Thyroid Peroxidase Antibody (anti-TPO), Blood Level (Test #8524 )
This is the recommended test for the evaluation of Autoimmune Thyroiditis
Thyroglobulin, Tumor Marker, Serum (Test #3069)
It is only indicated for monitoring of thyroid cancer treatment.
This result is reported with an Anti-Tg result to assess for possible interference.
This test should NOT be ordered for associated anti-Tg result provided by reference laboratory.
Thyroglobulin Antibody (anti-Tg) Test
Historically ordered with anti-TPO for evaluation of possible autoimmune thyroiditis.
The literature shows that anti-TPO, alone, has better sensitivity and specificity with only 5% of cases of Autoimmune thyroiditis with anti-TPO negative, anti-Tg positive.
Since 2/2011, requests for anti-Tg have been cancelled per Laboratory Communication: Memo Thyroglobulin Antibody 2/2011
Spectrum Health Regional Laboratory Experience February 2015 – March 2016 (13 months):
357 patients with both Anti-TPO and Anti-Tg results.
*Anti-Tg results were due to concomitantly ordered Thyroglobulin TM requests.
250 patients had positive Anti-TPO and/or Anti-Tg level
193 patients had both positive Anti-TPO and Anti-Tg level
56 patients had positive Anti-TPO and negative Anti-Tg level
1 patient had a negative Anti-TPO and positive Anti-Tg levels
Based on these results, and what is reported in the literature, we are confident of our current practices and strongly request discontinuation of Thyroglobulin TM requests for the associated Anti-Tg result
Caturegli P, De Remigis A, Rose NR. Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmun Rev. 2014 Apr-May;13(4-5):391-7
The manufacturer of the Estradiol reagent has reported a cross reactivity between their Estradiol assay and Fulvestrant causing a falsely elevated level of estradiol. Patients being treated with Fulvestrant should have their Estradiol levels monitored with the following test: Estradiol by LCMS.
Questions or inquiries may be direct to Dr. David Alter in the Pathology Department.
Effective March 22, 2016, the FTA-ABS syphilis serology test is no longer available through the Spectrum Health Laboratory. The orderables for this test in the Cerner and Epic systems have been inactivated.
At this current time, we cannot honor any existing or future requests for Neopterin due to issues with test availability. If this test is needed for urgent clinical reasons please contact Natalie Sluja, Referral department supervisor at (616) 267-2755. We apologize for any inconvenience this may cause.
We are currently evaluating serum Thyroglobulin Tumor Marker test ordering practices as the volume has quadrupled over the last 3 years without a quadrupling of total laboratory volume.
If you order this test, please contact Dr. David Alter with the reason for ordering the test.
Of note, the only stated reason in “UPTODATE” is monitoring for recurrence of medullary thyroid cancer status post treatment.
- Monitoring treatment
- Serum thyroglobulin as a marker for autoimmune thyroiditis
- Serum thyroglobulin ordered for the accompanying anti-thyroglobulin antibody result
- Other, please elaborate.
As of April 1, 2016, the following tests are no longer available at Spectrum Health Regional Laboratory (SHRL, Grand Rapids) due to low volume. These tests will still be available through Mayo Medical Laboratories as a send out. Please order as a Reference Miscellaneous (“Ref Misc.”) and indicate test name when ordering.
Effective immediately, VAP Cholesterol testing has been discontinued. Atherotech, the laboratory performing this test, recently abruptly ceased operations.
The NMR Lipoproteins test available through Mayo is clinically comparable to the VAP Cholesterol test. See the following link to an item on appropriate utilization of lipid tests published in the June 2015 newsletter at a time when Mayo discontinued the NMR Lipoproteins test (“NMR Lipoprotein Profile Test Discontinued” page 4). This test has since been reinstated by Mayo.
A1AT Proteotype S/Z and Alpha Globin Gene Analysis genetic tests now require informed consent along with those genetic tests that already require it (see below).
Spectrum Health Information Services has added an Ask at Order Entry question (AOE) “Has signed informed consent been obtained from the patient: Yes/No” to these tests. If the answer to this question is no, testing will either not be drawn (outpatient) or cancelled until informed consent is obtained by the ordering provider. Link to Informed Consent Form.
Tests which require informed consent:
|A1AT Proteotype S/Z
||FISH for Trisomy 21
|Alpha Globin Gene Analysis
||FISH for Turner
|Alpha1AT Defic Profile
||FISH for Williams
|Angelman/Prader Willi (15q11-q13) by FISH
||FISH for Wolf-hirschhorn
|Angelman/Prader Willi mPCR
||FISH for XX and XY
|CF Carrier Screening by Sequenom
|CF Gene Sequencing to MAYO
|Chromosomal Microarray (CGH)
|Chromosome Analysis Constitutional
|Chromosome Analysis POC
|Chromosome Analysis Prenatal
|Factor V Leiden DNA Analysis
|FISH for aneuVysion
|FISH for Common trisomies in POC
|FISH for DiGeorge
|FISH for Down syndrome
|FISH for Major trisomies
||Huntington’s Disease Molecular Analysis
|FISH for Miller-dieker
|FISH for Prader-willi
|FISH for Smith-Magenis
||Send Out CMA
|FISH for Subtelomeres
The Spectrum Health Laboratory is no longer performing the Chlamydia Antibody Screen test (#8874). The reagent the Laboratory was using for this test is no longer available.
Specimens for Chlamydia antibody testing will now need to be sent to Mayo Medical Laboratories for their Chlamydia Serology panel (#37). This panel includes IgG and IgM antibodies to Chlamydia pneumoniae, Chlamydia trachomatis, and Chlamydia psittaci.
It should be noted that cross reactivity commonly occurs between these different Chlamydia species, especially for IgM antibodies. Infection by a particular organism generally yields IgG titers higher than those for non-infecting organisms.
Any questions concerning these changes may be directed to Sue Koekkoek, Medical Technologist in the Immunochemistry Department or to Dr. Richard Horvitz in the Pathology Department.