Directory of Services Reference Book - Agnesian HealthCare

Directory of Services Reference Book

Revised December 27, 2016

Consultants Laboratory of Wisconsin, LLC 430 East Division Street Fond du Lac, Wisconsin 54935

Phone: (920) 929-9300 or (800) 826-1580 Fax: (920) 929-9640

Table of Contents

Preface: Accessing the directory on-line …………………………………………………………….. 3 Mission Statement ………………………………………………………………………………………….. 4 Accreditations and Phone Numbers ………………………………………………………………………. 5 Laboratory Site Directory ………………………………………………………………………………… 6 Services …………………………………………………………………………………………………… 8 Customer Service ………………………………………………………………………………… 8 Courier Services ………………………………………………………………………………… 8 Supplies ………………………………………………………………………………………….. 8 Consultation Services ………………………………………………………………………………… 8 Standing Orders (Long Term Care Facilities) ……………………………………………………. 8 Quality Assurance …………………………………………………………………………………. 8 Compliance Policies …………………………………………………………………………………. 9 Reporting of Results …………………………………………………………………………………. 9 Acute & Communicable Disease Reporting …………………………………………………….. 10 Paternity Testing …………………………………………………………………………………. 10 Significant Exposure Testing ………………………………………………………………………… 10 Critical Values / Call Results Policy ………………………………………………………………. 11 Important Personal or Public Health Results …………………………………………………….. 13 Reflex Testing …………………………………………………………………………………………… 14 Billing and Collection Information ………………………………………………………………………… 15 Advanced Beneficiary Notice (ABN) ………………………………………………………………………… 16 Genetic Testing – Preauthorization Required ………………………………………………………………. 16 Specimen Collection …………………………………………………………………………………………… 17 Blood Bank Orders and Special Instructions ………………………………………………………………. 23 Therapeutic Drug Sampling Times ………………………………………………………………………… 24 Alphabetical Listing of Tests ………………………………………………………………………………….. 25 Alphabetical Listing of Cytology and Pathology Test s …………………………………………… 150 Consultants Laboratory Test or Phrase Abbreviation List …………………………………………… 160 Consultants Laboratory Unit of Measure List ………………………………………………………………. 165 Prioritization of Lab Tests ………………………………………………………………………………….. 166 STAT Test List ……………………………………………………………………………………………. 167 Blood Bank Component Availability and Requirements ……………………………………………. 168 Microbiology Cultures – Media and Transport Instruc tions ……………………………………………. 171 Microbiology Antibiograms ………………………………………………………………………………….. 174 CLW Specimen Collections Charts ………………………………………………………………………… 182

Preface

This new edition of the Directory of Service Reference Book contains numerous modifications, updates and revisions. Every effort is made to ensure that this publication is up to date. Changes to our test menu and methodologies are common. To ensure the most accurate information, please refer to our on-line publication. Internet access:

1. Log on to www.agnesian.com 2. Select “Services” 3. Select “Laboratory” 4. Click “Click here for the Consultants Lab Directory of Services”

Intranet access:

1. Log on to Agnesian Intranet 2. Click on “Application Launching Pad” 3. Click on “CLW Directory of Services (Test Catalog)”

Mission Statement

OUR MISSION

We, at Agnesian HealthCare, provide compassionate care that brings

to those we serve by honoring the sacredness and dignity of all persons at every stage of life. We are rooted in the healing ministry of the Catholic Church

as we continue the mission of our sponsor, the Congregation of the Sisters of St. Agnes.

OUR VALUES HONESTY We affirm honesty as we bring truth and fairness to all our relationships.

EXCELLENCE

We affirm excellence as we continually improve the quality of our services and the knowledge and competencies of our associates.

COMPASSION

We affirm compassion through our responsive presence to one another, to those seeking wholeness of body, mind, spirit, and especially to the poor and vulnerable.

RESPECT We affirm respect as we honor the individuality and God given worth of all people by promoting human rights and giving witness to justice.

STEWARDSHIP We affirm stewardship as we protect our spiritual, human, natural, and fiscal resources for future generations and collaborate with others committed to improving our community’s health.

Accreditations

Accreditations and Licensure College of American Pathologists (CAP) 1793501 (Central Laboratory Fond du Lac) 1786101 (Waupun Memorial Hospital Laboratory) 8033625 (Ripon Medical Center Laboratory) Center for Medicare & Medicaid Services (CMS) CLIA Certification 52D0397685 (Central Laboratory Fond du Lac) 52D0671036 (Waupun Memorial Hospital Laboratory) 52D0397949 (Ripon Medical Center Laboratory)

Telephone Directory

Central Laboratory – Fond du Lac (920)929-9300 or (800)826-1580

Central Laboratory Customer Service fax: (920)929-9 640 Outpatient Laboratory fax: (920)926-8392

The following options are available through an automated phone system after calling the above numbers: Press 2 for our Customer Service Department Press 5 for our Billing Department Press 4 for Supply Orders Press 0 for an Operator

Press “1” and then the 4 digit extension for the numbers below. The numbers with the 926 prefix may be dialed directly or the last 4 digits used as an extension:

Department Direct Number or Extension Billing Department 929-9300 ext. 3891 Director of Client Services 926-5862 Human Resources 926-5705 Assistant VP of Laboratory Services 926-5898 Quality Assurance Supervisor 926-5871 Supply Requests 926-5842 Surgical Pathology/Cytology Reports 929-9300 ext. 3895 Director of Technical Services 926-5883

Laboratory Site Directory Phlebotomy services are available at all locations. Please call the specific location for hours of operation.

Site Code * Central Laboratory - Fond du Lac Outpatient Laboratory Hours: Monday-Friday 6am to 6pm Saturday 7am to noon

Located on the Agnesian Healthcare Campus 430 E. Division Street Fond du Lac, WI 54935 800-826-1580 or 920-929-9300 Fax: 920-929-9640 (Customer Service) Fax: 920-926-8392 (Outpatient Laboratory)

A

Fond du Lac Regional Clinic – Brandon

601 East Clark Street Brandon, WI 53919 920-346-8300 fax: 920-346-8304

E

Fond du Lac Regional Clinic – Brownsville

900 Main Street Brownsville, WI 53006 920-926-8375 fax: 920-583-4250

B

Fond du Lac Regional Clinic – Campbellsport

350 East Sheboygan Street Campbellsport, WI 53010 920-533-3848 fax: 920-533-5598

T

Fond du Lac Regional Clinic − Convenient Care

145 N. Main Street Fond du Lac, WI 54935 920-926-6047 fax: 920-926-6050

U

Fond du Lac Regional Clinic – Fox Lake

703 West State Street Fox Lake, WI 53933 920-928-6300 fax: 920-928-6304

X

Fond du Lac Regional Clinic – Markesan

730 N. Margaret Street Markesan, WI 53946 920-398-2406 fax: 920-398-3766

N

Fond du Lac Regional Clinic – Mayville

360 South Mountin Drive Mayville, WI 53050 920-387-2111 fax: 920-387-3252

M

Fond du Lac Regional Clinic – Mt. Calvary

100 Evergreen Road Mt. Calvary, WI 53057 920-753-2311 fax: 920-753-2804

Y

Laboratory Site Directory (cont.)

Site Code * Fond du Lac Regional Clinic – North Fond du Lac

723 Park Ridge Lane North Fond du Lac, WI 54937 920-926-8610 fax: 920-926-8679

F

Fond du Lac Regional Clinic − West

912 S. Hickory Street Fond du Lac, WI 54935 920-907-3919 fax: 920-929-7470

H

The Clinic at Westwind N6663 North Rolling Meadows Drive Fond du Lac, WI 54935 920-907-3970 fax: 920-921-2599

Z

Ripon Medical Center

845 Parkside Street Ripon, WI 54971 920-745-3310 fax: 920-745-7920

L

Waupun Memorial Hospital

620 W. Brown Street Waupun, WI 53963 920-324-6502 fax: 920-324-0172

W

� The test location code will appear on the Laboratory generated report to indicate the Laboratory site where

each test is performed.

Services

Consultants Laboratory offers a complete range of routine and specialty procedures in Chemistry, Hematology, Immunohematology, Microbiology, Cytopathology, and Histopathology. If you need a test that is not listed in our manual, please call to check on its availability. If we do not currently perform the test that you are requesting, we will make every effort to provide that testing procedure for you. Customer Service Customer Service is a focal point at Consultants Laboratory. The Customer Service Department has trained and qualified representatives available to respond to your inquiries. Our representatives will answer your questions or concerns regarding specimen requirements, turnaround time, patient results, add-on test requests, and miscellaneous other inquiries. Your call can also be referred to our Pathologists, Technical Associates, or any of our Laboratory Departments through the Customer Service Department. Courier Services Our dependable Courier Service provides scheduled daily pick-ups and deliveries Monday through Friday in our service area. Stops can also be set up on an as needed basis. Saturday pick-ups can be arranged with advance notification. Courier arrangements are handled through the Customer Service Department. When calling our Customer Service Department, please be sure that the specimen has been collected and is ready to be picked up. Provide the name, address and city of the facility, the patient’s name, the internal location where the specimen should be picked up and the type of specimen. Please call for a pick up as soon as possible after the specimen is obtained. This information enables our Courier Associates to efficiently handle your request. Requisitions must accompany specimens. Supplies Collection devices and transport supplies can be ordered by submitting a Supply Order Form (available upon request), or by calling our Materials Management Department at 920-926-5842. Completed Supply Order Forms can be faxed or given to your courier. Supplies will usually be delivered within 3 working days. The supplies are not to be used for any activity not connected with the collection of specimens being referred to this Laboratory. See the Appendix for a listing of available supplies. Consultation Services Pathologists are available for consultation upon request. Call our Customer Service Department to arrange for these services. Standing Orders (Long Term Care Facilities) For those facilities utilizing our Standing Order System, please be sure to fax any additional draws at least one day prior to your scheduled draw date and routinely review your log for Daily Draw Updates. Patient orders will be drawn on your scheduled draw morning, unless special arrangements are made through our Customer Service Department. Requisitions for late or add-on orders can be given to our Phlebotomist when they arrive at your facility. Please contact our Customer Service Department or fax your Log for Daily Draw Updates if there are any changes in patient status (room number change, transfer out, etc.) Having these updates will be a big help to our Phlebotomists as well as to your associates. Quality Assurance Consultants Laboratory receives accreditation through the Laboratory Accreditation Program through the College of American Pathologists (CAP). Consultants Laboratory also participates in External Quality Assessment through the Inter-Laboratory Proficiency Testing Surveys & Education Case Studies with CAP. The Internal Quality Assurance (QA) Program is implemented through the Quality Assurance Plan which monitors performance indicators such as result turnaround time, critical result notification, and canceled tests/redraws. The Plan is reviewed and monitored by the QA Committee consisting of the Management and Pathology Team. Lean/Work Smart Team projects are focused on improving the laboratory processes and reducing and/or eliminating errors and waste. Performance is measured through client surveys, associate surveys, audits, and process measures.

Services (cont.) Compliance Policies - HIPAA Compliance Consultants Laboratory is committed to respecting the privacy of individuals by protecting patient health information and other verbal, written, and/or electronic information. Information will be shared only for legitimate reasons and as required by law, professional ethics, and accreditation requirements. Consultants Laboratory takes the steps reasonably necessary to verify the identity and legal authority of any person requesting access or disclosure of laboratory results. If results are requested verbally by telephone, the caller must identify themselves with a first and last name and their position in their facility Compliance Policies - CMS / OIG Compliance Consultants Laboratory participates in an active compliance plan which follows the outline of the Centers for Medicare & Medicaid Services, Office of the Inspector General program. All ordering providers need to be fully informed and aware of the specific activities associated with the Government Compliance Program and its requirements. These requirements include, but are not limited to, the following:

� As of January 1st, 1998, Medicare regulations require only tests that are medically necessary for diagnosis or treatment of a patient may be billed. Each laboratory test request requires appropriate medical necessity documentation (ICD-9 codes).

� Screening tests (with a few exceptions) that are billed to Medicare will be denied reimbursement. � Each individual test component within the Organ and Disease Related Panels must meet the

criteria of medical necessity. � If all component tests within a panel do not meet the criteria of medical necessity, a physician

should order individual tests or a more appropriate panel. � A reflex test is a specific laboratory test in which an abnormal result causes one or more additional

tests to be automatically ordered, resulted, and billed. A listing of Consultants Laboratory’s reflex tests is available in this manual.

� Written documentation is required for all verbal orders that are received. Clients will receive a written confirmation of the verbal order which must be signed and returned to our facility.

� An Advance Beneficiary Notice is required for Medicare recipients when payment is not expected. Please see page 17 for further information.

Compliance Policies - Safety Precautions All specimens should be handled as if they are infectious. Every effort must be made to protect all health care workers from exposure to Human Immunodeficiency Viruses (HIV) and Hepatitis Viruses. Consultants Laboratory has safety policies that adhere to guidelines provided by the Occupational Safety and Health Administration (OSHA), the Department of Labor, and the Department of Health and Human Services. All specimens must be properly sealed prior to being transported. Leaking containers pose a health hazard. The Laboratory will not accept or transport any specimen contained in a syringe with a needle attached. Specimens should be placed in completely sealed biohazard bags for transport. Reporting of Results Testing is performed at Consultants Laboratory 24 hours a day, seven days a week. Availability of each test is indicated in the Alphabetical Listing of Tests section of this directory. Tests ordered STAT will be communicated to the ordering physician or facility as soon as available. Critical results will be communicated to the source facility as soon as they are identified. These results should be given promptly to the responsible clinician. Clients are required to “read back” results when verbal results are given. (See the Critical Values/Call Results Policy section of this manual on pages 11-13.) To expedite the reporting of test results, this information can be electronically transmitted to fax machines. In addition, reports can be mailed if requested. Results are reported in chart ready formats with reference ranges. NOTE: All pediatric reference ranges are obtained from literature; not validated in this Laboratory. Values are provided as a guide to be used in conjunction with the clinical setting.

Services (cont.) Acute & Communicable Disease Reporting Consultants Laboratory complies with the Wisconsin Department of Health & Family Services, Division of Public Health laboratory reporting requirements for reportable diseases. Qualifying reports are electronically submitted or faxed to the local public health department of the patient’s place of residence. Clients/providers shall be responsible for compliance with Wisconsin statutes concerning reportable conditions. Paternity Testing Consultants Laboratory is a collection site for Paternity Testing. Private, attorney and court requested testing is performed at various Reference Laboratories. Interested parties are requested to call a Reference Laboratory of their choice for testing kits and payment information. Some choices for References Laboratories are listed below.

� DNA Diagnostics Phone: 1-800-362-2368 � Orchid Phone: 1-800-362-8378 � Identigene Phone: 1-800-DNA-TYPE � Lab Corp. Phone: 1-800-222-7566 � Genetic Profiles: Phone: 1-800-551-7763 � American Red Cross Phone: 1-800-626-4017

Significant Exposure Testing Significant Exposure consultation services are available through Agnesian HealthCare’s Work and Wellness. Work and Wellness can be reached at (888) 333-6996 or (920) 926-5666. For clients using their own significant exposure protocol and needing only laboratory tests, please see the Appendix for Significant Exposure forms. Please note: Use of this specialized form prevents confidential reports from autofaxing to the primary facility fax location. If a routine requisition is used, clearly indicate specific report handling instructions (i.e.: “do not fax”, “call to”, or “mail results to”).

Critical Values / Call Results Policy

REVISED 10/7/15 The client is notified of the following Critical Values as soon as available, 24 hours per day. Test Critical Value Department Acetaminophen > 200 ug/mL Chemistry Acid Fast Smear Positive (1st in 7 days) Microbiology Alcohol ≥ 400 mg/dL (0.4%) Chemistry Bilirubin (infant) > 15 mg/dL Chemistry Blasts (new) All newly diagnosed patients Hematology Calcium < 6 or > 13 mg/dL Chemistry Calcium, Ionized < 0.75 or > 1.5 mmol/L Chemistry Carbon monoxide > 20% Chemistry

CKMB Index (CL, POC, Wau, RMC >3.5% along with a “H” CKMB Chemistry Point of Care

Clostridium difficile Positive Chemistry Cryptococcal Ag Positive Blood Bank

CSF cells Verified blasts or unclassified cells (non-oncology patient) Hematology

Culture (any) Suspected bioterrorism agent Microbiology

Culture (Fungal) All blood or CSF; or Zygomycete, dimorphic, Cryptococcus Microbiology

Culture (Hemodialysis) Dialysate/water > 200 CFU/mL Microbiology Cultures: B. anthrasis Isolate Microbiology

Cultures: Beta Hemolytic Strep Isolate from deep wound or sterile body fluid Microbiology

Cultures: Blood (including transfusion bags) Positive (first in 48 hour period) Microbiology Cultures: C. botulinum Isolate Microbiology Cultures: C. diphtheriae Isolate Microbiology Cultures: Clostridium Isolate from deep wound Microbiology Cultures: CSF Positive Microbiology

Culture: Duodenoscope Positive for pathogen; call to GI Supervisor and Infection Control nurse Microbiology

Culture: CRE screen Positive Microbiology Cultures: ESBL – blood, body Fld, sterile site and IP/NH Isolate Microbiology

Cultures: Franscisella tularensis Isolate Microbiology Cultures: H. ducreyi Isolate Microbiology Cultures: H. influenzae Isolate from epiglottis Microbiology Cultures: CRE – Blood, body fld, sterile site and IP/NH Isolate Microbiology

Cultures: Listeria Isolate Microbiology Cultures: MRSA Isolate Microbiology Cultures: N. meningitidis Isolate from sterile Microbiology Culture: Streptococcus pneumonia IF Ceftriaxone resistant Microbiology Cultures: TB Positive (1st in 7 days if AFS is neg) Microbiology Cultures: Vibrio cholerae Isolate Microbiology Cultures: VISA or VRSA Isolate Microbiology Cultures: VRE Isolate Microbiology Cultures: Yersinia pestis Isolate Microbiology

Culture/Smear, any Discrepant result from preliminary, gram, or identification Microbiology

D Dimer > 230 Central Lab, RMC and Waupun Hematology

Digoxin > 2.5 ng/mL Chemistry Digoxin (dialysis) > 2.0 ng/mL Chemistry Dilantin (Phenytoin) > 25 ug/mL Chemistry Fibrinogen < 80 mg/dL Hematology

Gentamicin (peak or random) > 12 ug/mL Chemistry

Test Critical Value Department Glucose (up to 1 day) < 30 or > 200 mg/dL Chemistry Glucose (1 day – 1 year) < 40 or > 400 mg/dL Chemistry Glucose (1 year – adult) < 50 or > 400 mg/dL Chemistry Gram stain: CSF Positive organisms Microbiology Gram stain: Joint Fluid Positive organisms Microbiology Gram stain: Peritoneal Dialysis (PD) Fluid Positive organisms Microbiology Gram stain: Sterile site (incl. blood transfusion bags) Positive organisms Microbiology HCO3 < 10 or > 40 Chemistry HCO3 (venous) < 10 or > 40 Chemistry Hematocrit (adult) < 20 or > 60% Hematology Hematocrit (infant) < 31 or > 70% Hematology Hemoglobin (adult) < 7 g/dL or > 20 g/dL Hematology Hemoglobin (infant) < 10.0 g/dL or > 23 g/dL Hematology Herpes Positives on sterile sites or on eyes Microbiology HIV (significant exposure, including intrapartum) Positive Blood Bank Influenza Molecular Positives on Inpatients Special Chem Respiratory Syncytial Virus (RSV) Molecular Positive (Age < 3 months)

KOH Wound or sinus/nasal specimen with nonseptate hypae; positive CSF; deep fungal morphology

Microbiology

Lactic acid > 3 mmol/L Chemistry Lead (0 – 15 years) ≥ 20 ug/dL Sp Chemistry Lead (16 years and older) ≥ 40 ug/dL Sp Chemistry Legionella urinary antigen Positive Blood Bank Lithium > 2.0 mEq/L Chemistry Magnesium < 1 or > 4.7 mg/dL Chemistry Methemoglobin > 30% Chemistry Myoglobin (core lab & POC) ≥ 200 ng/mL Chemistry pCO2 (arterial) < 20 or > 70 mm/Hg Chemistry pH (arterial) < 7.2 or > 7.6 Chemistry pH (cord) < 7.2 Chemistry pH (venous) < 7.2 or > 7.6 Chemistry Phenobarbital > 65 ug/mL Chemistry Phosphorus < 1.0 mg/dL Chemistry Platelets < 20K or > 900K Hematology Platelets (OB patients) < 100 K/uL Hematology Platelets (oncology) ≤ 10K Hematology pO2 (arterial) < 45 mm/Hg Chemistry pO2 (capillary) < 20 mm/Hg Chemistry Potassium (0 – 1 year) < 2.8 or > 6.9 mEq/L Chemistry Potassium ( > 1 year – adult) < 2.8 or > 6.2 mEq/L Chemistry

Procalcitonin > 2.0 ng/mL (all called if < 3 days old)

Chemistry

Prothrombin – INR ≥ 5.0 Hematology PTT > 100 Hematology Reference Lab Results Critical results called to CLW Salicylate > 30 mg/dL Chemistry Schistocytes 4+ on smear Hematology Sickle Cells Any present Hematology

Smear, blood Any new blood parasite or intracellular bacteria or yeast. Hematology

Sodium (< 1 year) < 125 or > 150 mEq/L Chemistry Sodium (> 1 year) < 120 or > 160 mEq/L Chemistry Streptococeal urinary antigen Positive Urinalysis Tegretol (Carbamazepine) > 15 ug/mL Chemistry Theophylline > 20 ug/mL Chemistry Tobramycin (peak or random) > 12 ug/mL Chemistry Tobramycin (trough) > 2 ug/mL Chemistry

Test Critical Value Department Troponin ≥ 0.5 ng/mL Chemistry Troponin (POC) > 0.6 mg/mL Point of Care Urine: Ketones ≥ 80 mg/dL (if glucose ≥ 1000) Urinalysis Urine: RBC casts Present Urinalysis Urine: Reducing substances (≤ 2 years) Positive Urinalysis Valproic Acid (Depakote) > 120 ug/mL Chemistry Vancomycin (peak or random) > 45 ug/mL Chemistry Vancomycin (trough) > 25 ug/mL Chemistry WBC (infant) < 5K or > 30K Hematology WBC (adult) < 2K or > 30K Hematology WBC, Absolute Neutrophil Count < 0.5K Hematology WBC, CSF > 10 with > 50% segs Hematology

Consultants Laboratory Call List Important Personal or Public Health Results

REVISED 10/7/15 The client is called upon completion of the test if the facility is open; otherwise the practitioner will be called within 24 hours between the hours of 8:00 am – 5:00 pm, 7 days a week.

Test Value Department Cord blood DAT Positive Blood Bank Giardia Specific Antigen (GSA) Cryptosporidium Specific Antigen (CSA)

Positive Microbiology

Culture, throat Positive for Strep A if rapid was negative; called only to Pediatrics on Sat/Sun

Microbiology

Culture, stool Growth of stool pathogen or Shigatoxin positive

Microbiology

Culture N. gonorrhoeae Microbiology Outbreak isolates Positive Microbiology/other (Test is referenced out)

Respiratory Syncytial Virus (RSV) Molecular Positive (Age > 3 months) Microbiology

MRSA screen VRE screen

Positive Microbiology or Special Chemistry

Gonorrhea (GC) or Chlamydia (by SDA) Positive Special Chemistry

Clostridium difficile (OP or discharged ED) Positive Chemistry

Hepatitis A IgM Positive Chemistry MRSA Culture (OP.or discharged ED) Positive Microbiology ESBL – Nonsterile site / urine (OP or discharged ED)

Positive

VRE Culture (OP or discharged ED) Positive Microbiology

Acid Fast Smear (OP. or discharged ED) Postive Microbiology

AFB Culture, if smear positive Positive Microbiology

Surgical Prosthesis Culture or Gram Stain Positive Microbiology

Environmental for CRE Positive Microbiology Bordetella Pertussis Culture or PCR Positive Microbiology/send out

Outpatient = Not inpatient, Nursing Home resident, or currently in Emergency Department

Reflex Testing Reflex testing allows a physician to order a test that will automatically reflex to additional testing if the results of the initial test fall within certain criteria. These criteria are based on good medical practice and are standard operating procedure for all patients. The following tests have been set up by the Medical Director of Consultants Laboratory. These tests will always reflex to the tests indicated, at an additional charge, when the criteria established have been satisfied indicating that the performing of the additional testing is medically necessary.

INITIAL TEST RESULT SECOND TEST

Acid Fast Culture Growth of Acid Fast Bacillus

Mycobacteria Isolate Identification (Wisconsin State Lab of Hygiene). If ID is M. tuberculosis, then susceptibility. Other Mycobacteria, susceptibility done on request.

Acid Fast Smear Acid Fast Bacilli observed

Mycobacterium Tuberculosis PCR testing at Wisconsin State Lab of Hygiene

Antibody Screen Positive Antibody identification and 2 units of antigen typed crossmatched blood for banded patients.

