November 11, 2016
Change in Microalbumin Testing
To be consistent with best practice, Parkview Laboratories are discontinuing the random Microalbumin, Semi-Quantitative dipstick test (MicralTM) on December 1, 2016.
The test will be replaced by the random Microalbumin, Quantitative Urine test (Test Code - UMALR) which includes a Microalbumin/Creatinine ratio.
Questions can be directed to Dr. Yi Zhuang, Medical Director, at 266-1644 or Lisa Derck at 266-6085
Red Blood Cell Folate Test Discontinued
Folate deficiency in the US is exceedingly rare since FDA-mandatory folic acid supplementation in grain beginning in the 1990’s. One recent estimate is ~0.1%. Studies on the Parkview patient population show that less than 1% have abnormal serum or RBC folate levels.
A recent large scale review and a large study at Mayo Clinic support that serum folate and RBC folate are equivalent in the assessment and diagnosis of folate deficiency.
Effective 12-1-2016, RBC folate testing will no longer be offered in house at Parkview Health Laboratories, but will be available as a send out test. The panels VBFOL (vitamin B12, RBC folate and serum folate) and VBFLS (vitamin B12 with serum folate) will be inactivated. Each test will be orderable as individual tests.
Ref: Am J Clin Nutr 2013;98:1041-7, Clin Chem Lab Med 2013;51(3):555-69, Red Cell Folate Testing. Mayo Hot Topics; Nov 2010.
For any questions please contact Dr. Craig McBride at 266-1637, or Rick Brown at 266-6083
Clostridium difficile Testing Criteria
The Microbiology Lab uses a sensitive and specific molecular amplification test to detect Clostridium difficile infection (CDI). Due to the sensitive nature of the test, it is not necessary to submit more than one specimen per week; specimens received in the lab within 7 days of previous testing will be rejected. CDI testing should be limited to those patients having clinically significant diarrhea (>=3 unformed stools within 24 hours). Formed stools will be rejected by the laboratory to help eliminate false positive results. Performing a test of cure is not recommended, as patients may remain positive after CDI has resolved. Stools collected within 10 days of a previous positive result will be rejected by the laboratory. If diarrhea returns after symptoms had previously resolved, testing is appropriate as treatment failure is possible.
For any questions please contact Dr. Craig McBride at 266-1637, or Karen Irven at 266-1593
October 10, 2016
Siemens, the manufacturer of our Vitamin D assay, has recently updated the Instructions for Use (IFU) for their 25-OH Vitamin D assay due to discrepancies in values when testing is performed on plasma versus serum.
Because of this, effective immediately, plasma is no longer an acceptable alternate or add-on specimen for 25-OH Vitamin D testing. This effects test code VD251 - Vitamin D, 25 Hydroxy
June 30, 2016
Coagulation test: D-Dimer result comment revision:
The D-Dimer test result comment has been revised to reflect manufacturer’s disclaimer regarding specificity and sensitivity claims. No changes have been made to reference range or interpretation.
New Comment: In excluding deep vein thrombosis (DVT) and pulmonary (PE): In a non-high clinical probability population, using a cutoff of 0.5 mg/L FEU, a normal (<0.5 mg/L FEU) result excludes deep vein thrombosis (DVT) and pulmonary (PE) effectively. (Negative predictive value is 96-100% and 97.5-100% respectively). In detecting DVT and PE: using a cutoff of 0.5 mg/L FEU, the sensitivity is 96-100% and 93.3-100% respectively and the specificity is 34.5% and 39.6% respectively.
June 20, 2016
Device Correction Notification:
Siemens Healthcare Diagnostics has announced that N-Acetylcysteine (NAC) and Metamizole (Dipyrone) interfere with some reagents used on Parkview Health Laboratories instruments, causing falsely depressed results.
N-Acetylcysteine (NAC) interferes with Triglycerides reagent.
Metamizole interfere with Triglycerides, HDL and Uric Acid reagents.
Venipuncture should occur prior to N-Acetylcycteine (NAC) or Metamizole administration to due to the potential for falsely depressed results.
Please direct questions to Richard Brown, Chemistry Specialist, at 266-1521, or Dr Steven Wang, Clinical Pathologist, at 266-1640.
June 1, 2016
Cryptococcal Antigen Assay
Beginning June 16th Cryptococcal Antigen Assay will be done by lateral flow methodology which will allow the Microbiology Department to run this test on all shifts.
This test may be run on CSF (Epic: Cryptococcal Antigen Screen Spinal Fluid) or serum (Cryptococcal Antigen Screen Serum) and will replace the current latex agglutination method (Epic: Cryptococcal Antigen Screen).
