Laboratory Medicine Updates - May 24, 2006
University of Virginia Health System
"Quality You Expect, Service You Deserve"
LABORATORY MEDICINE UPDATE
May 24, 2006
Blood cultures for Acid Fast Bacteria
Beginning June 5, 2006, the UVa Microbiology lab will once again be able to provide culture bottles for the detection of acid fast bacteria in blood and bone marrow. The appropriate bottles to use are BacT/Alert MB bottles that can be obtained from the laboratory by calling 4-LABS. Bottles should be inoculated with 3-5 ml of blood or marrow at the patient's bedside for optimal recovery.
Laboratory Areas on the Move
The Primary Care Phlebotomy collection area opened on Monday, May 22, 2006 in newly renovated space on the 1st floor of Primary Care. The renovated space is located just inside the main entrance of Primary Care, Room 1004. The hours of operation (8 am - 5:30 pm Monday - Friday), the phone numbers (924-5288, 924-1602) and tube station (212) are all the same.
The Blood Bank on the second floor of University Hospital moved all operations to room 2801 (same floor) in early May. All phone numbers and the tube station number remain the same.
Return to the "Old" Methotrexate Assay
In 2003, the Toxicology Lab changed from the Abbott Methotrexate
assay (the assay that most treatment protocols are based on) to an
assay another vendor. Since that time, two fields of results have
been reported for each sample: the actual measured value and a
"calculated" value that was the predicted Abbott assay
Because of problems with the new assay resulting in delays in reporting results, the UVa Toxicology Laboratory will re-implement the Abbott assay on June 1, 2006. Thus, only the single, measured value will be provided. Please contact the Clinical Chemistry resident if you have any questions (pic 1267).
Vitamin B1 (Thiamin) Specimen Requirement Change
Effective immediately, Mayo Medical Laboratories requires a serum sample for this test. Plasma is no longer an acceptable specimen type. All computer systems listing specimen requirements are being updated.
Changes to Syphilis Serology Testing at the State Lab
The Virginia Division of Consolidated Laboratory Services (DCLS) has tightened their algorithm for syphilis testing to meet CDC guidelines. The first step in testing is the nontreponemal screening assay such as the RPR test performed by UVa Medical Laboratories. If non-reactive, treponemal tests such as MHATP / FTA (follow-up testing to a reactive RPR) will not be performed by the State Lab. If both the screening and follow-up tests are ordered and the RPR is non-reactive, the MHATP or FTA request will be cancelled and the comment "RPR screen is nonreactive, MHATP / FTA not indicated per state lab policy" will be appended.
Serum Free Light Chain Analysis
The Medical Laboratories began in-house testing for serum free light chains in April after evaluating the rate nephelometric assay. The assay is useful for screening patients suspected of having a monoclonal gammopathy and for monitoring the efficacy of treatment of patients who have a monoclonal gammopathy. Results are reported for free kappa (reference interval 0.33 - 1.94 mg/dL), free lambda (0.57 - 2.63 mg/dL) and the ratio of free kappa to lambda (0.26 - 1.65). Specimen requirement is 1 mL serum and the assay is performed every day Monday through Friday. Results should be evaluated in conjunction with electrophoresis and other supporting data.
Ten Reminders of the Rules of MIS Lab Orders
A reference flow chart is provided at the end of this list.
- When lab orders are entered, the patient's location in MIS must be a unit that phlebotomy collects. Lab orders for units not collected by phlebotomy will print to the patient's MIS location. Units NOT collected by phlebotomy are: ANGI, CCATH, ER, GPACU, GUOR, KCRC, LD, MICU, MJR3, MSU1, MSU2, NBN, NICU, NNICU, OR, PACU, PBMTU, PICU, PTU, RADHU, RENAL, SAS, SFU, SICU, TCVPO, TRAN, CCU (there is a 6am draw for the CCU).
- STAT orders and Central Line draws are the responsibility of the units. Lab orders on patients with central line flags and labs ordered as STAT do not print to the phlebotomy list, so the lab is not aware of those orders.
- TIMED orders are collected as close to the time requested as possible but will depend on the volume of requests and availability of staff.
- Routine lab orders for Today entered after 10 pm at night will not be collected until the first morning list (6 am) the following day.
- Routine lab orders for Today entered between 6 am and 10 pm will print on the next collection list.
- Any lab order entered without clicking on Today or Tomorrow will default to the next morning (6 am) collection list.
- Between 6 am and 10 pm, collection rounds are made every two hours on the even hour and every effort is made to have the samples collected and delivered in that time. Due to the volume of 6 am orders, it often takes between three and four hours to complete those collections.
- The phlebotomy team draws only TIMED collections between 10 pm and 6 am. Assistance with other blood draws can be requested during this time but can only be provided if workload and staffing permits.
- Orders are evaluated and cancelled by the system when recognized as duplicates.
- For units collected by phlebotomy, discharge lab orders should be entered using the MIS Discharge pathway. The lab will collect the samples and the results will be available by 7:30 am.