June, 2022. The Lab Medicine Update is a collaboration between the UVA Medical Laboratories and the UVA Clinical Laboratory Stewardship Subcommittee. Feedback on the LMU? Contact Jim Harrison (james.harrison@virginia.edu).
Reflex pyrosequencing of NSCLC specimens that are insufficient for NGS-based assays ↑
Genomic testing has become a critical part of the work-up for non-small-cell lung cancer (NSCLC). However, in some cases the DNA recovered from small tissue specimens is insufficient to perform next-generation sequencing assays. In these instances, the lab will order and perform targeted pyrosequencing assays for EGFR, BRAF, and KRAS, in that order. This testing will be performed without recontact of the ordering physician. This workflow enhancement was approved by the Patient Care Committee and we believe it will increase the efficiency of our molecular work-up for NSCLC at UVA and reduce unnecessary interruption of clinical work. Any questions about this process should be directed to the UVA Clinical Genomics Laboratory (924-5179).
Update to propofol monitoring order panel ↑
Propofol is a short-acting sedative/analgesic that is used for procedural sedation and anesthesia induction. It may produce hypertriglyceridemia and rarely a more serious propofol infusion syndrome, particularly with longer use at higher doses, leading to metabolic acidosis and rhabdomyolysis. Current propofol treatment guidelines include monitoring triglycerides every other day and following lactic acid and total CK as necessary in rare instances. The propofol monitoring panel has been updated to include triglycerides rather than full lipid profiles, a baseline total CK, and optional lactate monitoring. This change was approved by the Patient Care Committee and should be reflected in all order sets that use the propofol order panel.
Clinical Laboratory Stewardship Subcommittee seeks clinical staff members ↑
The Clinical Laboratory Stewardship Subcommittee (CLSS) reports to the Patient Care Committee and advises the UVA Medical Laboratory. The Subcommittee seeks to maximize the value of the Medical Laboratory through review and optimization of laboratory policy, the test menu, test naming, order sets and protocols, and laboratory decision support. The CLSS welcomes participation by clinical staff from all departments who share an interest in optimizing the clinical use of laboratory testing.
Contact information:
Jim Harrison, MD PhD, jhh5y@virginia.edu
George Hoke, MD, gmh4s@hscmail.mcc.virginia.edu
Co-chairs, Clinical Laboratory Stewardship Subcommittee