Antibody Screen (Outpatient OB patients)

Positive Antibody identification

Antibody Screen on Surgical Patient Positive Crossmatch Antibody Screen with Crossmatch Positive Antigen typing for Crossmatches Antinuclear Antibody Screen Positive Antinuclear Antibody Titer

Bacterial Cultures Positive for pathogens

Organism identification and/or antibiotic sensitivity per CLSI recommendations; may include reference lab referral

C. difficile by EIA (antigen and toxin) Invalid or Inconclusive

C. difficile by PCR

Cord Blood from Rh negative Mother ABO, Rh and DAT CPK with reflex to MB Abnormal CKMB Culture if indicated Urinalysis Positive Urine culture Direct Coombs in recently transfused patient

Positive Elution Studies

Direct Coombs on Cord Blood Positive ABO, Rh, Ab Screen, Elution, and Bilirubin Fetal Screen Positive Quantitative Kleihauer Betke (to Theda Clark) Fungal Cultures Positive Fungal Identification Hepatitis B Surface Antigen Positive Hepatitis B Surface Antigen Neutralization Hepatitis C Antibody (unless ordered as No Reflex)

Positive Hepatitis C RNA RT-PCR

HIV Test Positive Multispot Lipid (LPD+R) Trig > 400 Direct LDL

Lyme Positive or Equivocal

Western Blot Lyme

Malaria Smear Positive Intracellular Malarial Organism ID (sent to State)

Protein Electrophoresis, Serum & Urine Abnormal Immunofixation Rapid Strep A Screen Negative Strep only or Throat Culture Reflex Urine Dipstick Positive Urine Microscopic Rh Type Negative Du Type (on newborns only) TSH (TSHRF) Abnormal Free T4

Billing and Collection Information Consultants Laboratory offers several choices for the billing of laboratory testing services. In order to properly bill for testing, Consultants Laboratory depends on our clients to provide us with complete billing information. If this information is not included on the original requisition, we will contact your office to request additional information. Consultants Laboratory’s Federal Tax ID number is 39-1528550. Client Account Billing Clients receive itemized statements on a monthly basis. Statements are generated within five business days following the month during which services are rendered. Statements include the date of service, patient name, physician code, CPT code, test name, and test price. Statements are considered to be correct unless the Billing Department is notified within 30 days of the statement date. Notifications of transfers/rebillings must be made to the Billing Office within this timeframe in order to ensure timely billing. Requests received after 30 days may not be processed. Payment terms are net 30 days. Acceptable payment methods are cash, check, or credit card. Client Account Billing – Nursing Homes (SNF) Skilled Nursing Facilities (SNFs) are required to submit all Medicare claims for services provided to their residents who are covered under a Part A stay. (Section 4432 (b) of the Balanced Budget Act (BBA) of 1997.) For services provided to patients covered under Medicare Part A, CLW will bill the Nursing Home. Nursing Homes are provided a weekly audit to ensure status accuracy prior to submitting claims or charges. Please notify our Billing Department with the status of your patients. Third Party Billing Consultants Laboratory will bill third party commercial insurances, Medicare, and Wisconsin Medicaid directly. An appropriate diagnosis code is required for each test ordered. To avoid incomplete or misinformation, we recommend that a copy (front and back) of the patient’s insurance card be attached to the test request form. If the billing information is incomplete, the client will be required to assume responsibility and will be bi lled for all charges. Consultants Laboratory does not bill Medicaid for states other than Wisconsin. The following information must appear clearly on the requisition form:

� Patient Legal Name (Last, First, Middle). No nicknames, please. � Date of Birth (month, date, year) � Sex � Referring Physician Information – Please provide first and last names. � Patient phone number � Bill to – Check type of billing wanted. � Medicare /Medicaid Number � Insurance Subscriber Name � Insurance Subscribers Relationship to Patient � Billing Party Address � Primary Insurance Company Name � Insurance Company Address � Insurance ID number � Group number � Responsible Party Employer � Diagnosis Code(s) for tests ordered � Date of injury and Employer name (for Workers Compensation claims) � Provider signature, if no other signed order

In today’s regulated healthcare climate, diagnosis codes are mandatory. When requisitions arrive without a valid or covered diagnosis code or a signed waiver (if necessary), the laboratory may not be reimbursed for services provided. Please assist us by providing this required information at the time you order the test. If you have any questions regarding this issue, please contact our Billing/Coding Department.

Billing and Collection Information (cont.) The Balanced Budget Act of 1997 requires physicians to provide diagnostic or other medical information when ordering services furnished by another entity furnishing the services. Consultants Laboratory is not allowed to determine what code should be used for the laboratory services. Only the ordering physician or authorized provider is authorized to determine the reason that the test is ordered. Advanced Beneficiary Notice (ABN) If a test identified by Local Medical Review Policies as a limited coverage test is ordered, a Medicare recipient must be informed that Medicare may deny payment for the service and that they will be responsible for payment to Consultants Laboratory. You and the patient should complete the ABN and submit it along with the Laboratory requisition. ABN forms can be ordered from Consultants Laboratory’s Supplies Department. If the patient requests a copy of the ABN, make a copy after the patient has signed the ABN. The original ABN should be attached to the requisition. (See Appendix for a copy of the ABN Form) The ABN must be completely filled out including:

� Patient’s full name � Date of service (Month, Day and Year) � Test(s) ordered must be checked � The reason why Medicare may deny payment must be checked (do not check all reasons) � Patient signature with date

If a patient refuses to sign the ABN but still wants the tests performed, sign the bottom of the form indicating that the patient refused to sign. The patient will still be responsible for payment of the testing if they choose to have the service after refusing to sign the ABN. Your facility will be billed at the Medicare reimbursement rate when no ABN is obtained and there is no Medicare acceptable diagnosis. (HCFA views write-offs in these instances as an inducement.) Limited coverage tests are backlit in blue on the Laboratory requisition. Genetic Testing – Preauthorization Required A genetic test is the analysis of human DNA, RNA, chromosomes, proteins, or certain metabolites in order to detect alterations related to a heritable disorder. Genetic tests are conducted for a number of purposes including predicting disease risk, newborn screening, determining clinical management, identifying carriers and establishing prenatal or clinical diagnoses or prognosis in individuals, families, or populations. In the 2015 edition of the AMA CPT Coding Manual, genetic tests have been identified with CPT codes 812xx, 813xx, 814xxx and 815xx. Most insurers require prior authorization for genetic testing. Tests requiring preauthorization vary by insurers and change frequently. Additionally, many insurance plans have genetic counselors and require their involvement. Consultants Laboratory will initiate a prior authorization when these tests are ordered; however, your office may be contacted if additional information is needed for the prior authorization. Prior authorizations can take up to 5 days to be approved by the insurers so patients may need to wait before the sample can be collected. Providers and patients need to be aware of out of pocket costs associated with this testing should the insurer deny payment. Cost of testing can range from hundreds to thousands of dollars.

Specimen Collection The quality of test results is dependent upon the proper collection and handling of the specimen submitted. The patient must be properly prepared and identified, the proper specimen for the tests requested must be collected by the correct method, and the specimen must be prepared for transport and stored at the correct temperature. Refer to the specific collection requirements in the Alphabetical Listing of Tests section of this manual. Check all blood collection tubes and swabs for expiration dates. Unfortunately, we cannot accept specimens collected with outdated materials. Surgical and cytology pathology specimens must be labeled and requisitions prepared in the room where the surgical procedure is performed. For a color chart of swabs, transport containers and tube types, please refer to the CLW Specimen Collection Chart in the Appendix. Identification & Labeling Verify the patient’s identification. All specimens submitted must be properly identified with a legibly printed patient’s name (legal first and last), the date of birth in the format of MM/DD/YYYY and the initial of the phlebotomist. The date and time the specimen was collected must be provided on the requisition/order. All specimens should be labeled in the presence of the patient. NOTE: When insufficient or inconsistent patient information is submitted, Consultants Laboratory will request that a new specimen be obtained. Processing Careful attention to processing procedures will eliminate common errors that can compromise the integrity of the specimen and, consequently, the test results.

Submit the proper specimen tube and volume as indicated in the specific test listing. Please note: Minimum required volumes are listed for some tests. A minimum volume listing is the amount of serum or plasma required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test, perform confirmatory, or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected. Keep specimen tubes at room/ambient temperature (18-25°C or 64.4-77°F) prior to centrifugation. EXCEPTIONS: Some tests require immediate icing after collection as indicated in test listing.

Clot or serum separator tube specimens will be reje cted if not spun within 2 hours of collection time. Allow SST tubes to clot at room temperature (ambient) a minimum of 30 minutes, but optimally no longer than 60 minutes before centrifuging. (CLSI Guidelines recommend no more than 2 hours.)

Blood should be spun for 10 minutes at 1100 RCF that equates to 3500 RPM on most centrifuges. (Centrifuges provided by Consultants Laboratory will have optimal speeds posted on each unit.) Please call Customer Service if you need help in computing the speed of your centrifuge.

Serum and plasma specimens drawn in gel separator tubes should be sent to the Laboratory in the original tube when specimen transport and storage instructions allow it. Use plastic transport tubes when pour off is indicated. Clearly label the transport tube PLASMA if submitting that type of specimen. If the gel separator does not cover the cells completely after centrifugation, the SST or PST tube cannot be respun. The serum/plasma needs to be pipetted off the original tube into a transport tube. That transport tube can then be spun to separate the remaining cells. The clear serum/plasma should then be placed into a new transport tube. If more than one test requires a frozen specimen, please freeze individual aliquots for each test.

Specimen Collection (cont.) Storage & Transport After centrifugation, store tubes at the temperature indicated in the catalog listing, keeping in mind transport time needed before specimen will reach testing laboratory while watching specimen stability limits. Couriers will transport the specimen at the temperature the sample was stored at the time of pickup. To minimize hemolysis, all centrifuged tubes should be kept upright during storage and transport. (Use foam racks available from laboratory.) Uncentrifuged specimens may be placed in foam racks or submitted in biohazard bags. When submitting urine, stool, or body fluid specimens, make sure that specimen containers are tightly capped to prevent spillage. Needles must be removed from all syringes that are submitted. To ensure safety when transporting these specimens, samples should be submitted in completely sealed biohazard transport bags. A separate bag should be used for each requisition and the specimens related to that requisition. If a requisition has samples that have different storage requirements such as room temperature, refrigerated, and frozen, place the requisition with the refrigerated specimen and place all room temperature specimens in one bag and frozen specimens in another bag. Care must be taken to prevent specimens from experiencing extreme temperature fluctuations during winter and summer transport. To minimize the risk of hemolysis, do not place whole blood specimens in direct contact with cold packs. Call our Customer Service Department if you have specific transport questions or needs. Lockbox Samples: Proper Packaging For sample integrity, proper packaging of lockbox samples is important. Without additional protection inside an unsheltered lockbox, a sample will reach the outside temperature in about 15 minutes! Studies were done at Consultants Laboratory on the following conditions and based on the lockbox being placed outside in the elements without shelter or shade. In extreme heat or cold, extra precautions or alternate delivery options are needed and stability will probably be shorter than what is listed. Definitions: ConstaTemp small blue cooler (brick size) with frozen or ambient packs that fit into the inside pockets. Cooler (six pack size) used as a overpack/overcooler Ambient pack - at room temperature can help soak up heat or cold If air temperature is 75-90ºF. Goal is to keep samples from getting too warm.

Refrigerated samples: � ConstaTemp with ONE FROZEN Gel pack. (Two frozen packs will make the sample freeze) � Cooler with ONE FROZEN Gel pack. � Place in Lockbox � *Sample will be stable for approximately 6 hours � NOTE: if only the cooler is used with an FROZEN pack (no ConstaTemp), sample stays cold

enough for 30 minutes. Room Temp samples:

� ConstaTemp with ONE AMBIENT Gel Pack � Cooler � Place in lockbox � *Sample will be stable approximately 1.5 hours

If air temperature is 46-75ºF Goal is to stabilize samples in moderate temperatures)

Refrigerated samples: � ConstaTemp with ONE FROZEN Gel Pack � Cooler � Place in lockbox � *Sample will be stable approximately 6 hours

Room Temp samples:

� ConstaTemp with TWO AMBIENT Gel Packs � Cooler

� Place in lockbox � *Sample will be stable approximately 2 hours

If air temperature is < 32ºF Goal is to keep samples from freezing

Refrigerated samples: � ConstaTemp with TWO AMBIENT Gel Pack � Cooler � Place in lockbox � *Sample will be stable approximately 45 minutes

Room Temp samples:

� ConstaTemp with TWO AMBIENT Gel Pack � Cooler � Place in lockbox � *Sample will be stable approximately 1 hour

Specimen Retention Except for unstable specimens, Consultants Laboratory retains most specimens for 5 days. If a test must be added or a repeat is necessary, please contact our Customer Service Department as soon as possible. Due to stability and specimen requirements, not all tests can be re-ordered or added on to existing specimens.

Order of Collection When drawing multiple tubes on a patient, follow this order of draw to ensure a quality sample. Order of Draw and Fill

1. Blood cultures (if needed) 2. Blue top (Sodium Citrate) 3. Red or SST / Vacuette® 4. Green top / PST (Heparin tubes) 5. TB QuantiFERON® Gold tubes (set of three) 6. Purple top (EDTA-K3 tubes) 7. Gray (Oxalate/Fluoride tubes) 8. Black (Buffer Sodium Citrate tubes)

NOTE: if the following specialty tubes are required, please follow these collection order guidelines:

� Yellow ACD – draw after EDTA tube in listing above � Royal blue with additive – draw in the same order as the EDTA tube in the listing above. � Royal blue without additive – draw first

Indwelling Catheter Collection (PICC, Central Line) Our phlebotomists do not perform indwelling catheter draws (exception: specifically trained Laboratory Assistants for certain hospital situations). We do offer bedside assistance to help with tube types, filling, and labeling. When a resident/patient has an Indwelling Catheter that the blood is to be obtained from, clearly indicate this need so we don’t draw peripherally.

Non-medication Catheter

1. Have ready, the appropriate size of syringe and the blood tubes needed for the tests ordered. a. Plan for the volume of blood needed. b. Order of fill is important to avoid cross contamination of tube additives. Order is Blood Cultures -

Blue - Red or SST - Green or PST - Lavender - Gray - Black c. Blood starts to clot once removed from the body, being timely with filling the tubes is important.

2. Wipe lumen with alcohol wipe, allow to dry. 3. Flush catheter with saline. 4. Using the same flush syringe, withdraw 6 mL of waste. Discard into sharps following your facility protocol. 5. Wipe lumen with alcohol, allow to dry. 6. Connect the sample syringe and withdraw the volume of blood needed. 7. Remove syringe. Use a safe transfer device (recommended to prevent a needlestick) to transfer blood

immediately into tubes, in order of fill. 8. As you fill the tubes, immediately mix gently 8-10 times. 9. Properly dispose of syringe and transfer device. 10. Flush catheter with appropriate solution of saline or heparin. 11. Label the tubes with Last Name, First Name (legal, no nicknames), date of birth in mm/dd/yyyy format, date

and time of collection, and collector’s initials. This same information is recorded on the requisition and must match for patient identification and safety.

12. Process and transport the specimen tubes according to the test requirements.

Medication Catheter

*If coagulation samples are ordered, such as an INR , and heparin is infusing, a peripheral blood samp le is required.

1. Stop infusion for two (2) minutes. a. TPN requires a two minute pause followed by a saline flush for all lumens. The sample must be

collected from the non-TPN lumen. b. Document the medication infusing on the requisition. This is important for result interpretation.

2. Follow procedure as noted in the Non-Medication Catheter 3. Restart infusion per your facility policy.

24 Hour Urine Collection – Special Instructions

Suitable containers, preservatives, and Collection Instruction Pamphlets are available from our Customer Service Department (929-9300 ext. 5800). If a preservative is required (see Alphabetical Listing of Tests), it is important that the designated preservative be in the collection container at the start of collection. The patient should be cautioned that the preservative may be toxic and/or caustic and not to spill or discard the preservative. Instruction Brochures for patients are available upon request. To collect a 24-hour urine specimen, follow these instructions:

• Discard the first morning urine. Collection begins after this urine is voided. • Collect all urine for the next 24 hours so that the morning urine voided on the second day is the final

collection. The specimen should be stored as indicated in the specific test instructions. • Mix the specimen well and measure the total 24 hour urine volume. Record the volume on the test request

form, as well as the patient’s height and weight if a clearance was ordered. If a preservative was added to the urine or none was added, please indicate this on the requisition. Place the requested volume of the well mixed urine in a transport container. Record the start date and time and the end collection date and time on the label and test request form.

Clean Voided Midstream Urine Collections

Urine is normally a sterile body fluid. However, unless the urine specimen is collected properly, it can become contaminated with bacteria from the perineum, prostate, urethra, or vagina. Midstream urine collections should be performed for all cultures, unless ordered to be collected by an alternate procedure. Patients should be given both verbal and written instructions on how to collect a “clean catch” urine. See instructions below. Patient instructions for Midstream Urine Collection

1. Open sterile urine container being careful not to touch inside of container or inside of cover. 2. Place lid upside down on flat surface, 3. Open packet of cleansing towelettes. 4. While continually holding the folds of skin away from the urethral opening, wipe the urethral area once with

each towelette using all three towelettes. 5. Holding the folds of skin away from the urethral opening, begin urinating into the toilet; as you continue to

urinate, bring the sterile container into the stream of urine to collect the specimen. Remove cup from urine stream just before finishing or after the container is about half full.

6. Screw lid back on container, again being careful not to touch inside of lid or container. 7. Label container with patient name, date of birth, and collection date and time.

Microbiology Cultures – Special Instructions

The date and time of the specimen collection must be indicated on the requisition. A specific anatomic source must be indicated on the requisition (i.e. “right leg wound”). It is also important to list any antibiotics that the patient is currently taking. List the antibiotics administered, any known antibiotic allergies, any suspected organism(s), and the patient diagnosis or history. The specimen source must be clearly indicated. The specimen (container, culturette, or other transport media) submitted must be properly identified with the patient’s name (first and last, legibly printed) and a date of birth as a second identifier. Person specific identifiers may include accession number, medical record number, or birth date. Labeling only the outside of the biohazard bag is NOT ACCEPTABLE. See Appendix for a quick reference guide for stool and culture collection and transport and the CLW Specimen Collection Chart.

Specimen Rejection Proper collection and handling of specimens is essential so as not to compromise the accuracy of results from Consultants Laboratory. If a specimen is unacceptable, the Laboratory will contact the client to request a new specimen or to explain the limitations on testing. When a new specimen is requested, a credit will be issued to the account and the test will be billed when a new specimen accompanied by a new requisition is received. The following guidelines are used for rejection of a specimen:

� Quantity not sufficient (QNS) for accurate test results. � Clots in EDTA or Citrate specimens will yield unacceptable results. � The correct ratio of blood to anticoagulant is essential for accurate results. � Uncentrifuged serum specimens received more than 2 hours after collection. Certain constituents

change when left in contact with red blood cells for extended periods of time. � Improper storage of specimens may result in rejection. The Alphabetical Listing of Tests includes

storage requirements. Please follow these instructions carefully. The stability of a specimen is dependent on temperature and time of storage.

� Proper labeling and identification is very important. All specimens must be labeled and accompanied by a Laboratory requisition. Information on the requisition and the specimen must be consistent. Use legal names only, no nicknames, for proper patient identification. A second identifier, such as a birthdate, should also be on the requisition and specimen. In exceptional instances, and with written authorization, the Laboratory will provide testing and final results on unlabeled or mislabeled specimens. Such exceptions apply only when the specimen would be difficult or impossible to obtain again such as body fluids, tissue samples, or timed blood collection specimens. Laboratory associates will contact the client to obtain necessary information.

� Lipemic (turbid) serum or plasma may cause interference with test results. For certain tests, it is recommended that patients fast for 10-12 hours before specimen collection, as a recent meal may cause lipemia (see Alphabetical Listing of Tests for affected tests). Lipemic specimens may be rejected or the Laboratory will ultracentrifuge the specimen and evaluate the lipemia. If a specimen is lipemic, submit as much serum or plasma as possible as ultracentrifugation requires more specimen.

� Grossly contaminated specimen containers. Standard precautions require prompt cleanup and disinfection of potentially infectious spills. Likewise, do not submit specimens with needles attached.

� Hemolysis occurs when the membrane surrounding red blood cells is disrupted and hemoglobin and other intracellular components escape into the serum or plasma. Hemolyzed serum or plasma varies in color from faint pink to bright red, rather than the normal straw color. Grossly or moderately hemolyzed specimens may be rejected and even slight hemolysis may alter certain test results.

Blood Bank Orders and Special Instructions

Patients with orders for Blood, FFP, or Cryoprecipitate transfusion must be banded using the Consultants Laboratory identification system. DO NOT REMOVE the Blood Bank bracelet unless you notify the Blood Bank. Removing the band could result in the need to re-crossmatch blood, causing transfusion delays and additional costs to the patient. Pre-Admission Testing (PAT) Patient samples may be drawn, banded, and crossmatched (or type & screened) up to 5 days before the surgery date provided the following conditions are met:

1. The patient has not been challenged (pregnant or transfused within the past 3 months). 2. There is an adequate supply of blood of that patient’s type available to keep it tagged for up to 5 days. 3. The patient’s Blood Bank ID band is intact upon admission.

Inpatient Blood Bank Samples Samples properly labeled for compatibility testing may be used for 3 days. Autologous Units for Inpatient Procedures Autologous blood must be crossmatched for the recipient to confirm compatibility. The Type & Screen is performed in the event that additional blood is required. To order an autologous crossmatch, follow normal crossmatch ordering. In the comment field, enter in “Autologous Blood”. Autologous donations are coordinated by the Blood Center of Wisconsin. For information about autologous donations or to schedule a patient donation, please call the Blood Center of Wisconsin at: (800)245-3117, extension 6188. Product Availability See Appendix for a list of the blood components that are available and the ordering requirements for those patients. Blood Center Donations For general information regarding blood donations and public blood drives conducted by the Blood Center of Wisconsin, please call 1-800-BeA-Hero (1-800-232-4376).

Therapeutic Drug Sampling Times

Drug

Optimal Sampling Time

Route

Peak

Trough

Carbamazepine (Tegretol) Close to Trough* Oral Within 30 min. before next dose

Digoxin Close to Trough* Oral > 8 hrs. post dose

Gentamicin

Peak & Trough IV 30 min. post completion of IV transfusion Within 30 min. before next dose

Peak IM 60 minutes after IM

dose

NOTE: Dialysis patients must have trough drawn after dialysis Lithium Close to Trough* Oral 12 hrs. post dose

Phenobarbital Close to Trough* Oral Within 30 min. before next dose

Phenytoin (Dilantin) Close to Trough* Oral Within 30 min. before next dose

Theophylline Close to Trough* Oral Within 30 min. before next dose

Tobramycin

Peak & Trough IV 30 min. post completion of IV infusion

Within 30 min. before next dose

Peak IM 60 minutes

after IM dose

NOTE: Dialysis patients must have trough drawn after dialysis Valproic Acid (Depakote, Depakene)

Close to Trough* Oral Within 30 min. before next dose

Vancomycin Peak & Trough(1) IV (60 min. infusion)

1 or 2 hrs. post completion of 60 minute IV infusion

Within 30 minutes before next dose

TDM Dose Information Form should be used to provide Laboratory with dosage information. (See Appendix for form)

* These drugs are presumed to be in steady state concentrations and therefore sampling times are not that crucial. However, levels drawn closer to the trough time will monitor the attainment of therapeutic ranges more effectively. If toxicity is clinically suspected, draw the level closer to the peak.

(1) Vancomycin peak levels can be drawn 1 or 2 hours after the infusion is complete.

NOTE: For information regarding therapeutic drugs not listed on this table, please call Consultants Laboratory’s Customer Service Department.

Alphabetical Listing of Tests ABO & Rh Type

COMPUTER ORDER ENTRY ABORH

SYNONYMS Blood Grouping and Rh (D) Typing; Blood Type; Group & Rh; Part of Type and Screen order. Tests may be ordered separately as ABO Type or as Rh Type.

AVAILABILITY Test performed daily; all shifts; available STAT.

TEST INCLUDES ABO (forward and reverse), and Rh type (two CPT codes). Weak D determination performed (in most cases) if Rh (D) is negative.

SPECIAL INSTRUCTIONS If this test is requested in anticipation of a possible transfusion, the patient must be banded with a unique Blood Bank band, a procedure performed solely by the Laboratory. (Other previously determined groups may also draw and band. Contact the Laboratory). Include the patient's date of birth on all tubes.

SPECIMEN REQUIREMENT Draw blood in one 6 mL or two 3 mL lavender top (EDTA) tubes (unless otherwise directed by the patient label). ACD, CPD, CPDA-1 or heparin anticoagulated blood is acceptable but renders the specimen unacceptable for Antibody Screen or Crossmatch.

STORAGE INSTRUCTIONS Refrigerate (2-8°C). Heparinized plasma stable for 48 hours, EDTA stable for 7 days, whole blood stable for 14 days. Fresh specimen is preferred.

CAUSES FOR REJECTION Specimens that are hemolyzed, contaminated with bacteria or other

contaminants; specimens that are not properly labeled or have discrepant demographics with requisition.

DEPARTMENT Blood Bank ABGs (Arterial Blood Gases)

COMPUTER ORDER ENTRY ABG02 (O2); ABGRS (respirator); ABGRM (room air)

SYNONYMS ABGS; ABG


TEST INCLUDES pH, pCO2, pO2, HCO3, tCO2, O2 Sat, and Base Excess.

