Hemostasis/Coagulation

Update: PT/INR Resulting Change

The Spectrum Health Laboratory Coagulation Department announces the following changes occurring on 6.29.21 because of new instrumentation:

• New coagulation instrumentation will go-live on 6.29.21.

• This new instrumentation will align the Spectrum Health Regional Laboratory (in GR) with current Regional/Blodgett reportable upper limit for Protime/INR results.

• The current Protime (PT) upper limit of 120 seconds will change to 90 seconds. Any result that is greater than 90 seconds, will be reported as >90 seconds.

• The current INR upper limit of 12.0 will change to 8.0. Any result that is greater than 8.0 will be reported as >8.0.

Any questions can be directed to the Spectrum Health Regional Laboratory Coagulation Department using the Contact Us link above.

TEST INFORMATION 

PT/INR (Protime with INR): Epic Code #LAB320 | Interface code #10059 | CPT #85610

Hemostasis/Coagulation

New Test: Factor VIII Chromogenic Assay

Effective July 1, 2021, the Coagulation Department within the Spectrum Health Regional Laboratory will go live with an in-house, bovine based, Chromogenic Factor VIII assay.

This assay, a photometric determination of Factor VIII activity, is useful for monitoring coagulation factor replacement therapy of selected extended half-life coagulation factor replacements and Emicizumab therapy, a recombinant, monoclonal antibody that restores the function of the missing activated factor VIII by bridging FIXa and FX. The action of Emicizumab interferes with all APTT clot based and human chromogenic based assays, leading to an overestimation of Factor VIII activity.  As such, the bovine based Chromogenic Factor VIII assay is recommended.  The Chromogenic Factor VIII activity also assists in the diagnosis of hemophilia A using a 2-stage assay, particularly when the 1-stage clot based assay is normal.

For questions about this test, please refer to the laboratory catalog or use the Contact Us link above.

TEST INFORMATION

Chromogenic Factor VIII Activity – Epic Code: LAB1230831 | Interface Code: 1230831 | CPT: 85240

Compliance & Safety, General Information

Pathology Narratives Release Hold Removed for Weekends and Holidays

Effective July 1, 2021, Pathology and Radiology Result Narratives will no longer be held on weekends and holidays. All finalized result narratives will be released at 6 a.m. and 12 p.m. daily. This adjustment aligns with the 21st Century Cures Act and corresponding CMS mandate to allow data to flow freely and securely between providers, payers, and patients.

Of note, patients may be able to see results in MyChart prior to a provider seeing the results. Ordering providers should consider discussing potential outcomes with patients to prepare patients for results. Results should only be held if releasing the result puts the patient at risk of physical harm, or the patient requests the information not be shared.

More information related to the 21st Century Cures Act and established interoperability requirements can be found on the Information Governance Insite page (Internal). Contact Information Governance at InformationGovernance@spectrumhealth.org with any questions or use the Contact Us link above.

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

Coagulation Blue Top Tube Shortage

Update 9/1/2021:

September 1, 2021

There continues to be a global 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 was anticipated to last through August 2021, but now, due to continued unprecedented demands, there is no end date in sight. 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.). Continue Reading

Chemistry, Compliance & Safety, General Information, Hematology, Hemostasis/Coagulation, Microbiology, Referral/Sendouts

CSF Priorities on QNS Specimens

When a Cerebrospinal fluid (CSF) specimen arrives into the laboratory and is deemed Quantity Not Sufficient (QNS) for ordered testing, the ordering provider is contacted to identify testing priorities. Occasionally, the laboratory is unable to secure these priorities.

If the lab is unable to secure priorities from the ordering provider within an hour of collection, the following will occur:

1. We will move forward with the Cell count with differential, Culture, and Protein/Glucose

2. The rest of the ordered testing will hold until we can clarify the priorities

Laboratory is partnering with Epic Beaker to discover if a prioritization of orders, upon CSF order entry, is possible.

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

General Information

Temporary Closure: Lab Draw Site – Evart

Beginning June 7th the draw site located at 5991 95th Ave, Evart, MI 49631 will be closed due to remodeling. The site is expected to reopen July 12th.

Site information: Spectrum Health Big Rapids Hospital – Lab at 5991 95th Ave

Alternative Spectrum Health lab draw site locations:

Spectrum Health Reed City Hospital – Lab

Spectrum Health Big Rapids Hospital – Lab

List of other sites

 

Hemostasis/Coagulation, Referral/Sendouts

Supply Change Notification: 4.5 mL Blue Citrate Blood Tubes

Effective April 26th, 2021, Spectrum Health Laboratories will discontinue 4.5 mL blue citrate blood tubes. These are a vendor discontinued item. The replacement item will be the 2.7 mL blue citrate blood tubes.

Due to this change, there may be a difference in the number of tubes required to collect for the lab tests below. Please refer to the lab catalog for specimen collection requirements. Continue Reading