Browsing Tag

Rheumatology

General Information, Immunochemistry

Immunochemistry ANA (Antinuclear Antibodies) Testing Name Update

Effective April 22nd, 2020, the following ANA (Antinuclear Antibodies) Tests’ name will be updated.  The change in naming convention comes in hopes of enhancing proper test utilization.  This update includes only the name change with no changes in laboratory testing workflow.

Old Test Name New Test Name Test Code Clinical Utility
ANA (Antinuclear Antibodies) Screen, Double Reflex to ANA IFA Hep2 Titer and Pattern, and if positive to ANA antibodies ANA screen LAB1230491 Preferred initial ANA screen for autoimmune connective tissue diseases.
ANA (Antinuclear Antibodies), Hep2 Substrate IFA with reflex to Titer and Pattern if positive IFA ANA (Rheumatology)

 

LAB3540 Preferred confirmatory ANA test for autoimmune connective tissue diseases.  With ordering recommendations for rheumatology only.
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. Continue Reading

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

Protein electrophoresis, serum, IFE if indicated 

Kappa and lambda free light chains  Continue Reading

General Information, Immunochemistry

Test Update: Beta-2 Glycoprotein 1 Antibodies

Effective November 5th, testing for Beta-2 Glycoprotein 1 antibodies (IgG and IgM, serum) will change from a reference send out test to Mayo Medical Laboratories to an in-house test available at Spectrum Health Laboratories.  This testing is useful for evaluation of patients of suspected antiphospholipid antibody syndrome.

In addition, a new Antiphospholipid Antibody Syndrome Panel will be added which allows for appropriate and complete testing for antiphospholipid antibody syndrome. This panel includes:

Lupus Screen

Cardiolipin IgG and IgM Antibodies

Beta-2 Glycoprotein 1 IgG and IgM Antibodies

Continue Reading

Immunochemistry, Test Utilization

Test Utilization: Cardiolipin Antibody Testing

Listed below are the Cardiolipin Antibody tests available in the Spectrum Health Regional Laboratory (SHRL) catalog. Please review the tests and the recommended test utilities.

Cardiolipin IgA testing should not be ordered unless the patient is negative for IgM and IgG. It should be restricted to very specific clinical scenarios for the evaluation of patients with suspected APS (Antiphospholipid Antibody Syndrome). Cardiolipin IgA requests will be reviewed for presence or absence of IgM/IgG testing.

Questions may be directed to Dr. David Alter by using the contact us link above.

Immunochemistry

dsDNA Antibody Update

Effective March 20, 2017, Spectrum Health Regional Laboratory’s Immunology department will be switching dsDNA vendors from Varelisa ™ to ThermoFisher/Phadia ™.

Both manufacturers (mfr) have similar methods but different reference criteria presumably due to manufacturer specific dsDNA epitopes identified.

The interpretive cutoffs will be changing, please refer to the table below. Continue Reading