Spectrum Health Regional Laboratory supplies purple priority bags for specimens that must be handled and processed immediately upon receipt in the laboratory. The purple color priority transport bag will be a visual cue to the receiving laboratory that the specimens inside the bag need to be handled or processed immediately at the time of arrival in the laboratory or the integrity of the specimen will be compromised.
On March 21, 2017, Spectrum Health Regional Laboratory (SHRL) will be switching instrument/vendors that perform the Beta CTX (BCTX assay); we will be switching from the ROCHE COBAS® platform to the ISYS-IDS platform. Both methods compare very well, however reference ranges will change due to the different methods.
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.
Anal cancer incidence, including in situ and invasive carcinoma is on the rise in North America, with a sharp increase over the past several decades. Oncogenic types of human papilloma virus (HPV) have been shown to be the principle cause of both cervical and anal cancer. HPV is the most common sexually transmitted disease in the United States and anal intercourse is a major risk factor for acquiring the infection. Anal cancer affects both men and women; women having the highest overall likelihood of developing carcinomas of the anorectal region. At risk populations for developing anal carcinoma include men who have sex with men, HIV positive individuals (including those without a history of anal intercourse), immunocompromised patients including a history of organ transplant, those with a history of genital warts, and women with abnormal vulvar, vaginal or cervical Pap results.
In 2014 The Bethesda System for reporting of Pap smears was revised. These revisions were published in 2015. We have modified our diagnostic categories to reflect these changes.
Reporting of endometrial cells in women over 40 years of age was changed to reporting endometrial cells in women over 45 years of age.
Recommendations were made to discontinue the use of Low grade squamous intraepithelial lesion (LSIL) with a few cells suggestive of high grade squamous intraepithelial lesion (HSIL). Based on the recommendations in Bethesda 2014, these lesions will be diagnosed as ASC-H in a background of LSIL.
The recommendation clarifies the treatment algorithm for these patients. These patients should have colposcopy. In our experience over 50% of these patients have biopsies diagnosed as high-grade squamous intraepithelial lesion (HSIL).
Laboratory reference ranges vary depending on the sex (gender) of the patient. Spectrum Health Laboratory’s policy is to report reference ranges for a result based on the sex the ordering provider provided on the order, or given to our staff via the patient’s ID. This will require extra care when interpreting results for patients who are transgender. Some reference ranges may change as a patient transitions between genders, while others may not. Please always evaluate results based on the reported sex and reference in light of your patient’s gender role.
Safety of our patient and quality of care are of utmost importance. For this reason we require specimens sent to the Spectrum Health Cytology Laboratory be labeled with at least two patient identifiers, (i.e., patient legal name, birth date and MRN.) We will no longer return to the collection site, unlabeled, mislabeled specimens lacking two patient identifiers or specimen containers with multiple different patient labels. These specimens will be discarded and repeat collection will be necessary.
Procedures to verify correct labeling of patient specimens at the time of collection are recommended. Specimen containers should not be pre-labeled. Variation of the “time-out” procedure used in the hospital and surgical center setting is an excellent way of confirming that the specimen is correctly labeled. This can easily be achieved by having the patient verify his or her name and birth date, by reading the label placed on the specimen container at the time the specimen is collected. This “time out” should occur before the specimen leaves the examination or treatment room.
It is our mission to provide the best and safest care we can to our patients. We know that physicians and other practitioners are required to see patients more efficiently and at times with less than adequate time allowed. Following a “time out” procedure and not pre-labeling specimen containers will prevent errors that may lead to diagnoses being assigned to wrong patients, hence, unnecessary procedures and lack of follow-up for the appropriate patient.
Numerous 1,25-Dihydroxyvitamin D (1,25(OH)2D) requests are received daily (1200 in 2015). This is not the standard test for Vitamin D status. 1,25-Dihydroxyvitamin D testing should be reserved for patients with renal disease, sarcoid, tuberculosis, lymphoma and rickets, as well as, long term use of protease inhibitors, glucocorticoids, or anticonvulsants. Vitamin D 25 (25 OH D) level is sufficient in most cases. The number of requests and review of the ordering providers raises a concern that a number of these requests were ordered inappropriately.
In an effort to decrease the number of potential improperly ordered tests and consequently decrease unnecessary costs to patients, insurance companies, and the laboratory, please review your individual ordering practices.
In the near future, this test name will be changed to “Renal 1,25 Dihydroxyvitamin D” to better reflect its appropriate utilization.
Any questions concerning Vitamin D testing may be directed to the Pathology Department.
As of March 1, 2016, Spectrum Health Laboratory, Grand Rapids, will no longer draw or send a courier for outpatient Ammonia testing (#8074). If outpatient Ammonia testing is needed, the patient must be collected at the 35 Michigan Draw Site. If outpatient Ammonia testing is needed and the patient cannot be drawn at the 35 Michigan Draw Site, approval must be obtained from Dr. David Alter or the Clinical Pathologist on-call, prior to ordering the test.
There will be no changes to inpatient collection. Note: Inpatients are patients who have been admitted to a hospital in the Medical Center (HDVCH, Butterworth, and Meijer Heart Center) or Blodgett Hospital.
Any questions concerning these changes may be directed to the Pathology Department using the Contact Us link above.