SPECIAL INSTRUCTIONS The syringe should contain at least 1 mL of blood. The patient must have acceptable Allen test if drawn arterially.

SPECIMEN REQUIREMENT Draw blood from an arterial puncture using a blood gas syringe.

STORAGE INSTRUCTIONS Send immediately to Lab at room temperature. Specimen should be analyzed within 30 minutes of collection.

Ripon Medical Center: Test within 10 minutes

CAUSES FOR REJECTION Improper collection, handling, or storage.

DEPARTMENT Chemistry

ABGs (Arterial Blood Gases) – Rapid Point Panel (PO C)

COMPUTER ORDER ENTRY RPABG

SYNONYMS ABGS; ABG

AVAILABILITY Test performed daily; all shifts; available STAT. PERFORMED ONLY IN SAH OR.

TEST INCLUDES pH, pCO2, pO2, HCO3, tCO2, O2 Sat, Base Excess, Hgb, Hct, CarboxyHb, OxyHb, MetHb, DeoxyHb, Sodium, Potassium, Chloride, Ionized Calcium and

Glucose.

SPECIAL INSTRUCTIONS The syringe should contain at least 0.5 mL of blood. The patient must have acceptable Allen test if drawn arterially.

SPECIMEN REQUIREMENT Draw blood from an arterial puncture using a blood gas syringe or from an arterial line.

SPECIMEN MINIMUM VOLUME 0.5 mL of whole blood

STORAGE INSTRUCTIONS Specimen should be analyzed immediately after collection.


DEPARTMENT Point of Care

ABGs (Arterial Blood Gases) – Rapid Point Panel plu s Lactate (POC)

COMPUTER ORDER ENTRY RPAB2

SYNONYMS ABGS; ABG

AVAILABILITY Test performed daily; all shifts; available STAT. PERFORMED ONLY IN SAH ICU.

TEST INCLUDES pH, pCO2, pO2, HCO3, tCO2, O2 Sat, Base Excess, Hgb, Hct, CarboxyHb, OxyHb, MetHb, DeoxyHb, Sodium, Potassium, Chloride, Ionized Calcium, Glucose and Lactate.







ABG Blood Gas/Chemistry Panel (POC) – ED EPOC Panel

COMPUTER ORDER ENTRY PCABG

SYNONYMS ABGS; ABG

AVAILABILITY Test performed daily; all shifts; available STAT. PERFORMED ONLY IN ST. AGNES HOSPITAL EMERGENCY DEPARTMENT

TEST INCLUDES pH, pCO2, pO2, HCO3, tCO2, O2 Sat, Base Excess, Hgb, Hct, Sodium, Potassium, Ionized Calcium, Glucose and Lactate.







ABG Blood Gas/Chemistry Panel (POC - Capillary) – N ursery EPOC Panel

COMPUTER ORDER ENTRY PCCBG

SYNONYMS Capillary ABG

AVAILABILITY Test performed daily; all shifts; available STAT. PERFORMED ONLY IN ST. AGNES HOSPITAL NURSERY

TEST INCLUDES pH, pCO2, pO2, HCO3, tCO2, O2 Sat, Base Excess, Hgb, Hct, Sodium, Potassium, Ionized Calcium, Glucose and Lactate.


SPECIMEN REQUIREMENT Draw blood from a heal stick puncture using an EPOC Care-Fill Capillary tube.

SPECIMEN MINIMUM VOLUME 92 uL of whole blood




Acetaminophen Level

COMPUTER ORDER ENTRY ACETA

SYNONYMS Tylenol


INTERFERENCES HAMA or Heterophile antibodies may interfere with this test. Possible clinical discrepancies may be resolved by ordering HAMA or Heterophile antibody detection.

Interpretation of results should be done in the context of the overall clinical presentation of the patient, including symptoms, clinical history, data from additional tests and other appropriate information.

SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube.

Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 4 hours Refrigerate (2-8°C) (spun): up to 48 hours SPECIMEN MINIMUM VOLUME 0.3 mL serum

STORAGE INSTRUCTIONS See above.


Acetone (Qualitative)

COMPUTER ORDER ENTRY BHOB

SYNONYMS See Beta-Hydroxybutyrate


ACT (Point of Care)

COMPUTER ORDER ENTRY ACT

AVAILABILITY Test performed daily; all shifts; available STAT. PERFORMED ONLY IN SAH ICU, CATH LAB AND OR.

SPECIAL INSTRUCTIONS If blood is obtained by venipuncture, the venipuncture should be clean and the first several mL of blood discarded to avoid contamination of the sample with tissue thromboplastin. Blood should not be taken from heparinized indwelling

catheters or other anticoagulant lines without thoroughly flushing the line. Withdraw and discard at least 7 mL of waste before obtaining the testing samples.

If testing fresh whole blood, samples should be run as quickly as possible after being drawn. Baseline samples, which contain no anticoagulant, should be run within one minute. Heparinized samples should be run within two minutes.

SPECIMEN REQUIREMENT Fresh whole blood samples. Draw in appropriate syringe.





ACTH (Adrenocorticotropic Hormone)

COMPUTER ORDER ENTRY LACTH

AVAILABILITY Test performed at a Reference Laboratory.

SPECIAL INSTRUCTIONS ACTH should be drawn between 7AM and 10 AM.

SPECIMEN REQUIREMENT Draw blood in an iced lavender (EDTA) top tube. After venipuncture, immediately immerse the tubes in an ice bath. Morning specimen (7-10am) is preferred.

SPECIMEN MINIMUM VOLUME 0.8 mL of EDTA plasma

STORAGE INSTRUCTIONS Centrifuge immediately in a refrigerated centrifuge. Send frozen aliquot to the Reference Laboratory.

DEPARTMENT Test performed at a Reference Laboratory

ACTH (Adrenocorticotropic Hormone) STIMULATION

COMPUTER ORDER ENTRY CORTR (random cortisols are ordered per provider instructions)

SYNONYMS Cosyntropin Stimulation, Cortrosyn Stimulation

AVAILABILITY Test performed daily; all shift; available STAT.

TEST INCLUDES Baseline cortisol and an additional timed cortisol, typically drawn 30 and/or 60 minutes post cosyntropin dose, depending on the provider order.

SPECIAL INSTRUCTIONS Testing is most often performed in Ambulatory Infus ion . Draw blood for baseline cortisol. Patient is given an injection of Cosyntropin IV or IM. Additional timed cortisol specimens are drawn according to provider instructions. (If no protocol is directed, the second specimen should be drawn at 30 minutes after administering Cosyntropin.)

SPECIMEN REQUIREMENT Draw blood in a green (Lithium heparin) PST (full tube) or a SST. Centrifuge

and send specimen in the original tube. Stability: Room Temp (unspun): optimally up to 1 hour

Room Temp (spun): up to 8 hours Refrigerate (2-8°C) (spun): up to 48 hours

SPECIMEN MINIMUM VOLUME 0.3 mL serum or plasma


CAUSES FOR REJECTION Sever hemolysis

DEPARTMENT Chemistry (Central Laboratory Fond du Lac)

AFB Smear (TB)

COMPUTER ORDER ENTRY AFBST

SYNONYMS AFS smear, Acid Fast smear; TB Smear

AVAILABILITY Test performed daily.

TEST INCLUDES Acid fast stain (order acid fast culture separately). If acid fast bacilli are identified on a respiratory specimen and a culture is ordered, the specimen will be sent to the WI State Lab of Hygiene for Mycobacterium tuberculosis complex PCR.

SPECIAL INSTRUCTIONS Send to the Laboratory promptly.

SPECIMEN REQUIREMENT Sputum: First morning specimen. Saline induction is acceptable. Collect three specimens. Each of the three consecutive sputum (not saliva) specimens should be collected in 8-24 hour intervals, with at least one being an early morning specimen. Urine: At least 40 mL of the first morning urine collected on three consecutive days. Swab specimens: Amies or Stuart are undesirable due to low yield, aspirate if possible. Induced sputa: Use sterile hypertonic saline (avoid nebulizer reservoir and tap water). Blood: Collect in SPS yellow cap tube available from the Laboratory. Tissue: Submit 1g Fluid: Submit 5 mL minimum CSF: 2 mL

STORAGE INSTRUCTIONS Refrigerate (2-8°C), transport to the Laboratory promptly.

CAUSES FOR REJECTION 24 hour pooled specimen or saliva specimen; frozen specimen; desiccated specimen; specimen received in fixative; swabs in gel medium.

DEPARTMENT Microbiology

AFP (Alpha-Fetoprotein) Tumor Marker

COMPUTER ORDER ENTRY LAFP



SPECIMEN MINIMUM VOLUME 0.8 mL of serum

STORAGE INSTRUCTIONS Centrifuge and send refrigerated aliquot to Reference Laboratory.


Albumin

COMPUTER ORDER ENTRY ALB


SPECIMEN REQUIREMENT Central Laboratory Fond du Lac, Waupun Memorial Hos pital, Dialysis Centers, and Convenient Care: Draw blood in a green (Lithium heparin) PST (full tube). Centrifuge and send specimen in the original tube.

Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerate (2-8°C) (spun): up to 4 days

Ripon Medical Center and all other sites: Draw blood in a SST. Centrifuge and send specimen in the original tube.

Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours

Refrigerate (2-8°C) (spun): up to 5 days SPECIMEN MINIMUM VOLUME 0.4 mL serum or plasma


CAUSES FOR REJECTION Sodium Fluoride/Potassium Oxalate anticoagulant.


Alcohol

COMPUTER ORDER ENTRY ALC

SYNONYMS See Ethanol


Alcohol, Urine

COMPUTER ORDER ENTRY UALC

SYNONYMS See Ethanol, Urine


Aldolase

COMPUTER ORDER ENTRY LADOL

AVAILABILITY Test performed Monday through Friday at a Reference Laboratory.

SPECIMEN REQUIREMENT Draw blood in a SST.

SPECIMEN MINIMUM VOLUME 0.5 mL of serum (2 mL recommended)



Aldosterone

COMPUTER ORDER ENTRY LALDO


SPECIMEN REQUIREMENT Draw blood in a SST.

SPECIMEN MINIMUM VOLUME 0.5 mL of serum (1 mL recommended)



Alkaline Phos (Alkaline Phosphatase)

COMPUTER ORDER ENTRY ALP

SYNONYMS Alk P'tase; Alk Phos


SPECIAL INSTRUCTIONS Fasting for 8 hours is recommended.




Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerate (2-8°C) (spun): up to 5 days SPECIMEN MINIMUM VOLUME 0.4 mL serum or plasma


CAUSES FOR REJECTION EDTA anticoagulant.


ALT (SGPT)

COMPUTER ORDER ENTRY ALT

SYNONYMS SGPT; GPT; Alanine Aminotransferase



Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerate (2-8°C) (spun): up to 5 days Ripon Medical Center and all other sites: Draw blood in a SST. Centrifuge

and send specimen in the original tube. Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerate (2-8°C) (spun): up to 5 days SPECIMEN MINIMUM VOLUME 0.4 mL serum or plasma


CAUSES FOR REJECTION Hemolysis. Potassium Oxalate/Sodium Fluoride anticoagulant.


Ammonia

COMPUTER ORDER ENTRY NH4

SYNONYMS NH3


SPECIAL INSTRUCTIONS Due to limited stability send the specimen promptly to the Laboratory. The tube should be filled completely and kept stoppered. Place the tube ON ICE. Centrifuge, separate plasma from cells within 15 minutes of collection. Pipette off plasma into aliquot tube and freeze immediately. Ammonia concentrations increase rapidly upon standing. Patient should not smoke after midnight before the AM draw. Heavy smokers should shower before the draw.

SPECIMEN REQUIREMENT Draw blood in a green (Lithium heparin) PST (full tube) or plain green Lithium heparin (full tube). Place the tube ON ICE.

NO FINGERSTICKS.

Stability: Centrifuge, pipette off plasma into an aliquot tube within 15 minutes of collection and freeze immediately. Frozen plasma stable up to 8 hours.

STORAGE INSTRUCTIONS FREEZE plasma immediately. See above.

CAUSES FOR REJECTION Hemolysis; excessive time lapse in processing (> 15 minutes); non-frozen specimen; use of other anticoagulants.


Amylase

COMPUTER ORDER ENTRY AMY (serum); FAMY (fluid)


SPECIAL INSTRUCTIONS If body fluid, indicate type on the requisition.





Fluids : 1 mL body fluid in a green top (Lithium heparin) tube or with no anticoagulant added. Indicate type of fluid on the requisition and the tube.

SPECIMEN MINIMUM VOLUME 0.4 mL serum or plasma STORAGE INSTRUCTIONS See above. CAUSES FOR REJECTION EDTA, Sodium Citrate, Potassium Oxalate/Na Fluoride anticoagulants


Amylase, Urine

COMPUTER ORDER ENTRY UAMYR (random); UAM24 (24 hour collection)


TEST INCLUDES Amylase on a random or timed refrigerated urine collection.

SPECIAL INSTRUCTIONS Indicate the total urine volume and collection time period on the requisition.

SPECIMEN REQUIREMENT 10 mL aliquot from a well-mixed random or timed urine specimen.

SPECIMEN MINIMUM VOLUME 1.0 mL urine

STORAGE INSTRUCTIONS Refrigerate (2-8°C) during and after collection.

CAUSES FOR REJECTION Presence of acid preservative.


ANA Screen & Titer if Positive

COMPUTER ORDER ENTRY ANA

SYNONYMS ANA; Antinuclear Antibodies; FANA; Antibodies against Nuclear Antigens

AVAILABILITY Test performed Monday through Friday on the AM shift.

TEST INCLUDES ANA screen by Immunoflourescence and pattern interpretation if positive. Titer is performed if ANA is positive.

SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Refrigerate (2-8°C) (spun): up to 3 days

Frozen (-10 to -20°C): up to 5 days



CAUSES FOR REJECTION Gross hemolysis; lipemia; bacterial contamination.

DEPARTMENT Special Chemistry (Central Laboratory Fond du Lac)

Antibody Identification

COMPUTER ORDER ENTRY ABID

SYNONYMS Antibody ID (Cell Panel); Antibody Identification, RBC

AVAILABILITY Test performed on all shifts. Ripon Medical Center sends all Antibody Identifications to the Community Blood Center in Appleton.

TEST INCLUDES RBC Antibody Identification. Test reflexes following a positive Blood Bank Antibody Screen. RBC Antigen testing as indicated.

SPECIAL INSTRUCTIONS Include the patient's transfusion, pregnancy, and/or current medication history.

SPECIMEN REQUIREMENT Draw blood in two 6 mL lavender top (EDTA) tubes. Special labeling instructions may apply. See ABO & Rh.

STORAGE INSTRUCTIONS Room temperature up to 24 hours. Refrigerate (2-8°C) up to 72 hours.

CAUSES FOR REJECTION Specimen not properly labeled; gross hemolysis; SST specimen.

DEPARTMENT Blood Bank

Antibody Screen (Red Cell)

COMPUTER ORDER ENTRY ABSC

SYNONYMS Indirect Antiglobulin Test; Antibody Detection Test; Indirect Coombs; Erythrocyte Antibody Screen


TEST INCLUDES Erythrocyte Antibody detection. Positive Antibody Screen reflexes to Antibody Identification (added charge).

SPECIAL INSTRUCTIONS See ABO & Rh special instructions. Include the patient's date of birth on all tubes. Include the patient’s pregnancy and/or transfusion history, if appropriate.

SPECIMEN REQUIREMENT Draw blood in one 6 mL or two 3 mL lavender top (EDTA) tubes (unless otherwise instructed by the patient label).

STORAGE INSTRUCTIONS Room temperature up to 24 hours. Refrigerate (2-8°C) up to 72 hours (screen is good for 3 days after draw).



Antibody Titer

COMPUTER ORDER ENTRY TITER

SYNONYMS Rh Titer; Antibody Titer; RBC Antibody Titer

AVAILABILITY Test performed by a Reference Laboratory.

TEST INCLUDES Titration of identified unexpected Erythrocyte Antibody.

SPECIAL INSTRUCTIONS Include the patient's transfusion, pregnancy, and/or current medication history. Red cell Antibody Identification will be done at an additional charge.

SPECIMEN REQUIREMENT Draw blood in two 10 mL or three 7 mL plain red top tubes (no additive, no

SST specimens) AND one 6 mL lavender top (EDTA) tubes.




Antithyroglobulin Antibodies (Anti-TG)

COMPUTER ORDER ENTRY ATG

SYNONYMS ATG; Thyroglobulin Antibody.

NOTE: This is NOT an equivalent test to Thyroglobulin.

AVAILABILITY Test performed daily; all shifts.




Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerate (2-8°C) (spun): up to 48 hours Ripon Medical Center and all other sites: Draw blood in a SST. Centrifuge

and send specimen in the original tube. Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerate (2-8°C) (spun): up to 48 hours




Antithyroid Peroxidase Antibodies (Anti-TPO)

COMPUTER ORDER ENTRY ATA

SYNONYMS Antimicrosomal Antibodies




TEST INCLUDES Microsomal Antibodies.


Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerate (2-8°C) (spun): up to 48 hours

Ripon Medical Center and all other sites: Draw blood in a SST. Centrifuge

and send specimen in the original tube. Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerate (2-8°C) (spun): up to 48 hours




Apolipoprotein B

COMPUTER ORDER ENTRY LAPB


SPECIAL INSTRUCTIONS Fasting for 12-14 hours.

SPECIMEN REQUIREMENT Draw blood in a red top, SST, PST (heparin) or lavender (EDTA) top tube. Separate serum or plasma from cells.

Stability: Room Temp (spun): up to 14 days Refrigerate (2-8ºC) (spun): up to 14 days



DEPARTMENT Reference Laboratory

ASO (Antistreptolysin O)

COMPUTER ORDER ENTRY ASO

AVAILABILITY Test performed daily on the AM shift.

SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (spun): up to 8 hours Refrigerate (2-8ºC) (spun): up to 3 days



CAUSES FOR REJECTION Grossly lipemic sample, which cannot be clarified by centrifugation; gross hemolysis.


AST (SGOT)

COMPUTER ORDER ENTRY AST

SYNONYMS GOT; Aspartate Aminotransferase







CAUSES FOR REJECTION Hemolysis.


Bence Jones Protein

COMPUTER ORDER ENTRY UPER (random); UPE24 (24 hour collection)

SYNONYMS See Electrophoresis, Urine – Random or 24 Hour; or Immunofixation, Urine


Beta-Hydroxybutyrate


SYNONYMS β-Hyroxybutyrate; Ketone Bodies


TEST INCLUDES Beta-Hydroxybutyrate


Stability: Refrigerate (2-8°C) (spun): up to 5 days


Stability: Refrigerate (2-8°C) (spun): up to 5 days SPECIMEN MINIMUM VOLUME 0.5 mL serum or plasma


CAUSES FOR REJECTION Gross hemolysis


B-hCG (Qualitative)

COMPUTER ORDER ENTRY BETA

SYNONYMS See Pregnancy Test, Serum

DEPARTMENT Hematology

B-hCG (Quantitative)

COMPUTER ORDER ENTRY HCGQ

SYNONYMS See Pregnancy Test, (BhCG) Quantitative


Bicarbonate, Whole Blood

COMPUTER ORDER ENTRY VHCO3

SYNONYMS HCO3


SPECIMEN REQUIREMENT Draw blood in a dark green (Lithium heparin) tube (full draw) or a heparinized syringe (minimum 1 mL).

NO FINGERSTICKS.

SPECIMEN MINIMUM VOLUME 1.0 mL whole blood STORAGE INSTRUCTIONS Send immediately to Laboratory at room temperature. Specimen should be

analyzed within 30 minutes of collection. DO NOT open the tube. Ripon Medical Center: Test within 10 minutes or place specimen in ice bath if

testing is delayed.

CAUSES FOR REJECTION Improper collection, handling or storage.


Bilirubin, Direct

COMPUTER ORDER ENTRY BILID

SYNONYMS Conjugated Bilirubin


SPECIAL INSTRUCTIONS Direct Bilirubin is photosensitive.





Pediatric patients: Draw blood in an amber colored micro separator system (no additive) or an amber green (Lithium heparin) PST microtainer. Centrifuge and send specimen in the original container.

SPECIMEN MINIMUM VOLUME 0.3 mL serum or plasma; 0.6 mL whole blood (1 full microtainer)

STORAGE INSTRUCTIONS See above. Analyte is light sensitive, minimize exposure to light during storage and transport.

CAUSES FOR REJECTION Moderate hemolysis.


Bilirubin, Total

COMPUTER ORDER ENTRY BILIT


SPECIAL INSTRUCTIONS Total Bilirubin is photosensitive.

INTERFERENCES The manufacturer of our Bilirubin, Total assay has identified that a metabolite of Naproxen has been shown to interfere with our method. Providers should be aware that samples from patients who are taking Naproxen have shown spurious elevations in Total Bilirubin levels. As a possible measure when clinically appropriate, and prior to testing, providers should consider stopping the patient’s Naproxen for three days in order to avoid the interference.

Alternatively, upon request, CLW can send the specimen to Mayo Medical Laboratories to verify the result if this interference is suspected. Mayo had confirmed that their method is not affected by Naproxen.





Refrigerate (2-8°C) (spun): up to 5 days Pediatric patients: Draw blood in an amber colored micro separator system (no additive) or an amber green (Lithium heparin) PST microtainer. Centrifuge and send specimen in the original container.



CAUSES FOR REJECTION Moderate hemolysis.


Blood Components, other than PRBC

COMPUTER ORDER ENTRY FFP; CRY; PLC (random donor platelet)

SYNONYMS Fresh frozen plasma (FFP); Platelets (pheresis or specified number of donor packs); Cryoprecipitate (Cryo)

AVAILABILITY FFP: (requires thawing) approximately 30 minutes. Platelets: 2 pheresis units routinely stocked (A Neg) at Central Laboratory

Fond du Lac Cryoprecipitate: 10 units stocked (therapeutic dose) at Central Laboratory

Fond du Lac Albumin: available from the Pharmacy.

SPECIAL INSTRUCTIONS FFP and Cryo recipients need to be blood typed and banded. Platelet recipients need to have a blood type on file. Contact the Laboratory in each instance to determine the need for a new specimen. A consent to transfuse blood products is required. Refer to Nursing Procedures for specifics.

SPECIMEN REQUIREMENT Component dependent - See ABO & Rh Type.


Blood Fecal, FIT

COMPUTER ORDER ENTRY FITSC (annual screening); FITDI (diagnostic)

SYNONYMS Occult Blood, FIT, Fecal Immunochemical Test


SPECIAL INSTRUCTIONS Patient Preparation: Patient should follow directions as stated in the specimen mailer.

INTERFERENCES No dietary restrictions. Hemorrhoids or menstruation may give false positive results.

TEST INCLUDES Occult Blood positive or negative.

SPECIMEN REQUIREMENT Fresh stool submitted in Polymedco testing vial (included in mailer). Room temperature up to 15 days; refrigerate (2-8°C) up to 30 days.

CAUSES FOR REJECTION Improper storage, outdated testing vial.

DEPARTMENT Urinalysis

Blood Parasites

COMPUTER ORDER ENTRY MALAR

AVAILABILITY Test performed daily; all shifts; collection is available STAT. Preliminary results are available within 2 hours; final results are available in 24 hours.

NOTE: If the pathologist confirms the presence of a parasite, the sample will be sent to the State Lab via STAT courier service (unless the pathologist approves that confirmation can wait).

TEST INCLUDES Thick and thin film smears, prepared from a finger stick collection.

SPECIAL INSTRUCTIONS Collect specimen immediately before a fever spike.

SPECIMEN REQUIREMENT Fresh finger stick smears.


Blood Typing

COMPUTER ORDER ENTRY ABORH

SYNONYMS See ABO & Rh Type


BMP

COMPUTER ORDER ENTRY BMP

SYNONYMS See Metabolic Basic Panel


BNP (B-Natriuretic Peptide)

COMPUTER ORDER ENTRY BNP

SYNONYMS BN Peptide; B-Type Natriuretic Peptide; Brain Natriuretic Peptide




SPECIMEN REQUIREMENT Draw blood in a lavender top (EDTA) tube, must be a full draw. Centrifuge and pipette into a plastic transfer tube capped tightly for transport.

Stability: Room Temp (spun or unspun): up to 4 hours Refrigerate (2-8°C) (pipette off plasma): up to 24 hours

Frozen (pipette off plasma): up to 72 hours


CAUSES FOR REJECTION Severe hemolysis.


Bordetella pertussis and Bordetella parapertussis, Real-time DNA PCR

COMPUTER ORDER ENTRY LBORD

SYNONYMS Pertussis; Whooping cough


SPECIMEN REQUIREMENT Nasopharyngeal (NP) swab, throat swab (dacron or rayon) OR 0.5 mL nasopharyngeal aspirate/wash

Preferred:

� Flocked COPAN NP swab (orange cap): submitted in plastic sleeve or Aluminum wire minitip (green cap) ages 6 and under

Alternate:

� NP swab (orange cap): submitted in charcoal containing transport media � NP/throat swab: submitted in universal transport media (UTM) � NP wash/aspirate: submitted in a sterile container

NOTE: Swab images are on pages 182-183

SPECIMEN MINIMUM VOLUME One NP/throat swab OR 0.5 mL nasal aspirate/wash

STORAGE INSTRUCTIONS Maintain specimen at room temperature or refrigerate. Do not freeze charcoal transport swabs or dry swabs. Swabs in UTM and NP aspirates/washes may be frozen for up to 7 days.

