Clinical Core Laboratory

Director & Clinical Consultant:              James C. Boyd, M.D.

Associate Directors Hematology:          Donald J. Innes Jr., M.D.

Associate Directors Chemistry:             David E. Bruns, M.D.

                                                      Dede Haverstick, Ph.D.

Associate Director Hemostasis:            Gail Macik, M.D.

Manager:                                         Dawn T. Burris, MT(ASCP)

Supervisors:                                     Donna Canterbury, MT (ASCP) SH - Hematology

                                                        Judy Hundley, MT (ASCP) - Chemistry

                                                        Gary Manuel, MT (ASCP) - Coagulation

                                                        Jim Veith, MT (ASCP) - Day Shift Operations

                                                        Carolyn Smith-Lee, MT (ASCP) CLS - Day Shift Operations

                                                        Amy Turner, MT (ASCP) - Evening Shift Operations

                                                        Steve Nelson, MT (ASCP) - Night Shift Operations

Telephone Numbers:                            Core Laboratory             924-5227  24 hours/day

                                                             Special Coagulation        924-8007 (M-F 0730-1530)

Location:                                              UVa Clinical Laboratory Building, 112 11th Street SW

Hours:                                                  Core Laboratory, open 24 hours/day

                                                             Special Coagulation, open 0730-1530, M-F

Laboratory Medicine Resident:             0800-1700 Weekdays

                                                             Chemistry              PIC 1267

                                                             Hematology           PIC 1386

                                                             1700-0800 M - F & 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, immunochemistry, 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.

 

HEMATOLOGY

BLOOD

Blood specimens for hematological tests should be collected into potassium EDTA-lavender top containers. One full lavender 3 mL tube is generally sufficient for all hematology tests. A sample in a lavender top tube showing any visible evidence of clot formation, insufficient blood volume, or gross hemolysis is unsatisfactory for testing and a new sample will be requested.

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.

URINE

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

Cell counts on wound fluid, drainage tube fluid, cyst fluid, pseudocyst fluid, and amniotic fluid are unacceptable specimen types and will no be analyzed.

**Atypical or abnormal cellular findings may result in a professional consultation review.

 

COAGULATION

Routine coagulation studies require a full 2.7 or 1.8 mL sodium citrate blue top container.  A sample in a blue top tube showing any visible evidence of clot formation, insufficient blood volume, or gross hemolysis is unsatisfactory for testing and a new sample will be requested. Also, 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.

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.

SPECIMEN COLLECTION NOTES

COMMENTS

PTT > 4 hours

Heparin PTT > 1 hour

Results will be unreliable.

Specimens clotted

WILL NOT BE PROCESSED

Tubes MUST be filled properly depending on size of tube (2.7 mL for 3 mL tube; 1.8 mL for 2mL tube)

Results will be unreliable; WILL NOT BE PROCESSED.

Patients with hematocrit > 55%

Results may be erroneous; OBTAIN SPECIAL TUBE and instructions from Hemostasis 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 Electronic order or consult form.  Tests must be approved by Clinical Pathology Resident.

Routine Coagulation tests include the following and are available 24 hours:

Partial Thromboplastin Time (PTT)

Prothrombin Time (PT)

Thrombin Time (TT)

Fibrinogen Determination (FBG)

D-Dimer (DD)

Antithrombin III

Heparin-Removed PT/PTT

Unfractionated and Low Molecular Weight Heparin

 

Specialized Coagulation testing is available by laboratory consultation. These tests are primarily designed for the evaluation of hemorrhagic or thromboembolic disorders. The following tests are available:

Assays For Coagulation Factors II, V, VII, VIII, IX,X, XI, XII, XIII(Screening)

von Willebrand Factor Antigen

von Willebrand Factor (Ristocetin Cofactor Activity)

Mixing Studies

Specific Factor Inhibitor Screen

Specific Factor Inhibitor Titer (Human)

Lupus Anticoagulant Tests(RVTTA, Silica Clot Time, Staclot-LA)

Alpha-2-Antiplasmin (Plasmin Inhibitor)

Protein C

Protein S

Plasminogen

Activated Protein C Resistance

Unfractionated Heparin and Low Molecular Weight Heparin Assay

Platelet Aggregation Studies (Requires 24 Hour Advance Scheduling)

Reptilase Time

FDP (Pathology Approval Required Prior To Testing)

P2Y12 Inhibitory Drug Evaluation (Clopidogrel, Prasugrel, Ticlopidine)

Platelet Inhibition Evaluation For Aspirin therapy

  A laboratory consultation request accompanied by 2-3 blue top tubes should be submitted to the Special Coagulation Section of the Core Laboratory (924-8007) from 0730-1530.  At other times call the Clinical Pathology Resident on-call (PIC 1383). Prior to calling the Clinical Pathology Resident, we strongly advise obtaining a consult from the Adult Hematology Service. Contact the Hematology Fellow on-call (PIC 1641) or Pediatric Hematology Services (923-4826).

NOTE: 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.