Third quarter 2025. The Lab Medicine Update is a collaboration between the UVA Medical Laboratories and the UVA Medical Laboratory Committee. Feedback on the LMU? Contact Jim Harrison (james.harrison@virginia.edu).
Introducing NT-proBNP testing ↑
Clinical chemistry will transition from BNP to NT-proBNP testing on September 9th, 2025. NT-proBNP has become preferred over BNP for heart failure evaluation because while the two tests have similar clinical application, NT-proBNP is more sensitive, is useful in a broader range of heart failure types, and is more reliable because is not affected by heart failure therapy that may affect BNP.
Key information:
- The new test name and code will be NT proBNP [Lab6735]
- Go live date: September 9, 2025
- A light green top tube will be required
- The results for NT-proBNP and BNP are different and cannot be used interchangeably
- NT-proBNP has different reference ranges
Reference ranges for Female:
| Age range (years) | Reference interval (pg/mL) |
| 18 to <50 | <104.8 |
| 50 to 75 | < 334.1 |
| > 75 | < 956.1 |
Reference ranges for Male:
| Age range (years) | Reference interval (pg/mL) |
| 18 to <50 | <180.3 |
| 50 to 75 | < 451.6 |
| > 75 | < 683.0 |
Contact the Clinical Chemistry Director on call at PIC 1657 with any questions.
Anti-Microsomal Antibody test name change ↑
On Tuesday, 8/26/25, the test name for Anti-Microsomal Antibody [LAB516] will change to Anti-TPO (Anti-Microsomal Antibody). The test code [in brackets] will stay the same and there are no changes in the method or result reporting.
New CMV drug resistance testing orderable in Epic ↑
The UVA Clinical Microbiology Laboratory has made CMV Drug Resistance by NGS [LAB6728] available as a new Epic orderable. This test is performed at ARUP Laboratories and detects resistance-associated mutations in CMV genes.
Test information:
- Listing in Epic test menu: CMV DRUG RESISTANCE BY NGS [LAB6278]
- Covers resistance to 5 drugs: ganciclovir, foscarnet, cidofovir, maribavir, and letermovir
- Targets 4 CMV genes: UL97, UL54, UL27, UL56
- Requires CMV DNA viral load >2.6 log IU/mL for testing
- Specimen requirement: 3 ml plasma. Collect 2 full tubes of whole blood in lavender (EDTA) or 1 pink (EDTA) top tube.
Contact the Clinical Microbiology director on call (PIC 1221) with any questions.
New Hepatitis C Antibody with reflex to hep C viral load ↑
Effective Tuesday, August 12, HEPATITIS C ANTIBODY [LAB868] will no longer be available. It will be replaced by HEPATITIS C ANTIBODY WITH REFLEX TO HEPATITIS C VIRAL LOAD [LAB6729].
Any reactive or borderline Hepatitis C Antibody test will automatically reflex to a R EAP HEPATITIS C (HCV) VIRAL LOAD [LAB4059] (molecular test). Clinicians no longer need to place a separate order for R EAP HEPATITIS C (HCV) VIRAL LOAD [LAB4059] when the Hepatitis C Antibody is reactive or borderline.
The reflexive test will require an additional red-top tube at the time of initial collection. If there is no separate tube collected for the R EAP HEPATITIS C VIRAL (HCV) LOAD [LAB4059], the viral load test will be cancelled and only the Hepatitis C Antibody will be performed.
The same reflexive testing will be in place for the following tests (note the LAB# changes):
- LAB8571 ACUTE HEPATITIS PANEL is now becoming LAB6731 ACUTE HEPATITIS PANEL (available in Community Health only)
- LAB2621 HEPATITIS PROFILE B,C is now becoming LAB6732 HEPATITIS PROFILE B,C
- LAB4512 CHILD HELP EXPOSURE PROFILE (no LAB# change)
- LAB2566 HEPATITIS SCREEN (EXP) (no LAB# change)
For existing order sets, R EAP HEPATITIS C ANTIBODY EIA [LAB868] will automatically be replaced with R EAP HEPATITIS C ANTIBODY WITH REFLEX TO HEPATITIS C VIRAL LOAD [LAB6729]. Clinicians will need to make this replacement in any personal preference lists, as these will not automatically update.
