-don't have an incident
-don't do your medical right after your leave
-stop drinking in public or with GR2 (not to be reported)
-stop drinking

Even if you are not a regurlar drinker you have to really look after what you have during your leave....really painfull !
For this year it should be fine, no one as more than 2 weeks leave in a row!

Good luck

[Emma Royds]

Then when do you get CDT checked? as per FR email, after an incident, maybe during your yearly medical or because a 19y/o GR2 report you.

Straight from the NPA document:

Only indicated if the AME at the time of the medical check, observed signs or medical problems which may be related/or induced by alcohol abuse (e.g. person with family history of addiction, cases of cardiac arrhythmia, insomnia, chronic headache , depression or anxiety, liver disease and cases of uncontrolled hypertension or diabetes).

Note 1: For all the applicants applying for renewal over 60 years, Alcohol Screening should be part of the psychological assessment.

Note 2: Screening should be standardized as much as possible within the GCAA Recognized clinics by using the Laboratory tests.

[Mr Good Cat]

Guys, please stop panicking.

The only chances of failing this test would be after LEAVE.

Ergo, no issue.

[lfrk]

Of course it's an issue!
You come back after your leave, were you had fun with friends and familly, long lunchs,bbq's, afternoon beers by the beach, glass of wine on a terrasse on a sunny day... just a normal holiday life for most of us!
That's more than 5 drinks a day easily.
After that no more drinks for 2 weeks and surprise CDT check for some reasons, even if you haven't touched a bottle for 2 weeks you would be done, consider as an alcoolic, probably fired, and loose your licence, just because you had 2 weeks leave! try to find a job after that!
Yes this is an issue.
I am not blaming the GCAA for trying to find strong drinkers! Obvioulsy if you drink every day you cannot focus properly, could do mistakes easily while flying and kill people on top of yourself.
What I really don't like is the tool they use. I am far away of being a strong drinker, but during my leave yes I do drink more that 5 per day! And I going soon for 2 weeks leave! Dam it:ugh::ugh::ugh::ugh:

[Mr Good Cat]

Lfrk...

It was just a sarcastic response after the leave debacle.

I.e. If you won't have leave you won't face a problem... Maybe I should have put a winky smiley after it :}

[FACSOFF]

Heard about this test - so decided to be very careful before my GCAA class 1 medical

I have just been stung by this!!!
Had not had a drop for 9 days, very little for 2 weeks before that and my CDT came in at 2.3 (FAIL) limit is 1.7% or above

The AME (here in the UAE) are not conducting the test fairly or within normal limits - see link below

www.viapath.co.uk/sites/default/files/upload/.../cdt%20report2.pdf

In a nut shell CDT 3% - 10% indicates 'possible alcohol misuse'
Three tests should be performed with an interval of 2 weeks
1.6% is the reading for a person that consumes little or no alcohol

I'm NOT going to see the Dr in Al Ain
I'm NOT going for 28 days rehab
I'm NOT going to have 15 or more random alcohol tests at home

I'm going to fly somewhere else, I'm going to continue the pleasure of drinking a few glasses of wine, I'm leaving and good by UAE.

[Sheikh Your Bootie]

I had the CDT thrust upon me at my last Medical, for unexplained reasons. The AME didn't follow the protocol in the CAAP 19, for the reasons for conducting a CDT test. Felt like banging my head against a brick wall and running around in circles, trying to not have to do the test.
Anyhow, I had been on leave had a few drink most days, and two weeks later Medical. Results came back absolutely normal :ugh:

I don't drink every day, and am not saying these tests prove anything habibi about your drinking habits. The Gnome has left, so maybe this will gradually be dropped, inshallah!

SyB :zzz::zzz:

[ekwhistleblower]

I had 32 markers checked at my last medical 2 weeks ago, CDT was not one of them! Make of it what you will.

[White Knight]

SYB... The Gnome HAS NOT left as I was offered a medical slot with him for later this month...

Not a bl00dy chance...........

[Oceanic]

He is working his period of notice.

[form717]

My medical due and I'd really like to avoid this "gnome" but I'm not actually sure which doctor he (she?) is! Anyone care to drop a hint without being too obvious?