CAUSES FOR REJECTION Calcium alginate swabs


BUN

COMPUTER ORDER ENTRY BUN

SYNONYMS Blood Urea Nitrogen







CAUSES FOR REJECTION Ammonia contamination of specimen.


C3 (Complement, C3)

COMPUTER ORDER ENTRY C3

SYNONYMS B1A Globulin


INTERFERENCES Non-specific interferences can occur with some samples.

SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (spun): up to 8 hours Refrigerated (2-8ºC) (spun): up to 3 days



CAUSES FOR REJECTION Gross lipemia; gross hemolysis.


C4 (Complement, C4)

COMPUTER ORDER ENTRY C4



SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (spun): up to 8 hours Refrigerated (2-8ºC) (spun): up to 3 days





CA 19-9 (Cancer Antigen 19-9)

COMPUTER ORDER ENTRY LC199

SYNONYMS Carbohydrate Antigen 19-9; GI Cancer Antigen


SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send aliquot to Reference Laboratory.

SPECIMEN MINIMUM VOLUME 0.3 mL (2 mL recommended)

STORAGE INSTRUCTIONS Refrigerate (2-8°C).


CA 125 (Cancer Antigen 125)

COMPUTER ORDER ENTRY CA125

SYNONYMS OV 125


SPECIAL INSTRUCTIONS CA 125 values obtained with different assay methodologies cannot be used

interchangeably in serial CA 125 testing. It is recommended that only one assay method be used consistently to monitor a patient's course of therapy.






Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerate (2-8°C) (spun): up to 48 hours SPECIMEN MINIMUM VOLUME 0.4 mL serum or plasma STORAGE INSTRUCTIONS See above.



Calcium, Ionized, Serum

COMPUTER ORDER ENTRY CAISR


TEST INCLUDES Both Calcium, Ionized (Adj) - result value adjusted to pH 7.40 and Calcium, Ionized (Unadj) - result value not adjusted for pH.

SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Tube must be full and remain stoppered at all times. Keep the specimen anaerobic. DO NOT TRANSFER serum to another tube.

NO FINGERSTICKS.

Stability: Refrigerate (2-8°C) (spun): up to 24 hours

STORAGE INSTRUCTIONS See above. DO NOT OPEN.

CAUSES FOR REJECTION Improper collection, handling, or storage; moderate to severe hemolysis.


Calcium, Ionized, Whole Blood (Inpatients Only)

COMPUTER ORDER ENTRY CAIWB


TEST INCLUDES Calcium, Ionized (Unadj) - result value not adjusted for pH.

SPECIMEN REQUIREMENT Draw blood in a low heparin (GasLyte®) syringe. Keep the specimen anaerobic.

NO FINGERSTICKS.

STORAGE INSTRUCTIONS Syringe must remain stoppered; maintain anaerobic conditions. Send the specimen to the Laboratory immediately at room temperature. Test must be

performed within 30 minutes of collection.



Calcium, Ionized, Whole Blood (Ripon Medical Center ONLY)

COMPUTER ORDER ENTRY CAIWB


TEST INCLUDES Calcium, Ionized (Unadj) - result value not adjusted for pH.

SPECIMEN REQUIREMENT Draw blood plain Lithium Heparin vacutainer. Keep the specimen anaerobic.

NO FINGERSTICKS.

STORAGE INSTRUCTIONS Keep the vacutainer closed until immediately before testing is begun to maintain anaerobic conditions. Test must be performed within 30 minutes of collection.


DEPARTMENT Chemistry (Ripon Medical Center)

Calcium, Total

COMPUTER ORDER ENTRY CA

SYNONYMS Ca; Total Calcium


SPECIAL INSTRUCTIONS Fasting at least 8 hours is recommended.






CAUSES FOR REJECTION Specimen collected in a lavender top (EDTA) tube; contamination from a gray top (Sodium Fluoride/Potassium Oxalate) tube.


Calcium, Urine

COMPUTER ORDER ENTRY UCAR (random); UCA24 (24 hour collection)

SYNONYMS Urine Ca


TEST INCLUDES Calcium on a 24 hour or random urine collection.

SPECIAL INSTRUCTIONS Indicate the total volume and collection time period on the requisition.

SPECIMEN REQUIREMENT 20 mL aliquot from a well mixed 24 hour or random urine collected without preservative.




Calculi, Urine

COMPUTER ORDER ENTRY LSTNE

SYNONYMS See Kidney Stone Analysis


Carbamazepine (Tegretol)

COMPUTER ORDER ENTRY CARBA

SYNONYMS Tegretol




SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 4 hours Refrigerate (2-8°C) (spun): up to 48 hours SPECIMEN MINIMUM VOLUME 0.3 mL serum



Carbon Monoxide, Whole Blood

COMPUTER ORDER ENTRY CO

SYNONYMS HbCO; Carboxyhemoglobin


SPECIAL INSTRUCTIONS Fill the tube completely. Avoid exposure to the atmosphere. DO NOT remove the stopper.

SPECIMEN REQUIREMENT Draw blood in a dark green top (Lithium heparin) tube. DO NOT CENTRIFUGE; or draw blood in a heparinized stoppered syringe.

Stability: Whole blood stoppered up to 72 hours NO FINGERSTICKS.

SPECIMEN MINIMUM VOLUME 1.0 mL

STORAGE INSTRUCTIONS See above. Refrigerate (2-8°C) or room temperature. Tube/syringe must remain stoppered, maintain anaerobic conditions.

CAUSES FOR REJECTION Fluoride, Oxalate, or Citrate anticoagulants (gray or light blue top tubes); improper collection and storage.


CBC

COMPUTER ORDER ENTRY CBC

SYNONYMS Complete Blood Count; CBC with No Diff


TEST INCLUDES WBC, RBC, HGB, HCT, Indices, and Platelet Count.

SPECIMEN REQUIREMENT Draw blood in a lavender top (EDTA) tube.


STORAGE INSTRUCTIONS Room temperature up to 24 hours. If the tube is refrigerated it must be brought to room temperature prior to testing.

CAUSES FOR REJECTION Clotted specimen; incorrect anticoagulant; frozen specimen; low volume; gross hemolysis.


CBC with Autodifferential

COMPUTER ORDER ENTRY CBCAD

SYNONYMS Complete Blood Count with Autodiff


TEST INCLUDES WBC with differential, RBC, HGB, HCT, Indices, and Platelet Count.



STORAGE INSTRUCTIONS Room temperature up to 24 hours. If the tube is refrigerated it must be brought to room temperature prior to testing.

CAUSES FOR REJECTION Clotted specimen; incorrect anticoagulant; frozen specimen; low volume; gross hemolysis.


C. difficile by PCR (C. diff by PCR)

COMPUTER ORDER ENTRY CDIFF

SYNONYMS Clostridium difficile; C. diff by PCR; Toxigenic C. diff


INTERFERENCES Inhibition of the Xpert® C. difficile assay has been observed in the presence of the following substances: zinc oxide paste and Vagisil cream.

TEST INCLUDES This test detects but does not differentiate the NAP1 (Ribotype 027) strain from other toxigenic strains of C. difficile. This test targets the tcdB gene for Toxin B production. This test will not detect strains of C. difficile that do not contain the tcdB gene.

SPECIAL INSTRUCTIONS The Society for Healthcare Epidemiology of America and the Infectious Disease Society of America recommend testing only specimens from patients older than one year of age (due to high carriage rate of infants). The diarrheal stool is the recommended specimen from patients with history of antimicrobial therapy within past thirty days or that develops three days after hospitalization.

SPECIMEN REQUIREMENT Collect unformed or soft stool into a laboratory stool container with no preservative. Avoid using household food containers.

STORAGE INSTRUCTIONS Room temperature up to 24 hours or refrigerate (2-8º) up to 5 days.

CAUSES FOR REJECTION Formed stool, colon aspirates, stool preservative or media. Excessive mucous in a stool sample may inhibit PCR.


C. difficile (Antigen and Toxin)

COMPUTER ORDER ENTRY 2CDIF

SYNONYMS Clostridium difficile

AVAILABILITY Test performed daily; all shifts; available STAT for RMC ER and IP’s ONLY. INTERFERENCES None

TEST INCLUDES Test used to detect Clostridium difficile glutamate dehydrogenase antigen and toxins A and B in human fecal specimens from patients suspected of having Clostridium difficile associated disease

SPECIAL INSTRUCTIONS The Society for Healthcare Epidemiology of America and the Infectious Disease Society of America recommend testing only specimens from patients older than one year of age (due to high carriage rate of infants). The diarrheal stool is the recommended specimen from patients with history of antimicrobial therapy within past thirty days or that develops three days after hospitalization.

SPECIMEN REQUIREMENT Collect unformed or soft stool into a clean airtight container with no preservative.

STORAGE INSTRUCTIONS Room temperature up to 24 hours or refrigerate (2-8º) up to 3 days.

CAUSES FOR REJECTION Specimens preserved in formalin, merthiolate, sodium acetate or polyvinyl alcohol (O&P preservatives). Formed stool and all specimens collected on patients under twelve months old will be rejected.

DEPARTMENT Ripon Medical Center only

NOTE: Antigen positive/Toxin negative or Antigen negative/Toxin positive results, as well as any results deemed inconclusive or invalid, will reflex to PCR testing at Central Laboratory Fond du Lac.

CEA

COMPUTER ORDER ENTRY CEA

SYNONYMS Carcinoembryonic Antigen


SPECIAL INSTRUCTIONS The concentration of CEA in a given specimen determined with assays from different manufacturers can vary due to differences in assay methods and reagent specificity. Values obtained with different assays cannot be used interchangeably.



SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (spun): up to 8 hours Refrigerate (2-8°C) (spun): up to 48 hours Frozen (pipette off serum): up to 5 days



DEPARTMENT Chemistry (Central Laboratory Fond du Lac

Cell Count, Body or Joint Fluid

COMPUTER ORDER ENTRY FLCEL

SYNONYMS Synovial Fluid Cell Count (for Joint Fluids)


TEST INCLUDES WBC, RBC, and 5 Part Cell Differential, if applicable.

SPECIAL INSTRUCTIONS Sterile collection. For optimum results, specimen should be submitted to Laboratory within 1 hour of collection.

Needles must be removed from syringes submitted to the Laboratory.

Indicate type of fluid on the requisition.

SPECIMEN REQUIREMENT 1 mL fluid.

STORAGE INSTRUCTIONS Room temperature or refrigerate (2-8°C).


Cell Count, CSF

COMPUTER ORDER ENTRY FLCEL


TEST INCLUDES WBC, RBC, and Cell Differential.

SPECIAL INSTRUCTIONS Tubes should be received within ½ hour of aspiration with labels indicating order of withdrawal. Obtain aseptically. A copy of the doctor's orders must accompany the specimen.

SPECIMEN REQUIREMENT 1 mL fluid in a sterile container.

STORAGE INSTRUCTIONS Room temperature.


Ceruloplasmin

COMPUTER ORDER ENTRY CER

SYNONYMS Cerul


SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (spun): up to 8 hours Refrigerate (2-8°C) (spun): up to 72 hours





Chlamydia by PCR

COMPUTER ORDER ENTRY CHLM

SYNONYMS Chlam; Chlamydia Probe by Nucleic Acid Test (NAAT); Chlamydia trachomatis

AVAILABILITY Test performed Monday through Friday on AM shift.

SPECIAL INSTRUCTIONS Specify specimen origin on the requisition. Use appropriate collection device.

NOTE: This test is not a test of cure; nor is it intended for use in cases of suspected abuse.

SPECIMEN REQUIREMENT Source Collection Device Vaginal APTIMA Vaginal Swab Collection kit or

ThinPrep® Liquid Cytology Collection kit Male Urethral APTIMA Unisex Swab Collection kit Cervical or endocervical ThinPrep® Liquid Cytology Collection kit Urine (male only) Sterile urine container NOTE: Specimen sources other than listed above (collected with an APTIMA Unisex Swab) and female urine specimens will be referred to a Reference Laboratory. Pharyngeal samples are not collected by laboratory personnel.

Vaginal Swab Specimen Collection Instructions

1. Partially open the swab package. Remove the swab. Do not touch the soft tip or lay the swab down. If the soft tip is touched, the swab is laid down, or the swab is dropped, use a new kit.

2. Hold the swab, placing your thumb and forefinger in the middle of the swab shaft covering the score line. Do not hold the swab shaft below the score line.

3. Carefully insert the swab into the vagina about 2 inches (5 cm) past the introitus and gently rotate the swab for 10 to 30 seconds. Make sure the swab touches the walls of the vagina so that moisture is absorbed by the swab and then withdraw the swab without touching the skin.

4. While holding the swab in the same hand, unscrew the cap from the tube. Do not spill the contents of the tube. If the contents of the tube are spilled, use a new APTIMA Vaginal Swab Specimen Collection Kit.

5. Immediately place the swab into the transport tube so that the score line is at the top of the tube.

6. Carefully break the swab shaft at the score line against the side of the tube.

7. Immediately discard the top portion of the swab shaft. 8. Tightly screw the cap onto the tube.

Male Urethral Swab Collection Instructions 1. The patient should not have urinated for at least one hour prior to sample

collection. 2. Insert the collection swab (blue shaft) 2-4 cm into the urethra. 3. Gently rotate the swab clockwise for 2-3 seconds in the urethra to ensure

adequate sampling. 4. Withdraw the swab carefully. 5. Remove the cap from the swab transport tube and immediately place the

collection swab into the transport tube. 6. Carefully break the swab shaft at the scoreline; use care to avoid

splashing of contents. 7. Tightly screw the cap onto the tube.

Urine Collection Instructions 1. The patient should not have urinated for at least one hour prior to

specimen collection. 2. Direct patient to provide a first-catch urine (approximately 20-30 mL of the

initial urine stream) into a urine collection cup free of any preservatives. Collection of larger volumes may result in rRNA target dilution that may reduce test sensitivity.

3. Urine must be received in the central laboratory within 24 hours of collection. If this cannot be achieved, urine transport tubes containing RNA stabilizers must be used. Should you need the urine transport tubes, please contact Specimen Handling for further instructions.

STORAGE INSTRUCTIONS APTIMA® swab: room temperature (2-30°C) up to 60 days. Urine: room temperature (2-30°C) up to 24 hours; ThinPrep® Liquid Cytology container: 2-30°C up to 30 days (Cannot be added if the vial has been used to prepare a Pap Smear)

CAUSES FOR REJECTION Wrong swab submitted; Improper storage


Chloride

COMPUTER ORDER ENTRY CL








Chloride, Urine

COMPUTER ORDER ENTRY UCLR (random); UCL24 (24 hour collection)

SYNONYMS Urine Cl


TEST INCLUDES Cl on a 24 hour or random urine collection.


SPECIMEN REQUIREMENT 20 mL aliquot from a well-mixed random or 24 hour urine collection.



Cholesterol

COMPUTER ORDER ENTRY CHOL







CAUSES FOR REJECTION Specimen collected in Potassium Oxalate/Sodium Fluoride or EDTA.


CK (Creatine Kinase)

COMPUTER ORDER ENTRY CPK

SYNONYMS Total CK; Creatine Kinase





Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 4 hours Refrigerate (2-8°C) (spun): up to 5 days. SPECIMEN MINIMUM VOLUME 0.4 mL serum or plasma STORAGE INSTRUCTIONS See above. Analyte is light sensitive, minimize exposure to light during storage

and transport. Keep stoppered until analysis.

CAUSES FOR REJECTION Moderate hemolysis; Sodium Fluoride/Potassium Oxalate anticoagulant.


CKMB

COMPUTER ORDER ENTRY CKMB+

SYNONYMS CKMB Iso; CKMB Isoenzyme


TEST INCLUDES CKMB Relative Index will be calculated when a total CK is ordered with a CKMB except at Ripon Medical Center.



SPECIMEN REQUIREMENT Draw blood in a green (Lithium heparin) PST (full draw) Centrifuge and send specimen in the original tube.

Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 4 hours Refrigerate (2-8°C) (spun): up to 24 hours Frozen: (pipette off plasma): up to 72 hours

Ripon Medical Center: Draw SST tube Stability: Room Temp (spun): up to 4 hours Refrigerate (2-8°C) (spun): up to 48 hours

STORAGE INSTRUCTIONS See above. Analyte is light sensitive, minimize exposure to light during storage and transport. (except at Ripon Medical Center).



CKMB (Point of Care)

COMPUTER ORDER ENTRY MBED+

SYNONYMS CKMB Iso; CKMB Isoenzyme

AVAILABILITY Test performed daily; all shifts; available STAT. Performed only in SAH ED.

TEST INCLUDES CKMB Relative Index will be calculated when a total CK is ordered with a CKMB



SPECIMEN REQUIREMENT Whole blood drawn in a blood in a 4 mL green (Lithium heparin) Vacutainer (full draw).

Stability: Room Temp (unspun): up to 2 hours



CMP

COMPUTER ORDER ENTRY CMP

AVAILABILITY See Metabolic Comprehensive Panel


CO2

COMPUTER ORDER ENTRY CO2

SYNONYMS Carbon Dioxide





Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerate (2-8°C) (spun): up to 24 hours SPECIMEN MINIMUM VOLUME 0.4 mL serum or plasma

STORAGE INSTRUCTIONS See above. Keep stoppered until analysis.

CAUSES FOR REJECTION Improper collection and storage; severe hemolysis. EDTA anticoagulant.


Cold Agglutinin Titer (Quantitation)

COMPUTER ORDER ENTRY MYCOP

SYNONYMS See Mycoplasma pneumonia, IgM for suspected cases of Mycoplasma pneumonia. Cold Agglutinin Titer is not offered at CLW. For suspected cases of Cold Autoimmune Hemolytic Anemia, request send out test for Cold Agglutinin Titer (sent to Mayo Medical Laboratories or the Blood Center of Wisconsin).


Cortisol

COMPUTER ORDER ENTRY CORTR (random); CORTA (am); CORTP (pm)


SPECIAL INSTRUCTIONS Indicate the time collected on the requisition.

SPECIMEN REQUIREMENT All sites: Draw blood in a green (Lithium heparin) PST (full tube) or a SST. Centrifuge and send specimen in the original tube.

Stability: Room Temp (unspun): optimally up to 1 hour Room Temp (spun): up to 8 hours

Refrigerate (2-8°C) (spun): up to 48 hours “AM” specimens should be drawn between 6:00 and 8:00 am. “PM” specimens should be drawn between 3:00 and 5:00 pm unless otherwise indicated.





Cotinine, Blood

COMPUTER ORDER ENTRY COTIN

AVAILABILITY Test performed weekly.

SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Refrigerate (2-8ºC) (spun): up to 14 days

SPECIMEN MINIMUM VOLUME 0.1 mL serum


CAUSES FOR REJECTION Hemolyzed specimen


C Peptide, Serum

COMPUTER ORDER ENTRY CPE

SYNONYMS Connecting Peptide; C-Peptide Reactivity; Insulin C-Peptide


SPECIAL INSTRUCTIONS Patient should fast for 14-16 hours for basal value s.

SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (spun): up to 8 hours Refrigerate (2-8°C) (spun): up to 24 hours Frozen (pipette off serum): up to 5 days



CAUSES FOR REJECTION Patient not fasting; severe icterus.


Creatine Kinase (CK)

COMPUTER ORDER ENTRY CPK

AVAILABILITY See CK (Creatine Kinase)


Creatinine

COMPUTER ORDER ENTRY CREAT


TEST INCLUDES Creatinine; also includes a Glomerular Filtration Rate calculated on patients 18 years and older.

SPECIAL INSTRUCTIONS NOTE: A high meat diet may increase the Creatinine result by 10%.








Creatinine Clearance (includes Serum Creatinine)

COMPUTER ORDER ENTRY CRECL


TEST INCLUDES Blood Creatinine, Urine Creatinine; also includes Glomerular Filtration Rate (calculated) on patients 18 years and older.


NOTE: Interpretation for urine collection other than a 24 hour collection is indeterminate for renal function.

SPECIMEN REQUIREMENT 20 mL aliquot from a well mixed 24 hour urine collected without preservative and a blood specimen. NOTE: Blood specimen should be collected during the urine collection period. If this isn't possible, blood should be drawn at least within 6 hours of the urine collection. (Provided the patient is adhering to normal fluid intake for 24 hours before and after the urine collection.) Central Laboratory Fond du Lac, Waupun Memorial Hos pital, Dialysis Centers, and Convenient Care: Draw blood in a green (Lithium heparin) PST (full tube). Centrifuge and send specimen in the original tube.




STORAGE INSTRUCTIONS See above. Refrigerate (2-8°C) urine during and after collection.

CAUSES FOR REJECTION Blood specimen not drawn during urine collection; presence of stool in urine.


Creatinine, Urine

COMPUTER ORDER ENTRY UCRER (random); UCR24 (24 hour collection)


SPECIAL INSTRUCTIONS Indicate the time period and volume of collection on the requisition.

SPECIMEN REQUIREMENT 20 mL aliquot from a well mixed 24 hour or random urine collected without preservative.



CAUSES FOR REJECTION Presence of stool in urine.


Crossmatch

COMPUTER ORDER ENTRY LRC

SYNONYMS Compatibility Testing

AVAILABILITY Test performed on all shifts.

TEST INCLUDES Compatibility testing using immediate spin or antiglobulin technique for allogenic donor bank PRBCs for the number of units specified. PRBC units are leukoreduced in Adsol. Special orders for CMV negative or irradiated products must be prearranged by contacting the Laboratory and will incur added charges. If the patient has an antibody identified, donor RBCs are typed negative for that antigen, if possible (added charge).

SPECIAL INSTRUCTIONS Call the Laboratory for special instructions. Patient must be banded with a Blood Bank arm band by Laboratory associate or other designated groups. ABO, Rh, and Antibody Screen must also be performed for each draw. Units set up are available for transfusion for three days after the specimen is drawn.

Specify whether the patient has been pregnant or transfused. If not indicated, the Laboratory assumes this is the case.


Ripon Medical Center: Draw blood in two 3 mL lavender top (EDTA) tubes.




C Reactive Protein (CRP)

COMPUTER ORDER ENTRY CRP


SPECIAL INSTRUCTIONS NOTE: This test is intended for use in evaluating possible inflammatory conditions.






Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerate (2-8°C) (spun): up to 5 days SPECIMEN MINIMUM VOLUME 0.3 mL serum or plasma; 0.6 mL whole blood (1 full microtainer)



CRP, High Sensitivity

COMPUTER ORDER ENTRY HSCRP

SYNONYMS High Sensitivity C-Reactive Protein; hsCRP


SPECIAL INSTRUCTIONS NOTE: This test may be used to screen for cardiovascular risk in some patients in conjunction with other testing. Levels will be elevated in patients who have inflammatory conditions, tumors, and/or tissue necrosis.







Refrigerate (2-8°C) (spun): up to 5 days




Cryptococcus Antigen

COMPUTER ORDER ENTRY CRYPT

SYNONYMS Cryptococcal Antigen. This test is performed instead of India Ink when ordered on CSF.

AVAILABILITY Test performed daily; available STAT.

TEST INCLUDES If positive, a titer is performed and billed. Method: Latex Particle Agglutination. 99% sensitivity in CSF and 87% specificity in Cryptococcal meningitis.

INTERFERENCES Trichosporosis or rheumatoid factor may cause false positives. SPECIMEN REQUIREMENT CSF Blood: Draw in a SST or a plain red top tube (no additive). Centrifuge and

send specimen in the original tube.

STORAGE INSTRUCTIONS Refrigerate (2-8°C) up to 72 hours.

CAUSES FOR REJECTION Plasma specimen.

DEPARTMENT Blood Bank (Central Laboratory Fond du Lac)

Cryptosporidium Specific Antigen, Fecal

COMPUTER ORDER ENTRY CSA

SYNONYMS Cryptosporidium Antigen, CSA

AVAILABILITY Test performed Monday through Friday.

TEST INCLUDES Rapid Immunoassay method.

SPECIAL INSTRUCTIONS Testing patients who develop diarrhea after 3 days of hospitalization is discouraged.

SPECIMEN REQUIREMENT Stool. A single stool is generally sufficient. STORAGE INSTRUCTIONS Para Pak: Refrigerate (2-8°C) or room temperature up to 2 months. OR Cary-Blair: Refrigerate (2-8°C) up to 2 weeks.

CAUSES FOR REJECTION Stools concentrated or treated with PVA fixative. Colonic washes, aspirates or other diluted sample types; stool samples contaminated with oily or particulate base (such as barium or mineral oil).


Crystals Only, Fluid

COMPUTER ORDER ENTRY CRYST

SYNONYMS Uric Acid Crystals; Calcium Pyrophosphate Crystals; Gout; Pseudogout


SPECIAL INSTRUCTIONS Sterile collection, aseptic technique. Needles must be removed from syringes submitted to the Laboratory.

SPECIMEN REQUIREMENT Heparinized or unanticoagulated fluid. Indicate fluid type on the requisition.

STORAGE INSTRUCTIONS Room temperature or refrigerate (2-8°C).

CAUSES FOR REJECTION Fluids submitted in aqueous solutions are not acceptable for Uric Acid Crystal analysis.


