Clinical Laboratory Information

NEW MICROBIOLOGY TEST: CRYPTOCOCCAL ANTIGEN BY LFA

Effective May 13th, 2019, the Microbiology Laboratory will be changing the methodology of Cryptococcal antigen testing from the Meridien Enzyme Immunoassay (EIA) to the more sensitive IMMY CrAg Lateral Flow Assay (LFA). The specimen requirement is a minimum 0.2 ml serum and/or CSF. This change will also affect how titers are reported. Please see below with changes marked in blue.

Parameter

Old Method

New Method

Sensitivity

Serotype A: 28 ng CrAg/mL

B: 23 ng CrAg/mL

C: >2,000 ng CrAg/mL

D: 770 ng CrAg/mL

Serotype A: 1 ng CrAg/mL

B: 1 ng CrAg/mL

C: 9 ng CrAg/mL

D: 8 ng CrAg/mL

Titer Range

1:2 - 1:18,750

1:5 - 1:2,560

Titers >1:2,560 can be determined upon request

This test will be run from 6am-9:30pm with a turnaround time of ~1 hour. Specimens arriving after the cut-off time will be run immediately the following morning. Results will be reported in PowerChart under Special Microbiology, and positive results will be called to the provider. Please call the Laboratory (x5750) or the Microbiology Manager, Dr. Holly Huse (x5780), if you have any questions or concerns.

Sincerely,

Sachiv Sheth, MD

NEW MICROBIOLOGY TEST: BIOFIRE FILMARRAY MENINGITIS/ENCEPHALITIS (ME) PANEL

Effective May 13th, 2019, the Microbiology Laboratory will begin in-house testing of the BioFire FilmArray Meningitis/Encephalitis (ME) Panel. This rapid PCR based test has been previously sent to ARUP. The specimen requirement is a minimum of 0.25 ml CSF. This test does NOT replace CSF culture and/or Cryptococcal antigen testing. The test can be ordered as a Careset “ME Panel by PCR with Bacterial Culture.” When appropriate, fungal culture and Cryptococcal antigen testing should be ordered in addition to the FilmArray ME Panel and bacterial culture.

Targets on the test:

Bacteria:

  • Escherichia coli K1
  • Haemophilus influenzae
  • Listeria monocytogenes
  • Neisseria meningitidis (encapsulated)
  • Streptococcus agalactiae
  • Streptococcus pneumoniae

Viruses:

  • Cytomegalovirus
  • Enterovirus
  • Herpes simplex virus 1
  • Herpes simplex virus 2
  • Human herpesvirus 6
  • Human parechovirus
  • Varicella zoster virus

Yeast:

Cryptococcus neoformans/gattii

The overall sensitivity and specificity of this test is 94.2% and 99.8%, respectively.

Test limitations include:

  • The FilmArray ME Panel is NOT a replacement for CSF bacterial and/or fungal culture and Cryptococcal antigen testing for at-risk patients.
  • Non-K1 E. coli serotypes and non-encapsulated strains of Neisseria meningitidis are NOT detected.
  • The panel does NOT differentiate active from latent HSV, CMV, or HHV-6 infections.
  • A negative result should not rule-out central nervous system infection in patients with a high pretest probability for meningitis or encephalitis. False negatives can occur when the concentration of nucleic acids in the specimen is below the limit of detection of the test.
  • False positives can occur due to the sensitive nature of the FilmArray ME Panel. Results are intended to aid in the diagnosis of illness and are meant to be used in conjunction with other clinical and epidemiological findings.

The test will be run daily from 6am-4:30pm. Specimens that reach the lab after the cut-off time will be run STAT the following morning. All positive results will be called to the provider. Reports will appear in PowerChart. Please make sure to review the attached comment that describes the test limitations.

Please call the Laboratory (x5750) or the Microbiology Manager, Dr. Holly Huse (x5780), if you have any questions or concerns.

Sincerely,

Sachiv Sheth, MD

Chemistry Instrument Upgrade 3-19-2019

Effective March 19th, 2019 at 0900, the Laboratory will go live with the Beckman Coulter Automation system which incorporates new chemistry and immunoassay analyzers. Following regulatory guidelines, our Department performed extensive validation studies to ensure the prior and new methodologies provide comparable results.

Due to vendor product variation, some tests warrant a change in reference range values. The table below highlights those specific tests with a change in reference ranges. For the next 3 months, these tests will have a reminder to alert you of the new reference ranges.

