West Michigan influenza infections peaked mid-March 2022 and have been declining in the weeks that followed. Now with a low prevalence of circulating influenza, using the most sensitive diagnostic test is recommended in order to obtain accurate and actionable results. Influenza antigen testing (e.g. Sofia instrument) is no longer appropriate at this time and Influenza PCR testing should be ordered when clinically indicated.
More detailed information can be found as published by the CDC:
Algorithm to assist in the interpretation of influenza testing results and clinical decision-making during periods when influenza viruses are NOT circulating in the community, and in previous lab newsletters: Influenza Diagnosis and Test Utilization
As of April 12, 2022, Spectrum Health Laboratory will no longer add microbiology cultures to placental tissues received based on paper requisition forms.
Viral and bacterial cultures from placental tissue are rarely clinically beneficial and are no longer the gold standard diagnostic approach due to the relative insensitivity of culture methods.
If viral studies are desired (possible indications could include known CMV exposure with positive IgM or intrauterine fetal demise at < 28 weeks), then molecular testing is the recommended diagnostic approach. HSV and CMV PCR tests may be ordered in Epic.
• Herpes Simplex 1/2 Qualitative PCR, Tissue (LAB1230413)
• Cytomegalovirus (CMV) Qualitative PCR, Tissue (LAB1230291)
Bacterial cultures are challenging to interpret since they typically grow normal genital flora and histopathological analysis used to diagnose acute chorioamnionitis correlates poorly with growth from bacterial placenta cultures. If indicated, culture and PCR tests may be ordered in Epic.
• Tissue Culture (LAB2111173)
• Metamycoplasma hominis, Molecular Detection, PCR, Varies (LAB848)
• Ureaplasma species, Molecular Detection, PCR, Varies (LAB848)
Placenta tissues sent to the lab in formalin are not acceptable for PCR or culture orders.
As of March 21, 2022, Spectrum Health Laboratories will adopt a new C. difficile testing approach that no longer reflexes to PCR testing for indeterminate toxin enzyme immunoassay (EIA) results. Rather, PCR testing will only be available upon consultation with Infectious Disease.
LIVE Webinar –Managing Rhinitis Patients and the Role of Specific IgE Testing, available at Spectrum Health!
Featuring Guest Speaker Scott Duhaime, MPAS, PA-C
Please join us for a 30-minute webinar on the importance of the primary care providers’ role in regard to managing patients suffering with symptoms consistent with rhinitis—itchy watery eyes, runny nose, and congestion.
We are offering two training webinars for all providers and clinical staff on March 24th.
The goal of this webinar is to address:
♦ Importance of ruling in and ruling out allergies
♦ Debunking misconceptions around managing rhinitis
♦ Simplified patient care management
♦ Qualified referral
To provide efficient and safe testing for patient specimens, please review the following information when sending COVID-19 PCR and Influenza A/B PCR testing in the same encounter to Spectrum Health Laboratories.
Two labels will be available for this testing. Labels must be fixed so that
• The test and patient information are shown
• The barcode may be easily scanned by Lab staff or instruments
When this is not done correctly, Laboratory staff removes the labels and re-fixes or re-prints it, which obstructs workflow, causes delays, and could result in patient information being peeled off. With patient safety and efficient testing being two of the Lab’s top priorities, it is vital that specimens arrive in such a way as to best accomplish both.
Beginning Tuesday, January 4, 2022, Spectrum Health Laboratories will include an automated neutrophil (PMN) count on Cell Count with Differential, Body Fluid (LAB210) orders for peritoneal body fluids. This component will be displayed in Epic as an absolute PMN count, body fluid.
• The absolute PMN count in the peritoneal fluid is calculated by multiplying the total nucleated cell count by the percentage of PMNs in the differential.
• This calculation aids in the diagnosis of spontaneous bacterial peritonitis (SBP).
• The diagnosis of bacterial peritonitis is established by a positive peritoneal fluid bacterial culture and an elevated peritoneal fluid absolute PMN count (≥250 cells/uL).
• Epic will automatically calculate the absolute PMN count in peritoneal body fluids based on the manual differential data.
• This component ONLY calculates for Cell Count with Differentials (LAB210) on PERITONEAL BODY FLUIDS
Spectrum Health and Spectrum Health Medical Group (SHMG) Supply Chain Update:
AbbottTM has discontinued their Mono Test Kit. The identified replacement product is from Cardinal HealthTM. This product is already in use in some spaces throughout Spectrum Health. Please see ITM number for the replacement product below and update your ordering processes accordingly.
Discontinued Product: ITM-1002651 Kit Test Mono CLIA Waived (Abbott 92407)
Replacement Product: ITM-1049839 Test Mono II Rapid (Cardinal Health CH1145)
The mitigation strategies enacted during the COVID-19 pandemic to reduce the spread of this virus led to essentially non-existent influenza prevalence during the 2020-2021 winter season. However, influenza has now returned and case numbers are increasing throughout West Michigan.
Influenza prevalence guides the most appropriate testing approach and sufficient prevalence has now been reached for influenza rapid antigen testing (e.g. Sofia instrument) to have improved performance. The use of rapid antigen testing as a screening method during high prevalence reduces both the cost to the patient and turn-around-time as compared to lab-based molecular methods. Rapid antigen tests generally have high analytical specificity, but lack the sensitivity of nucleic acid amplification methods (e.g. PCR). For this reason, PCR testing is still recommended for hospitalized patients and for outpatients with a negative antigen result if influenza is still suspected and if the result will impact clinical decision making.
Effective December 6, 2021, Spectrum Health Reference Laboratory (SHRL) Coagulation department will go live with a new lot of Prothrombin Time (Protime/PT) reagents. The reference range for the PT will be adjusted to reflect this reagent lot change and align with our Regional Laboratories. The new reference range will be 9.5 – 12.0 seconds. There will be no change to the INR ranges.
||Current Reference Range
||New Reference Range
|Prothrombin Time (PT)
||9.7 – 12.6 seconds
||9.5 – 12.0 seconds
Spectrum Health Lab has noticed an increase in outpatient orders for Respiratory Pathogens by Film Array [LAB3359]. This may be due to a shortage of supplies for some Point of Care (POC) testing platforms. Film Array is typically used for emergency and high acuity patients and therefore has a high cost that may not be covered by most patients’ insurance. To lesson out of pocket costs for your patients, please order the below for RSV, COVID, or Flu testing.