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Compliance & Safety, Education & Training, Microbiology, Molecular Diagnostics, Referral/Sendouts, Test Utilization
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Test Utilization
Education & Training, General Information, Test Utilization
Appropriate Thyroid Peroxidase Antibody Ordering
The most conclusive evidence for using thyroid peroxidase antibody (TPO) is predictive in nature when evaluating possible subclinical hypothyroidism. If this test is positive, hypothyroidism occurs at a rate of 4.3% per year versus 2.6% per year when the antibody is negative. While this scenario does not cover all clinical indications for ordering TPO, there is no definitive evidence that repeat TPO testing provides additional information.1
Based on this information the ordering of TPO within Spectrum Health is being modified. If the test is ordered more than once on a patient, a screen will appear in EPIC indicating the following: “This test should typically only be resulted once per lifetime. The duplicate checking indicates that this patient has already had this testing performed. Please see chart review for results.” This is not a “hard stop” but providers will need to click “Continue” to proceed with the order.
General Information, Immunochemistry, Main lab, Test Utilization
Protein Electrophoresis Testing Update
In December, serum and urine protein electrophoresis testing will be simplified and standardized. The only testing available will be:
Protein electrophoresis, serum, IFE if indicated
Protein electrophoresis, random urine, do IFE if indicated
Protein electrophoresis, 24 hour urine, do IFE if indicated
In addition, on December 5, 2019, a new panel will be added which reflects expert recommendations for first line testing for monoclonal gammopathy, including plasma cell myeloma and most cases of amyloidosis, called “Monoclonal Gammopathy Screen”
Blood Bank, Compliance & Safety, Education & Training, Test Utilization
Reminder: Choosing Wisely Recommendations for Blood Products
As part of the Choosing Wisely campaign, the American Association of Blood Banks (AABB) released five recommendations for transfusions:
Microbiology, Test Utilization
Helicobacter pylori Diagnosis – Serologic Testing is no Longer Recommended
Overview
Clinical guidelines no longer recommend serologic testing as a method for the diagnosis of H. pylori infection. Rather than IgG serology testing, other non-invasive testing methods such as H. pylori stool antigen and urea breath tests may be used to both diagnose and monitor response to therapy for H. pylori infection. In anticipation of an increase in stool antigen testing, currently a reference lab send-out test, Spectrum Health Regional Laboratory (SHRL) will be implementing this test as of October 29, 2018. By offering this test in-house, results will typically be available one day faster than present state.
On June 27th, the name of the current order “Respiratory (non-sputum) Culture without Gram stain” will change to “Throat Culture Comprehensive.” All other specimen collection details and culture workup will remain the same. Given the fact that there are currently several similarly named tests, this change is being made to reduce confusion regarding test selection and to clarify acceptable specimen types.
Immunochemistry, Test Utilization
Utility of specific IgE (sIgE) testing to foods and food allergen components
The diagnostic evaluation of allergic disease occurs in the context of a patient’s complete clinical presentation. Important factors include, age, clinical signs and symptoms, relevant allergen exposures, and the performance characteristics (sensitivity, specificity, and predictive values) of the allergy tests themselves. Allergy tests yield information about sensitization to allergens, which is not always equivalent to allergic hypersensitivity (i.e., sensitivity); thus, interpretation in the context of clinical history is essential for accurate diagnosis.
In anticipation of “Flu season”, it is valuable to revisit available testing methods for influenza and discuss when each test should be ordered. Though generally a self-limited infection for otherwise healthy individuals, influenza can be particularly severe for high-risk populations including infants, elderly, pregnant women, and immunocompromised hosts. Influenza incidence is largely seasonal with the majority of cases occurring between December and April of each year.