[jack schidt]

The Gnome (poisoned dwarf) is GNOMorE

J

[SOPS]

Please PM this man.

[Kapitanleutnant]

Not to worry..

The Gnome is OFFICIALLY off EK property. Going/Went to the UK to start a private practice offering UK flight medicals. Think he might have to change his ways and bedside manner for that to be a success….

Was also told he will "dabble" in EASA stuff as a consultant (?)

K

[Thridle Op Des]

Quoting reliable sources, 'he will still have influence from a distance' (what ever that means) TOD

[Monarch Man]

If it's that concerning that you are worried about a CDT result after leave, be organised and get the medical done before you go on leave :ugh: Heaven forbid if you had to moderate the plonk intake for a week or two.
As ever with these daft rules the company invents, they are written by individuals who rarely look beyond the scope of their own little fiefdoms.

[BigGeordie]

Agree with Monarch Man, you can renew your medical up to 45 days before the expiry date so it should be possible to do it before leave. That is what I try to do but more because of my tendency to put weight on when on holiday! Hhmmmm, cake...:ok:

[Gordomac]

Cripes ! I am so glad to be outa this . Apologies also for "in the good ole days" stuff but really, what have we come to ? Joining my sponsoring airline in 1972 I was a non-drinker because, simply, I didn't like the taste of the stuff. I was quickly taken in hand and trained by the hard-drinkin brigade, delightful ex WW2 (well, almost) who enjoyed the famous 'After Landing Drinks' and then insisted I joined them in the pub afterwards. In my fave airline, the only reason that the ALD tradition stopped (circa 1982) was that one silly girl set up the tray and forgot to pull across the curtain before delivering lots of alcohol to the FD. Seen by pax, reported and that was the end of that.

Same airline, developing into Long haul, the down-route parties were legendary and we really did observe the rules of no alcohol 8 hrs before reporting for duty and 12 hours in some countries. But, in between ; gosh ! Party on.

Then, in Holland, Dutch RLD gave a gentle warning that my alcohol level was borderline. I thought they meant it was too low and went on a celebratory binge with my other ex-pat mates before commencing Line Training. Six month's later I got a written notice, all in Dutch , that I should seek help. This in a Company where tradition was that after a flight we would go to a lovely place, jokingly called "Dispatch" where alcohol was provided in a self dispense machine and added to by our own purchases , feverishly consumed whilst the CB counted the Bar money, paid the drivers the allowances and then joined us. Legend has it that some of these after landing activities lasted for days.

For my 17 year stint in the ME, alcohol consumption was never an issue. Always within the law and I never witnessed in a 40 year career any alcohol related incidents whilst on duty. Lots while off, of course.

6 years into retirement, I am laying off the heavy stuff because it doesn't rest well but enjoy daily intakes of cheap plonk and the very occasional binge. I have never felt fitter.

So, what do we make of it all. You poor rotters forced to watch what you do on Leave for heaven's sake ! I do worry where these ridiculous and over-monitored restrictions affect a healthy, balanced intake and possibly, long-term, adversely affect psychological health. Another stress factor in our profession.

Sorry, off to the pool and choosing a Pimm's as it is Wimbledon. I can also shout at the 767 that daily flies over my house and is obviously to low and fast. Maybe he needs an ALD...............ooops, not over yet..................another six hours after the turn-round and then straight home with no alcohol. What a dreadful life. And in the good ole days, the real test of a good landing was not to spill your ALD !

[Oceanic]

Lovely post Gordo, legendary tales, living life to the full. Bottoms up:ok:

[CDRW]

The ALDs, Gordo, continued long into out days in ME. The Purser coming up asking " what we want". The landing drink, the transport drink and what you going to put into the bath tub drink at the hotel.

Ahhh yes - those where the days -

Then it was voice over....

[strobes_on]

Aahh yes - Flying the GF 1011 light years ago and the standard ALD (for me anyway) was a brown cow (in the plastic cups of course). Very civilized way to finish the trip.

Let alone the beers for the crew bus and supplies for the night stop. Second home in those days was the Gulf Hotel in AUH, closely followed by the same hotel in MCT.

Times long gone but well remembered.

CDT then was not even thought of.