Parkview Health Laboratories (PHL) provides high-quality, cost-effective laboratory services to the community. (more)
Sickle Cell Disease (SCD) patients (those with HbSS) are at an increased risk for developing alloantibodies. This increased risk is due in part to the greater number of transfusions received by these patients and in part to significant antigenic differences between donor and patient red cells, and can cause decreased transfused red cell survival, delayed transfusion reaction and difficulty obtaining blood products for future transfusions. The risk of alloimmunization is significantly decreased when patients are transfused with phenotypically similar red cells, especially when matched for Rh and Kell antigens. In addition patients with SCD receive red blood cells that are screened and negative for Hemoglobin S trait.
When ordering packed red blood cells, the special red blood cell attributes section now includes the choice “Blood Products for Sickle Cell Disease.” This attribute should be used for all SCD patients.
The laboratories of Parkview are no longer performing the Meningitis Screen on CSF or urine. Current laboratory best practices do not include this test. Please call Dr. Craig McBride, 266-1637, with any questions.
Reticulocyte Count Standardization
Parkview Health Laboratories will be changing the reticulocyte calibration on all hematology analyzers on Monday, September 17, 2012 . This change will result in better correlation of results among the Parkview instruments. After the recalibration, patient reticulocyte counts may show an increase of 15-30% compared to previous results.
Please call Lisa Daniel, PRMC Lab Manager, at 266-1505, or Lisa Derck, PRMC Lead Hematology Scientist, at 266-1580 with any questions.
On 6-18-12, Parkview Health Laboratories will discontinue the Xylose Absorption Test. Questions may be directed to Dr. Zhuang, Technical Consultant, at 266-1644.
The normal range for the TSH will be updated on June 6, 2012 to 0.3 to 3.8 uIU/ML. A pediatric reference range has not been established for this test. The American Association of Clinical Endocrinologists recommends a target adult reference range of 0.3-3.0 uIU/ml. Please refer any questions to Dr. Zhaung at 266-1644.
Due to a manufacturing change, the reference ranges for Estradiol have been revised effective 5-29-12. The new ranges are:
Follicular Phase 20-144 pg/ML
Mid-Cycle Phase 64-357 pg/ML
Luteal Phase 56-214 pg/ML
Postmenopausal <32 pg/ML
Male: <40 pg/ML
Please refer any questions to Dr. Cobanov, Technical Consultant at 266-1641
Parkview Health Laboratories have changed to a new D-dimer reagent since the manufacturer will be discontinuing the current D-dimer kit . The new D-dimer method is FDA approved with a revised cut-off level of >0.50 mg/L (FEU). Please note that the samples will be stable for four hours at room temperature.
Please call Dr. Wan at 266-1639, or Lisa Daniel at 266-1505 with questions.
New Ketone Test Measures Beta-Hydroxybutyrate
Parkview Health Laboratories will implement a new Ketone test using beta-hydroxybutyrate effective 5-14-12. The manufacturer has ceased production of current method. With the new test comes significant changes in result reporting. Beta-hydroxybutyrate (ordered as BHB) is one of three sources of ketone bodies. Its relative proportion in the blood (78%) is greater than the other two ketone bodies which are acetoacetate (20%) and acetone (2%). During periods of ketosis, beta-hydroxybutyrate increases more than acetoacetate with the ratio of beta-hydroxybutyrate/acetoacetate typically between 3:1 and 7:1 in severe ketotic states. Beta-hydroxybutyrate has been shown to be a better index of ketoacidosis including the detection of subclinical ketosis.
The BHB test is a quantitative test with a patient reference range of 0.00-0.28 mmol/L.
Please refer questions to Dr Yi Zhuang at 266-1644 or Lisa Daniel at 266-1505.
TSH 2nd Generation
April 16, 2012 Parkview Health Laboratories have begun performing all orders for TSH using a 3rd generation assay. Based on recommendations from the American Association of Clinical Endocrinologists, a new TSH reference range of 0.30-3.00 uIU/mL has been implemented for this assay. Please address any questions to Lisa Daniel, Technical Manager, at 266-1505 or Dr. Yi Zhuang, Technical Director, at 266-1644.
Change in Testing fetal lung maturity
Beginning May 1, 2012, Parkview Laboratory will offer Lamellar Body Counts (LBC)as a means of assessing fetal lung maturity. The current FLM testing method, using the Abbott TDx analyzer, has been discontinued. Lamellar bodies are storage granules of pulmonary surfactant secreted by type II pneumocytes. This test offers rapid turnaround time and very reproducible results while using a smaller amniotic fluid sample. Interferences include visible blood (Hct >1%), visible meconium and mucous.
