CLINICAL CORE LABORATORY
DIRECTOR &
CLINICAL CONSULTANT: James C. Boyd,M.D.
ASSOCIATE DIRECTORS
Hematology: Donald J. Innes, Jr., M.D.
John B. Cousar, M.D.
Chemistry: David E. Bruns,M.D.
Dede Haverstick, Ph.D.
MANAGER: Dawn T. Burris, MT(ASCP)
SUPERVISORS:
Day Shift: Donna Canterbury, MT (ASCP) SH - Hematology
Judy Hundley, MT (ASCP) - Chemistry
Gary Manuel, MT (ASCP) - Hemostasis
Victoria Reynolds, MT (ASCP) - Chemistry
Jim Veith, MT (ASCP) - Hematology
Evening Shift: Amy Ensinger, MT (ASCP)
Night Shift: Steve Nelson, MT (ASCP)
TELEPHONE NUMBERS Core Laboratory 924-5227
Special Coagulation 924-8007 (M-F 0730-1530)
LOCATION : UVa Clinical Laboratory Building
112 11th Street SW,.
HOURS: 24 hours/day except Special Coagulation, open 0730-1530, M-F
LAB MEDICINE RESIDENT 0800-1700 Weekdays
Chemistry PIC 1267
Hematology PIC 1386
1700-0800 Weekdays & Weekends
PIC 1383
The Clinical Core Laboratory is a fully automated facility which operates 24 hours a day to provide routine and stat testing for clinical chemistry, hematology, and hemostasis analysis. This consolidated laboratory is located adjacent to the Specimen Management Support area, thus is able to provide efficient clinical laboratory analyses to both the inpatient and outpatient services.
Routine test procedures are offered daily and are available between 0700-2300 hours. Between 2300-0700 hours a limited menu of test services is available on a stat basis or for critical care monitoring.
The Clinical Core Laboratory provides 24 hour stat testing for a limited number of test services which have been determined as essential for immediate patient care management. Stat tests are generally completed within 1 hour of specimen receipt. The stat services currently available are listed below. For more information, consult the individual test listings in this handbook. Refer to the following pages for special instructions for collection and processing of specimens.
STAT requests will be phoned only to those locations where computer terminals (or printers) are not available. If a location has a terminal (or printer), the STAT will be reported on the terminal (or printer) as soon as the laboratory verifies the result.
STAT CHEMISTRY TESTS AVAILABLE 24 HOURS A DAY
Plasma
Acetaminophen Fetal Fibronectin (ffN)
Acetone, Qual. Glucose
Alanine Aminotransferase (ALT) HCG, Qual. & Quant.
Alkaline Phosphatase Lactate Dehydrogenase (LDH)
Ammonia Lactic Acid
Amylase Lithium (serum)
Aspartate Aminotransferase (AST) Lipase
Bilirubin, Total Magnesium
B-type Natriuretic Peptide (BNP) (EDTA) Osmolality
Calcium Phenobarbital
Carbamazepine Phenytoin
Carbon Dioxide Phosphorus
Chemistry Panel, Basic Metabolic Potassium
Chemistry Panel, Comprehensive Salicylate
Chemistry Panel, Electrolytes Sodium
Chemistry Panel, Hepatic Theophylline
Chloride Troponin I
Creatine Kinase (CK) Valproic Acid
Digoxin Vancomycin
Ethanol
Gentamicin
Serum Arterial Blood
Cortisol pH Potassium
Estradiol pCO2 Ionized Calcium
Prolactin pO2 Hemoglobin
TSH, T3uptake, Glucose Coox Profile
Thyroxine Sodium
Total T3
Cerebrospinal Fluid Urine
Glucose Amylase Creatinine
Protein HCG, Qualitative Myoglobin, Qualitative
Lactate Osmolality Porphobilinogen, Qualitative
Potassium Sodium
Total Protein
STAT HEMATOLOGY TESTS AVAILABLE 24 HOURS A DAY
CBC* (includes platelets)
Prothrombin Time
Partial Thromboplastin Time (PTT)
Heparin PTT
Fibrinogen
Thrombin Time
D-dimer
Antithrombin III
*Differentials are not STAT procedures. A slide can be prepared in the laboratory for review by the house officer, if requested, at any time.
STAT MICROSCOPY TESTS AVAILABLE 24 HOURS A DAY
Urinalysis
CSF Analysis
Trauma Lavage
GENERAL HEMATOLOGY
TEST REQUESTS
Blood specimens for all hematological tests should be collected into potassium EDTA-lavender top containers. Routine coagulation studies require a full 4.5 mL sodium citrate blue top container. One full lavender 3 mL tube is generally sufficient for all hematology tests. Results of routine requests submitted for the early morning collection will be reported the same day. Coagulation screening studies on nonsurgical admissions should be requested for the early morning collections. Any samples in lavender or blue top tubes showing any visible evidence of clot formation, insufficient blood volume, or gross hemolysis are unsatisfactory for testing and new samples will be requested.