May 31, 2016
New In-House Molecular Tests for GI Pathogens and Meningitis/Encephalitis
The Microbiology Department is now running two new molecular panels:
Epic Name: Gastrointestinal Pathogen Panel by BioFire PCR
Specimen: Stool placed in Cary Blair Vial (green top stool vial—HEMM #91915) within two hours. No endoscopy stool aspirates or rectal swabs.
TAT: Within 24 hours after receipt in the Microbiology Lab
Enteric Pathogens detected by PCR:
Bacteria: Campylobacter (C. jejuni/C. coli/C. upsaliensis), Clostridium difficile toxin A/B, Plesiomonas shigelloides, Salmonella, Vibrio (V. parahaemolyticus/V.vulnificus/V. cholerae), Yersinia enterocolitica, Diarrheagenic E. coli (Enteroaggregative E. coli (EAEC), Enteropathogenic E. coli (EPEC), Enterotoxigenic (ETEC) heat-labile (lt) and heat-stable (st) Enterotoxins , Shiga-like toxin-producing E. coli (STEC) including E. coli O157, Shigella/Enteroinvasive E. coli (EIEC).
Viruses: Adenovirus F 40/41, Astrovirus, Norovirus GI/GII, Rotavirus A, Sapovirus (Genogroups I, II, IV and V).
Parasites: Cryptosporidium, Cyclospora cayetanensis, Entamoeba histolytica, Giardia lamblia
Epic Name: Meningitis Encephalitis Pathogen Panel by BioFire PCR
Specimen: CSF from tap (no shunt fluid)
TAT: Within 4 hours after receipt in the Microbiology Lab
Meningitis/Encephalitis Pathogens detected by PCR:
Bacteria: Escherichia coli, Haemophilus influenzae, Listeria monocytogenes, Neisseria meningitidis, Streptococcus agalactiae, Streptococcus pneumoniae
Viruses: Cytomegalovirus (CMV), Enterovirus, Herpes simplex virus 1 (HSV 1), Herpes simplex virus 2 (HSV 2), Human herpes virus 6 (HHV 6), Parechovirus, Varicella-zoster virus (VZV)
Fungi: Cryptococcus neoformans/gattii
May 23, 2016
Parkview Health Laboratories presently reflexes a Group A Strep Culture on all negative Rapid Strep A results. Beginning May 31st we will begin reflexing cultures on only those patients less than eighteen years of age.
May 19, 2016
For those patients eighteen and older, a Group A Strep Culture (Soft Code: CXGRA) or Throat Culture (Soft Code: CXTHR) may be ordered separately if desired.
On June 1, 2016, PRMC Chemistry will begin Procalcitonin (PCT) testing. The specimen requirement will be 1 ml plasma from Lithium Heparin (Mint Green top PST) tube. Testing will be performed Monday-Sunday on all shifts.
The reference ranges are:
PCT <=0.5 ng/ml = Low risk for progression to severe systemic infection(severe sepsis/septic shock.
CAUTION: PCT levels below 0.5 ng/ml do not exclude infection, because localized infections (without systemic signs) may be associated with such low levels. If PCT is measured very early after a bacterial challenge (usually <6 hours), these values may still be low. In this case, PCT should be re-assessed 6-24 hours later.
PCT >0.5 to <=2 ng/ml= Moderate risk for progression to severe systemic infection (severe sepsis/septic shock).
The patient should be closely monitored both clinically and by re-assessing PCT within 6-24 hours.
PCT >2 ng/ml = High risk for progression to severe systemic infection (severe sepsis/septic shock).
For questions, contact Janet Benoit, Laboratory Technical Manager, at 266-1505, Richard Brown, Laboratory Chemistry Specialist, at 266-1521, or Dr. Steven Wang, Laboratory Pathologist, at 266-1640.
May 6, 2016
Changes effective 5-17-16, Prothrombin time reference range 9.4-11.6 seconds, APTT reference range 23.8-33.8 seconds, INR upper reportable range >8.9. If you have any questions please contact Dr. Cindy Nie at 266-1641.
On May 17, 2016, the CK and reflex CKMB will be removed from the Cardiac Stat Panel (test code CARDC). The CK or the CKMB (which includes CK & CKMB) can be ordered as needed. For questions, contact Janet Benoit, Laboratory Technical Manager, at 266-1505, Richard Brown, Laboratory Chemistry Specialist, at 266-1521, or Dr Steven Wang, Laboratory Pathologist, at 266-1640.