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.
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.
Folate (aka Folic Acid) is a test that requires the patient to be fasting in order for the results be accurate. Results are falsely elevated if the patient is not fasting. Spectrum Health Laboratories recently updated our system to hard stop a test from being collected if the patient is not fasting. Please remind your patients to fast 8 hours prior to having their blood drawn.
Spectrum Health Laboratories recommends:
• No caloric or caffeine intake for 8-12 hours prior to testing. Do not eat or drink anything except normal amounts of plain water. This also includes no smoking, chewing gum, candy, cough drops, etc.
• Take normal dosages of medications unless the provider has instructed otherwise.
Click here for a list of tests the require or recommend fasting.
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.
Effective February 24, 2021, Cerebrospinal Fluid (CSF) Xanthochromia results of “Present” will be considered a critical laboratory value.
This change was approved by the MEC and driven by a collaboration between neurology and laboratory departments to assist in expediting the diagnosis and management of patients with possible subarachnoid hemorrhage (SAH).
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 Changes”
Effective December 11th, 2019, Spectrum Health Regional Laboratory’s Immunochemistry laboratory will be upgrading the following tests from the Immunoassay Vidas platform to the Multiplex flow immunoassay Bioplex 2200 platform.