Browsing Tag

Obstetrics & Gynecology

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

Cytology

Update on Pap Smear Reporting

In 2014 The Bethesda System for reporting of Pap smears was revised. These revisions were published in 2015. We have modified our diagnostic categories to reflect these changes.

Reporting of endometrial cells in women over 40 years of age was changed to reporting endometrial cells in women over 45 years of age.

Recommendations were made to discontinue the use of Low grade squamous intraepithelial lesion (LSIL) with a few cells suggestive of high grade squamous intraepithelial lesion (HSIL). Based on the recommendations in Bethesda 2014, these lesions will be diagnosed as ASC-H in a background of LSIL.

The recommendation clarifies the treatment algorithm for these patients. These patients should have colposcopy. In our experience over 50% of these patients have biopsies diagnosed as high-grade squamous intraepithelial lesion (HSIL).

Compliance & Safety, Cytology, Education & Training

Appropriate Labeling of Specimens

Safety of our patient and quality of care are of utmost importance. For this reason we require specimens sent to the Spectrum Health Cytology Laboratory be labeled with at least two patient identifiers, (i.e., patient name, birth date and MRN.) We will no longer return to the collection site, unlabeled, mislabeled specimens lacking two patient identifiers or specimen containers with multiple different patient labels. These specimens will be discarded and repeat collection will be necessary.

Procedures to verify correct labeling of patient specimens at the time of collection are recommended.   Specimen containers should not be pre-labeled. Variation of the “time-out” procedure used in the hospital and surgical center setting is an excellent way of confirming that the specimen is correctly labeled. This can easily be achieved by having the patient verify his or her name and birth date, by reading the label placed on the specimen container at the time the specimen is collected. This “time out” should occur before the specimen leaves the examination or treatment room.

It is our mission to provide the best and safest care we can to our patients. We know that physicians and other practitioners are required to see patients more efficiently and at times with less than adequate time allowed. Following a “time out” procedure and not pre-labeling specimen containers will prevent errors that may lead to diagnoses being assigned to wrong patients, hence, unnecessary procedures and lack of follow-up for the appropriate patient.

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.

Microbiology

Discontinued Microbiology Testing

The following tests have been discontinued, please order the replacement test

Questions regarding these tests may be directed to Mary Coram, Microbiology Department Manager.