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Referral/Sendouts

Chemistry, Referral/Sendouts, Test Utilization

Appropriate Thyroglobulin Tumor Marker and Anti-Thyroperoxidase Ordering Practices

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

Compliance & Safety, Referral/Sendouts

Warning: Patients being treated with Fulvestrant (Faslodex)

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.

Referral/Sendouts

Neopterin Currently Unavailable

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.

Referral/Sendouts, Test Utilization

Thyroglobulin Tumor Marker Evaluation

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.

Options

  1. Monitoring treatment
  2. Serum thyroglobulin as a marker for autoimmune thyroiditis
  3. Serum thyroglobulin ordered for the accompanying anti-thyroglobulin antibody result
  4. Other, please elaborate.
Referral/Sendouts, Toxicology

Tests to be discontinued April 1, 2016

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.

Test Code Test Name
4071 Dibucaine Number
4064 RBC Cholinesterase Blood Level
4063 Cholinesterase Level
Referral/Sendouts

VAP Cholesterol Testing

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.

Advanced Technology Laboratory, Compliance & Safety, Cytogenetics, Flow Cytometry, General Information, Molecular Diagnostics, Referral/Sendouts

Informed Consent Requirement

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 FISHAneuTCPanel
CF DNA FISHAneuVysion
CF Gene Sequencing to MAYO FISHDiGeorge
Chromosomal Microarray (CGH) FISHDownSyn
Chromosome Analysis Constitutional FISHMillerDieke
Chromosome Analysis POC FISHPraderWilli
Chromosome Analysis Prenatal FISHSmithMageni
Factor V Leiden DNA Analysis FISHSubtelomeres
FISH for aneuVysion FISHWilliams
FISH for Common trisomies in POC FISHWolf
FISH for DiGeorge FISHXXYYSRY
FISH for Down syndrome Hemochromatosis DNA
FISH for Major trisomies Huntington’s Disease Molecular Analysis
FISH for Miller-dieker MTHFR C677T
FISH for Prader-willi Prothrombin G20210A
FISH for Smith-Magenis Send Out CMA
FISH for Subtelomeres
Immunochemistry, Referral/Sendouts

Chlamydia Antibody Testing Changes

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.