If you have any questions or concerns, please contact the Chemistry supervisors Susan Lee or Ben Haro at x5730 or Anne Au, Director of Laboratory at x5773.

Medical Director Sachiv Sheth M.D.

Following the retirement of Dr. Henry Slosser, Dr. Sachiv Sheth has become the new Medical Director of the Department of Pathology and Laboratory Medicine as of Jan. 1st, 2019.

Dr. Sachiv Sheth, member of the Alpha Omega Alpha Medical Society and recipient of the prestigious Walter E. Shepherd Award for Academic Achievement, completed residency training in Anatomic and Clinical Pathology and fellowship training in Dermatopathology and General Surgical Pathology with emphasis in Soft Tissue Pathology at UCLA Medical Center in Los Angeles. He has earned subspecialty Board Certification in Dermatopathology and worked as an Assistant Professor at the University of British Columbia in Vancouver, Canada for several years prior to joining Huntington Hospital in 2014 as a General Surgical Pathologist and Dermatopathologist. During his career, Dr. Sheth has been nationally recognized and awarded the United States and Canadian Stowell Orbison Award for his research, authored over 10 research publications and abstracts, and has been an invited speaker in national multidisciplinary symposiums on melanocytic lesions. Dr. Sheth is currently an active member of the American Society of Dermatopathology and the College of American Pathologists.

Please join us in welcoming Dr. Sheth in his new role.

Past messages

New Method for Occult Blood Testing

Effective April 1, 2017, immunochemical testing for fecal occult blood (iFOB) will replace all guaiac card testing (Hemoccult) except in ED.

For In-patients, send stool samples directly to microbiology.

For Out-patients, please contact the outreach coordinator for iFOB supplies.

New test order will be: Occult Blood Stool FIT

M. tuberculosis Complex Detection and Rifampin Susceptibility - 1/3/2017

Effective Jan. 3 rd, 2017 - please order M. tuberculosis Complex Detection and Rifampin Susceptibility by PCR - ARUP whenever a direct specimen screening for M. tuberculosis is intended.

Message from Henry D. Slosser, MD. on Respiratory Panel by PCR - for rapid identification of upper respiratory viruses and bacteria (updated 4-25-2016)

Effective May 2nd, 2016, the FilmArray Respiratory Panel will be done in-house in Microbiology.

The FilmArray Respiratory Panel (RP) is a multiplexed nucleic acid test intended for use with FilmArray systems for the simultaneous qualitative detection and identification of multiple respiratory viral and bacterial nucleic acids in nasopharyngeal swabs (NPS) obtained from individuals suspected of respiratory tract infection.

The following upper respiratory viruses and bacteria are detected:

  • Adenovirus
  • Coronavirus 229E
  • Coronavirus HKU1
  • Coronavirus NL63
  • Coronavirus OC43
  • Influenza A (with subtyping for hemagglutinin genes H1, H1-2009 and H3)
  • Influenza B
  • Human Metapneumovirus
  • Parainfluenza Virus 1
  • Parainfluenza Virus 2
  • Parainfluenza Virus 3
  • Parainfluenza Virus 4
  • Respiratory Synctial Virus
  • Rhinovirus/Enterovirus
  • Bortadella pertussis
  • Chlamydophila pneumoniae
  • Mycoplasma pneumoniae

Testing summary is as follows:

Instrumentation/ Method FilmArray™ Respiratory Panel (RP)
Specimen Collection/Storage Nasophyarynegeal (NP) swab specimen should be collected according to standard technique and immediately placed in viral transport media (VTM)
Minimal Volume 0.3 mL of Nasopharyngeal Swab collected and placed in viral transport media (VTM).
Ordering in Cerner Respiratory Panel by PCRFilmArray
Test Schedule Testing performed: 0700 - 20:00 daily
Results from graveyard set up will be reported by 0700 daily
Result Turn-Around Time 1.5 hour (completion of panel)
Reference Ranges Negative
Critical Values/Reportable Target detected

Effective immediately, Hemoglobin Electrophoresis and Direct Measurement LDL will be sent to Reference Lab ARUP. The Lipid Panel contains Total Cholesterol, Triglycerides, Direct Measurement HDL, Calculated LDL and VLDL.

Message from Dr. Henry D. Slosser on Testing of Uncommon Organisms (updated 3-9-2015)

To ensure quality patient care, uncommon organisms which are not routinely identified and tested for susceptibility will be sent immediately to a referral lab. The ordering physician will be notified of the isolate being sent out along with an expected turn-around time for results.

We describe here a recent case which supports our hospital’s laboratory policy on the testing of uncommon organisms.

