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Lab Manual for UCSF Clinical Laboratories

Lab Manual for SFGH

Internal Resources

Lab Updates, Archive

11/2005

The UCSF Clinical Laboratories occasionally receive requests for test(s) that are performed in-house, to be sent out to a specified reference laboratory or institution. Such requests will NOT be honored and we will automatically order the in-house test to be performed.

If there is question regarding the validity of our in-house test result(s) or another reason that you feel warrants the testing to be sent out you may contact me, or the responsible testing section director, to discuss the issue before having the patient undergo phlebotomy.

Similarly, requests for esoteric tests that are not performed in-house and that are not listed in the on-line laboratory manual (http://pangloss.ucsfmedicalcenter.org/LabManPage.html) should be discussed with the laboratory before samples are obtained. Laboratory regulations require that we obtain copies of license and accreditation documents from a laboratory BEFORE we can send them samples and this may take hours or days. Without this forewarning samples often have exceeded their stability period before they can be sent and must then be recollected.

Your assistance in these matters is appreciated.

7/2005

The UCSF Cytogenetics Laboratory is pleased to announce that as of July 18, 2005, we are accepting Amniotic Fluid (AF), Chorionic Villi Sampling (CVS), Products of Conception (POC), and Non-neoplastic Blood samples for chromosome studies. We also offer Direct FISH (AneuVysion) testing on Amniotic Fluids and Fluorescent In-situ Hybridization (FISH) on most microdeletion tests. Subtelomere FISH is not offered at this time, however.

As a result of this, we have designed a temporary UCSF Cytogenetic Requisition (a formal requisition is being created). Attached to this e-mail is a copy of the this form. Please use this requisition for all cytogenetic study requests, fill it out completely send the form back, together with the sample, to the UCSF Cytogenetics Laboratory at China Basin. For any questions, please feel free to contact Romeo Fauni, Lab Supervisor at 415-353-4844 or 415-353-4813

Thank you for your cooperation in providing the best patient care to all of UCSF community.

7/2005

Beginning on Monday August 1, 2005 the UCSF Clinical laboratories will initiate the following important change in regard to laboratory test requests.

The laboratory often receives requests for tests that are unclear, that use inappropriate abbreviations or are for test panels that are not offered. Such orders waste staff time in trying to clarify what was requested and may result in inappropriate testing that delays patient care and increases costs. When such requests are received the laboratory will hold the sample and place a note in STOR that indicates what was requested and adds: "LAB REQUIRES CLARIFICATION, PLEASE CALL 3-1667 (option 3) ASAP. DELAY MAY JEOPARDIZE THE STABILITY OF THE SPECIMEN. THANK YOU. The laboratory will process any tests we have clear orders for and will hold the sample a maximum of 7 days for clarification of the unclear request. After 7 days the sample will be discarded. In order to avoid this please review the on-line lab manual (http://pangloss.ucsfmedicalcenter.org/LabManPage.html) and request test(s) specifically.

7/2005

New PTT reagent starting July 1, 2005

Please refer to the new heparin drip algorithm below. Also refer to the Anticoagulation in Adults Guidelines.

HEPARIN DRIP ALGORITHM **NEW July 1, 2005**

Obtain first aPTT 6 hrs after initiation of heparin therapy. FOLLOW ALGORITHM BELOW

Obtain aPTTs Q6 hrs until therapeutic or after a dose change and adjust rate using TABLE below*

Obtain daily aPTT after aPTT is stable*

Obtain daily CBC & platelets

Obtain stool guaiac every other day

aPTT
(seconds)

Rebolus

Hold drip
(minutes)

Change drip
(Units/hr)

Repeat aPTT
(After dose adjustment)

<40

Rebolus, if indicated at top of form

0

+200

6 hrs

40-44

0

0

+200

6 hrs

45-49

0

0

+100

6 hrs

50-75
THERAPEUTIC RANGE

0

0

0

Q6hrs until stable*
Once stabilized, then QAM

76-85

0

0

-100

6 hrs

86-95

0

30

-200

6 hrs

>95

0

60

-300

6 hrs

*Stable = 2 consecutive aPTT values within therapeutic range [aPTT 50-75]

5/2005

SWEAT CHLORIDE TESTING FOR CYSTIC FIBROSIS

Effective immediately, sweat samples for sweat chloride testing will be collected by the staff of the Neonatal Clinical Physiology Laboratory (NCPL) rather than Clinical Laboratories. To make an appointment for sweat chloride testing, please call the NCPL at 353-1755.