Culture, Aerobic

COMPUTER ORDER ENTRY CXROU (abscess, wounds, etc.); CXFLD (fluids – NOT urine or CSF); CXEYE (eyes); CXEAR (ears)

NOTE: Add order comment if screening for MRSA, VR E, S. aureus, or N. meningitidis.

SYNONYMS General. Please see specific sources for details.

AVAILABILITY Test performed daily. Turnaround time depends on source.

TEST INCLUDES Bacterial isolation and identification of pathogens, as deemed appropriate according to specimen site and growth. Reflex to susceptibility if appropriate. Anaerobic culture from appropriate sites and in an anaerobic environment will be performed unless specifically requested not to perform anaerobic culture. Gram stain will be performed on appropriate specimens.

SPECIAL INSTRUCTIONS Indicate if a specific pathogen is suspect or should be excluded, e.g. Brucella or Diptheria, as some organisms require special processing. Also indicate if the patient is on antibiotics. A specific anatomic source must be indicated on the requisition. The indicated source should distinguish between "surface" and "deep/surgical" specimens. DO NOT label as only "wound". Direct smear gram stains and routine bacterial cultures with organism identification will be performed according to Laboratory protocols. Susceptibilities are performed by disk diffusion, agar dilution, and/or microdilution, as appropriate, and

charged accordingly.

NOTE: Alert the Laboratory in cases of suspected bioterrorism; e.g. Anthrax, Brucellosis, Plague, Tularemia.

INTERFERENCES Antibiotics may inhibit growth. SPECIMEN REQUIREMENT Closed abscess (SPECIMEN OF CHOICE): In a sterile fashion aspirate the

abscess contents with a syringe. Remove the needle and replace with a cap before submitting the specimen. Or, submit the specimen in a sterile leak proof container.

Lesions and abscesses: Remove the superficial flora by decontaminating the skin before collecting the specimen from the advancing margin or base. Fluids : Submit in a sterile leak proof container (without anticoagulants). Swab collections: BBL™ CultureSwabs™ are available from the Laboratory. White caps are single swab, red caps are double swabs, and green caps are mini-tip wire shaft swabs. Single or double CultureSwabs™ may be used for wounds, mini-tip swabs can be used to collect eye or ear cultures. Store at room temperature until prompt transport to the Laboratory. Tissue: Submit at least 1g of tissue in a sterile leak proof container. Transport to Laboratory immediately. If an anaerobic culture is also needed, collect another specimen as instructed for Anaerobic Culture.

STORAGE INSTRUCTIONS Room temperature. DO NOT REFRIGERATE. Transport to the Laboratory promptly; culturette stable up to 24 hours.

CAUSES FOR REJECTION Fixed specimen; desiccated specimen; frozen specimen; grossly contaminated specimen container.


Culture, AFB (TB)

COMPUTER ORDER ENTRY CXTB

SYNONYMS Acid Fast Bacteria culture; Mycobacterium culture; TB culture


TEST INCLUDES Acid fast stain on respiratory specimens, tissues, and body fluids (additional charge) and TB culture with identification (identification performed at the WI State Lab of Hygiene). Sensitivity, if indicated, at additional charge (contact the Laboratory to order). See Also Acid Fast Smear.

SPECIAL INSTRUCTIONS Send to the Laboratory promptly.

SPECIMEN REQUIREMENT Sputum: First morning specimen. Saline induction is acceptable. Collect three specimens. Each of the three consecutive sputum (not saliva) specimens should be collected in 8-24 hour intervals, with at least one being an early morning specimen. Urine: At least 40 mL of the first morning urine collected on three consecutive days. Swab specimens: Amies or Stuart are undesirable due to low yield, aspirate if possible. Induced sputa: Use sterile hypertonic saline (avoid nebulizer reservoir and tap water). Blood: Collect in SPS yellow cap tube available from the Laboratory. Tissue: Submit 1g in a sterile leak-proof container. Fluid: Submit 5 mL minimum. CSF: 2 mL or more is optimal. Bronchial washing, brushing or lavage (BAL): 5 – 20 mL

STORAGE INSTRUCTIONS Refrigerate (2-8°C) within 1 hour of collection, transport to the Laboratory

promptly (ideally within 30 minutes of collection; but at least within 1 day of collection).

CAUSES FOR REJECTION 24 hour pooled specimen or saliva specimen; frozen specimen; desiccated specimen; specimen received in fixative; swabs in gel medium.


Culture, Anaerobic

COMPUTER ORDER ENTRY CXANR


TEST INCLUDES Gram stain, at additional charge, on appropriate specimens. Beta lactamase as appropriate and identification of potential pathogens (additional charge). Sensitivity upon request (contact Laboratory).

SPECIAL INSTRUCTIONS Collect the specimen while avoiding contamination with indigenous anaerobic flora from the skin or mucous membranes. The anaerobic culture will be added the aerobic culture if appropriate.

SPECIMEN REQUIREMENT Closed abscess (SPECIMEN OF CHOICE): In a sterile fashion aspirate the

abscess contents with a syringe. Remove the needle and replace with a cap before submitting the specimen. Or, submit the specimen in a sterile leak proof container.

Lesions and abscesses: Remove the superficial flora by decontaminating the skin before collecting the specimen from the advancing margin or base. Fluids : Submit in a sterile leak proof container (without anticoagulants). Swab collections: BBL™ CultureSwabs™ Plus (blue cap) are available from the Laboratory. Store at room temperature until prompt transport to the Laboratory. NOTE: Swabs are less than ideal for optimal anaerobic recovery. Submit aspirate or tissue if possible. Biopsy/Tissue: Submit at least 1g of tissue in a sterile leak proof container. Transport to Laboratory immediately. Transport specimen immediately (within 30 minutes) to the Laboratory. If transport is delayed use anaerobic transport media (blue cap BBL™ CultureSwab™ Plus).

STORAGE INSTRUCTIONS Room temperature. DO NOT REFRIGERATE. Transport to the Laboratory promptly unless in anaerobic transport media, stable up to 48 hours.

CAUSES FOR REJECTION The following specimens are NOT suitable for anaerobic cultures: skin, superficial wounds, sputum, throat, nasopharynx, bronchoscopy, voided or catheterized urine, GI tract (except C. difficile), urogenital swabs, ears, endotrach tubes, mouth, or nose; fixed, desiccated, or frozen specimens.


Culture, Antimicrobial Susceptibility

COMPUTER ORDER ENTRY Laboratory will order.

SYNONYMS Sensitivity Studies; Antibiotic Sensitivity

AVAILABILITY Test performed daily. Results typically available in 24-48 hours.

SPECIAL INSTRUCTIONS Routinely performed on most pathogens isolated from the primary aerobic bacterial culture, as determined by Laboratory associates (additional charge). Or, submit a pure culture of organism on a culture plate or TSA slant. Methodology may include microdilution or disk diffusion and/or agar dilution.

SPECIMEN REQUIREMENT Pure bacterial isolate or culture, fresh, on supportive agar media.

STORAGE INSTRUCTIONS Room temperature. DO NOT FREEZE.

CAUSES FOR REJECTION Impure culture; nonviable culture.


Culture, Blood

COMPUTER ORDER ENTRY CXBLD

SYNONYMS BacT/ALERT®


TEST INCLUDES Isolation and definitive identification, if possible, of both aerobic and anaerobic microorganisms, and susceptibility testing on all isolates at additional charges. For Fungal Blood Cultures use Isolator tubes (available from the Laboratory). For suspected fastidious bacteria (e.g. Brucella, HACEK group, especially in SBE) notify Laboratory so incubation time can be extended. For AFB culture, see Culture, Acid Fast Bacteria.

SPECIAL INSTRUCTIONS Call the Laboratory for BacT/ALERT® blood culture bottles.

Perform a gross cleanse first of the venipuncture site, then with 70% isopropyl alcohol, then Clorascrub swab, let air dry. Cleanse the top of the bottles with 70% isopropyl alcohol, let air dry. Keep the bottles upright during collection.


SPECIMEN REQUIREMENT Draw venous blood (5-10 mL) into each aerobic (green cap) and anaerobic (orange cap) bottle. Pediatric or difficult draw patients: Draw blood in a yellow cap bottle - maximum 4 mL of blood (minimum 1 mL). Bottles are available from the Laboratory. Transport to Laboratory as soon as possible, within 6 hours of collection.

Recommendations:

� Adult patients: collect two or three separate blood cultures from separate anatomic sites per febrile episode.

� Suspected Endocarditis cases or patients on antibiotics may require more specimens. Indicate if the patient is on antibiotics shortly before or at the time of collection.

STORAGE INSTRUCTIONS Room temperature until prompt transport to Laboratory. Specimen should be received within 6 hours of collection. Call the Microbiology Department if transport to Laboratory will exceed 6 hours. DO NOT REFRIGERATE OR FREEZE.

CAUSES FOR REJECTION Blood submitted in a Vacutainer tube.


Culture, Blood for Fungus

COMPUTER ORDER ENTRY CXFBL

AVAILABILITY Test performed daily. Negative results available in 4 weeks.

TEST INCLUDES Identification of Fungal isolates at additional charge (contact the Laboratory to request sensitivity).

SPECIAL INSTRUCTIONS Call the Laboratory for the Isolator tube for Fungal Blood Culture. Perform a gross cleanse first of the venipuncture site, then with 70% isopropyl alcohol, then Clorascrub swab, let air dry. Cleanse the top of the Isolator tube with 10% Providone iodine, then 70% isopropyl alcohol, let air dry.

SPECIMEN REQUIREMENT Draw 10 mL venous blood in an Isolator tube for adult patients or 1.5 mL venous blood in a pediatric Isolator tube. Submit within 16 hours of collection. If patient is on antibiotics, specimen must be submitted within 1 hour of

collection.

STORAGE INSTRUCTIONS Room temperature. DO NOT REFRIGERATE.

CAUSES FOR REJECTION Blood submitted in a Vacutainer tube; frozen specimen.


Culture, CSF

COMPUTER ORDER ENTRY CXCSF

SYNONYMS Culture, Cerebrospinal Fluid; CSF Fluid


TEST INCLUDES Gram stain performed STAT, bacterial culture with identification and sensitivities on all isolates at additional charge(s).

SPECIMEN REQUIREMENT 1 mL CSF submitted in a sterile, leak proof, screw-capped tube. Collect aseptically. If multiple CSF tubes are collected, the second or most turbid specimen is preferred for Microbiology (2 mL CSF for Fungal and Mycobacterial CSF cultures).

STORAGE INSTRUCTIONS Specimen must be sent to the Laboratory immediately. DO NOT REFRIGERATE.


Culture, Fungus

COMPUTER ORDER ENTRY CXFNM (misc – other than skin, hair, or nail); CXFN S (skin, hair, or nail)

SYNONYMS Mycology; Mold Culture; Yeast Culture; Dermatophyte Culture

AVAILABILITY Test performed daily. Negative results available in 4 weeks.

TEST INCLUDES Fungal smear (KOH/Calcofluor) (additional charge) and fungus culture identification of isolates at additional charge. Sensitivity must be specifically requested by contacting the Laboratory.

SPECIAL INSTRUCTIONS The same specimen may also be used for bacterial and acid fast culture, order appropriately. Swabs are not encouraged unless other collection means are unsuitable.

SPECIMEN REQUIREMENT Skin or nail scrapings for Dermatophytes : Cleanse area with 70% alcohol. With a sterile blade, scrape material from subsurface portion of the infected nail. Scrape active border of skin lesion. Transport scrapings in a sterile screw capped container or place between two clean glass slides taped together. If slides are used, place in a slide carrier or sterile screw capped container. Hair (dry) for Dermatophytes: Place 10-12 involved hairs in sterile screw capped container or clean envelope. Sputum: 10-15 mL first morning deep cough collection (not saliva) in a sterile screw capped container. Collection on 3 consecutive days is recommended.

Bronchoscopy wash : 10-15 mL in a sterile screw capped container. Biopsy or Tissue: 1g in a sterile screw capped container. Blood: See Culture, Blood for Fungus. Aspirate of abscess : Submit in a sterile screw capped container. Swab of mouth, vagina, conjunctiva, or ear : submit in BBL™ CultureSwab™. CSF: 2 mL spinal fluid in a sterile screw capped container. Bone marrow: 3-5 mL in pediatric (1.5 mL) Isolator Tube. Urine : Catheterized or clean catch early AM midstream collection.

STORAGE INSTRUCTIONS Room temperature for Dermatophytes; refrigerate others. Transport to the Laboratory within 2 hours of collection. CSF must be transported to the Laboratory STAT.

CAUSES FOR REJECTION 24 hour collection of urine or sputum; anaerobic swab.


Culture, GC (N. gonorrhoeae)

COMPUTER ORDER ENTRY CXGC

SYNONYMS Gonorrhoeae Culture; Culture for Neisseria gonorrhoeae

AVAILABILITY Test performed daily. Negative results available in 3 days.

TEST INCLUDES Culture for N. gonorrhoeae only. Beta lactamase reported on GC isolates. Gram stain of male urethral specimen (added charge).

SPECIMEN REQUIREMENT Males: Collect and transport in orange cap BBL™ CultureSwab™ with

charcoal (wire shaft). Females, eye, anal, or oral specimens : Collect and transport in black BBL™

CultureSwab™ (plastic shaft).

STORAGE INSTRUCTIONS Room temperature up to 24 hours. DO NOT REFRIGERATE.

CAUSES FOR REJECTION Specimen received in BD ProbeTec™ ET culturette transport media; desiccated specimen.


Culture, Group Strep B Strep Screen

COMPUTER ORDER ENTRY CXV

SYNONYMS Vag for Strep; Strep B Only; Prenatal Strep Group B Screen; Vag/rectal Strep B

AVAILABILITY Test performed daily. Results available in 3 days.

TEST INCLUDES Detection of Group B Streptococcus using a pigmented enrichment broth. Specimens that are negative with the broth will reflex to Nucleic Acid Amplification utilizing LAMP technology (additional cost). Antimicrobial susceptibility can be performed (additional cost) for penicillin-allergic women or if requested, by calling the microbiology department.

SPECIMEN REQUIREMENT Vaginal or vaginal-rectal swab specimen submitted on white cap (single swab) or red cap (double swab) BBL™ CultureSwab™. Increased sensitivity with combined collection by swabbing both the lower vagina and rectum (vagina without speculum or lubricant and then rectum through the anal sphincter). Ideally collected 35-37 weeks gestation for screening purposes.

STORAGE INSTRUCTIONS Room temperature up to 24 hours.

CAUSES FOR REJECTION Desiccated swab; mislabeled swabs; swabs with gel or charcoal; cervical, perianal, perirectal or perineal specimens are not acceptable.


Culture, Pathogenic Organism Screen

COMPUTER ORDER ENTRY CXPTS (Add order comment to specify organism to scr een)

SYNONYMS Screen for MRSA; Screen for VRE; Surveillance Culture for MRSA

AVAILABILITY Test performed daily. Results available in 3 to 4 days.

TEST INCLUDES Any of the following: screen for MRSA, S. aureus, VRE, or N. meningitidis. Only the organism of concern is screened.

SPECIAL INSTRUCTIONS Indicate the source on the Microbiology specimen requisition.

SPECIMEN REQUIREMENT For MRSA or S. aureus : Collect nares, axilla, or groin swabs using BBL™ Culturette swab.

For VRE: Collect perianal or rectal swab using BBL™ Culturette swab. For N. meningitidis : Collect nasopharynx swab using BBL™ Culturette swab.

STORAGE INSTRUCTIONS Room temperature. Transport to the Laboratory within 24 hours.

CAUSES FOR REJECTION Desiccated specimen.


Culture, Respiratory (Sputum, BAL, Tracheal Aspirat e, etc.)

COMPUTER ORDER ENTRY CXRES


TEST INCLUDES Bacterial culture, gram stain (additional charge), identification, and sensitivity testing of potential pathogens (additional charges).

SPECIAL INSTRUCTIONS For organisms such as Legionella, Mycoplasma, Chlamydia, Viruses, etc., contact the Laboratory as these organisms have special requirements.


SPECIMEN REQUIREMENT Deep cough specimen: Submit approximately 3 mL in a sterile leak proof container. Induced specimen may increase yield, but take care not to contaminate sputum with the reservoir fluid.

Bronchial washing: Submit in a sterile leak proof container. Bronchial alveolar lavage (BAL): Submit in a sterile leak proof container. Tracheal aspirate: Submit in a sterile leak proof container. Transtracheal aspirate: Submit in a sterile leak proof container. Lung aspirate : Submit in a sterile leak proof container.

STORAGE INSTRUCTIONS Transport to the Laboratory as soon as possible. Refrigerate if transport must be delayed, but not longer than 24 hours.

CAUSES FOR REJECTION Excess oral contamination (identified with gram stain); fixed specimen; 24 hour collection.


Culture, Stool (without Shiga Toxin 1 and 2)

COMPUTER ORDER ENTRY CXSTL2

SYNONYMS Enteric pathogens; Culture for Salmonella, Shigella, Campylobacter, or E. coli 0157

USEFUL FOR This test is recommended for test of cure of a known bacterial enteropathogen that is not E. coli. It may be appropriate during outbreaks caused by Salmonella, Shigella, or Campylobacter. For patients with suspected, but undefined bacterial diarrhea that is not suspected C. difficile related, CULTURE, STOOL WITH SHIGA TOXIN 1 & 2 (CXST1) is recommended because of the better sensitivity over culture alone, for the detection of enteropathogenic E. coli, the second or third most frequently identified enteropathogen identified in our laboratory.


TEST INCLUDES Campylobacter, Salmonella, Shigella, and E. coli 0157: H7 (identification and sensitivity on appropriate isolates at additional charge). Rectal swabs submitted on black cap BBL™ CultureSwab™ may be tested for Neisseria gonorrhoeae or Strep pyogenes submitted on white cap BBL™ CultureSwab™, but indicate this on order. Salmonella, Shigella, Campylobacter and E. coli 0157 isolates are sent to a Reference Laboratory for serotyping and confirmation.

SPECIAL INSTRUCTIONS If other pathogens are suspected, contact the Laboratory.

Specimen limitations: � No more than 2 specimens per patient will be accepted without prior

consultation with Laboratory associates since yield is limited with more than 1-2 specimens. Studies have shown that culture of a single stool specimen has a sensitivity of > 95% for detection of the usual enteric pathogens causing enterocolitis. If the initial stool culture is negative, then additional fecal samples may be submitted for testing provided the patient collects them from different defecations on successive days. The Laboratory will not culture 2 specimens received from a patient collected on the same day.

� No stool specimens for culture will be accepted after the third day of an inpatient hospital stay without Pathologist approval or unless suspected outbreak.

� If multiple cultures are ordered, collect specimens on SEPARATE DAYS.

SPECIMEN REQUIREMENT Ask the patient to defecate into a clean container. Place fresh specimen (approximately 10g stool) in Cary-Blair transport media (available from the Laboratory) within one hour after collection. Do not fill above the line indicated on the vial. Mix well. Note: The specimen should not be mixed with urine, but semisolid to solid stool may be scooped out of urine.

If needed, diapers may be lined with plastic wrap to collect a very loose stool specimen. Transfer the specimen to the Cary Blair transport vial. DO NOT submit the stool in the diaper to the laboratory.

Rectal swabs submitted in black or white cap BBL™ Culture Swab may be tested for Neisseria gonorrhoeae or Streptococcus pyogenes, respectively.

STORAGE INSTRUCTIONS Store specimen in transport media at room temperature up to 24 hours or refrigerate (2-8ºC) up to 2 days (prefer refrigerated).

CAUSES FOR REJECTION Specimen in ParaPak transport media; fresh specimens not in Cary Blair media; frozen specimen; barium in specimen; specimen passed into toilet bowl or onto toilet paper; specimen received in a diaper; rectal swab for enteric pathogens.


Culture, Stool with Shiga Toxin 1 & 2

COMPUTER ORDER ENTRY CXST1

SYNONYMS Enteric pathogens; Culture for Salmonella, Shigella, Campylobacter, E. coli 0157:H7, Enterohemorrhagic E. coli or Shiga producing E. coli

USEFUL FOR This test is recommended for the evaluation of diarrheal patients of suspected bacterial etiology (except C. difficile). In our laboratory, Campylobacter, enteropathogenic strains of E. coli (EHEC), and Salmonella are the most frequently isolated bacterial enteropathogens. Culture with Shiga Toxin detection (for EHEC) provides a substantially better sensitivity than culture alone for EHEC and is recommended for most cases. For patients previously diagnosed with Campylobacter, Salmonella, or Shigella who are being evaluated for test of cure, or as part of a known outbreak involving those organisms, stool culture without Shiga Toxin is a more cost effective method to evaluate those specimens. See CULTURE, STOOL (CXSTL). For evaluation of possible viral enteritis or C. difficile (antibiotic associated) diarrhea, see those specific tests.

AVAILABILITY Test performed daily. Completion varies with results.

TEST INCLUDES Campylobacter, Salmonella, Shigella, and E. coli 0157: H7 (identification and sensitivity on appropriate isolates at additional charge) and an immunochromatographic method for Shiga like Toxins 1 & 2. Rectal swabs submitted on black cap BBL™ CultureSwab™ may be tested for Neisseria

gonorrhoeae or Strep pyogenes submitted on white cap BBL™ CultureSwab™, but indicate this on order. Salmonella, Shigella, Campylobacter, Shiga toxin producing E.coli and E. coli 0157 isolates are sent to a Reference Laboratory for serotyping and confirmation.

SPECIAL INSTRUCTIONS If other pathogens are suspected, contact the Laboratory.

Specimen limitations: � No more than 2 specimens per patient will be accepted without prior

consultation with Laboratory associates since yield is limited with more than 1-2 specimens. Studies have shown that culture of a single stool specimen has a sensitivity of > 95% for detection of the usual enteric pathogens causing enterocolitis. If the initial stool culture is negative, then additional fecal samples may be submitted for testing provided the patient collects them from different defecations on successive days. The Laboratory will not culture 2 specimens received from a patient collected on the same day.

� No stool specimens for culture will be accepted after the third day of an inpatient hospital stay without Pathologist approval or unless suspected outbreak.

� If multiple cultures are ordered, collect specimens on SEPARATE DAYS.

SPECIMEN REQUIREMENT Ask the patient to defecate into a clean container. Place fresh specimen (approximately 10g stool) in Cary-Blair transport media (available from the Laboratory) within one hour after collection. Do not fill above the line indicated on the vial. Mix well. Note: The specimen should not be mixed with urine, but semisolid to solid stool may be scooped out of urine.

If needed, diapers may be lined with plastic wrap to collect a very loose stool specimen. Transfer the specimen to the Cary Blair transport vial. DO NOT submit the stool in the diaper to the laboratory.

Rectal swabs submitted in black or white cap BBL™ Culture Swab may be tested for Neisseria gonorrhoeae or Streptococcus pyogenes, respectively.

STORAGE INSTRUCTIONS Store specimen in transport media at room temperature up to 24 hours or refrigerate (2-8ºC) up to 2 days (prefer refrigerated).

CAUSES FOR REJECTION Specimen in ParaPak transport media; fresh specimens not in Cary Blair media; frozen specimen; barium in specimen; specimen passed into toilet bowl or onto toilet paper; specimen received in a diaper; rectal swab for enteric pathogens.


Culture, Throat Full

COMPUTER ORDER ENTRY CXTHR

AVAILABILITY Test performed daily. Results available in 48 hours.

TEST INCLUDES Identification of potential aerobic bacterial pathogens (additional charge). Sensitivities performed at the discretion of the Laboratory, dependent upon organism, at an additional charge. Organisms like C. diptheria, Bordetella, Acranobacterium, N. gonorrhoeae, Viruses, and Mycoplasma have special requirements and are not routinely cultured. Contact the Laboratory for these requests.

SPECIMEN REQUIREMENT Swab posterior pharynx and tonsils, avoiding tongue and uvula, using single swab (white cap) or double swab (red cap).


CAUSES FOR REJECTION Desiccated swab.


Culture, Throat Strep Only

COMPUTER ORDER ENTRY CXSTR

SYNONYMS Strep Culture; Group A Strep; Strep pyogenes


TEST INCLUDES Cultures for Beta Hemolytic Streptococci including Group A and Beta Hemolytic Strep, not pyogenes. No sensitivity or gram stain is performed.

SPECIAL INSTRUCTIONS Swab posterior pharynx and tonsils, avoiding tongue and uvula, using single swab (white cap) or double swab (red cap).


CAUSES FOR REJECTION Desiccated swab.


Culture, Urine

COMPUTER ORDER ENTRY CXURN


TEST INCLUDES Identification of aerobic pathogens with sensitivity as appropriate (additional charges).

SPECIAL INSTRUCTIONS Indicate midstream vs. straight cath vs. suprapubic aspirate. (Laboratory workup varies with collection technique). If not indicated, workup will be as for midstream collection. Anaerobic cultures will be performed on suprapubic aspirates.

NOTE: Organisms identified in a catheterized urine specimen may represent colonization rather than infection. Clinical judgment is needed to determine the significance of growth in these types of specimen.

SPECIMEN REQUIREMENT Fresh clean catch midstream or catheterized urine submitted in sterile leak proof container. (For indwelling catheters, cleanse the port and discard the pooled urine. Aspirate a fresh sample and submit for analysis.) Refrigerate promptly for up to 24 hours.

