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Chemistry, General Information

Discontinuation of CKMB

Effective Wednesday, January 1, 2025, the in-house test, Research Creatine Kinase MB Fraction (CK-MB) (LAB2111534) will be made inactive. Recommended alternative testing is CK-MB (CK-2) (TC:17581) which is referred to Quest Diagnostics.

For questions or additional information, please use the Contact Us link above.

General Information, Microbiology

Influenza Antigen Testing (December 2024)

Influenza prevalence fluctuates seasonally, and case numbers are currently increasing throughout West Michigan. The onset of “flu season” varies year-to-year though typically begins its upswing in the month of December. It is important for providers to have an awareness of influenza prevalence (in addition to other respiratory viruses) to help guide when influenza testing should be pursued.

The use of point of care (POC) antigen testing reduces both the cost to the patient and turn-around-time as compared to lab-based molecular methods. POC antigen tests are typically available for COVID-19, influenza A/B, and as a COVID-19/influenza A/B combination test. During warmer months when influenza prevalence is negligible yet COVID-19 may be circulating, a COVID-only antigen test may be helpful for diagnosis. As influenza increases into colder months, a COVID-19/Influenza A/B combo test would act as a screen for both viruses.

POC tests generally have high analytical specificity but lack the sensitivity of nucleic acid amplification methods (e.g. PCR). For this reason, PCR testing is still recommended for hospitalized patients and for outpatients with a negative POC result if influenza is still suspected and if the result will impact clinical decision making. Influenza PCR may be ordered as a standalone test (LAB3255) or as a part of a panel alongside COVID-19 and RSV (LAB1230746).

 

Test Information

  • Influenza PCR Epic Code: LAB3255, Interface EMR Code: 11594, CPT Code 87502
  • COVID-19, Influenza A/B, RSV PCR Epic Code: LAB1230746, Interface EMR Code: 1230746, CPT: 0241U

 

Contact/Resources

Local Infection Prevention Team

Michigan Department of Health and Human Services

 

Compliance & Safety, Hemostasis/Coagulation

Update: Platelet Aggregation Studies Scheduling

Effective immediately, platelet aggregation testing will require a pathology consult prior to scheduling for testing performed at Corewell Health Reference Laboratory West, Grand Rapids. This consult request must be completed prior to scheduling the patient for testing.

After consultation the testing may be ordered and scheduled.

As a reminder testing is performed for scheduled patients Monday – Thursday from 7:30 am-9:30 am at the 35 Michigan Street Laboratory. Patients should be resting, fasting, non-smoking, and should not be pregnant. Patients should avoid taking any prescription or over the counter medications known to affect platelet function for ten (10) days to two (2) weeks prior to the test. Click for a list of medications with known anti-platelet effects.

Test Information:

 

General Information, Hemostasis/Coagulation

Reference Range Updates Coagulation Laboratory

Effective December 2, 2024 at 08:00 AM, Corewell Health West Laboratory Coagulation Department will be updating the reference range for several assays. The following will be impacted by these changes:

APTT testing for the BCS XP analyzers will be updating to 22.0 – 27.0 seconds.

This will include the following tests:


Effective December 2, 2024 at 08:00 AM, the Corewell Health West and South Coagulation Departments will be updating the reference range of the Fibrinogen Level (LAB 314) to 190-450 mg/ dL.


Questions may be directed to the Coagulation Laboratory using the Contact Us link above.