Cutoffs for interpretation are:
<15 TH/uL = immature
15-50 TH/uL = transitional
>50 TH/uL = mature.
Refer questions to Lisa Daniel, Laboratory Manager, at 266-1505, or Lisa Derck, Laboratory Lead, at 266-1524.
Discontinuing reflex testing for urine and stool reducing surgars on children less than 1 year old
Beginning May 1, 2012, Parkview Health Laboratories will no longer perform reflex testing for urine reducing sugars on children less than 1 year old. The sole manufacturer of the reagent has discontinued production. Stools for reducing sugars will also be discontinued at that time. Please contact Lisa Daniel, Laboratory Manager at 266-1505 with any questions.
Beginning April 17, 2012 our reference laboratory will no longer offer allergy mixes. In the past these mixes have allowed non-specific screening of groups of allergens, giving a qualitative result. After the April change each allergen requested will be an individual allergen, giving a semi-quantitative result, specific for that causative agent. Allergy panels will still be available but each allergen will continue to be tested independently.
From the Billing Dept - Anthem Routine Physicals:
Many of your patients have Anthem policies with special coverage for routine physical exams. If you are ordering lab tests related to a routine physical exam, (ie: routine screening), please include diagnosis code V70.0 on the patient’s requisition. If the order is written as “routine screening”, the lab cannot code it as V70.0, and V70.0 is the only diagnosis code that is covered under your patients’ wellness benefits.
The lab is receiving many calls from patients whose order did not include V70.0 as a diagnosis and their claims are not being paid under their wellness benefits. These patients then contact your office for documentation so that their claim can be reviewed by Anthem.
By including V70.0 as a diagnosis on your routine physical exam/routine annual screening lab orders (when this is the reason for the testing), your patients’ claims can be processed the first time through their wellness benefits. This means more satisfied patients and less calls to your office asking for documentation related to these review requests.
CLOSTRIDIUM DIFFICILE TESTING
Parkview Health Laboratories began performing Clostridium difficile testing by a molecular method on August 9, 2011. This new method has 95-98% sensitivity and specificity. The Laboratory will be following the 2010 Clinical Practice Guidelines of Society for Healthcare Epidemiology of America (SHEA) and Infectious Diseases Society of America (IDSA) . Due to the need for further client education and policy review, the following recommendations for testing will be put into place in September 25, 2011.
1. Due to the higher sensitivity, one specimen will be tested in a 7 day period. There is no longer a
clinical need for testing X 3.
2. Patients must be symptomatic. Only specimens that conform to the container shape will be
tested. Formed stool specimens will be rejected.
3. No "test of cure" specimens should be submitted. Patients may remain positive for long periods
4. This test is not FDA approved for colonoscopy specimens. Specimens collected during
colonoscopies will be sent to a referral laboratory for testing.
Until that time, all specimens, with the exception of those collected during colonoscopy, will be tested. Please note that due to the increased sensitivity of this test, patients may test positive for an indefinite time period. More information can be found on the 2010 Clinical Practice Guidelines at: http://www.jstor.org/stable/10.1086/651706
For questions, please contact Phyllis Bonner, MT (ASCP), Microbiology Lead, at extension 373-9491, or Craig McBride, MD, Medical Director, at extension 373-3656.
Methadology changes for Clostridium Difficile Testing
Beginning August 8, 2011, Microbiology will be changing to a molecular method for the diagnosis of Clostridium difficile infection. (CDI) Molecular methods are more accurate with a 95-98% sensitivity/specificity in contrast to the current EIA technology which is between 50-80%. The new method detects both A+B+ and A-B+ toxin producing strains of Clostridium difficile. As a result of the increased accuracy with the new DNA method, the following recommendations will also go into effect:
1) One specimen will be tested in a 7 day period. No X3 orders will be accepted.
2) Patients must be symptomatic. Only specimens that conform to the container shape will be tested. Formed stool specimens will be rejected.
3) No "test of cure" specimens should be submitted. Patients may remain positive for long periods without symptoms.
4) This test is not currently approved for colonoscopy specimens.
After 8-8-11, any orders for the current EIA methodology will be converted to the new method. Testing will be performed 7 days per week with at least one run per shift. For questions, please contact Phyllis Bonner, MT (ASCP), Microbiology Lead, at extension 373-9491, or Craig McBride, MD, Medical Director, at extension 373-3656.
It is with great pleasure to announce that Parkview Health Central Laboratory at 328 Ley Road is relocating to the new Parkview Regional Medical Center (PRMC) on the Parkview North campus, effective November 17, 2011.
The move to PRMC will allow Parkview Health Laboratories to consolidate laboratory testing to better improve its services to physicians and their patients.