STORAGE INSTRUCTIONS Refrigerate (2-8°C). Do not store at room temperature longer than 30 minutes.

CAUSES FOR REJECTION Specimen greater than 24 hours old; delayed refrigeration; frozen specimen; 24 hour specimen; specimen obtained from an indwelling urine catheter collection bag.


Culture, Urogenital

COMPUTER ORDER ENTRY CXGEN

SYNONYMS Vaginal Culture; Cervical Culture

AVAILABILITY Test performed daily. Negative results available in 3 days.

TEST INCLUDES Identification of potential bacterial pathogens at additional charge. Sensitivity (additional charge) at the discretion of the Laboratory. Isolates of N. gonorrhoeae, Yeast, Gardnerella, Groups A and B Strep, and Staph aureus are reported from vaginal, cervical, and male urethral specimens. Tissue/endometrial specimens include cultures for most bacteria, including anaerobes if properly submitted.

SPECIMEN REQUIREMENT Males: Collect and transport in orange cap BBL™ CultureSwab™ (wire shaft). Females: Collect and transport in black cap BBL™ CultureSwab™ (plastic

shaft). Tissue: Submit in a sterile container, transport to Laboratory immediately.

STORAGE INSTRUCTIONS Room temperature up to 24 hours on appropriate swab. Transport immediately to Laboratory if tissue. DO NOT REFRIGERATE OR FREEZE.

CAUSES FOR REJECTION Refrigerated specimen; desiccated swab; specimen received in APTIMA® vaginal swab collection kit.


Cyclic Citrullinated Peptide Antibody, IgG

COMPUTER ORDER ENTRY LCCP

SYNONYMS CCP; Anti-CCP






D-Dimer

COMPUTER ORDER ENTRY DD


SPECIAL INSTRUCTIONS Tube must be a full draw, do not overfill or underfill.

NOTE: D-Dimer test is used as an aid in the diagnosis of venous thromboembolism and pulmonary embolism.

Elevated D-Dimer is abnormal but not specific. Increased levels can be seen in a variety of conditions or result from interfering substances. Therefore this result must be interpreted in conjunction with the clinical situation.

SPECIMEN REQUIREMENT Draw blood in a light blue top (Sodium Citrate) tube (full tube). Centrifuge for 15 minutes at 3000 RPM and pipette plasma into a plastic transfer tube capped tightly for transport.

STORAGE INSTRUCTIONS Refrigerate (2-8°C) plasma (spun off cells) up to 24 hours. Whole blood samples can be stored for 4 hours at room temperature. Plasma may be frozen up to 5 days.

CAUSES FOR REJECTION Improper volume; clotted specimen.


Depakote Level

COMPUTER ORDER ENTRY VALP

SYNONYMS See Valproic Acid Level


DHEA-SO4

COMPUTER ORDER ENTRY DHSO4

SYNONYMS DHEA-S; Dehydroepiandristerone Sulfate

NOTE: Dehydroepiandrosterone (DHEA) is a separate test that is sent to a Reference Laboratory.




SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerate (2-8°C) (spun): up to 48 hours

A green (Lithium heparin) PST (full draw) is an acceptable substitute if delivery to the Laboratory will not exceed 8 hours.





Digoxin

COMPUTER ORDER ENTRY DIG

SYNONYMS Lanoxin


SPECIAL INSTRUCTIONS Optimal sampling time: draw specimen 8-24 hours after oral dose.



SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 4 hours Refrigerate (2-8°C) (spun): up to 48 hours SPECIMEN MINIMUM VOLUME 0.4 mL serum



Dilantin (Phenytoin)

COMPUTER ORDER ENTRY DILAN

SYNONYMS Dilantin



Interpretation of results should be done in the context of the overall clinical

presentation of the patient, including symptoms, clinical history, data from additional tests and other appropriate information.

SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 4 hours Refrigerate (2-8°C) (spun): up to 48 hours




Direct Coombs Test

COMPUTER ORDER ENTRY DATP

SYNONYMS Direct Antiglobulin Test (DAT); Anti-human Globulin Test

AVAILABILITY Test performed on all shifts; available STAT.

TEST INCLUDES Direct Coombs with Polyspecific (IgG, complement) Coombs serum; reflex Monospecific (IgG) and Anti-C3b, C3d testing on positives (added charges). Eluates with Antibody Identification in selected cases (added charge).

SPECIAL INSTRUCTIONS Include the patient's transfusion, pregnancy, and/or current medication history.



CAUSES FOR REJECTION Specimen not properly labeled; gross hemolysis; clotted blood.


Double-Stranded DNA Antibody, IgG

COMPUTER ORDER ENTRY LDDNA

SYNONYMS DS DNA

AVAILABILITY Test performed daily at a Reference Laboratory.

SPECIMEN REQUIREMENT Draw blood in a red top or SST. Centrifuge and send aliquot to Reference Laboratory.




Draw and Hold – Blood Bank

COMPUTER ORDER ENTRY HOLD


TEST INCLUDES Phlebotomy draw of Blood Bank specimen suitable for Crossmatch, with Type and Screen as appropriate if the need for transfusion is identified within 3 days. The patient is banded with a unique Blood Bank arm band.

SPECIAL INSTRUCTIONS Laboratory and previously determined groups may obtain this specimen.




CAUSES FOR REJECTION Specimen and/or requisition not properly labeled; gross hemolysis; SST

specimen. DEPARTMENT Blood Bank Drug Screen, Urine (Qualitative)

COMPUTER ORDER ENTRY UDRUG


TEST INCLUDES Immunochromatographic assay for the presumptive identification of Amphetamines, Methamphetamines, Barbituates, Benzodiazepine, Buprenorphine, Cocaine, Methadone, Opiates, Oxycodone, PCP, Propoxyphene, THC, and TCA. Evaluation cutoffs are listed below. Ethanol must be ordered separately, if needed.

MEDTOX® Panel

Drug Class cut off concentration

(ng/mL)

AMP-Amphetamine 500

BAR-Barbiturates 200

BUP-Buprenorphine 10

BZO-Benzodiazepines 150

COC-Cocaine 150

mAMP-Methamphetamine 500

MTD-Methadone 200

OPI-Opiates 100

OXY-Oxycodone 100

PCP-Phencyclidine 25

PPX-Propoxyphene 300

TCA-Tricyclic Antidepressants 300

THC-Cannabinoids 50

CAUTION: If the clinical situation is such that the result must be absolutely correct, confirmation of a positive result should be ordered as a quantitative drug analysis, which will then be performed at a Reference Laboratory.

A positive result indicates that the patient may have recently taken a drug in that drug class. False positives may occur and results should be interpreted in light of all clinical data. Confirmatory testing, at a Reference Laboratory, of a positive result that does not “fit” should be ordered as soon as an unexpected result is received.

SPECIAL INSTRUCTIONS This drug screen is not intended to be used for legal purposes since a chain of custody and second method confirmation will not be performed. The screen should be not be used for employment decisions.

It is important to remember that instant drug testing immunoassays, are screening tests and they give you a preliminary result. Any presumptive positive result(s) should be explored for possible alternative explanations--i.e. known related/unrelated cross reactive compounds, etc. Alternative, more specific methods like GC/MS or LC/MS should be utilized to obtain a definitive confirmed quantitative result. Note: false negative results might be obtained if

the urine is reanalyzed using higher workplace screening or confirmation thresholds. No immunoassay screen is 100% accurate or specific. Not all presumptive positive screens will confirm positive. This is true of laboratory based instrumented immunoassays as well as on site drug screening

The specificity and cross reactivity table on the following page lists a number of drugs and metabolites which may be detected within the individual drug screening classes. A drug's cross reactivity is dependent on its concentration in the urine. This concentration is dependent on a number of factors including, but not limited to: dosage, frequency, metabolism and state of hydration. A complete MEDTOX® listing may be obtained from the laboratory.

SPECIMEN REQUIREMENT 10 mL aliquot from a well mixed random urine.



MEDTOX® Specificity and Cross Reactivity

ASSAY Most Sensitive To Less Sensitive To

Known Cross Reactant

Amphetamine d-Amphetamine, MDA I-Amphetamine Phentermine, Fenfluramine Barbiturates Butalbital

Phenobarbital Butabarbital Amo-, Pento-, Seco-barbital

Phenytoin

Benzodiazepines Nordiazepam Alprazolam Flurazepam metabolite Diazepam, Oxazepam, Temazepam Flunitrazepam Nitrazepam Chlorazepate metabolites Triazolam

Lorazepam Midazolam Clonazepam Chlordiazepoxide metabolites

Buprenorphine Buprenorphine, (& glucuronide)

Norbuprenorphine & gluc.

Cocaine Benzoylecgonine (Coc Metab) Cocaine

Methadone Methodone Methamphetamine d-Methamphetamine

MDMA I-Methamphetamine MDE (MDEA)

Ephedrine, Ephedra, (ma huang) Phenylephrine (PE) Procaine, Fenfluramine

Opiates Codeine Morphine 6 MAM (Heroin Metabolite) Hydrocodone Dihydrocodeine

Nalorphine Levorphanol Hydromorphone

Poppy Seeds (often contain enough morphine to cause a positive opiate screen at lower cut off concentrations)

Oxycodone Oxycodone Oxymorphone

Codeine, Dihydrocodeine Morphine Hydrocodone Hydromorphone Naloxone Naltrexone

Note: Higher concentrations of the opiates (Codeine, Morphine, Hydrocodone, Hydromorphone, etc., on the left) may cause a Positive Oxycodone Screen, in addition to a positive Opiate Screen.

Phencyclidine (PCP)

Phencyclidine Suspected: venlafaxine metabolites, Lamotrigine metabolites

Propoxyphene Propoxyphene & Norpropoxyphene

THC (Cannabinoids)

Carboxy-THC (Marijuana Metab)

Sustiva & Atripla contain Efavirenz—unmetabolized Efavirenz does not cause a positive THC screen, BUT its metabolites may cause a positive THC screen.

Tricyclic Antidepressants

Amitriptyline Nortriptyline Imipramine Desipramine Nordoxepin (Doxepin) metabolite Maprotiline

Trimipramine Doxepin

Cyclobenzaprine Quetiapine Promazine Clozapine Prochlorperazine Perphenazine

Electrolyte Panel

COMPUTER ORDER ENTRY LYTES


TEST INCLUDES CO2, Chloride, Potassium, and Sodium.


Stability: Room temp (unspun): optimally up to 1 hour Room temp (spun): up to 8 hours Refrigerated (2-8°C) (spun): up to 24 hours

Ripon Medical Center and all other sites: Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room temp (unspun): optimally up to 1 hour Room temp (spun): up to 8 hours Refrigerated (2-8°C) (spun) up to 24 hours



CAUSES FOR REJECTION See individual tests.


Endomysial Antibody, IgA

COMPUTER ORDER ENTRY LENDA






Eosinophil Count

COMPUTER ORDER ENTRY EOSRV

SYNONYMS Eosin, Fluid

AVAILABILITY Test performed on all shifts.

TEST INCLUDES % eos present / 100 WBC.

SPECIMEN REQUIREMENT 12 mL fresh urine, nasal swab, or 2 air dried slides.

STORAGE INSTRUCTIONS Swabs: refrigerate (2-8°C) up to 24 hours; Urine: prepare sildes within 2 hours of voiding.

CAUSES FOR REJECTION Unlabeled slides; desiccated swab.


ESR (Erythrocyte Sedimentation Rate)

COMPUTER ORDER ENTRY ESR

SYNONYMS See Sed Rate


Estradiol

COMPUTER ORDER ENTRY E2

SYNONYMS Estradiol-17β




SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room temp (unspun): up to 2 hours Room temp (spun): up to 8 hours Refrigerated (2-8°C) (spun): up to 48 hours


Stability: Room temp (unspun): up to 2 hours Room temp (spun): up to 8 hours Refrigerated (2-8°C) (spun): up to 48 hours




Ethanol

COMPUTER ORDER ENTRY ALC

SYNONYMS Ethanol; ETOH; Ethyl Alcohol; Ethanol Blood Medical


SPECIAL INSTRUCTIONS The tube should be completely filled. Do not remove the stopper. The venipuncture site should be cleansed with an alcohol-free disinfectant such as iodine.

NOTE: This test is not intended to measure blood volatiles other than ethanol. For methanol or isopropanol determinations, order a Volatile Screen. This test is intended for medical treatment and evaluation. Legal Alcohol Levels require a chain of custody in processing. Contact the Laboratory for these requests.

SPECIMEN REQUIREMENT Draw blood in a SST. Do not remove stopper otherwise loss of volatile alcohol may occur.

NO FINGERSTICKS.

Stability: Refrigerate (2-8°C) (spun) up to 24 hours.

STORAGE INSTRUCTIONS See above. Do not remove stopper.


Ethanol, Urine

COMPUTER ORDER ENTRY UALC

SYNONYMS Urine Ethanol; Urine Alcohol


SPECIAL INSTRUCTIONS Transport container must be tightly capped.

SPECIMEN REQUIREMENT 10 mL aliquot from well-mixed random urine. Container must be tightly capped.

STORAGE INSTRUCTIONS Refrigerate (2-8°C). Analysis should be completed the same day as collection.


Factor II 20210 MUT *** Prior authorization is required

COMPUTER ORDER ENTRY FAC2M

SYNONYMS Factor 2 Prothrombin, Factor 2 Mutation, Factor 2, F2


SPECIMEN REQUIREMENT Draw blood in a lavender top (EDTA) tube. Tube must be a dedicated tube

STORAGE INSTRUCTIONS Room temperature up to 24 hours; refrigerate (2-8°C) up to 15 days.

CAUSES FOR REJECTION Lavender top (EDTA) tube was used for other testing.

DEPARTMENT Special Chemistry

Factor V Leiden MUT *** Prior authorization is required

COMPUTER ORDER ENTRY FAC5L

SYNONYMS Factor 5, F5


SPECIMEN REQUIREMENT Draw blood in a lavender top (EDTA) tube. Tube must be a dedicated tube


CAUSES FOR REJECTION Lavender top (EDTA) tube was used for other testing.


Ferritin

COMPUTER ORDER ENTRY FER





Stability: Room temp (unspun): up to 2 hours

Room temp (spun): up to 8 hours Refrigerated (2-8°C) (spun): up to 48 hours

Ripon Medical Center and all other sites: Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room temp (unspun): up to 2 hours Room temp (spun): up to 8 hours Refrigerated (2-8°C) (spun) up to 48 hours




Fetal Fibronectin, Rapid

COMPUTER ORDER ENTRY FFN

AVAILABILITY Test performed 24 hours a day; available STAT.

TEST INCLUDES Fetal Fibronectin measurement in cervicovaginal secretions.

SPECIAL INSTRUCTIONS Specimen must be collected using Adeza Specimen Collection Kit. Contact the Laboratory for kit and follow kit instructions. Obtain specimen prior to digital exam or manipulation of the cervix, taking care to avoid lubricants, monistat creamy excessive mucus, soaps, and disinfectants. These events will invalidate the test. Coitus within 24 hours of specimen collection should be avoided. DO NOT use this test in cases of suspected or known placental abruption, placenta previa, or moderate to gross vaginal bleeding.

NOTE: A positive result in symptomatic women with intact membranes and < 3 cm dilation between 24 and 34 weeks, 6 days gestation indicates the risk of preterm delivery in 7 to 14 days. This test assesses the risk of preterm delivery in asymptomatic women with singleton gestation whenever sampled between 22 and 30 weeks, 6 days.

CONTRAINDICATIONS: Testing should not be performed on patients with one or more of the following conditions:

Symptomatic women: � Cervical dilation (≥ 3 cm) � Rupture of amniotic membranes � Cervical cerclage � Moderate or gross vaginal bleeding

Asymptomatic women: � Multiple gestations � Cervical cerclage � Placenta previa � Sexual intercourse in the preceding 24 hours

INTERFERENCES Bloody specimens may give false positive results.

SPECIMEN REQUIREMENT Special Cervico vaginal swabs. See special instructions. Swab posterior fornix and/or ectocervical os only.

STORAGE INSTRUCTIONS Refrigerate (2-8°C) up to 3 days. Storage at 2-25°C up to 24 hours.

CAUSES FOR REJECTION No secretion absorbed into swab; specimen not collected with Adeza Collection Kit. Excessive blood, excessive mucus, presence of interfering substances, leakage of buffer from the tube.


Fetal Screen (Rhogam [Rh Immune Globulin] Evaluatio n)

COMPUTER ORDER ENTRY PPRHO

SYNONYMS Antepartum Rhogam; Postpartum Rhogam; Screen for Fetal-Maternal Hemorrhage; RhIG


TEST INCLUDES ANTEPARTUM : Agnesian Healthcare system patient: Rh (D) with Du and Antibody Screen if not previously performed with this pregnancy in the system (added charge). Antibody Identification if screen is positive (added charge). Non Agnesian system patient: Rh (D) with Du and Antibody Screen if not performed at CLW during this pregnancy (added charges). Antibody Identification if screen is positive (added charge). MISCARRIAGE : cessation of pregnancy or ectopic pregnancy (less than 26 weeks gestation). As above for antepartum Rhogam. At or beyond 26 weeks gestation, as above, plus Fetal Screen with quantitation if positive (added charge). POST PARTUM: Rh (D); Neonate - cord blood Rh (D). If negative, no further Rhogam (RhIG) evaluation needed. If positive maternal Rh(D), Fetal Screen test with quantitation (added charge) and maternal Antibody Screen with Identification (added charge) if Rhogam not given prenatally. NOTE: One 300 µg dose of Rhogam is indicated for a 30 mL fetal-maternal bleed. Positive Fetal Screen results will be evaluated for larger bleeds and possible additional doses of Rhogam.

SPECIAL INSTRUCTIONS Postpartum maternal sample should be drawn no sooner than 1 hour but within 72 hours after delivery.

If mother received RhIG during this pregnancy, provide the date of injection.

SPECIMEN REQUIREMENT ANTEPARTUM or MISCARRIAGE : Draw blood in a lavender top (EDTA) tube (refrigerate up to 14 days). No SST specimens.

POST PARTUM: � If the antepartum studies were performed at CLW, no maternal studies

are required. � If no antepartum Rhogam was given or the patient had non Agnesian

system prenatal care, two 7 mL clotted whole blood in plain red top tubes (no additive) (refrigerate up to 14 days) and a cord blood.

Rh requires 7 mL clotted whole blood from a plain red top tube (no additive) and 3 mL whole blood from a lavender top (EDTA) tube. No SST specimens. Refrigerate (2-8°C) up to 7 days.

STORAGE INSTRUCTIONS See Specimen Requirements.

CAUSES FOR REJECTION Maternal Rh (D) positive or Fetal Rh (D) negative Anti D identified in maternal serum not related to antepartum Rhogam.


Fibrinogen

COMPUTER ORDER ENTRY FIBR


SYNONYMS Fibrinogen level; Factor I

SPECIAL INSTRUCTIONS CAUTION! Blue top tube must be a full draw. Do not overfill or underfill. Patient should not receive heparin within one hour of specimen collection.

SPECIMEN REQUIREMENT Draw blood in a light blue top (Sodium Citrate) tube (full tube).

STORAGE INSTRUCTIONS Store at room temperature on cells for up to 8 hours. If delivery to the Laboratory exceeds 8 hours, centrifuge for 15 minutes, place plasma into a

plastic transfer tube capped tightly for transport, and freeze.

CAUSES FOR REJECTION Severe hemolysis or icterus; moderate lipemia; inadequately filled tube; clotted specimen; frozen specimen received thawed.

DEPARTMENT Hematology (Central Laboratory Fond du Lac)

Folate

COMPUTER ORDER ENTRY FOLIC

SYNONYMS Folic Acid

SPECIAL INSTRUCTIONS Patient should be fasting at least 8 hours.





Stability: Room temp (unspun): up to 2 hours Room temp (spun): NONE. Refrigerate ASAP. Refrigerated (2-8°C) (spun) up to 8 hours Frozen (pipette off serum): up to 48 hours





Folate, Erythrocytes (RBC)

COMPUTER ORDER ENTRY LFOLA

AVAILABILITY Test performed Sunday through Friday at a Reference Laboratory.

SPECIAL INSTRUCTIONS Verify that the patient has not had vitamins containing folic acid during the previous three to five days. If yes, consult the physician.

SPECIMEN REQUIREMENT Three full lavender top (EDTA) tubes.

STORAGE INSTRUCTIONS Transfer 7 mL from two whole blood tubes into a plastic transport tube and freeze . Refrigerate third whole blood tube.


FSH (Follicle Stimulating Hormone)

COMPUTER ORDER ENTRY FSH






Ripon Medical Center and all other sites: Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room temp (unspun): up to 2 hours Room temp (spun): up to 8 hours Refrigerated (2-8°C) (spun) up to 48 hours




Fungus Culture

COMPUTER ORDER ENTRY CXFNM (misc – other than skin, hair, or nail); CXFN S (skin, hair, or nail)

SYNONYMS See Culture, Fungus


GC by PCR

COMPUTER ORDER ENTRY GONO

SYNONYMS See Gonorrhea, Neisseria by SDA (N. gonorrhoeae, SDA)


Gentamicin Level

COMPUTER ORDER ENTRY GENTP (peak); GENTR (random); GENTT (trough)

SYNONYMS GENTA; Garamycin


SPECIAL INSTRUCTIONS Trough : Draw 30 minutes before dose. Peak: Draw 30 minutes after the completion of an IV infusion or 60 minutes after IM dose.

INTERFERENCES Patients on Sisomicin or Carbenicillin will cross-react with this method.

HAMA or Heterophile antibodies may interfere with this test. Possible clinical discrepancies may be resolved by ordering HAMA or Heterophile antibody detection.


Hemolysis and lipemia for Ripon Medical Center testing.

SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room temp (unspun): up to 2 hours Room temp (spun): up to 4 hours Refrigerate (2-8°C): up to 48 hours SPECIMEN MINIMUM VOLUME 0.3 mL serum; 0.6 mL whole blood (1 full microtainer)


DEPARTMENT Chemistry (Central Laboratory Fond du Lac and Ripon Medical Center)

Gestational Diabetes Screen

COMPUTER ORDER ENTRY GEST

SYNONYMS O'Sullivan Screen; Prenatal Diabetes Screen


TEST INCLUDES 1 hr post dose glucose.

SPECIAL INSTRUCTIONS Pregnant adult dose: 50g glucose. Draw blood specimen 1 hour after the glucose is administered. Fasting is not required.

SPECIMEN REQUIREMENT Preferred specimen: Draw blood in a gray top (Sodium Fluoride/Potassium Oxalate) tube, completely filled.

Stability: Refrigerate (2-8°C): up to 24 hours

Central Laboratory Fond du Lac, Waupun Memorial Hos pital, Ripon Medical Center, Dialysis Centers, and Convenient Ca re: Draw blood in a green (Lithium heparin) PST (full tube). Centrifuge and send specimen in the original tube.


All other sites: Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room temp (unspun): optimally up to 1 hour Room temp (spun): up to 8 hours Refrigerated (2-8°C) (spun) up to 5 days



GFR (Glomerular Filtration Rate)

COMPUTER ORDER ENTRY CRGFR

SPECIAL INSTRUCTIONS This calculation is routinely reported any time a Creatinine is ordered. If a GFR is ordered independently, a Creatinine will be ordered and charged. This calculation is not available on patients under the age of 18 years.

NOTE: This calculation uses the MDRD Equation (Modification of Diet in Renal Disease Study Group.) The Glomerular Filtration Rate is based on age, gender, race, and Creatinine.

Estimated GFR is not a reliable measure of renal function in acutely ill individuals.

DEPARTMENT Chemistry GGTP (GGT)

COMPUTER ORDER ENTRY GGT

SYNONYMS Gamma GT; Gamma Glutamyl Transferase



Stability: Room temp (unspun): up to 2 hours Room temp (spun): up to 8 hours Refrigerated (2-8°C) (spun): 48 hours

Ripon Medical Center and all other sites: Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room temp (unspun): up to 2 hours Room temp (spun): up to 8 hours Refrigerated (2-8°C) (spun) up to 5 days



CAUSES FOR REJECTION Hemolysis; specimen collected in Potassium Oxalate/Sodium Fluoride, Sodium Citrate, or EDTA (gray, light blue or lavender top tubes).


Giardia Specific Antigen, Fecal

COMPUTER ORDER ENTRY GSA

SYNONYMS Giardia Antigen, GSA


TEST INCLUDES Rapid Immunoassay method.

SPECIAL INSTRUCTIONS A single stool specimen is generally sufficient, unless the patient remains symptomatic. Testing patients who develop diarrhea after 3 days of hospitalization is discouraged.

SPECIMEN REQUIREMENT Stool. STORAGE INSTRUCTIONS Para Pak: Refrigerate (2-8°C) or room temperature up to 2 months. OR Cary-Blair: Refrigerate (2-8°C) up to 2 weeks.

CAUSES FOR REJECTION Stools concentrated or treated with PVA fixative. Colonic washes, aspirate or other diluted sample types; stool samples contaminated with oily or particulate base (such as barium or mineral oil).


Gliadin (Deaminated) Antibody Evaluation, IgG and I gA

COMPUTER ORDER ENTRY LGLAB






Glucose

COMPUTER ORDER ENTRY GLU (random); FGLU (fluid); CFGLU (CSF)

SYNONYMS Blood Sugar; Fasting Blood Glucose; FBS; Random Sugar


SPECIAL INSTRUCTIONS Fasting at least 8 hours is recommended.

