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.
Chromogenic Factor VIII Activity – Epic Code: LAB1230831 | Interface Code: 1230831 | CPT: 85240
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).
The Spectrum Health Regional Laboratory Coagulation Department will be going live with the Helena AggRam analyzer on February 3, 2021. This analyzer uses platelet rich plasma to analyze human platelet aggregation which is measured by absorbance. The following aggregating agents are used in these studies: Arachidonic Acid, ADP, Collagen, Epinephrine, and Ristocetin.
Patients for platelet aggregation studies should be resting, fasting, and non-smoking. Patients should avoid taking any prescription or over the counter medications known to affect platelet function for ten (10) days to two (2) weeks prior to the studies. For a list of medications known to have anti-platelet effects, click here.
Effective September 28th, 2020, a new generation of the serum kappa/lambda free light chain assay has been implemented.
With the implementation of the new generation of the assay there is an approximately 20% negative bias for kappa free light chains in serum containing >20 mg/dL kappa free light chain. This may affect the trending for patient who are serially monitored by this assay.
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 March 4th, 2020, Thrombin Time will change from a sendout reference test performed by Mayo Clinic Laboratories to an in-house test performed by Spectrum Health Regional Laboratory. This test will be performed in the Coagulation Laboratory and will include a new reference range (please see link in Test Information below).
Thrombin Time is suitable for monitoring fibrinolysis therapy, screening for disorders of fibrin formation and in cases of suspected fibrinogen deficiency states. It is also useful for the differentiation between a heparin induced prolongation of the thrombin time and fibrin formation disorders.
For questions around this test, please contact the Coagulation Department at 616-267-2740.
Thrombin Time – Epic Code: #LAB11230581, Interface Code: #11230581, CPT: #85670
In December, serum and urine protein electrophoresis testing will be simplified and standardized. The only testing available will be:
Protein electrophoresis, serum, IFE if indicated
Protein electrophoresis, random urine, do IFE if indicated
Protein electrophoresis, 24 hour urine, do IFE if indicated
In addition, on December 5, 2019, a new panel will be added which reflects expert recommendations for first line testing for monoclonal gammopathy, including plasma cell myeloma and most cases of amyloidosis, called “Monoclonal Gammopathy Screen”
Protein electrophoresis, serum, IFE if indicated
Kappa and lambda free light chains
Effective November 5th, testing for Beta-2 Glycoprotein 1 antibodies (IgG and IgM, serum) will change from a reference send out test to Mayo Medical Laboratories to an in-house test available at Spectrum Health Laboratories. This testing is useful for evaluation of patients of suspected antiphospholipid antibody syndrome.
In addition, a new Antiphospholipid Antibody Syndrome Panel will be added which allows for appropriate and complete testing for antiphospholipid antibody syndrome. This panel includes:
Cardiolipin IgG and IgM Antibodies
Beta-2 Glycoprotein 1 IgG and IgM Antibodies
Effective November 5th, the following test order names will be modified. These changes have been made to enhance clarify regarding the testing performed. In all cases, prior Cerner names are set as aliases that direct to the new Epic order names.