Additional information, such as mailing address, phone and fax numbers announced with future communications. We are looking forward in continuing to provide excellent laboratory services to our patients and clients at our new location in the very near future.
Utilization of Reference Laboratories
Parkview Health Laboratories is continuing to lean processes, increase efficiency, and reduce costs associated with send out testing to outside reference labs. Reference labs are selected with medical staff approval based on quality, methodology, cost effectiveness and turnaround time. Special requests may be denied if testing needs can be met more cost effectively at an approved laboratory. Specific reference laboratory requests will only be guaranteed if accompanied by requisition and shipping supplies from desired laboratory. Please contact Dr. Wan at extension 33650 with any questions.
Change in Susceptibility Reporting
Due to a recall from the bioMerieux company, which produces the Vitek susceptibility cards, you may notice the absence of piperacillin/tazobactam (Zosyn®) susceptibility data. The Parkview microbiology department has begun suppressing the automated reporting of Zosyn for several bacterial isolates including: E. coli, Pseudomonas, Morganella, Proteus, and several others. To supplement the missing data in hospitalized patients, manual alternative Zosyn susceptibility testing will be automatically performed for all Pseudomonas and Morganella isolates and for other Gram-negative isolates that are resistant to cefazolin. Additional manual testing will be performed as requested.
If you have further questions, please contact Craig McBride, MD (Pathologist, ext. 33656), Phyllis Bonner, MT (Microbiology Lead Technologist, ext. 39491) or Shannon Matsko, PharmD (Infectious Diseases Clinical Specialist Pharmacist, ext. 33432).
Change in testing formats calls for a change in Specimen Types
Infectious Mononucleosis Screen has changed to a waived test. Specimen requirements as of March 4, 2011. Preferred sample 0.3 mL whole blood in Lavendar Top tube (EDTA plastic vial) refrigerated for up to 24 hours.
Beginning 3-28-11, the specimen requirement for a Quantitative Ethylene Glycol will change. The new requirement is 4.0 mL whole blood collected in a gray-top tube (sodium fluoride potassium oxalate).
To better conform to World Health Organization standards, TSH testing will be consolidated to the laboratory's Siemens Centaur testing platform beginning 4-4-11. After this date, plasma will no longer be an acceptable specimen. Please collect a serum separator tube for all TSH tests. Questions can be directed to Dr. Wan, Medical Director, at 373-3660.
Lab Draw Site at 328 Ley Road to close effective March 15.
The Parkview Laboratory at 328 Ley Road will be relocating to the Parkview North Campus as part of the Parkview Regional Medical Center. In preparation for that move, the laboratory drawing site at the Ley Road location will be closing effective March 15, 2011. We are notifying all patients that have used the 328 Ley Road location within the past 6 months and providing them with information regarding alternate draw sites. At this time, 328 Ley Road will continue to be the collection/drop off site for Semen Analysis. Home Health agencies may also continue to drop off samples at 328 Ley Road. This will not change until the rest of the laboratory relocates later this year.
LAB CUMULATIVE REPORTS TO CHANGE JANUARY 11, 2011:
The cumulative style lab report, which is used in Access Anywhere for Inpatient, Outpatient and ER lab reports, will be updated. Currently, hematology and chemistry results print in a horizontal fashion. While this old style was good for trending a single lab result across multiple days, it was difficult when trying to view a series of lab results for one particular day. The NEW and IMPROVED lab cumulative report is a single column vertical style. The lab results will go down the page, instead of across. Hematology results, for example, will group together, in chronological order, followed by chemistry results, in chronological order, etc. Trending of individual lab results is available in GE Centricity (Carecast). Please contact Alice Friedt, Director of Laboratories, with questions. (373-9443).
Effective on December 22, 2010, the adult reference range for CK and LD will change.
The CK range will be: Males 21-224 U/L, Females 10-175 U/L.
The LD range will be 107-230 U/L.
These changes are necessary due to a change in the manufacturer's reagent.
For questions or concerns, please contact Dr Xiaoying Wan at 260-373-3660.
As of January 1, 2011, the American Red Cross blood services will no longer prepare volume-reduced platelet products for transfusion to neonates. Whole blood derived platelets are the recommended product of choice because manipulation of platelets during the volume-reduction process can lead to platelet activation and a suboptimal clinical response. A 10 mL/Kg transfusion of whole blood derived platelets has the potential to raise the platelet count of a 1 Kg infant by 100,000 platelets/uL. Please direct any question to Craig McBride, MD, Pathologist at 373-3656.
Beginning September 20, 2010, the reference ranges and diagnostic comments for Troponin I testing are being revised. See below for changes: