Parkview Labs News:

November 30, 2018
Biotin and laboratory testing
Parkview health will be requesting that patients discontinue high dose Biotin use for 48 hours prior to certain laboratory chemistry testing. Biotin peaks in the blood stream between 1-2 hours after ingestion, and begins to rapidly clear from the body, so in more urgent situations, testing at 8 hours of discontinuation may be considered since the interference will be less than 15%. (The half-life of Biotin varies from 8-18 hours.) 
Biotin (a.k.a Vitamin B7 or Vitamin H) is found in over-the-counter multivitamins (low-doses) and hair/skin/nail care products. Biotin is also used in certain reagents that generate patient test results, so an excess of the OTC products (an unusually high dose) can cause a false result to be reported by the Laboratory.
When a patient is taking a multivitamin as directed on the package, he/she does not need to wait to have your blood drawn. Typical daily multivitamin (30-60 mcg of biotin) pose no risk of interference, in the Roche assays.
When a patient is taking a supplement for hair, skin, or nail care as directed on the package, he/she needs to wait 48 hours after the dose to get your blood drawn.
When a patient is taking Biotin, Vitamin B7, or Vitamin H by prescription from a physician, he/she needs to wait 48 hours after the dose to get your blood drawn.
 
o   Patients taking vitamin supplements containing high doses of biotin (>5 mg/day) may have falsely increased test results generated.
o   Patients taking vitamin supplements containing doses of >5 mg/day may have falsely decreased test results generated.
Please contact Dr. Karen Wan, Pathologist, at 266-1639, or Richard, Brown, Laboratory Chemistry Specialist, at 266-6083.

June 1, 2018
Cortisol Testing Changes
On June 6, 2018, the reference range for the Cortisol, 8AM Cushings, the reported portion of the Dexamethasone Suppression Cushing’s test, will change from the current 0.0-0.5 ug/dL to 0.0-1.8 ug/dL.

April 30, 2018
Coagulation Reference Range Changes, effective after 10 am. on Tuesday May 8, 2018.
   Prothrombin time reference range: 9.2 – 11.2 seconds (currently: 9.2-11.1).   Epic Test code: Lab320
  APTT reference range: 23.7-32.2 seconds (currently 23.6-32.6). Epic Test code: Lab325
The unfractionated heparin therapeutic range remains unchanged. For any questions please contact Dr. Karen Wan at 266-1639

March 26, 2018
The AABB consensus on CMV testing is that Leukocyte reduction by any method capable of achieving a residual leukocyte count < 5 x 106 allows for the reduction of transfusion-transmitted CMV to a level at least equivalent to the level occurring with the use of CMV-seronegative components transfused to CMV-seronegative recipients.
 
Our blood supplies provide only products that are prestorage leukoreduced. These products have been termed “CMV-safe” and are an approved product for adult patients who are at risk for transfusion-transmitted CMV infection. It is not necessary to note “CMV reduced-risk” or “CMV-negative” on blood product orders.
 
Parkview Health Laboratories will continue to supply CMV-seronegative red blood cells and platelets for neonates and recipients of intrauterine transfusion only.


March 9, 2018

Scope of Biotin Interference on Roche System
The daily recommended allowance for Biotin is 0.03 mg However, supplements containing high biotin levels may contain up to 20 mg of biotin for hair, skin, and nail benefits, and physicians may recommend up to 300 mg per day for conditions such as multiple sclerosis.
Patients taking Biotin at doses > 5 mg/day will see interference in IA tests that use biotin in the reaction. The chart below lists the Roche IA tests currently in use at Parkview Health Laboratories with the method used on the Roche instruments.
IA tests using a competitive reaction will show a falsely elevated result.
IA tests using a competitive reaction will show a falsely decreased result.
The degree of interference is dependent on the amount of biotin taken.


February 28, 2018
Parkview Health Laboratories will now include an Oxycodone screen in the Urine Drug Screen, Clinical. Laboratory code: UDS Epic Code/Test: LAB2673 – Drug Screen Urine

 
This screening assay utilizes a cut-off of 100 ng/mL for the detection of oxycodone and oxymorphone.  This screen should be used for medical purposes only.  Alternate confirmatory testing is available, as needed.  Additional details may be found in the lab test directory at http://lab.parkview.com.  For any questions please contact Dr. Karen Wan at 266-1639 or Richard Brown at 266-6083.