WBC, HCT, and PLT will be reported under special conditions, i.e., patient sample has interfering high WBC, cold agglutinins, abnormal proteins, etc., sample inadequate, instrument trouble and power outages that may temporarily limit lab capability. Indices may be manually calculated when necessary as determined by the laboratory on first request and at intervals of seven days thereafter unless specifically requested by the physician. Atypical or abnormal cellular findings may result in a professional consultation review. Professional review and/or follow up testing may result in additional charges to the patient. To decline futher testing, please designate this desire on the test request form or contact the lab before testing.
MICROTAINERS (purple top) are available for micro-samples. A properly filled microtainer is required for accurate platelet counting. These collection devices should only be used for the newborn nursery, newborn intensive care unit, pediatric floors and pediatric outpatients. Please note that microtainer samples are suitable for testing only within 4 hours of specimen collection.
HEMOSTASIS AND BLOOD COAGULATION TESTS
Routine coagulation tests include the partial thromboplastin time (PTT), the prothrombin time (PT), thrombin time (TT), fibrinogen determination (FBG), D-dimer (DD), fibrin/fibrinogen degradation products (FDP), Antithrombin III, heparin-removed PT/PTT, Unfractionated and Low Molecular Weight Heparin. These tests are available 24 hours per day.
Meticulous collection of blood specimens is essential for these tests; traumatic venipuncture, bubbling of the blood specimens, and insufficient or excessive anticoagulant may invalidate the results.
|
SPECIMEN COLLECTION NOTES |
COMMENTS |
|
PTTs > 4 hours Heparin PTTS > 1 hour |
Results will be unreliable. |
|
Specimens clotted |
WILL NOT BE PROCESSED |
|
Tubes MUST be filled properly depending on size of tube (4.5 mL for 5 mL tube; ,1.8 mL for 2 mL tube) |
Results will be unreliable; WILL NOT BE PROCESSED. |
|
Patients with hematocrit > 55% |
Results may be erroneous; OBTAIN SPECIAL TUBE and instructions from Coag Lab. |
|
All procedures except PT, PTT, FBG, DD, TT, ATIII, Heparin removed PT/PTT, Unfractionated and Low Molecular Weight Heparin |
Submit 2-3 blue top tubes along with consult form. Tests must be approved by Hematology or Clin. Path Resident. |
Samples collected from a heparin lock or other vascular access devices should be avoided, since even with flushing, the sample is often contaminated with enough heparin to affect results. If using a vascular access device is unavoidable, it is crucial that a minimum of 10 mL of blood be discarded prior to collecting the sample. Since heparin affects all coagulation factor assays, these tests should not be ordered when a patient is on heparin therapy.
The heparin PTT must be sent immediately to the laboratory (within 1 hour). Special handling is required to minimize time-dependent alteration in the sample. The heparin PTT must be properly labeled or it will be timed for 140.0 seconds only.
Specialized coagulation testing is available by laboratory consultation. These tests are primarily designed for the evaluation of hemorrhagic or thromboembolic disorders. The available tests include:
Assays for coagulation factors II, V, VII, VIII, IX,
X, XI, XII, XIII, Prekallikrein, and HMWK
von Willebrand factor antigen
von Willebrand factor (ristocetin cofactor activity)
Mixing studies
Specific factor inhibitor screen
Specific factor inhibitor titer (Human or Porcine)
Lupus anticoagulant tests(RVTTA, PTT-LA, Staclot-LA)
Alpha-2-antiplasmin
Protein C
Protein S
Plasminogen
Activated Protein C Resistance
Heparin and low molecular weight Heparin assay
Platelet aggregation studies (Requires 24 hour advance scheduling)
Reptilase Time
FDP
Other (call laboratory for further information, 924-8007)
Requests for laboratory consultation, accompanied by 2-3 blue top tubes, should be submitted to Hemostasis/ Coagulation Section of the Hematology Laboratory (924-8007) from 0730-1530. At other times call the Laboratory Medicine resident on-call. Prior to calling the Laboratory Medicine resident, we strongly advise obtaining a consult from the Adult Hematology Service. Contact the Hematology Fellow on-call (924-0000) or Pediatric Hematology services (924-5105).
The house officer should obtain routine screening tests prior to submitting an emergency consult. It should be remembered that the single greatest difficulty in the emergency evaluation of bleeding disorders is the failure to obtain specimens prior to treatment; e.g., the administration of heparin, warfarin blood, or blood products. As a consequence, the Coagulation Laboratory should be notified at the earliest possible time of situations where special coagulation studies may be required.
MICROSCOPY
URINE
STAT and routine urine samples are received in the Clinical Hematology Laboratory on a 24 hour basis. Cellular components may be affected by a delay in examination, therefore routine samples should arrive in the laboratory between 1-2 hours after collection or be refrigerated.
FLUIDS
A minimum specimen volume of l mL is required for cerebrospinal fluid cell counts. Tube number 3 is preferred to minimize the presence of any cellular elements which may be due to trauma from the "tap" procedure.
All serous and synovial fluids must be submitted in EDTA purple top containers except trauma lavage fluid which should be sent in a non-anticoagulated container. Cell counts on would fluid, cyst fluid, pseudocyst fluid, and amniotic fluid are unacceptable specimen types.
Atypical or abnormal cellular findings may result in a professional consultation review.