There are no changes to the availability of R EAP HEPATITIS C (HCV) VIRAL LOAD [LAB4059] as a stand-alone testing option.
For question or concerns, please contact Melinda Poulter, medical director of Clinical Microbiology and Molecular Diagnostics at PIC 3677.
Update to the Lupus Anticoagulant Panel (LAB6001) ↑
Effective July 21, 2025, the HexLA assay is replacing the Silica Clotting Time in the Lupus Anticoagulant Panel (LAB6001). The HexLA assay is an integrated (screen and confirm) silica-based APTT assay. The presence of a Lupus Anticoagulant in a plasma sample is confirmed by the correction of the aPTT clot time upon the addition of a reaction mixture containing hexagonal phase phospholipid. The test incorporates a pooled normal plasma (mixing test) and a heparin neutralizer.
The Lupus Anticoagulant Panel (LAB6001) now consists of the following elements:
- dRVVT
- HexLA, reference range: Delta < 13
- PT and PTT if not already ordered
- Lupus interpretation
Typenex bands are going away; new "Type and Screen" order ↑
Typenex blood bands will no longer be used at UVA Health facilities effective July 15, 2025. Accurate labeling of blood products and patient identification will be accomplished by the combinatino of Electronic Positive Patient Identification (EPPID), the Epic Blood Product Administration Module (BPAM), and Transfusion Time-Outs, which all currently standard work across UVA Health. The "Type and Hold" order will be retired from Epic and replaced with a new “Type and Screen” (TASN) order for pre-transfusion testing, and a streamlined “Prepare” order to request the number of units to be crossmatched for the patient. Starting July 15, Ambulatory clinics will need to replace active collected or signed “Type and Hold” orders that contain a red blood cell (RBC) order with the new “Type and Screen” order and a separate “Prepare RBC” order.
More information is available at:
Toxicology STAT alcohol testing – New panel ↑
The current practice at the UVA Toxicology Lab is to order alcohol testing for methanol, isopropanol, acetone, and ethylene glycol individually. As of July 24, 2025 there is a single test to order instead of individual components. For all alcohol testing in the Toxicology laboratory please order the Toxic Alcohol Panel (LAB6687). This panel will include Methanol, Isopropanol, Acetone, and Ethylene Glycol. Quantitative results will be reported and the reference interval is < 10 mg/dL for all alcohol components.
Toxicology urine drug confirmation reflex process ↑
Current practice at the UVA Toxicology Lab is for urine specimens that screen positive for any drug to automatically reflex for confirmation. There are situations when the more specific confirmation method will detect a drug that screened negative because the confirmation method is more sensitive than the screen. The Toxicology Lab will now reflex and report positive drug confirmation results detected even if the screen is negative.
How to request new send-out or local laboratory tests ↑
Clinicians who wish to request addition of new send-out or local laboratory tests to the UVA Medical Laboratory test menu with ordering in Epic may submit a request online using the form at https://www.medicalcenter.virginia.edu/medlabs/requisitions/new-sendout-test-or-referral-lab-request-form/. Clinicians may also navigate to the online test request form by linking to the UVA Medical Laboratories Web site, clicking "Laboratory Requisition Forms" in the top row of tabs, and then clicking "New Sendout Test or Referral Lab Request Form." Instructions for filling out the form are included at the top of the form. Requests are routed to the Sendout section of the Medical Laboratory and to the Medical Laboratory Committee. The Committee reviews the clinical validity and utility of the test in comparison with existing and potential alternatives, and recommends action to the Medical Laboratory. Requesters may participate in the review if desired.