Appointments can be made for Monday to Friday from 8:30 to 11:30 a.m. We regret that, for the present, we cannot schedule appointments for the afternoon. This is because the chloride analysis is being done at the lab in China Basin and the sweat sample must be transported to that site. The test is not accurate if the sample is kept overnight. We expect that in the future the analysis will be done on site at Parnassus. When that occurs, we will accept afternoon appointments.

As before, both pediatric and adult patients go to the Pediatric Clinic on the second floor of the Ambulatory Care Center, 400 Parnassus Ave. For inpatients, the test will be done in the patient's room.

If there are any questions or problems with this service, please contact:
* Gene Qin, NCPL supervisor, at 353-1755
* Joseph A. Kitterman, M.D., NCPL director, at 476-7242

5/2005

LAB DOWNTTIME, NEW TUBE LABELS

On Sunday, May 15, the UCSF Clinical Laboratories computer will be taken off-line from about 2 to 6 a.m. Lab staff will phone ED results, panic results per downtime protocol and other test results (e.g., stats) as possible during this period. Please limit test orders and calls to the laboratory during this time.

The downtime is the first phase in a process to implement laboratory automation. We will make significant changes to the laboratory computer as well as how specimens are handled in the lab. This is the culmination of a several year project to improve sample handling and turnaround times.

Due to the change in labels (see below) the laboratory will NOT perform pre-accessioning for orders placed Saturday night, May 14 for the Sunday, May 15 morning draws. We will resume pre-entry on Sunday night for the Monday, May 16 morning rounds.

Label Changes

One of the most noticeable changes will be the use of new specimen labels. Initially, this will impact the pre-accessioned orders for morning labs where labels are printed in advance and provided to the wards. When electronic order entry in UCare is available, these labels will be used for virtually all inpatient samples.

The new labels specify the type of container to which it should be affixed. For example, an "SST" label would be placed on a gold-top Vacutainer.

It is imperative that these labels are placed on the correct tubes. Incorrectly labeled tubes will be mishandled or simply not processed by our automated system. This may result in ruined samples, repeat draws and delayed test results.

We are working with nursing to train staff in the correct use of the new labels. I have attached a copy of a poster that will be distributed explaining these new labels and their use.

If you have any questions, please contact Tim Hamill at hamillt@labmed2.ucsf.edu.

2/2005

Starting March 1, 2005, growth hormone results will read approximately 50% lower than they have been in the past due to a change in growth hormone calibrators by the assay manufacturer.

The calibrators are being changed based on recommendations of the WHO/NIBSC expert committee for growth hormone testing to use the recombinant DNA derived calibrator material (NIBSC 2nd IS 98/574) that will provide better lot-to-lot consistency than the older WHO 1st IS 80/505 reference preparation. The assay format (sandwich assay) and antibody reagents (one monoclonal and one polyclonal) have not been changed.

As a result of this calibrator change, the new reference ranges will be adjusted to be approximately 50% lower than the current reference ranges. Specifically, the new reference limits on the reports will be adjusted by multiplying 0.56 x the old reference limits.

Note that this assay change should also reduce the cutoffs used when interpreting the results of stimulation tests. With the old calibrators, failure to increase GH levels by >6 mcg/L in two or more provocative tests would suggest deficiency. With the new calibrators, failure to increase GH levels by 3.4 mcg/L in two or more provocative tests should suggest deficiency.

A STOR banner will be generated to highlight the date when the growth hormone assay change takes place and the comment "Note new reference range" will be appended to growth hormone results during the transition period.

1/2005

Hematology Laboratory specimens

This is a reminder that several Hematology Laboratory specimen types require testing within a relatively short period to yield accurate results. Please deliver these specimens to the laboratory as soon as possible.

The following tests must be completed within two hours of specimen collection:

  • Cerebral spinal fluid (CSF) and body fluids for cell count and differential -- A time delay can result in cellular degeneration, thus adversely affecting results.

  • Urinalysis - This includes urine dipstick and microscopic examination.

The following test must be completed within four hours of specimen collection:

  • Coagulation tests - These include prothrombin time (PT) and partial thromboplastin time (PTT). Additional coagulation tests cannot be added to a specimen that has exceeded this time period from collection.

