Laboratory Medicine Updates - January 27, 2005

University of Virginia Health System

Medical Laboratories

“Quality You Expect, Service You Deserve”

LABORATORY MEDICINE UPDATE

January 27, 2005

Successful Laboratory Inspection

The Medical Laboratories and Department of Pathology were inspected by a group of 14 pathologists and laboratorians from Baylor University (Dallas ) on January 13 and 14.  This inspection, sponsored by the College of American Pathologists (CAP), fulfills the federal requirement for bi-annual inspection of pathology and medical laboratory operations.  Almost 30 checklists containing ~3500 questions were reviewed by the inspectors.  These checklists cover all areas of pathology and laboratory operations: quality assurance and management, procedure manuals, accuracy and TAT of results, interactions with clinical services, patient and employee safety, and the physical facilities of all laboratory areas including the remote sites of Student Health and Fontaine Clinic Building .  We are pleased to announce that we received an almost perfect score, receiving only a single citation for lack of adequate temperature control at the Fontaine Clinic Building .

 

Laboratory Relocation Update

 

Last month we reported a moving date of mid-February.  However, unexpected construction delays have been encountered and it is now more likely that the Core, Microbiology, and Molecular Diagnostics Laboratories will move into the new facility in early March.

Every effort is being taken to ensure uninterrupted lab services throughout the move and the Express Tube System will ensure timely and reliable movement of specimens to the new lab once we begin operations.  With the consolidation of these divisions, there will a reduction in the amount of handling required for shared specimens.

Other improvements include a new front end automated Chemistry analyzer that will offer an expanded menu and allow Medical Laboratories to decrease turnaround times on some of the more commonly ordered tests.

The next Lab Medicine Update should include final details on the move.   We sincerely appreciate everyone’s patience and support throughout the planning and construction process.

For additional information or questions regarding the upcoming relocation please contact Cavell Kopetzky in Medical Laboratories Administration at 434-243-2649 (email: cak3w@virginia.edu).


Improvement in HDL-Cholesterol Reagent

The Core Laboratory has implemented a new reagent formulation for HDL cholesterol. This new method is not subject to interference from Triglycerides up to a level 2200mg/dL.  Previously specimens with Triglycerides greater than 400mg/dl could not be analyzed.

 

Hepatitis B Core IgM Antibody Testing

Medical Laboratories is now performing hepatitis B core IgM antibody testing in-house to meet the clinical needs of the GI and transplant departments.  The assay requires one gold-topped tube (serum) and is performed weekly in the Davis Laboratory.  Requests for STAT testing need to be approved by the pathology resident on-call (1383).

 

Growth Hormone Reference Interval Change

Nichols Institute Diagnostics, manufacturer of the human growth hormone reagent used in Medical Laboratories, has instituted a change in calibration that impacts the reference interval for this assay.  The new reagent is calibrated to the NIBSC 2nd IS 98/574 for Somatropin (recombinant DNA derived material).   The change in standardization was driven by World

Health Organization (WHO) and will provide better consistency across different lots of reagents.  New reference interval is 0.3 – 30 ng/mL.

 

DHEA-SO4 Reference Interval Change

Nichols Institute Diagnostics, manufacturer of DHEA-SO4 reagent used in Medical Laboratories, has recommended new reference intervals based on age and sex.  After review, the laboratory directors have approved the recommendations and these ranges are now being applied to our test results.

Age

Female

Male

<18

Dependent upon both age and pubertal stage

18-29

55-430 µg/dL

80-500 µg/dL

30-39

57-408 µg/dL

78-430 µg/dL

40-49

28-290 µg/dL

56-360 µg/dL

50-59

14-180 µg/dL

42-426 µg/dL

>60

14-180 µg/dL

16-200 µg/dL

 


Reference Interval Changes for Coagulation Tests

The annual change in reagents for coagulation tests has begun and has resulted in the following new reference intervals:

aPTT (PTT): 25.0 – 36.7 sec

Post Hepsorb PTT (PSTPTT): 25.0 – 36.7 sec

Heparin PTT (HEPTTA): 66-101 sec

Prothrombin Time (PT): 12.5 – 15.2 sec

 

Guidelines for Low Molecular Weight Heparin and Direct Thrombin Inhibitors

The University of Virginia Hemostasis Laboratory has not established therapeutic ranges for Low Molecular Weight Heparin or Direct Thrombin Inhibitors.

 

Referenced guidelines for venous thromboembolism are as follows:

 

Adult Low Molecular Weight Heparin therapeutic range:  0.6 – 1.0 Anti-Xa U/mL.

Pediatric Low Molecular Weight Heparin therapeutic range: 0.5 – 1.0 Anti Xa U/mL

(Adapted from CHEST, vol. 126/No. 3/Sept. 2004, pp. 195s, 650s)

 

Direct Thrombin Inhibitors reference therapeutic guideline:  1.5 – 2.5 the baseline aPTT.

(Adapted from BLOOD 2000; 96,pp. 846-851)

 

Questions and consult requests should be directed to the Heme/Onc fellow on-call (pic 1641) or the Clinical Pathology resident on-call (pic 1663).

 

Qualitative Fecal Fat Analysis

This test will no longer be performed by the Microbiology Division of Medical Laboratories.  All requests will be sent to our primary referral laboratory, Quest Diagnostics.

The collection requirements remain the same.  A minimum of 2 grams of random stool specimen should be submitted in a plastic container that must have a tight-fitting lid securely in place.  Do not contaminate outside of container; do not overfill container.   The container should be labeled in accord with Health System Policy 0083. Do NOT use preservatives.

The test is set up at Quest Diagnostics Monday thru Friday with an estimated turn around time of 3 days.