September, 2023. 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).
New chemistry analyzers now live ↑
The Chemistry Core Laboratory went live with new Abbott Alinity automated chemistry and immunoassay analyzers on 9/13. These are the Laboratory's primary high-volume clinical chemistry analyzers. While this project was a huge undertaking for the Core Laboratory, requiring several hundred hours of planning and coordination over the past year, most of the transition has been transparent to laboratory users. The methodology and output of the instruments is mostly compatible with the previous Abbott platform except for several details noted below. A smaller Alinity platform instrument has been running in the Cancer Center laboratory for about six months with excellent performance and stability, and we expect similar results with the new Core Lab analyzers. We want to express our gratitude to the clinical teams for your patience through this transition.
Change in female 99th percentile for high-sensitivity Troponin I ↑
For the high-sensitivity Troponin I assay, the sex-specific 99th percentile for females has been reduced from 17 ng/L to 14 ng/L after the upgrade to the Alinity platform. This change reflects both a slight methodologic variation with the new platform and an FDA-approved clinical improvement in the reference range from the manufacturer.
CKMB discontinued in-house ↑
As part of the transition to the new chemistry analyzers this month we are no longer running CK-MB in house. This change reflects both current clinical guidelines and reduced clinical demand for the test. For acute evaluation of cardiovascular disease it is recommended to order high sensitivity troponin I, which is available in-house. If necessary, CK-MB can be ordered as a send-out test using "MISC SENDOUT TEST (NON-GENETIC NON-MAYO)" and entering the test code "ARUP 0080480".
Blood Bank & Transfusion Medicine Alert: Blood product wastage ↑
Recently there has been a significant increase in blood product wastage because of canceled transfusions after the transfuse order has been released by nursing. This is especially concerning as we are experiencing a nationwide shortage of this precious resource. In September a total of 36 blood products were wasted. This is about double our typical monthly wastage rate of 19.6 (± 5.6) blood products.
We encourage providers to place transfuse orders only if transfusion is to be imminent, and certain to take place.
We are seeing recurring and frequent episodes of the following pattern leading to unnecessary wastage of units of blood:
- The provider orders TYHD with one or more units of RBC to be transfused.
- The transfuse request is released by nursing.
- The Blood Bank tubes the unit(s) to the appropriate location.
- The provider changes their mind about transfusing, perhaps because the most recent CBC indicates that the patient does not need a transfusion, or for some other reason; in any case, the decision is made not to transfuse.
- The unit(s) are then returned to the Blood Bank, where their temperature is taken and found to be >10°C, which is above the acceptable temperature range (<10°C) for RBC.
- The unit(s) are therefore discarded (wasted).
Note: For the vast majority (>98%) of patients, the turnaround time for a unit of RBC to be prepared and sent to the patient is approximately 15 minutes. A small percentage (~2%) of patients have developed an alloantibody; for these patients, the turnaround time is typically one hour for blood preparation and delivery.
To reiterate, please try to place transfuse orders only if transfusion is to be imminent, and certain to take place.
Thank you for your attention to this matter.
James D. Gorham MD PhD
Medical Director, UVA Blood Bank and Transfusion Services
Sara Hoffman
Blood Bank Quality Analyst
434-924-2273
SARS-CoV-2 IgG antibody testing discontinued in-house ↑
SARS CoV-2 IgG antibody testing is no longer performed by the UVA Medical Laboratory. This testing is now being performed by Mayo Laboratories as send-out tests. The orderable test codes in Epic have changed and the new orderable test names and codes are:
SARS-COV-2, SPIKE ANTIBODY, SEMI-QUANTITATIVE, SERUM [LAB4693]
SARS-COV-2, NUCLEOCAPSID, TOTAL ANTIBODY, SERUM [LAB4695]
Urine NTX-Telopeptide [LAB3770] to become obsolete at Mayo ↑
The Mayo send-out test for urine NTX-Telopeptide will be made obsolete on November 1, 2023. Mayo Clinic Laboratories recommends a transition to the use of CTX (Beta-CrossLaps, Serum). In Epic this test is orderable as Beta-Crosslaps [LAB6599]. CTX is an alternative marker of bone resorption and has been recommended by the International Osteoporosis Foundation and the Endocrine Society for monitoring response to therapy in postmenopausal osteoporosis. Bridging of patient results is suggested, if serial testing is clinically indicated.