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Microbiology, Test Spotlight, Test Utilization

Stool Ova & Parasite Exam: New Order Criteria

Effective September 15, 2021, Spectrum Health’s Epic will contain new ask-at-order questions to help improve clinical decision support and appropriate utilization of stool ova and parasite (O&P) testing. O&P testing may be used to diagnose several parasitic infections, though the staining of stool smears and their microscopic review is very labor intensive for laboratories. Historically, O&P testing has been widely ordered for patients with diarrhea, however, there are now other testing options able to detect the most common pathogens associated with community-acquired diarrhea. While Enteric Pathogens PCR and Giardia/Cryptosporidium testing is more appropriate for the identification of common bacterial/viral and parasitic pathogens, respectively, O&P testing should be reserved for patients with specific exposure or immune status criteria.

The Pharmacy and Infectious Disease Stewardship Committee has endorsed the following order criteria for O&P testing. If any of these criteria are met, then then order can be placed.

♦ Past foreign residence or recent foreign travel followed by at least 2 weeks of diarrhea.

♦ Immunocompromised status.

♦ Unexplained microcytic anemia or peripheral eosinophilia.

♦ Unique exposure (daycare, MSM, waterborne outbreak, etc.)

Note: If no criteria are met, cancel the order and consider Giardia/Cryptosporidium Screen (LAB258) or Enteric Pathogens PCR testing (LAB3618).

Please direct question to the Contact Us link above.

 

TEST INFORMATION

Ova and Parasites, Complete – Epic: #LAB9550, Interface Code #50033, CPT #87328, 87329, 87177, 87209

Enteric Pathogens by PCR – Epic #LAB3618, Interface Code #55078, CPT #87506

Giardia/Cryptosporidium Screen – Epic #LAB258, Interface Code #50025, CPT #87329, 87328

 

September 15, 2021 by
Advanced Technology Laboratory, Education & Training, General Information, Immunochemistry, Microbiology, Test Utilization

Reminder: COVID Orders and Scheduling

Effective July 1, 2021, Spectrum Health no longer offers patient self-screening through MyChart or telephonic COVID screening appointments to patients. Patients will need an order from their provider prior to scheduling a COVID-19 test. Patients should be symptomatic or have a recent exposure, all other visit types should go through Michigan.gov (travel, athletic, or return to work or school, etc.)

If the patient does not have a provider, they may utilize the SHNow On Demand Visit via MyChart or find testing site options on Michigan.gov.

Once the order is placed, patients may schedule an appointment through MyChart or calling the Covid Hotline (for paper orders).

For more information:

COVID-19 Lab Information

COVID-19 General Information

COVID-19 Screening and Testing

August 27, 2021 by
Chemistry, Compliance & Safety, General Information

Update: Salicylate Results Reporting

Effective Wednesday, August 18, 2021, to align with Clinical and Laboratory Standards Institute (CLSI) guidelines, the Salicylate lower limit of reporting will increase from 0.3 mg/dL to 2.0 mg/dL.

Note: The therapeutic range for Salicylate is 2.0 – 10.0 mg/dL and this test is best utilized for assessment of Salicylate toxicity.

 

TEST INFORMATION

Salicylate Level – Test Codes: Epic #LAB34, Interface #10245, CPT #80329

August 2, 2021 by
Hemostasis/Coagulation

Update: PT/INR Resulting Change

The Spectrum Health Laboratory Coagulation Department announces the following changes occurring on 6.29.21 because of new instrumentation:

• New coagulation instrumentation will go-live on 6.29.21.

• This new instrumentation will align the Spectrum Health Regional Laboratory (in GR) with current Regional/Blodgett reportable upper limit for Protime/INR results.

• The current Protime (PT) upper limit of 120 seconds will change to 90 seconds. Any result that is greater than 90 seconds, will be reported as >90 seconds.

• The current INR upper limit of 12.0 will change to 8.0. Any result that is greater than 8.0 will be reported as >8.0.

Any questions can be directed to the Spectrum Health Regional Laboratory Coagulation Department using the Contact Us link above.

TEST INFORMATION 

PT/INR (Protime with INR): Epic Code #LAB320 | Interface code #10059 | CPT #85610

June 29, 2021 by
Hemostasis/Coagulation

New Test: Factor VIII Chromogenic Assay

Effective July 1, 2021, the Coagulation Department within the Spectrum Health Regional Laboratory will go live with an in-house, bovine based, Chromogenic Factor VIII assay.

This assay, a photometric determination of Factor VIII activity, is useful for monitoring coagulation factor replacement therapy of selected extended half-life coagulation factor replacements and Emicizumab therapy, a recombinant, monoclonal antibody that restores the function of the missing activated factor VIII by bridging FIXa and FX. The action of Emicizumab interferes with all APTT clot based and human chromogenic based assays, leading to an overestimation of Factor VIII activity.  As such, the bovine based Chromogenic Factor VIII assay is recommended.  The Chromogenic Factor VIII activity also assists in the diagnosis of hemophilia A using a 2-stage assay, particularly when the 1-stage clot based assay is normal.

For questions about this test, please refer to the laboratory catalog or use the Contact Us link above.

TEST INFORMATION

Chromogenic Factor VIII Activity – Epic Code: LAB1230831 | Interface Code: 1230831 | CPT: 85240

June 28, 2021 by
Blood Bank, Compliance & Safety, General Information, Hemostasis/Coagulation, Referral/Sendouts, Test Utilization

Coagulation Blue Top Tube Shortage

Update 9/1/2021:

September 1, 2021

There continues to be a global shortage of sodium citrate (“blue top”) blood collection tubes used for coagulation testing as a result of unprecedented demand, in part due to COVID-19 surges, vaccine and treatment development. This was anticipated to last through August 2021, but now, due to continued unprecedented demands, there is no end date in sight. Please take this into consideration when ordering coagulation testing (i.e. Protime, aPTT, Fibrinogen, D-dimer, Lupus Screens, Factor Assays, Mixing Studies, von Willebrand testing, etc.). Continue Reading

June 10, 2021 by
Chemistry, Compliance & Safety, General Information, Hematology, Hemostasis/Coagulation, Microbiology, Referral/Sendouts

CSF Priorities on QNS Specimens

When a Cerebrospinal fluid (CSF) specimen arrives into the laboratory and is deemed Quantity Not Sufficient (QNS) for ordered testing, the ordering provider is contacted to identify testing priorities. Occasionally, the laboratory is unable to secure these priorities.

If the lab is unable to secure priorities from the ordering provider within an hour of collection, the following will occur:

1. We will move forward with the Cell count with differential, Culture, and Protein/Glucose

2. The rest of the ordered testing will hold until we can clarify the priorities

Laboratory is partnering with Epic Beaker to discover if a prioritization of orders, upon CSF order entry, is possible.

If you have questions or concerns, please use the “Contact Us” link above.

June 9, 2021 by
Hemostasis/Coagulation, Referral/Sendouts

Supply Change Notification: 4.5 mL Blue Citrate Blood Tubes

Effective April 26th, 2021, Spectrum Health Laboratories will discontinue 4.5 mL blue citrate blood tubes. These are a vendor discontinued item. The replacement item will be the 2.7 mL blue citrate blood tubes.

Due to this change, there may be a difference in the number of tubes required to collect for the lab tests below. Please refer to the lab catalog for specimen collection requirements. Continue Reading

April 23, 2021 by