Monoclonal gammopathies are characterized by the secretion of a monoclonal protein or M-protein. A wide variety of conditions can produce an M-protein, and the initial screening and monitoring of these patients require an array of tests. Herein we described best practices for protein electrophoresis ordering at Corewell Health.
Microalbumin/Creatinine, Random Urine Result Comment Update
Effective January 4, 2023, the process for reporting the Microalbumin/Creatinine ratio was changed for situations where one of the results, microalbumin and/or creatinine, is below or above the assay’s analytical measuring range (AMR).
Effective February 28th, 2023, Vitamin D 25-Hydroxy Level (25-OH Vitamin D) [LAB535] will be replaced by 25-Hydroxyvitamin Level D2 and D3 [LAB1230925]. Send out testing for 25-Hydroxyvitamin D2 and D3, Serum [LAB1230428] to Mayo will be discontinued. The testing methodology will change from an immunoassay to liquid chromatography-mass spectrometry.
The new test will include concentrations for
- 25-hydroxyvitamin D2
- 25-hydroxyvitamin D3
- 25-hydroxyvitamin D Total
Albumin Reagent Conversion
Corewell Health Laboratories (formerly Spectrum Health) has utilized the Bromcresol Purple (BCP) method for the measurement of albumin concentration in serum, plasma, and serous body fluids for well over 20 years. The test principle consists of a reaction where the BCP binds selectively with albumin, causing a color change that is measured photometrically. A vast majority of labs across the country, including reference labs such as Mayo Medical Laboratories, utilize an alternative method for albumin measurement that consists of Bromcresol Green (BCG) instead of BCP. To align with the majority of institutions this size, and to be included in a larger peer group for proficiency testing purposes, Corewell Health Laboratories – West, has been transitioning to BCG for the measurement of albumin over the last few weeks.
Starting November 29th, 2022, Corewell Health West, Hematology Laboratories will begin reporting absolute counts for white blood cell (WBC) manual differentials, in addition to relative (percentage) counts. The WBC differential count determines the number of each type of white blood cell present in the blood. It can be expressed as a percentage or as an absolute value. Of these, the absolute value is much more important than the relative value, given that clinically relevant WBC elevations and declines are defined by their absolute numbers, not by their relative proportions, and there is potential for error if this conversion is performed outside the laboratory.
Cell Count w/ Differential if indicated, Cerebrospinal Fluid [LAB2111025] and Cell Count with Differential, Cerebrospinal Fluid (Pediatric Oncology) [LAB212] currently result nucleated cell counts as a White Blood Cell (WBC) count.
Effective Tuesday, August 16, 2022, the WBC component will be removed and instead reported as a Total Nucleated Cell (TNC) Count for CSF.
After consultation with our clinical partners, Spectrum Health West Michigan Laboratory will be adjusting the pediatric reference ranges for our new ALT and AST reagents in an effort to better serve our population. Numerous academic studies were reviewed, and the values listed below were adopted on August 3, 2022:
Effective August 2, 2022, reference ranges for the below tests will be updated to better align with the vendor’s recommendation and with Spectrum Health Lakeland Laboratory. Please click on the links below and scroll to the Reference Range field to see the updated ranges.
• Lithium Level [LAB29]
• PTH Intact [LAB108]
• IgM Level [LAB72]
• IgA Level [LAB73]
• CA 125 Level [LAB155]
• C4 Complement Level [LAB151]
• C3 Complement Level [LAB152]
• Albumin Level [LAB45]
• Transferrin Level [LAB133]
Questions or inquiries may be directed to the “Contact Us” link above.
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