General Information, Immunochemistry

Update to Breath Tests

Effective December 4, 2024, breath methane will be added to Bacterial Overgrowth, Breath Test (LAB3295) and Lactose Intolerance, Breath Test (LAB3097). As a result, the test will include both breath hydrogen and methane. Methane is being added as a small percentage of patients who have either bacterial overgrowth or lactose intolerance will not produce hydrogen when challenged during the test. These patients are considered methane-producers.
In addition, the collection time point of 150 minutes is being eliminated to align with system-wide standards.
Questions may be directed to the Immunochemistry Laboratory using the Contact Us link above.
Cytology, General Information

Update to PAP-HPV Reflexing Algorithm

The algorithm that reflexes HPV testing off the PAP Test (LAB1230097) when the “HPV Reflex” option is selected during PAP ordering will no longer include pregnancy status as a criterion for reflexing on LSIL patients. Prior to this update, if HPV Reflex was selected, a PAP Diagnosis of LSIL on patients 25 and older would only reflex HPV testing if the patient was non-pregnant. Starting 11/6/2024, if HPV Reflex was selected, a PAP Diagnosis of LSIL on patients 25 and older will reflex HPV testing regardless of pregnancy status. This update aligns with current ASCCP Risk-Based Management Consensus guidelines.

Chemistry, Compliance & Safety

Parathyroid Hormone Corrections

An equipment issue resulted in artificially high parathyroid hormone results for some patients from July 31- August 17, 2024. We have repeated testing on the potentially affected samples, corrections were made as necessary, and providers for the impacted patients have been notified.

Review of quality indicator data suggested that issue affecting the results began July 31. Not all patient values were affected, but those that were had artificially high values. The laboratory repeated all PTH testing from this instrument for which remaining sample was available, corrected results, and contacted providers via epic inbox message for CHW providers and other appropriate means for CHW affiliates and external providers whose lab work is performed at CHW in Grand Rapids. Providers of potentially impacted patients whose samples could not be repeated have also been notified.

Recommendations Continue Reading

Advanced Technology Laboratory, Cytology, Education & Training, Referral/Sendouts

New Test: HPV High Risk Screen with HPV Genotype Reflex

Effective August 26, 2024,  Corewell Health Laboratories West will be updating their High-Risk HPV testing.  The new assay will be performed on the Abbott Alinity m at Corewell Health Reference Laboratory West, Grand Rapids.  Testing will now automatically include HPV Genotype results whenever HPV is detected.  There will no longer be a separate charge to the patient for HPV Genotype testing.

There will also be an expanded number of High-Risk HPV Genotypes reported:

  • HPV Genotype 16
  • HPV Genotype 18
  • HPV Genotype 45
  • HPV Genotype 31/33/52/58
  • HPV Genotype 35/39/51/56/59/66/68

The new assay is FDA approved for Primary screening in addition to co-testing.

Post hysterectomy vaginal specimens will still be a send out test (LAB1230722). Continue Reading

Main lab, Microbiology, Referral/Sendouts

Measles Ordering and Collecting Specimens

With several suspected cases of measles within Michigan, we thought it would be an excellent time to highlight Corewell Health West’s guidance on testing suspected patients. Specimens are sent to a reference lab for testing, which must be coordinated with local public health departments. Typically an upper-respiratory swab (throat or nasopharyngeal)  is collected for PCR testing in addition to a serum for measles IgM if collection is possible.

  • Patients should not be directed to a Corewell Health Laboratory or other healthcare facility for serum collection if patient is within 4 days after the onset of rash (with onset of rash considered to be Day 0). If Day 5 of rash or later, immunocompetent patients are no longer considered contagious and may be sent to a laboratory for a serum draw.
  • Corewell Health Providers:
    • Please reach out to Corewell Health Infection Prevention (IP) via Perfect Serve to make them aware of the situation.
    • Corewell Health Infection Prevention will contact the appropriate county.
  • Non-Corewell Health Facilities:
    • The provider’s office must coordinate with the county health department that the patient lives in to obtain permission to send measles testing.
    • Visit the following link for county health department contact information: Slide 1 (michigan.gov)
      • The county will coordinate with MDHHS for testing permission.

The preferred testing specimen is a throat or nasopharyngeal swab collected in office. Corewell Health Laboratories do not collect swabs.

For further collection and ordering instructions, please visit: Measles PCR – Laboratory Test Catalog | West

Any additional questions or concerns, please use the contact us link above or reach out to your local health department.