Laboratory Medicine Updates - November 19, 2003
University of Virginia Health System
“Quality You Expect, Service You Deserve”
LABORATORY MEDICINE UPDATE
November 19, 2003
Medical Laboratories Reflex Testing Policy
The Medical Laboratories has published the Reflex Testing Policy on the Laboratory website. This policy was established to ensure that Medical Center Staff understand the circumstances under which one test result will lead to additional testing and how these will be billed to Medicare, Medicaid, and other federally funded payors. To view the Reflex Testing Policy and the list of tests and results that will generate additional testing, please visit:
Critical Value Read-Back Policy
One element of the 2nd JCAHO National Patient Safety Goal (improving communication among caregivers) requires collaboration between front line nursing and physician staff and the laboratory. The new requirement is for verbal communication of laboratory critical values to be read back by the caregiver. This is an important feature to verify that the correct information was said and heard and is designed to ensure patient safety and effective treatment and diagnosis.
BEGINNING DECEMBER 1, 2003 THE POLICY WITHIN OUR LABORATORY WILL REQUIRE THAT A READ-BACK OF ALL CRITICAL AND TOXIC LABORATORY VALUES BE OBTAINED AND DOCUMENTED.
The laboratory will ask that you recite or read back both the patient's name and the verbal result you were given. Your cooperation is essential and we ask that you help make this new process a smooth one. A JCAHO expectation is that this element of patient care be incorporated into local policies in addition to those of the laboratory.
New Immunohistochemical Stains
The Immunohistochemistry section of the Surgical Pathology Laboratory has recently made available to the Pathology Staff, the following new antibodies for Immunohistochemical staining in formalin-Fixed, paraffin embedded tissues:
Fascin 55K-2 (Synonyms: p55 and Actin Bundling Protein)
Fascin, encoded by the human homolog for sn(hsn)gene, has been localized to microspikes and stress fibers of cultured cells where it is thought to be involved in the formation of microfilament bundles. Fascin expression has been demonstrated in the cytoplasm of Reed-Sternberg cells and their variants in most Hodgkins lymphomas. In HIV-related lymphoid hyperplasia (HLP), Fascin is expressed in both Follicular Dendritic Cells (FDC) and Interdigitating Rectiulum Cells (IRC) from the T-Cell zones of lymph nodes. Fascin has also been expressed in a subset of high grade breast carcinomas.
Caldesmon (Synonyms: h-cd, Crude Human Uterus Extract)
Caldesmon is a developmentally regulated protein involved in smooth muscle and non muscle contraction. In breast carcinomas, it has been demonstrated to label a subpopulation of myoepithelial cells and the smooth muscle cells of the blood vessels, but not cells of the lobules, ducts and luminal epithelial cells.
CD138 (Synonyms: MI15, Syndecan-1)
CD138 plays a role in cellular proliferation and cell to cell adhesion. It expression is reduced during malignant transformation of various epithelia and the antigen is lost by myeloma cells entering apoptosis. It is associated with multiple myelomas, and together with BCL-6 is used in the diagnosis of AIDS-related Non-Hodgkin lymphomas and HIV-related Hodgkin lymphomas.
DBA.44 (Synonym: Hairy Cell Leukemia A)
This antibody labels more than 97% of Hairy Cell leukemias and about 79% of splenic lymphomas. DBA.44 recognizes an unknown, fixation-resistant antigen expressed by mantle cell lymphomas, reactive immunoblasts, monocytoid B cells, and a small proportion of high and low grade lymphomas.
CD21 (Synonyms: C3d-receptor, CR2, and EBV-receptor)
CD21 is a transmembrane glycoprotein belonging to the same family as CD35, C4, CD55 and Factor H. It labels follicular dendritic cells and mature B cells and is a useful tool in the identification of alteration in follicular dendritic cells frequently found in malignant lymphomas. It also has been expressed on several types of epithelial cells with low expression on T-cell acute lymphoblastic leukemia cells, subsets of normal thymocytes and mature T-cells.
BCL6 (Synonym: PG-B6p)
This antibody labels cells expressing BCL6 Protein and is useful for differentiating proliferating centers in B-cell chronic lymphocytic lymphomas (BCL2+/BCL6-)from trapped germinal centers in mantle cell lymphomas (BCL2-/BCL6+). It is also used to identify neoplastic cells in cases of nodular, lymphocyte predominance Hodgkin's disease. The neoplastic counterparts of germinal center B-cells, including Burkitt's, follicular, and diffuse large cell lymphomas, also display high levels of BCL6 expression.
Change in Location for Tobramycin Testing
Testing for Tobramycin levels will be moved to the Toxicology Laboratory beginning December 1, 2003. The reagent system remains the same; this is only a change in location. Questions or concerns should be directed to the Laboratory Medicine Resident on-call, pic 1383.