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Test Utilization

Blood Bank, Compliance & Safety, General Information, Hemostasis/Coagulation, Referral/Sendouts, Test Utilization

Coagulation Blue Top Tube Shortage

There is currently a national 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 is anticipated to last through August 2021. 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.).

Here are additional steps you can take to help:

• Eliminate collection of extra blue top tubes

• Discontinue standing orders for coagulation tests, when possible

• Avoid the use of coagulation tubes as discard tubes

• Please refrain from ordering Lupus Screens ( LAB478) when patients are actively taking non vitamin K antagonists, including apixaban, dabigatran, and rivaroxaban. They have a significant impact on clot-based coagulation testing.  It is best to carry these tests out prior to drug administration or during a trough setting.

• Reduce cancelled specimens by making sure to collect specimens correctly by using the lab catalog for specimen collection instructions.

Thank you for your help during this exceptional time.

If you have any questions or concerns, please use the “Contact Us” link above.

General Information, Microbiology, Referral/Sendouts, Test Utilization

Obsoletion of Mayo Send-Out Test Influenza Virus A/B Antibodies, IgG and IgM

As of October 29, 2020, the following send-out tests will be will become obsoleted due to lack of clinical utility:

SFLA Influenza Virus A Antibodies, IgG and IgM (Separate Determinations), Serum [LAB802]

SFLB Influenza Virus B Antibodies, IgG and IgM (Separate Determinations), Serum [LAB803]

For diagnosis of acute Influenza infection the following molecular tests are recommended:

Influenza A/B PCR [LAB3255]

Influenza A/B Rapid [LAB9240]**

Influenza A/B Rapid, Influenza A/B PCR if Negative [LAB2111530]**

**Available only at regionals and during times of high flu incidence Continue Reading

General Information, Immunochemistry, Test Utilization

Protein Electrophoresis Orderable Changes

As of August 26, 2020, the following tests will be obsoleted or made as lab orderables only.  This was implemented to streamline protein electrophoresis orders and ensure that patients receive the recommended testing for the assessment of plasma cell proliferative diseases.

In addition to streamlining protein electrophoresis orders, order questions have been implemented to the available tests to access the reason for ordering to ensure that the proper reflex testing is applied.

For more information, see the lab test directory under the available tests for a protein electrophoresis orders tip sheet entitled “Orders- Protein Orderable ChangesContinue Reading

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