SV is a morbidly obese 62 year old female who presented with sepsis secondary to possible community-acquired pneumonia and left lower extremity cellulitis. Two sets of blood cultures grew gram positive bacilli which was later identified as Corynebacteriumamycolatum/striatum and initially reported to be sensitive to penicillin but subsequently changed to resistant to penicillin upon further evaluation of results. Concerns regarding the penicillin susceptibility results prompted a request for repeat speciation and susceptibility testing to be performed at a referral laboratory. Results were available after 3 and 5 days respectively. In contrast to in-house results, the species identified at the referral laboratory was Corynebacterium striatum/simulans with a higher level of resistance to penicillin and ceftriaxone than was reported in-house.

Corynebacterium spp. is a common colonizer of the skin and mucous membranes and rarely causes invasive infection. Thus, speciation of the organism and susceptibility testing is not routinely performed in house. The discrepancy in speciation and susceptibility results between the in-house laboratory and the referral laboratory illustrated in this case has the potential to negatively affect treatment outcome. Thus, our current policy of sending test requests for uncommon organisms immediately to a referral laboratory helps to ensure timely reporting of reliable results to guide appropriate treatment decisions.

Message from Dr. Henry D. Slosser on ordering Ketones (updated 1-15-2013)

Due to the continuing nation-wide production problems with the Acetest tablets used for ketone body testing, we are again unable to perform the test. In order to provide a test that measures ketones, we will temporarily send the specimens to ARUP for quantitative beta-hydroxybutyric acid testing.

What will not change:

  • Specimen requirements
  • How you place the order for ketones

What will change:

  • The order for ketones will be mapped to beta-hydroxybutyric acid, and sent to ARUP.
  • Turn-around time will be 1-3 days.
  • To view results in EMR, you’ll need to access the Chemistry group of Laboratory Tests, and select Beta-Hydroxybutyric Acid. The reports will include an explanatory comment.

You also have to option of ordering beta-hydroxybutyric acid directly.

If you have any questions or concerns, please contact Karen Watkins (Manager, Clinical Laboratory, x5780), or Kiem Injo (Hematology Lead CLS, x5720).

Bone Marrow Microbiology Culture (Updated 11-28-2011)

For consideration of bacterial, fungal or mycobacterial cultures, bone marrow will be processed as “blood” and placed into the Bactec blood culture vials. The blood cultures vials will support the growth and detection of most entities that could be associated with infection in bone marrow (Brucella, Cryptococcus neoformans, Histoplasma capsulatum, and mycobacteria.)

Requesting a bone marrow culture without specific indication is discouraged.

Laboratory Orderable Test Index

New Method for Occult Blood Testing

Effective April 1, 2017, immunochemical testing for fecal occult blood (iFOB) will replace all guaiac card testing (Hemoccult) except in ED.

For In-patients, send stool samples directly to microbiology.

For Out-patients, please contact the outreach coordinator for iFOB supplies.

New test order will be: Occult Blood Stool FIT

Lab Orderable Test Index

Tests no longer available from ARUP

Tests no longer available from ARUP Date No Longer Available Replacement ARUP Test
SCN1A-Related Seizure Seq and Del/Dup-ARUP (2005896) 6/6/16 None identified
Helicobacter pylori IgM Antibody-ARUP (98392) 6/6/16 due to limited diagnostic value None identified
Helicobacter pylori IgG Antibody-ARUP (99359) 6/6/16 due to limited diagnostic value None identified
Helicobacter pylori IgG, IgA Abs-ARUP (50994 6/6/16 due to limited diagnostic value None identified
Cysticercosis Antibody, IgG by Western Blot-ARUP (55283) 7/5/16 None identified
Tropheryma whipplei Detection by PCR, Blood (2011025) 7/5/16 Tropheryma whipplei PCR (2013290)
Inactivate Scleroderma Antibodies Panel (2006462) 7/5/16 Systemic Scleroderma Comprehensive Panel (2013325)
Inactivate Inflammatory Bowel Disease Differentiation Profile-ARUP (50567) 7/5/16 Inflammatory Bowel Disease Panel (2013270)
Inactivate Apolipoprotein E (APOE) 2 Mutations, Cardiovascular Risk 7/5/16 Apolipoprotein E (APOE) Genotyping, CR (2013337)
Modify Cytochrome P450 2C19, 9 Mutations-ARUP (51104) 7/5/16 Cytochrome P450 2C19, CYP2C19-9 Variants-ARUP (2012769)