February 12, 2018

On Monday, February 12, 2018, the Parkview health Laboratories will change the Calcium reference range for adults to 8.5-10.3 mg/dl.
Please contact Dr. Karen Wan, Pathologist, at 266-1639, or Richard, Brown, Laboratory Chemistry Specialist, at 266-6083.


October 2017

Beginning Oct 31, 2017, Parkview Health System Laboratories will implement a new Erythrocyte Sedimentation Rate Analyzer, the Alcor iSED. The iSED ESR analyzer is fully automated. following a three-minute mix cycle, the ESR result is available in 20 seconds.
This photometric rheoscope technology is unaffected by variables commonly associated with traditional ESR testing, such as mixing, temperature, timing compared to other Westergren methods. This technology is less likely to be affected by the low hematocrit levels as compared to other methodologies.
Thus, if the ESR is being used to follow the progress of a patient’s inflammatory disease, during treatment, there may be some variation from prior evaluations, and the patient may need to have a new baseline established.
Specimen collection criteria remains unchanged. Sample stability remains at 24 hours, refrigerated.
The male reference range will be revised. <=50 years of age: 0-15mm/hr (current 0-20mm/hr); >50 yrs. of age: 0-20mm/hr (current 0-25mm/hr). Female ranges do not change (<50 yrs = 0-20mm/hr, >50 yrs = 0-30mm/hr) .
Dr. Zhuang, Hematology Medical Director, 266-1644.


June 2017

Parkview Health Laboratories has begun using a new manufacturer for our O&P kits.  With this change, you will notice that the light blue cap vial is now a gray cap vial.  Please utilize the new gray cap vial just as you would the old blue cap vial.  The pink and white caps vials will remain the same in color.  You will start to see this change with any new O&P kits that you request.  Please continue to use any current kits that you may have as long as they are not expired.  For any further questions, please contact Karen Irven at 260-266-1593.


April 18, 2017

Coagulation reference range changes, effective 5-17-2017 (after 10am). Prothrombin time reference range 9.2 – 11.1 seconds. APTT reference range 23.6 – 32.6 seconds. The unfractionated heparin therapeutic range remains unchanged.
If you have any questions, please contact Dr. Karen Wan at 266-1639.



March 14, 2017

Effective March 15, 2017, the Trauma Panel will include a Blood Alcohol (Ethanol) for all patients 12 years and older.  Orders on patients younger than 12 years of age will not include a blood alcohol.  For questions, please contact Dr. Karen Wan, Laboratory Pathologist, 266-1630, or Richard Brown, Laboratory Chemistry Specialist, 266-6083.


March 9, 2017

On March 21, 2017, four of Parkview Health Laboratories locations will begin reporting patient results for Chemistry testing using the Roche Cobas analyzers.
PRMC, PVH, PHH, and PWB will make this switch at 9AM. The other laboratory locations (PWH, PWR, PLH, and PNH) will move to the Roche analyzers over the next 3 months.  In addition to the change from Troponin I to Troponin T, there are some tests that have reference ranges that will change from what is currently being reported. The updated ranges are attached.
For questions, contact Dr. Karen Wan, Laboratory Pathologist, 266-1630, or Richard Brown, Laboratory Chemistry Specialist, 266-6083.

Click here for complete list of changes;



January 31, 2016

On February 28, 2017, Parkview Health Laboratories will begin converting Chemistry testing from the Siemens Dimension platform to the Roche Cobas platform. 
The rollout of the Roche instruments will occur in 4 phases:

                Feb 28, PRMC and PVH will go live on the Roche instruments.

                March 14, PHH and PWB will go live.

                May 2, PWH and PWR will go live.

                May 23, PNH and PLH will go live.

During this period of time, there will be limited standardization of reference ranges between the Laboratories.

The reference range changes are in the process of being evaluated and will be posted as soon as they are established.

The most significant change will be the use the current Troponin I to the Roche Troponin T assay.  The diagnostic criteria for Troponin T is:

 

Troponin T

   < 0.01 ng/ml - Does not indicate cardiac damage

   0.01 - 0.09 ng/ml - Abnormal, undetermined significance, repeat testing and     
                                   further testing  may be indicated according to clinical findings
 
  > 0.09 ng/mL - Consistent with myocardial infarction, if clinical characteristics 
                            correlate
 

Troponin I and Troponin T values are not interchangeable. It is recommended that if a patient is transported to a facility using the other Troponin, that the timing for serial determinations be reset.

