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Hemostasis/Coagulation

aPTT Range Update for Heparin Nomograms

On Tuesday October 26, 2021, a new lot of aPTT reagent will go live for the Spectrum Health Laboratory Information System starting at 10:00 AM.

• The aPTT therapeutic range for ADULT patients on continuous heparin infusions will be updated to reflect the new reagents.  The therapeutic range, for most indications, will be changed from 37 to 52 seconds to a new range of 42 to 57 seconds. UFH anti-Xa therapeutic ranges will remain unchanged (0.3 to 0.7 units/mL).  All ADULT nomograms will be adjusted to reflect the new therapeutic ranges.

• For PEDIATRIC  patients, aPTT nomograms will no longer be used in this population. Only the unfractionated heparin (UFH) anti-Xa nomograms will remain for PEDIATRIC patients, again with no changes made to their current UFH anti-Xa nomograms.

The aPTT reference range remains unchanged. Continue Reading

October 21, 2021 by
Main lab, Microbiology, Test Utilization

Influenza Testing Reminder

The mitigation strategies enacted during the COVID-19 pandemic to reduce the spread of this virus have also impacted the transmission of other respiratory viruses. Influenza is typically prevalent during the winter months (December through March), however, influenza cases were essentially non-existent during the 2020-2021 season and influenza is not currently circulating in our community.

In the absence of circulating influenza activity, it is recommended to use the most sensitive diagnostic test in order to obtain accurate and actionable results. Influenza antigen testing (e.g. Sofia instrument) is not appropriate at this time. More detailed information can be found as published by the CDC: Algorithm to assist in the interpretation of influenza testing results and clinical decision-making during periods when influenza viruses are NOT circulating in the community

Low Influenza
prevalence		 High influenza
prevalence
Recommended order Influenza PCR (LAB3255) Influenza Rapid Antigen (LAB2111530)
or
Influenza PCR (LAB3255)

TEST INFORMATION

Test name Epic code Interface EMR Code CPT Code
 Influenza PCR  LAB3255 11594 87502
 Influenza Rapid Antigen  LAB2111530 11208 87804 x4
September 16, 2021 by
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