Laboratory Medicine Updates - May 6, 2002
University of Virginia Health
“Quality You Expect, Service You Deserve”
LABORATORY MEDICINE UPDATE
May 6, 2002
Change in reporting for Streptococcus pneumoniae susceptibility to cefotaxime
Due to new National Committee for Clinical Laboratory Standards (NCCLS) guidelines, the microbiology lab will soon be reporting both CSF and non-CSF S/I/R breakpoints for cefotaxime when Streptococcus pneumoniae is isolated from a non-CSF source. The comment that will accompany the report is: “In cases of suspected meningitis, CSF interpretive criteria must be used independent of the specimen source.”
Pathology Review Requested
The Medical Laboratories has instituted a new test:
Pathology Review Requested
This test replaces the previously orderable DIFCOM and RBCWET. It has been established for Pathologist review of peripheral blood smears, fluids, etc. Please be sure to specify the specimen type when ordering this test. In MIS, the request is orderable as follows:
Under the "Blood Tests" it is listed under 'P' for Pathologist review.
Under the "Spot Urines" it is listed under 'P' for Pathologist review.
Under "Non Blood / Non Urine" it is listed under Amniotic fluid, Acites fluid, CSF, Dialysate, Joint fluid, Pericardial, Peritoneal, Pleural, and Synovial
NEW REFERRAL LABORATORY TESTS
Due to an inability to receive reagents, the following tests will now be sent to our Referral Lab, Quest Diagnostics, for analysis:
Specimen requirements: Serum (Red top tube ONLY)
Minimum volumes – 2 ml
Ethosuximide (Zarontin ®)
Specimen requirements: Serum (Red top tube ONLY) or Plasma (EDTA, Sodium Heparin)
Also now a referral laboratory test: LAP (Leukocyte Alkaline Phosphatase)
Specimen requirements: Sodium Heparin, Green top tube OR two (2) well-made smears from a finger stick – no fixative.
GESTATIONAL DIABETES TESTING
Two new gestational diabetes tests that have been established to meet new NACB and ADA guidelines:
Gestational Diabetes Screening Test (Test code GDM)
A 50 g oral glucose challenge is given without regard to time of day or fasting state and a single sample (gray top tube) is drawn at one-hour. The “reference interval” is a threshold at 135 mg/dL and the results are interpreted as follows:
a. Values less than 135 mg/dL – no indication of gestational diabetes
b. Values greater than 185 mg/dL – considered diagnostic for gestational diabetes and do not perform 3 hour challenge
c. Values between 135 and 184 mg/dL – perform the challenge
Gestational Diabetes Glucose Tolerance Test (Test code OBGTT)
The results include fasting, 1 hour, 2 hour, and 3 hour glucose levels; all specimens are drawn into gray top tubes. The test consists of a 100 g oral glucose dose, performed in the morning after an overnight fast and 2-3 days of unrestricted diet and physical activity. The subject should remain seated and not smoke for the duration of the test.
There are distinct reference intervals for each time point:
a. Fasting: 95 mg/dL (A fasting result of >110 mg/dL is considered a positive test and glucose loading should not be performed.)
b. 1 hour: 180 mg/dL
c. 2 hour: 155 mg/dL
d. 3 hour: 140 mg/dL.
If two or more values are greater than the threshold values listed, then the diagnosis of gestational diabetes is made.
LOCATION CHANGE FOR CYCLOSPORINE ANALYSIS
Beginning May 10, 2002, analysis of Cyclosporine levels will be performed in the Toxicology Laboratory, rather than the Core Laboratory. Analysis will be performed once per day with a cut-off time of 1100 for receipt of samples.
JCAHO INSPECTION OF POINT OF CARE TESTING PROGRAM
The 2002 JCAHO Point-of-Care laboratory inspection took place April 15th - 19th. The surveyor visited testing sites in the University Hospital, Provider Based Clinics and regional Primary Care facilities.
The Program received several recommendations for overall improvement of Quality control and Proficiency Testing oversight. The inspection was successful and the Point of Care Testing Team will be working with sites to finalize and implement a corrective action plan in the next few weeks. We would like to extend our gratitude to everyone involved in preparation and participation of the inspection to make this a successful event.
NATIONAL MEDICAL LABORATORY WEEK
This year’s National Medical Lab Week was celebrated April 14th – April 20th. One of the highlights of the week was the announcement of the three Laboratorian of the Year Awards. This annual award recognizes outstanding achievements in the areas of professional excellence, communication, critical thinking, problem solving, and personal initiative. A ceremony was held to honor recipients of three chosen categories:
· Clinical Pathology-Barbara Greb, Clinical Laboratory Scientist in the Davis Laboratory
· Anatomic Pathology-Jamie Covell, Cytology Lab Manager
· Support Staff-Sharon Jones, Administrative Assistant in the Blood Bank
Congratulations to the three recipients of this year’s award and a special thanks to all the professional and support staff who play an important role in ensuring the high standards for UVA Medical Laboratories