Jennifer Marino, Roche Diagnostics Corporation Medical and Scientific Liaison, is available to answer questions concerning the conversion to Troponin T, Jennifer is working with nursing and physician groups to communicate the changes.   

 

For further information or questions, please contact Karen Wan, Laboratory Pathologist, 266-1639, or Richard Brown, Laboratory Chemistry Specialist, 266-6083.

 

January 16, 2017

New Testing
Effective January 24, 2017, Parkview Health Laboratories will begin offering Mycobacterium tuberculosis, PCR testing in house.  This test detects Mycobacterium tuberculosis complex DNA in raw expectorated sputum or concentrated sputum sediment prepared from induced or expectorated sputum. In specimens where Mycobacterium tuberculosis complex (MTB-complex) is detected, the test also detects the rifampin-resistance associated mutations of the rpoB gene.  This test is intended for use with specimens from patients for whom there is clinical suspicion of tuberculosis (TB) and who have received no anti-tuberculosis therapy, or less than three days of therapy. This test should always be used in conjunction with Acid Fast Bacilli culture, not as a replacement for the culture.  For any questions please contact Dr. Karen Wan at 266-1639, or Ann Vick at 266-1521.



December 19, 2016
Teichoic Acid - Discontinued
MSH6 Mutation, One Exon, HNPCC - Discontinued (Now Order Quest 93945)
BRCAvantageTM, Single Site - Discontinued (Now Order Quest 93945)
Heavy Metal Screen, Whole Blood (Now Order Quest 7655)

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:
GI Panel
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
Meningitis/Encephalitis Panel
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. 

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.

May 19, 2016
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.


April 28, 2016
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.


March 18, 2016
To be consistent with best practice, Parkview Laboratories are discontinuing the Thyroid Profile and Thyroid Profile with TSH tests on 4-5-16. All the tests included in these profiles are available individually. Orders previously placed for these profiles will be converted into the TSH with reflex Free T4. Questions can be directed to Dr. Steven Wang, Medical Director, at 266-1630.
On February 28, 2017, Parkview Health Laboratories will begin converting Chemistry testing from the Siemens Dimension platform to the Roche Cobas platform.
The rollout of the Roche instruments will occur in 4 phases:
                Feb 28, PRMC and PVH will go live on the Roche instruments.
                March 14, PHH and PWB will go live.
                May 2, PWH and PWR will go live.
                May 23, PNH and PLH will go live.
During this period of time, there will be limited standardization of reference ranges between the Laboratories.
The reference range changes are in the process of being evaluated and will be posted as soon as they are established.
The most significant change will be the use the current Troponin I to the Roche Troponin T assay.
The diagnostic criteria for Troponin T is:
 
                Troponin T
                 0.01-0.09 ng/ml- Abnormal, undetermined significance, repeat testing and further testing may  be indicated according to clinical findings                 >0.09 ng/ml- Consistent with myocardial infarction, if clinical characteristics correlate
For further information or questions, please contact Karen Wan, Laboratory Pathologist, 266-1639, or Richard Brown, Laboratory Chemistry Specialist, 266-6083.
On February 28, 2017, Parkview Health Laboratories will begin converting Chemistry testing from the Siemens Dimension platform to the Roche Cobas platform.
The rollout of the Roche instruments will occur in 4 phases:
                Feb 28, PRMC and PVH will go live on the Roche instruments.
                March 14, PHH and PWB will go live.
                May 2, PWH and PWR will go live.
                May 23, PNH and PLH will go live.
During this period of time, there will be limited standardization of reference ranges between the Laboratories.
The reference range changes are in the process of being evaluated and will be posted as soon as they are established.
The most significant change will be the use the current Troponin I to the Roche Troponin T assay.
The diagnostic criteria for Troponin T is:
    Troponin T
    < 0.01 ng/mL Does not indicate cardiac damage
  
     
  0.01-0.09 ng/ml- Abnormal, undetermined significance, repeat testing and further 
                                   testing may  be indicated according to clinical findings                 

    > 0.09 ng/ml- Consistent with myocardial infarction, if clinical characteristics correlate
For further information or questions, please contact Karen Wan, Laboratory Pathologist, 266-1639, or Richard Brown, Laboratory Chemistry Specialist, 266-6083.

 

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