SPECIMEN REQUIREMENT Preferred specimen: Draw blood in a gray top (Sodium Fluoride/Potassium Oxalate) tube, completely filled.


Central Laboratory Fond du Lac, Waupun Memorial Hos pital, Dialysis

Centers, and Convenient Care: Draw blood in a green (Lithium heparin) PST (full tube). Centrifuge and send specimen in the original tube.


Ripon Medical Center and all other sites: Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room temp (unspun): optimally up to 1 hour Room temp (spun): up to 8 hours Refrigerated (2-8°C) (spun) up to 5 days

CSF: 1 mL CSF in a plastic container.

Fluid: 1 mL heparinized fluid in a dark green top (Lithium heparin) tube, or with no anticoagulant added. Indicate the type of fluid on the requisition.



CAUSES FOR REJECTION Specimen not processed properly.


Glucose Tolerance - Gestational

COMPUTER ORDER ENTRY 3GEST

SYNONYMS Gestational OGTT


TEST INCLUDES Blood glucose at timed intervals.

SPECIAL INSTRUCTIONS Call Laboratory for instructions. Patient should be fasting at least 8 hours but not more than 16 hours. The patient should be on a normal diet and unrestricted activity 72 hours prior to the test. Early morning testing following an overnight fast is preferable. No alcohol should be consumed after the evening meal. Caffeine and nicotine should be avoided before and during the test. The patient should remain seated during the test. Blood is collected at timed intervals before and after the glucose is given.

Pregnant adult dose: 100g

SPECIMEN REQUIREMENT Collection times: fasting, 1 hour, 2 hour, and 3 hour. Indicate time of draw on all tubes.

Preferred specimen: Draw blood in a gray top (Sodium Fluoride/Potassium Oxalate) tube, completely filled.


Central Laboratory Fond du Lac, Waupun Memorial H ospital, Ripon Medical Center, Dialysis Centers, and Convenient Care: Draw blood in a green (Lithium heparin) PST (full tube). Centrifuge and send specimen in the original tube.





CAUSES FOR REJECTION Patient not arriving in fasting state; specimens not labeled with correct times; patient experiences nausea to the point of emesis production.

DEPARTMENT Chemistry Glucose Tolerance – Nongestational (Non-WHO Standar d Protocol)

COMPUTER ORDER ENTRY OGTT3 (3 hr); OGTT4 ( 4 hr); OGTT5 (5 hr); OGTT6 (6hr)

SYNONYMS GTT


TEST INCLUDES Blood glucose at timed intervals. This is a non-WHO standard test format; reference ranges for all draw times are not available. Data interpretation to be provided by the ordering practitioner.

SPECIAL INSTRUCTIONS Call the Laboratory for instructions. Patient should be fasting at least 8 hours but not more than 16 hours (fasting is defined as no caloric intake for at least 8 hours). Early morning testing following an overnight fast is preferable. No alcohol should be consumed after the evening meal. Caffeine and nicotine should be avoided before and during the test. The patient should remain seated during the test. Blood is collected at timed intervals before and after the glucose is given.

Non-pregnant adult dose: 75g Children: 1.75g/Kg body weight, not to exceed 75g For pregnant patient, see Glucose Tolerance – Gestational.

Patient should be on a suggested diet for 3 days prior to the test. – See Appendix.

SPECIMEN REQUIREMENT Collection times: fasting, 30, 60, 90, and 120 minutes, and hourly thereafter until a time specified for completion. Indicate time of draw on all tubes.

Preferred specimen: Draw blood in a gray top (Sodium Fluoride/Potassium

Oxalate) tube, completely filled. Stability: Refrigerate (2-8°C): up to 24 hours Central Laboratory Fond du Lac, Waupun Memorial H ospital, Ripon

Medical Center, Dialysis Centers, and Convenient Ca re: Draw blood in a green (Lithium heparin) PST (full tube). Centrifuge and send specimen in the original tube.







Glucose Tolerance – 1 Hour

COMPUTER ORDER ENTRY GEST

SYNONYMS See Gestational Diabetes Screen


Glucose Tolerance – 2 Hour OGTT (WHO Standard Proto col)

COMPUTER ORDER ENTRY OGTT2


TEST INCLUDES Fasting glucose and 2 hour post dose Glucose.

SPECIAL INSTRUCTIONS Call the Laboratory for instructions. Patient should be fasting at least 8 hours but not more than 16 hours (fasting is defined as no caloric intake for at least 8 hours). No alcohol should be consumed after the evening meal. Caffeine and nicotine should be avoided before and during the test. The patient should remain seated during the test. Blood is collected at timed intervals before and after the glucose is given.

Non-pregnant adult dose: 75g Children: 1.75 g/Kg body weight, not to exceed 75g. For pregnant patient, see Glucose Tolerance - Gestational.

Patient should be on a suggested diet for 3 days prior to the test. – See Appendix.

SPECIMEN REQUIREMENT Collection times: fasting and 2 hour. Indicate time of draw on both tubes.


Stability: Refrigerate (2-8°C): up to 24 hours Central Laboratory Fond du Lac, Waupun Memorial Hos pital, Ripon Medical Center, Dialysis Centers, and Convenient Ca re: Draw blood in a green (Lithium heparin) PST (full tube). Centrifuge and send specimen in the original tube.







Glucose Tolerance – 2 Hour Post Prandial COMPUTER ORDER ENTRY 2HRP SYNONYMS 2HRPP; 2 HR Post Meal


TEST INCLUDES Blood Glucose level drawn 2 hours after a meal. NOTE: Test DOES NOT include a Fasting Glucose; if requested, this requires an additional order.

SPECIAL INSTRUCTIONS The physician or nurse should direct the patient in preparation for the 2 Hour

Post Prandial collection. If not, see Appendix for a sample meal. SPECIMEN REQUIREMENT Preferred specimen: Draw blood in a gray top (Sodium Fluoride/Potassium

Oxalate) tube, completely filled. Stability: Refrigerate (2-8°C): up to 24 hours Central Laboratory Fond du Lac, Waupun Memorial Hos pital, Ripon

Medical Center, Dialysis Centers, and Convenient Ca re: Draw blood in a green (Lithium heparin) PST (full tube). Centrifuge and send specimen in the original tube.





CAUSES FOR REJECTION Specimen not processed properly. DEPARTMENT Chemistry Glucose, Urine (Quantitative)

COMPUTER ORDER ENTRY UGLUR (random); UGL24 (24 hour collection)

SYNONYMS Urine Glucose


TEST INCLUDES Glucose on 24 hour or random urine collection.


SPECIMEN REQUIREMENT 20 mL aliquot from a well mixed random or 24 hour urine collection.



Glyco (Glycosylated Hemoglobin)

COMPUTER ORDER ENTRY HGBA1

SYNONYMS See Hemoglobin A1C


Gonorrhea, Neisseria by PCR (N. gonorrhoeae, PCR)

COMPUTER ORDER ENTRY GONO

SYNONYMS GC Nucleic Acid (NAAT)





ThinPrep® Liquid Cytology Collection kit Male Urethral APTIMA Unisex Swab Collection kit Cervical or endocervical ThinPrep® Liquid Cytology Collection kit Urine (male only) Sterile urine container NOTE: Specimen sources other than listed above (collected with an APTIMA Unisex Swab) and female urine specimens will be referred to a Reference Laboratory. Pharyngeal samples are not collected by laboratory personnel. Vaginal Swab Specimen Collection Instructions








Male Urethral Swab Collection Instructions 1. The patient should not have urinated for at least one hour prior to sample

collection. 2. Insert the collection swab (blue shaft) 2-4 cm into the urethra. 3. Gently rotate the swab clockwise for 2-3 seconds in the urethra to ensure

adequate sampling. 4. Withdraw the swab carefully.

5. Remove the cap from the swab transport tube and immediately place the collection swab into the transport tube.

6. Carefully break the swab shaft at the scoreline; use care to avoid splashing of contents.

7. Tightly screw the cap onto the tube.

Urine Collection Instructions 1. The patient should not have urinated for at least one hour prior to

specimen collection. 2. Direct patient to provide a first-catch urine (approximately 20-30 mL of the

initial urine stream) into a urine collection cup free of any preservatives. Collection of larger volumes may result in rRNA target dilution that may reduce test sensitivity.

3. Urine must be received in the central laboratory within 24 hours of collection. If this cannot be achieved, urine transport tubes containing RNA stabilizers must be used. Should you need the urine transport tubes, please contact Specimen Handling for further instructions.

STORAGE INSTRUCTIONS APTIMA swab: room temperature (2-30°C) up to 60 days. Urine: room temperature (2-30°C) up to 24 hours; ThinPrep® Liquid Cytology container: 2-30°C up to 30 days (Cannot be added if the vial has been used to prepare a Pap Smear)



Gram Stain

COMPUTER ORDER ENTRY GRAM

SYNONYMS Bacterial stain


TEST INCLUDES Gram stain smear examined for WBCs and bacteria.

SPECIAL INSTRUCTIONS Record the source and site of the specimen. BE SPECIFIC, e.g. “wound, lower left leg”. Gram Stain will be added to appropriate bacterial specimens.

SPECIMEN REQUIREMENT Clinical specimens such as sputum, wounds, body fluids, urine, aspirates, drainage, lesions, tissues, etc. Specimens may be submitted in a sterile leak proof containers without preservatives; or submitted on a single or double culturette swab.

STORAGE INSTRUCTIONS Room temperature. Transport to the Laboratory promptly.

CAUSES FOR REJECTION Specimens received in formalin or other fixatives.


GSA

COMPUTER ORDER ENTRY GSA

SYNONYMS See Giardia Specific Antigen


Haptoglobin

COMPUTER ORDER ENTRY HAPTO

AVAILABILITY Test performed daily on AM shift.


SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (spun): up to 8 hours Refrigerated (2-8ºC) (spun): up to 72 hours



CAUSES FOR REJECTION Grossly lipemic sample which cannot be clarified by centrifugation; gross hemolysis.


hCG

SYNONYMS See Pregnancy Test, (BHCG) Quantitative for quantitative testing; see Pregnancy Test – Urine or Serum for qualitative results

NOTE: For Tumor Marker (or β-hCG, Tumor), order Chorionic Gonadotropin, β Subunit, Quantitative Tumor CHORI (sent to a Reference Laboratory)


HDL Cholesterol

COMPUTER ORDER ENTRY HDL1

SYNONYMS High Density Lipoprotein Cholesterol


SPECIAL INSTRUCTIONS Patient should fast for 12 hours.


Stability: Room temp (unspun): up to 2 hours Room temp (spun): up to 8 hours Refrigerated (2-8°C) (spun): up to 5 days




CAUSES FOR REJECTION Specimen with greatly elevated triglycerides; non-fasting specimen.


Hematocrit

COMPUTER ORDER ENTRY HCT




CAUSES FOR REJECTION Clotted or frozen specimen; incorrect anticoagulant; gross hemolysis; low volume.


Hematology Consult

COMPUTER ORDER ENTRY REVU

SYNONYMS Smear Review; Physician Requested Smear Review

AVAILABILITY Test performed on all shifts. NOTE: Requests received on the night or week-end shifts require specific instructions to be performed prior to the next business workday.

TEST INCLUDES Review of Peripheral Blood Smear and CBC with written interpretation by a Pathologist.

SPECIAL INSTRUCTIONS Include pertinent patient history.

SPECIMEN REQUIREMENT Draw blood in a lavender top (EDTA) tube and send stained blood smears if available or send instrument results from your facility with the peripheral blood smear.

STORAGE INSTRUCTIONS EDTA whole blood: room temperature up to 24 hours.

CAUSES FOR REJECTION Clotted specimen; excessive hemolysis; low volume.


Hemoglobin

COMPUTER ORDER ENTRY HGB




CAUSES FOR REJECTION Clotted or frozen specimen; incorrect anticoagulant; gross hemolysis; low volume.


Hemoglobin A1C

COMPUTER ORDER ENTRY HGBA1

SYNONYMS HGB A1C; Glycosylated Hemoglobin; Hemoglobin A1c; Glyco Hemoglobin

NOTE: This is not the same test as Hemoglobin C, Hemoglobin A, A1, or A2, or Hemoglobin F.


TEST INCLUDES Estimated Average Glucose (EAG) in mg/dL

SPECIMEN REQUIREMENT Draw blood in a lavender top (EDTA) tube

SPECIMEN MINIMUM VOLUME 0.2 mL of EDTA whole blood

STORAGE INSTRUCTIONS Refrigerate (2-8°C) up to 5 days. DO NOT FREEZE.



Hemosiderin, Urine

COMPUTER ORDER ENTRY HEMOS

SYNONYMS Urine Hemosiderin

AVAILABILITY Test performed weekdays.

SPECIMEN REQUIREMENT 20 mL random urine collected in a plastic container, free of preservative and iron. Deliver specimen to the Laboratory within 1 hour of collection. pH of specimen must be < 7.0.



Heparin Assay (Point of Care)

COMPUTER ORDER ENTRY HPASY

AVAILABILITY Test performed daily; all shifts; available STAT. PERFORMED ONLY IN SAH OR.

SPECIAL INSTRUCTIONS Venipuncture collection: The venipuncture must be fast and non-traumatic. The first 10 mL of blood collected should be discarded in a separate syringe in order to prevent contamination of the test sample with tissue activator (thromboplastin) to prevent the potential for erroneous results. Blood should flow quickly into the syringe.

Arterial or Venous Line Collection: A 7 mL discard sample should be collected and discarded prior to collection of the test sample in order to eliminate the risk of excess dilution and contamination of the sample with heparin from the catheter or line.

SPECIMEN REQUIREMENT Fresh whole blood samples. Draw in appropriate syringe.





Hepatic Panel

COMPUTER ORDER ENTRY LIVER

SYNONYMS See Liver (Hepatic) Panel


Hepatitis A Antibody, IgM

COMPUTER ORDER ENTRY HAV

SYNONYMS HAVAB-M; IgM Antibody to Hepatitis A Virus (IgM Anti-HAV)


SPECIAL INSTRUCTIONS Detects acute phase or recent (usually 6 months or less) Hepatitis A viral infection. This test will not assess immunity or past infection.

NOTE: Requests for Hepatitis A Antibody (not otherwise specified) will be performed as this test. If Hepatitis A, IgG is needed, clearly specify this on the order.

SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room temp (spun): up to 8 hours

Refrigerated (2-8°C) (spun) up to 5 days



CAUSES FOR REJECTION Heat inactivated specimen, cord blood, neonatal sample, other body fluids such as saliva, urine, amniotic or pleural fluids; gross hemolysis.


Hepatitis B Core Antibody, IgM

COMPUTER ORDER ENTRY HBCOR

SYNONYMS Core-M; IgM Antibody to Hepatitis B Core Antigen (IgM Anti-HBc); Core Antibody


SPECIAL INSTRUCTIONS NOTE: Requests for Hepatitis B Core (not otherwise specified) will be performed as this test. If the IgG Core Antibody is needed, or if Hepatitis B DNA is needed, clearly specify this on the order.







Hepatitis B Surface Antibody (Qualitative)

COMPUTER ORDER ENTRY HEPBS

SYNONYMS ANTI-HBs; Antibody to Hepatitis B Surface Antigen


SPECIAL INSTRUCTIONS Detects immunity to Hepatitis B or clinical recovery. The only marker detected after successful immunization.







Hepatitis B Surface Antigen

COMPUTER ORDER ENTRY HBSAN

SYNONYMS HBSAG; HBsAg


TEST INCLUDES Reactive specimens are verified with a neutralizing confirmatory test (additional charge).









Hepatitis C Antibody (IgG)

COMPUTER ORDER ENTRY HCV

SYNONYMS Anti-HCV


SPECIAL INSTRUCTIONS NOTE: This test does not discriminate acute, chronic, or remote infection. A positive HCV result will reflex to an order for Hep C RNA RT-PCR.







Hepatitis C Antibody (IgG) – No Reflex

COMPUTER ORDER ENTRY HCVNR

SYNONYMS Anti-HCV


SPECIAL INSTRUCTIONS NOTE: This test does not discriminate acute, chronic, or remote infection. Positive results should have follow up testing by HCV RNA PCR and/or RIBA, as appropriate. Please note that these tests must be specifically ordered as such. Refer to the current CDC guidelines for further information.






Hepatitis C Virus (HCV) RNA Detection and Quantitat ion

COMPUTER ORDER ENTRY LHCQT

SYNONYMS HCV Quant; HCV Viral Load; Hepatitis C Viral Load



STORAGE INSTRUCTIONS Centrifuge within 6 hours of collection and send frozen serum aliquot to the Reference Laboratory.



Hepatitis Panel, Acute

COMPUTER ORDER ENTRY HEPPN

SYNONYMS NOTE: This is NOT a Hepatic Function Panel. This panel does not include Hepatitis B Surface Antibody


TEST INCLUDES Hepatitis A Antibody, IgM; Hepatitis B Core Antibody, IgM; Hepatitis B Surface Antigen; and Hepatitis C Antibody. A positive Hepatitis C Antibody will reflex to an order for Hep C RNA RT-PCR.




CAUSES FOR REJECTION Heat inactivated specimen, cord blood, neonatal sample, other body fluids such as saliva, urine, amniotic or pleural fluids; gross hemolysis. See individual test components for additional information.


Herpes Culture and Typing

COMPUTER ORDER ENTRY LHSVT

SYNONYMS HSV Culture and Typing; Herpes Simplex Virus Typing

AVAILABILITY Testing performed at a Reference Laboratory.

TEST INCLUDES Cell culture by ELVIS® method; identification and typing of herpes simplex virus.

SPECIAL INSTRUCTIONS Specimen is best collected within the first three days after appearance of lesion but no more than seven days.

SPECIMEN REQUIREMENT Vesicular fluid, ulcerated lesions, pharyngeal and throat swabs, urine, cerebrospinal fluid (CSF), autopsy and biopsy material, eye exudates, vaginal swabs. Volume needed: Swab in viral transport media, 1 mL fluid, 0.5 g tissue in transport medium

STORAGE INSTRUCTIONS Specimen should be kept at 4°C (refrigeration) and transported to the laboratory within 24 hours of collection.

CAUSES FOR REJECTION Bacterial swab specimen; specimen received in grossly leaking transport container; dry specimen; specimen submitted in fixative or additive; specimen received in expired transport media or incorrect transport device; inappropriate specimen transport conditions; specimen received after prolonged delay in transport (usually more than 72 hours); specimen stored or transported at room temperature; wooden shaft swab in transport device; calcium alginate swab; unlabeled specimen.


HIV-1/2 Antibody and p24 Antigen Combo

COMPUTER ORDER ENTRY HIVGB

SYNONYMS AIDS; HIVAB; HIV-1/HIV-2; HIV1/2; Human Immunodeficiency Virus

AVAILABILITY Routine testing performed on Tuesday and Friday; available STAT for Significant Exposures.

TEST INCLUDES If reactive, specimen is sent to Reference Laboratory for confirmation.

SPECIAL INSTRUCTIONS Wisconsin State Law requires informed consent for HIV testing, with some exceptions. Please refer to your facility Significant Exposure Policies for details. The submitting facility should obtain a signed consent form from the patient. Send a copy of the consent with the requisition.

NOTE: Currently available assays for the detection of p24 antigen and/or antibodies to HIV-1 and or HIV-2 may not detect in all infected individuals. A negative test result does not exclude the possibility of exposure to or infection with HIV. HIV antibodies and/or p24 antigen may be undetectable in some stages of the infection and in some clinical conditions.






Homocysteine

COMPUTER ORDER ENTRY HOMOC


SPECIAL INSTRUCTIONS Patient should be fasting. Collect blood and put ON ICE.



NOTE: Specimens from patients who are on drug therapy involving S-adenosyl-methionine may show falsely elevated levels of Homocysteine. Specimens from patients taking Methotrexate, Carbamazepine, Phenytoin, Nitrous Oxide, or 6-Azauridine Triacetate may have elevated levels of Homocysteine due to their effect on the metabolic pathway.

SPECIMEN REQUIREMENT COLLECT AND PLACE ON ICE. Draw blood in a green (Lithium heparin) PST (full tube). Centrifuge promptly and send specimen in the original tube.

Stability: Refrigerated (2-8°C) (spun) up to 5 days

SPECIMEN MINIMUM VOLUME 0.1 mL plasma



H. pylori Antigen in Stool Specimens

COMPUTER ORDER ENTRY HPSA

SYNONYMS Helicobacter pylori Antigen, Fecal


SPECIAL INSTRUCTIONS Conventional medical practice recommends that testing to confirm the loss of antigen be done at least 4 weeks following completion of therapy.

INTERFERENCES Antimicrobials, proton pump inhibitors, and bismuth preparations are known to suppress H. pylori. If patient has ingested these compounds within 2 weeks prior to testing, a false negative result may occur.

SPECIMEN REQUIREMENT 5g stool in a plastic screw cap container. No transport media or preservative.

STORAGE INSTRUCTIONS Refrigerate (2-8°C) in an airtight container up to 72 hours. Specimen should be tested as soon as possible.

CAUSES FOR REJECTION Watery stools composed mainly of fluid with little or no solid matter may give false negative results.


IBC

COMPUTER ORDER ENTRY IBC

SYNONYMS See TIBC


IgA, IgG, or IgM (Immunoglobulin A, G, or M Quantit ation)

COMPUTER ORDER ENTRY IGA or IGG or IGM


TEST INCLUDES Quantitation of IgA, IgG, and/or IgM.

SPECIAL INSTRUCTIONS Each Immunoglobulin must be ordered separately on a Laboratory requisition.



Refrigerated (2-8°C) (spun): up to 3 days





Immunofixation, Serum or Urine

COMPUTER ORDER ENTRY SIMFX (serum); UIMFX (urine)

SYNONYMS IFE; Urine Bence Jones Protein

AVAILABILITY Test performed Tuesday and Thursday on AM shift.

TEST INCLUDES IFE interpretation of heavy and light chain patterns for IgG, IgA, and IgM.

SPECIAL INSTRUCTIONS Serum Immunofixation orders require Protein Electrophoresis testing. Provide a copy of the Protein Electrophoresis report if not done at this facility. (Fasting is preferred.) Urine Immunofixation can be ordered alone.

SPECIMEN REQUIREMENT Blood: Draw blood in a SST. Centrifuge and send specimen in the original tube.

Stability: Refrigerated (2-8°C) (spun) up to 5 days Urine: 30-50 mL urine (random or 24 hour collection).

SPECIMEN MINIMUM VOLUME 0.5 mL serum; 0.1 mL urine


CAUSES FOR REJECTION Plasma sample; hemolyzed serum; bloody urine


India Ink, CSF

COMPUTER ORDER ENTRY CRYPT

SYNONYMS See Cryptococcus Antigen. If India Ink is ordered on CSF, Cryptococcus Antigen will be performed instead.


Influenza Panel Test, PCR

COMPUTER ORDER ENTRY ABFLU

SYNONYMS Flu A, H1N1, 2009 Novel H1N1, Flu B, Swine Flu

AVAILABILITY Test performed daily; all shifts; available STAT (ED and hospital inpatient only)

TEST INCLUDES Flu A, Flu B, 2009 H1N1

SPECIAL INSTRUCTIONS In the event that results are not able to be obtained on the primary method of analysis due to unknown interference, the order will be converted to a secondary method of analysis to obtain a result.

SPECIMEN REQUIREMENT Nasopharyngeal: Collect one nasopharyngeal. Place the swab in BD™ universal viral transport media. � Use flocked swabs or swabs with a synthetic tip (e.g. polyester) and an

aluminum or plastic shaft. Swabs with cotton tips and wooden shafts are not recommended. Calcium alginate swabs are NOT acceptable.

Nasopharyngeal wash or aspirate: � Volumes of 1-3 mL are recommended. Excess volume may interfere with

test performance. � Transfer the wash/aspirate into BD™ universal viral transport media.

Perform this step using the biological safety cabinet.

STORAGE INSTRUCTIONS Room temperature up to ½ hour; refrigerate (2-8°C) up to 3 days; Frozen (-70°C) for longer storage. NOTE: If specimen is NOT in BD™ viral transport media. Transport ASAP to Laboratory ON IC E.

CAUSES FOR REJECTION Use of calcium alginate swab. DEPARTMENT Chemistry (Central Laboratory Fond du Lac) INR (PT)

COMPUTER ORDER ENTRY PT

SYNONYMS Protime; Prothrombin Time


SPECIAL INSTRUCTIONS CAUTION! The tube must be full draw, do not overfill or underfill.

SPECIMEN REQUIREMENT Draw blood in a light blue top (Sodium Citrate) tube (full tube).

STORAGE INSTRUCTIONS Submit the entire unopened sample. Store at room temperature. If delivery to the Laboratory will exceed 24 hours, centrifuge for 15 minutes, pipette the plasma into a plastic transfer tube capped tightly for transport, and freeze.

CAUSES FOR REJECTION Improper volume (high or low); clotted; extreme hemolysis.


Insulin

COMPUTER ORDER ENTRY LINSL


SPECIAL INSTRUCTIONS Patient should be fasting at time of collection.