Thank you for your attention to this matter. If you have any questions, please contact Dr. Joan Etzell, director of the Clinical Hematology Laboratory, at etzellj@labmed2.ucsf.edu or 353-1750.

9/2004

Triglyceride and LDL results change

The formulation of the triglyceride assay materials used by the Moffitt-Long and Mt Zion Clinical Laboratories is being changed by the manufacturer to improve test accuracy. The assay change is scheduled for Sept 1, 2004 and will cause an increase in triglyceride results of approximately 11% and a decrease in calculated LDL results of approximately 3%.

8/2004

OPIATE SCREENING NOW AVAILABLE

Effective immediately, opiate testing is available as part of our Rapid Urine Drug Screen. The vendor has resumed providing a supply of reagents for opiate testing in urine.

7/2004

OUTPATIENT LAB REQUISITIONS

To comply with patient safety goals, UCSF Medical Center has adopted bar-code patient identification. The inclusion of a bar-code patient ID on inpatient wrist bands and outpatient labels will significantly improve patient safety by ensuring proper identification for test orders, blood product administration and drug administration as well as any time a patient's ID must be confirmed. I personally applaud this technology.

To make room for this on patient labels, physician names were removed and this has had an unintended consequence for the clinical lab.

Federal laboratory regulations, College of American Pathologist certification requirements and California state law all require that the name of a person authorized to order laboratory tests be present on the test request form. Requests received without this information are not considered valid orders.

Until the recent change in the labels, UCSF Clinical Laboratories accepted outpatient test requisitions without the ordering physician's name as long as there was a physician's name on the IDX label or stamp. The laboratory can no longer use this "fall-back" mechanism and we now require that the ordering physician information (name and UC ID number) is included on all outpatient laboratory test requests.

Although this will necessitate changes in your processes for filling out lab requests that may seem onerous, there are positive effects to this change. It not only will allow for the benefits of bar coding but also will correct a long-standing problem in identifying the actual individual who ordered lab tests.

Therefore, effective Monday, Aug. 2, all outpatient laboratory requisitions must have the ordering physician's name and five-digit physician code listed.

Thank you for your cooperation.

TEMPORARY REMOVAL OF OPIATES FOR URINE DRUG SCREEN

The vendor for our urine drug screening test (Drugs of Abuse Panel) cannot provide reagents for the opiate portion of the screen. Beginning Monday July 26, opiates testing will be temporarily deleted from the panel. We will add opiates back to the panel as soon as the reagents are available. Testing for amphetamines, benzodiazepines, cocaine metabolites, THC and barbiturates still will be offered in-house.

For patients requiring documentation of opiate use, urine can be sent to the Quest reference lab for screening. This testing takes several days to a week to complete and is not available stat. The Quest assay, while similar to the UCSF test, utilizes a lower negative cut-off threshold of 300 ug/L and so may yield positive results when our assay would not. The nationally recommended cut-off for opiate screening tests is 2000 ug/L to avoid false positive results. To order this assay, please write in "Urine for Opiates" on the Urine and Body Fluid requisition and submit it with a freshly voided urine sample.

In the situation of suspected acute opiate intoxication, a diagnostic/therapeutic trial of Narcan would be appropriate.

Federal laboratory regulations, College of American Pathologist certification requirements and California state law all require that the name of the person authorized to order laboratory tests be present on the test request form. Requests received without this information are not considered valid orders.

Until recently, the UCSF Clinical Laboratories was able to accept test requisitions that did not include the ordering physician's name as long as there was a physician's name on the IDX label or stamp. With the recent elimination of this information to make room for the patient barcode, the laboratory cannot use this 'fall-back' mechanism.

EFFECTIVE JULY 26, 2004: ALL LABORATORY REQUISITIONS THAT DO NOT HAVE THE ORDERING PHYSICIAN NAME AND 5-DIGIT PHYSICIAN CODE WILL BE RETURNED TO THE ORIGINATING LOCATION TO PROVIDE THIS INFORMATION BEFORE SAMPLES WILL BE COLLECTED OR PROCESSED FOR TESTING

3/2004

Effective immediately, the UCSF Clinical Laboratories will no longer process, package or ship samples on an ad hoc basis to research laboratories or for clinical testing that is not authorized, ordered and resulted by the clinical laboratory.

This DOES NOT apply to samples handled for researchers or vendors as part of an arrangement with Laboratory Administration and which is billed to a research account.

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