Iron

COMPUTER ORDER ENTRY IRON

SYNONYMS Fe


SPECIAL INSTRUCTIONS It is recommended that specimens be collected in the early morning. Patient should be fasting for 12 hours before the specimen is drawn. Iron-containing supplements should be avoided for 24 hours prior to collection.






CAUSES FOR REJECTION Hemolysis; EDTA, Sodium Citrate, or Potassium Oxalate/Sodium Fluoride anticoagulant contamination.


Joint Fluid

SPECIAL INSTRUCTIONS There is no AMA approved Joint Fluid Panel. Desired tests must be individually requested.

Ketones, Serum or Plasma (Qualitative)


SYNONYMS See Beta-Hydroxybutyrate. Ketones, Serum or Plasma (Qualitative) is no longer offered at Consultants Laboratory.


Kidney Stone Analysis

COMPUTER ORDER ENTRY LSTNE

SYNONYMS Urine Calculi


SPECIAL INSTRUCTIONS Obtain kidney stone collection kit and collection instructions (Patient Brochure CLW 789) from the Laboratory.

SPECIMEN REQUIREMENT Calculi must be submitted completely dry.



KOH Prep

COMPUTER ORDER ENTRY KOH (misc – other than skin, hair, or nail); KOHSK (skin, hair, or nail)

SYNONYMS KOH, Calcofluor white


TEST INCLUDES Examination for yeast and fungal elements.

SPECIMEN REQUIREMENT Skin flakes or scrapings: Submit in a leak proof container. Nail pieces or scrapings: Submit in a leak proof container. Fluid: Submit in a leak proof container. Pus: Submit in a leak proof container. Sputum: Submit in a leak proof container. Plucked hair: Submit in a leak proof container. Tissue: Submit in a leak proof container. Vaginal: Submit on a single or double swab culturette.

STORAGE INSTRUCTIONS Room temperature; refrigerate (2-8ºC) sputum.

DEPARTMENT Microbiology (Central Laboratory Fond du Lac)

Lactate, Plasma

COMPUTER ORDER ENTRY LAVPL

SYNONYMS Blood Lactic Acid; Lactic Acid; L-Lactate


SPECIAL INSTRUCTIONS Preferably, patient should be fasting and at complete rest. Blood should be drawn without a tourniquet and without fist clenching and ICED immediately. Plasma must be separated from cells within 15 minutes of collection. Analysis should be performed promptly. See Specimen Requirements.

NOTE: Test will not detect D-lactate.

SPECIMEN REQUIREMENT Draw blood in a gray top (Sodium Fluoride/Potassium Oxalate) tube (full draw). Centrifuge immediately and separate plasma off cells into an aliquot tube within 15 minutes of collection. Stability: Refrigerated (2-8°C) (spun) up to 5 days

Frozen (pipette off): up to 5 days


CAUSES FOR REJECTION Improper collection technique; gross hemolysis.


Lactate, Whole Blood

COMPUTER ORDER ENTRY LAAWB (arterial whole blood); LAVWB (venous whole b lood)

SYNONYMS Blood Lactic Acid; Lactic Acid; L-Lactate


SPECIAL INSTRUCTIONS Preferably, patient should be fasting and at complete rest. Blood should be drawn without a tourniquet and without fist clenching and iced immediately.

NOTE: Test will not detect D-lactate.

SPECIMEN REQUIREMENT Venous Blood : Draw in a dark green (Lithium heparin) tube. Fill tube completely. DO NOT remove stopper.

Arterial Blood: Draw in a blood gas syringe.

Indicate if venous or arterial blood.

STORAGE INSTRUCTIONS Send specimen to the Laboratory on ice to be analyzed immediately after drawing.

CAUSES FOR REJECTION Improper collection technique, handling, or storage.


Lactic Acid

SYNONYMS See Lactate


Lactose Tolerance

COMPUTER ORDER ENTRY LACTT


TEST INCLUDES Blood Glucoses at times intervals.

SPECIAL INSTRUCTIONS Call Laboratory for instructions. Procurement of Lactose is the client's responsibility. The patient should bring the Lactose with them to their scheduled tolerance test at a CLW facility. Blood is collected at timed intervals before and after Lactol is given.

Adult dose: 50g. Children: 1 g/Kg body weight, not to exceed 50g.

Patient should be fasting for 12 hours. Patient may drink water during the test. Lactol may cause diarrhea or cramping.

SPECIMEN REQUIREMENT Collection times: fasting, 15, 30, 60, 90, and 120 minutes. Label all tubes with the appropriate time of collection.



Central Laboratory Fond du Lac, Waupun Memorial Hos pital, Dialysis

Centers, and Convenient Care: Draw blood in a green (Lithium heparin) PST (full tube). Centrifuge and send specimen in the original tube.




CAUSES FOR REJECTION Patient not arriving fasting; specimens not labeled with correct times; patient experiences nausea to the point of emesis production; severe icterus.


Lamotrigine, Serum

COMPUTER ORDER ENTRY LLAMO


SPECIMEN REQUIREMENT Draw blood in a plain red top tube. Serum gel tube (SST) is NOT acceptable.


STORAGE INSTRUCTIONS Centrifuge and store serum aliquot at room temperature.


LDH

COMPUTER ORDER ENTRY LDH (serum); FLDH (body fluid)

SYNONYMS Lactate Dehydrogenase


SPECIMEN REQUIREMENT Blood: Central Laboratory Fond du Lac, Waupun Memor ial Hospital, Dialysis Centers, and Convenient Care: Draw blood in a green (Lithium heparin) PST (full tube). Centrifuge and send specimen in the original tube.


Ripon Medical Center and all other sites: Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room temp (unspun): optimally up to 1 hour Room temp (spun): up to 8 hours Refrigerated (2-8°C) (spun) up to 24 hours Body fluid: Indicate type on requisition

SPECIMEN MINIMUM VOLUME 0.4 mL serum, plasma or body fluid


CAUSES FOR REJECTION Hemolysis; specimen collected in EDTA or Sodium Fluoride/Potassium Oxalate (lavender or gray top tubes).


Lead Level, Blood

COMPUTER ORDER ENTRY LEADT

SYNONYMS Pb


SPECIAL INSTRUCTIONS Capillary specimens are more sensitive to contamination and should be avoided. The patient’s hands must be thoroughly washed prior to the capillary

collection. If a capillary specimen is elevated, the test should be confirmed on a venous sample.

NOTE: All blood Lead levels are reported to the State of Wisconsin Department of Health and Family Services.

SPECIMEN REQUIREMENT Draw blood in a lavender top (EDTA) tube, whole blood. Tube or microtainer must be at least ¼ full and free of clots. DO NOT CENTRIFUGE OR SEPARATE PLASMA.

Stability: Room temperature up to 24 hours

SPECIMEN MINIMUM VOLUME ¼ full EDTA container

STORAGE INSTRUCTIONS See above. DO NOT REFRIGERATE.

CAUSES FOR REJECTION Lavender top (EDTA) tube was refrigerated or is greater than 24 hours old; specimen tube contains clots; plasma removed from the cells.


Legionella Urinary Antigen

COMPUTER ORDER ENTRY LEGIO


TEST INCLUDES Binax NOW® Legionella Urinary Antigen test for L. pneumophila Serogroup 1 by Immunochromatographic Membrane Assay.

SPECIAL INSTRUCTIONS Only suitable for urine testing, not for other body fluids or environmental testing. Antigen excretion may begin within 3 days of onset of symptoms and may persist for up to one year. Interpret results with corroborative clinical, radiographic, and/or Laboratory information. Test is most sensitive to L. pneumophila serogroup 1, but may be positive with other Legionella species and serogroups.

CAUTION: Results must be interpreted with other laboratory tests and clinical findings. A presumptive positive result suggests current or past infection. A presumptive negative result suggests no recent or current infection with L pneumophila. Infection due to Legionella cannot be ruled out with a negative result since other serogroups and species of Legionella may cause disease. The antigen may not be present in early infection and the antigen may be below the level of detection for this test.

SPECIMEN REQUIREMENT Collect several mL of urine in a standard urinalysis container.

STORAGE INSTRUCTIONS Stable at 15-30°C up to 24 hours. Refrigerate (2-8°C) up to 14 days.

CAUSES FOR REJECTION Fecal contamination; specimen not urine.

DEPARTMENT Urinalysis (Central Laboratory Fond du Lac)

LFT


SYNONYMS See Liver Panel


Lipase

COMPUTER ORDER ENTRY LIPAS







CAUSES FOR REJECTION Specimen collected in a lavender top (EDTA) tube.


Lipid Panel

COMPUTER ORDER ENTRY LPD+

SYNONYMS Lipid Evaluation; Cardiac Risk Panel


INTERFERENCES Calculated LDL and VLDL will not be reported on specimens with Triglycerides > 400 mg/dL.

TEST INCLUDES Cholesterol, Triglycerides, HDL Cholesterol, Calculated LDL Cholesterol, Calculated VLDL Cholesterol, Cholesterol/HDL Ratio, and Non-HDL Cholesterol.

SPECIAL INSTRUCTIONS Patient should fast for 12 hours. Alcohol should not be consumed for 24 hours before the specimen is drawn.




Stability: Room temp (unspun): up to 2 hours Room temp (spun): up to 8 hours Refrigerated (2-8°C) (spun): up to 4 days SPECIMEN MINIMUM VOLUME 0.4 mL serum or plasma


CAUSES FOR REJECTION Use of collection tubes having stoppers lubricated with glycerol; patient not fasting.


Lithium Level

COMPUTER ORDER ENTRY LITH

SYNONYMS Li


SPECIAL INSTRUCTIONS Optimal sampling time: draw trough level 12 hours after dose.


Stability: Room temp (unspun): up to 2 hours Room temp (spun): up to 4 hours Refrigerated (2-8°C) (spun): up to 48 hours SPECIMEN MINIMUM VOLUME 0.4 mL serum


CAUSES FOR REJECTION Severe icterus or hemolysis.


Liver (Hepatic) Panel


SYNONYMS LFT; Hepatic Function Panel.

NOTE: This is NOT the Hepatitis Panel.


TEST INCLUDES Albumin, Total Bilirubin, Direct Bilirubin, Alkaline Phosphatase, ALT, AST, and Total Protein.





Stability: Room temp (unspun): up to 2 hours Room temp (spun): up to 8 hours






Low Molecular Weight Heparin (Anti Factor Xa)

COMPUTER ORDER ENTRY FXALM

SYNONYMS Enoxaparin (Lovenox®), Daltaparin (Fragmin®) NOTE: This test is NOT intended to monitor Fondapainux (Arixtra®)

AVAILABILITY Test performed daily; all shifts; available STAT. Performed at Central Laboratory Fond du Lac only.


SPECIMEN REQUIREMENT Draw blood in a light blue top (Sodium Citrate) tube (full tube). A 7 mL red top tube should be drawn and discarded prior to drawing the blue top tube. When drawing a specimen with a syringe, the blue top should be filled first.


STORAGE INSTRUCTIONS Submit the entire unopened sample. Store at room temperature. If delivery to the Laboratory will exceed 1 hour, centrifuge for 15 minutes, pipette the plasma into a plastic transfer tube capped tightly for transport, and freeze.

Plasma must be platelet poor, platelet count < 10

CAUSES FOR REJECTION Improper volume (overfilled or underfilled); clotted; extreme hemolysis


Luteinizing Hormone

COMPUTER ORDER ENTRY LH







Stability: Room temp (unspun): up to 2 hours Room temp (spun): up to 8 hours Refrigerated (2-8°C) (spun): up to 48 hours SPECIMEN MINIMUM VOLUME 0.4 mL serum or plasma



Lyme Disease Serology (ELISA)

COMPUTER ORDER ENTRY LYMEP

SYNONYMS Lyme Disease Antibody

AVAILABILITY Test performed Monday and Thursday.

TEST INCLUDES Qualitative monovalent detection of IgG and IgM antibodies to Borrelia burgdorferi, with reflex to send out Western Blot confirmation on positive ELISA tests (added charge).

SPECIAL INSTRUCTIONS Antibody detection methods do not provide definitive results for establishing or ruling out a diagnosis of Lyme disease. Clinical correlation is imperative. Serology may not be positive until 2-4 weeks after the appearance of a rash. Treatment early in the infection may diminish antibody formation. Positive serology does not establish a definitive diagnosis of Lyme Disease without other corroborating clinical evidence.



STORAGE INSTRUCTIONS Refrigerate (2-8°C). Freeze after 5 days at -20°C.

CAUSES FOR REJECTION Heat inactivated, hemolyzed, or hyperlipemic specimen; plasma specimen.


Magnesium

COMPUTER ORDER ENTRY MG

SYNONYMS Mg









CAUSES FOR REJECTION Hemolysis; EDTA or Sodium Fluoride/Potassium Oxalate anticoagulants.


Magnesium, Urine

COMPUTER ORDER ENTRY UMGR (random); UMG24 (24 hour collection)


TEST INCLUDES Magnesium on a 24 hour or random urine collection.

SPECIAL INSTRUCTIONS Indicate the total volume and collection time period on requisition.

SPECIMEN REQUIREMENT 20 mL aliquot from a well mixed random or 24 hour urine collected with no preservative.



Malarial Smear

COMPUTER ORDER ENTRY MALAR

SYNONYMS See Blood Parasites


Manual Differential

COMPUTER ORDER ENTRY MDIFF

SYNONYMS Differential Leukocyte Count


TEST INCLUDES Neutrophilic segs, neutrophilic bands, lymphocytes, monocytes, basophils, eosinophils, erythrocyte morphology and platelets. Any immature forms of the cell types will be noted.

NOTE: This test does not include a CBC, CBC with Autodifferential, or WBC. If indicated, these tests must be ordered separately.

SPECIMEN REQUIREMENT Draw blood in a lavender top (EDTA) tube or send instrument results from your

facility with the peripheral smear.


CAUSES FOR REJECTION Specimen > 24 hours old; specimen not collected in EDTA.


Measles Immune Status (Rubeola IgG, Qualitative)

COMPUTER ORDER ENTRY RUBEO

SYNONYMS MSG; Rubeola


TEST INCLUDES IgG antibodies to Rubeola by ELFA (positive or negative)

SPECIAL INSTRUCTIONS Antibody levels in the equivocal range for this assay may be insufficient to protect against illness upon exposure to the Rubeola virus. A new specimen should be obtained and retested if clinically appropriate. If upon retest (within 3 months) the result is still equivocal, testing for Rubeola IgG by IFA titer may be useful.



STORAGE INSTRUCTIONS Refrigerate (2-8°C) up to 5 days. Freeze at -20°C for longer periods.

CAUSES FOR REJECTION Severely hemolyzed or icteric specimen; heated serum; plasma specimen.


Metabolic Basic Panel (BMP)

COMPUTER ORDER ENTRY BMP

SYNONYMS Chem 7


TEST INCLUDES CO2, Chloride, Creatinine, Glucose, Potassium, Sodium, Urea Nitrogen (BUN), Calcium, and a Glomerular Filtration Rate is calculated on patients 18 years and older.

SPECIAL INSTRUCTIONS Patient fasting for 8 hours is recommended.







CAUSES FOR REJECTION Improper collection and storage. See individual tests for further information.


Metabolic Comprehensive Panel (CMP)

COMPUTER ORDER ENTRY CMP


TEST INCLUDES Albumin, Total Bilirubin, Calcium, CO2, Chloride, Creatinine, Glucose, Alkaline Phosphatase, Potassium, Total Protein, Sodium, Urea Nitrogen (BUN), AST, ALT, and a Glomerular Filtration Rate is calculated on patients 18 years and older.

SPECIAL INSTRUCTIONS Patient fasting for 8 hours is recommended.





SPECIMEN MINIMUM VOLUME 0.5 mL serum or plasma; 1.0 mL whole blood (2 full microtainers) STORAGE INSTRUCTIONS See above. Keep tube stoppered until analysis. Analyte is light sensitive,

minimize light exposure during storage and transport.



Methemoglobin, Whole Blood

COMPUTER ORDER ENTRY METHE

SYNONYMS MetHb


SPECIAL INSTRUCTIONS Fill the tube completely; do not remove the stopper. Specimen should be analyzed promptly, within 1 hour of collection.

SPECIMEN REQUIREMENT Draw blood in a dark green top (Lithium heparin) (full tube). DO NOT CENTRIFUGE or draw blood in a heparinized stoppered syringe (minimum 1 mL).

STORAGE INSTRUCTIONS Room temperature (unspun) up to 1 hour. Tube/syringe must remain stoppered. Maintain anaerobic conditions.

CAUSES FOR REJECTION Improper collection, handling, storage.


Methylmalonic Acid, Quantitative

COMPUTER ORDER ENTRY LMMA

SYNONYMS MMA




STORAGE INSTRUCTIONS Send refrigerated aliquot to the Reference Laboratory.


Microalbumin, Urine

COMPUTER ORDER ENTRY MIC/C (random); MA24 (24 hour collection)

SYNONYMS Albumin, Urine


TEST INCLUDES Random : Urine Creatinine, Microalbumin and Microalbumin/Creatinine Ratio.

24 Hour : Urine Volume and Microalbumin in mg/24 hours and µg/min.

SPECIAL INSTRUCTIONS Although random urine samples are not as reliable as 24 hour samples, they can be corrected using the Creatinine measurement. Creatinine, a byproduct of muscle metabolism, is normally excreted into the urine on a consistent basis. Its level in the urine is relatively stable. Since the concentration (or dilution) of urine varies throughout the day, this property of Creatinine allows its measurement to be used as a corrective factor in random urine samples. When a Creatinine measurement is performed along with a random Microalbumin, the resulting Microalbumin/Creatinine Ratio approaches the accuracy of the 24 hour Microalbumin test without the extended collection.

When a 24 hour urine is submitted, indicate the total volume and time on the requisition.

SPECIMEN REQUIREMENT 10 mL aliquot from a well mixed random or 24 hour urine collection, no preservative. Use a non-glass container.

SPECIMEN MINIMUM VOLUME 0.2 mL of a voided volume of at least 5 mL

STORAGE INSTRUCTIONS Refrigerate (2-8°C) up to 3 days. DO NOT FREEZE.

CAUSES FOR REJECTION Bloody specimen.


Microsomal Antibodies

COMPUTER ORDER ENTRY ATA

SYNONYMS See Antithyroid Peroxidase Antibodies


Mono Test (Monospot)

COMPUTER ORDER ENTRY MONO

SYNONYMS Infectious Mono Test; Heterophile Antibody Screen


TEST INCLUDES Slide Agglutination test for Infectious Mononucleosis Heterophile Antibodies.

SPECIAL INSTRUCTIONS Patients who test negative, but for whom there is a high level of clinical suspicion for EBV infection, should be retested in several days, or tested for EBV Antibodies.

SPECIMEN REQUIREMENT Serum: Draw blood in a SST. Centrifuge and send specimen in the original tube.

Plasma : Draw blood in a lavender top (EDTA) tube.

STORAGE INSTRUCTIONS Serum: refrigerate (2-8°C) up to 48 hours. Freeze at -20°C for longer storage. Plasma: refrigerate (2-8°C) up to 24 hours.

CAUSES FOR REJECTION Hemolyzed or visibly contaminated sample; plasma other than EDTA.


MRSA Nasal Swab by PCR

COMPUTER ORDER ENTRY MRSA

SYNONYMS MRSA, Amplified Probe by PCR; Methicillin Resistant Staph aureus; Community Acquired Staph


SPECIAL INSTRUCTIONS Must use the FDA approved Copan (LQ Stuart) “scored” double swab.

1) Have patient blow nose.

2) Ask patient to tilt head back. Insert both dry swabs approximately 1-2 cm into each nostril.

3) Apply slight pressure with a finger on the outside of the nose to help assure good contact between the swab and the inside of the nose. Rotate the swabs against the inside of the nostril for 3 seconds.

4) Using the same swabs, repeat for the second nostril, trying not to touch anything but the inside of the nose.

5) Remove and discard the cap from the plastic transport tube. Place the swabs into the plastic transport tube. The swabs should go all the way into the tube until they rest on top of the sponge at the bottom of the tube. Make sure the red cap is on tightly.

SPECIMEN REQUIREMENT Copan (LQ Stuart) “scored” double swabs (red cap). Collect using the procedure in the Special Instructions listed above.


CAUSES FOR REJECTION Incorrect swab.


Mumps IgG

COMPUTER ORDER ENTRY MMIGG

SYNONYMS Mumps


TEST INCLUDES IgG antibodies to Mumps by ELFA (positive or negative).



STORAGE INSTRUCTIONS Refrigerate (2-8°C) up to 5 days. Freeze at -20°C for longer periods.

CAUSES FOR REJECTION Grossly hemolyzed, lipemic or icteric specimens.


Mycoplasma IgM (Qualitative)

COMPUTER ORDER ENTRY MYCOP

SYNONYMS Mycoplasma pneumoniae.

Requests for Cold Agglutinins are converted to this test unless the Laboratory is specifically notified that the patient is being evaluated for Cold Autoimmune Hemolytic Anemia.


TEST INCLUDES Identification of M. pneumoniae IgM antibodies.

SPECIAL INSTRUCTIONS Testing performed very early in illness may yield negative results. Convalescent IgG levels should be measured as clinically appropriate. Test may be positive for several months. Positive test results may not be valid in

persons who have received blood transfusions or other blood products within the past several months.


STORAGE INSTRUCTIONS Refrigerate (2-8°C) up to 72 hours. Freeze at -20°C if testing is further delayed. Testing should be performed as soon as possible.

CAUSES FOR REJECTION Plasma specimen; specimen not properly labeled.


Myoglobin

COMPUTER ORDER ENTRY MYOG




SPECIMEN REQUIREMENT Draw blood in a green (Lithium heparin) PST (full draw). Centrifuge and send specimen in the original tube.

Stability: Room temp (unspun): up to 2 hours Room temp (spun): up to 8 hours Refrigerated (2-8°C) (spun): up to 24 hours Frozen (plasma poured over): up to 72 hours



Myoglobin (Point of Care)

COMPUTER ORDER ENTRY MYOED








Obstetric Panel

COMPUTER ORDER ENTRY OB

SYNONYMS OB Panel; Prenatal Panel

TEST INCLUDES CBC and Platelet with Automated Differential, Hepatitis B Surface Antigen, Rubella Antibody, RPR, Antibody Screen, and ABO & Rh Typing.

SPECIAL INSTRUCTIONS Include the patient's date of birth on the Blood Bank tube.

SPECIMEN REQUIREMENT See individual test components.

DEPARTMENT Blood Bank / Special Chemistry / Hematology

Occult Blood, Fecal FIT (Fecal Immunochemical Test)

COMPUTER ORDER ENTRY FITDI (Diagnostic); FITSC (annual screening)

SYNONYMS See Blood Fecal, FIT


Occult Blood, Gastric

COMPUTER ORDER ENTRY OCBLG

SYNONYMS Gastroccult


SPECIMEN REQUIREMENT Vomit or a gastric aspirate obtained by nasogastric intubation in a plastic crew cap container.

STORAGE INSTRUCTIONS Refrigerate (2-8°C). Best results are obtained by testing immediately after collection. If not possible, the sample is stable at room temperature (15-30°C) for 24 hours or refrigerate (2-8°C) up to 5 days.

CAUSES FOR REJECTION Improper storage.


Osmolality, Serum

COMPUTER ORDER ENTRY OSMO






Osmolality, Urine

COMPUTER ORDER ENTRY UOSMO


SPECIMEN REQUIREMENT 10 mL aliquot from a well-mixed random or timed urine collection.




Ova and Parasites

COMPUTER ORDER ENTRY LOPEX

SYNONYMS O&P; Stool for Ova and Parasites

AVAILABILITY Test performed at a Reference Laboratory

TEST INCLUDES Concentration of material and examination of specimen for ova and parasites by conventional iodine/saline and trichrome staining. The will NOT detect Cryptosporidium, Cyclospora cayetanensis, or Microsporidium.

SPECIAL INSTRUCTIONS No more than 3 specimens collected on subsequent days should be submitted (collect only 1 specimen per day). Stool examinations for Ova and Parasites are probably unnecessary for patients who develop diarrhea more than 3 days after hospitalization. Specifically request Sarcocystis, Isopora, Microsporidia, or Cyclospora. Cryptosporidium should be ordered as CSA (see Cryptosporidium Specific Antigen). Giardia may be identified, but should be ordered as GSA (see Giardia Specific Antigen).

SPECIMEN REQUIREMENT Approximately 10g fresh stool placed in each vial of 10% formalin and ZN-PVA (ParaPak vials) immediately. Do not fill above the line indicated on the vials; mix well.

Avoid mineral oil, barium, and bismuth. Avoid contact with urine or toilet water.

STORAGE INSTRUCTIONS Room temperature. DO NOT FREEZE.

CAUSES FOR REJECTION Specimen received in only formalin or only PVA; excess barium in parasitological exam; fresh specimen not received in ParaPak vials; specimen received in a diaper.

DEPARTMENT Reference Laboratory Panels

SYNONYMS See individual listings of Panels offered: ELECTROLYTE PANEL HEPATIC (LIVER FUNCTION) PANEL HEPATITIS PANEL, ACUTE LIPID PANEL METABOLIC PANEL, BASIC METABOLIC PANEL, COMPREHENSIVE OBSTETRIC PANEL RENAL (KIDNEY) FUNCTION PANEL Pap Smear

SYNONYMS See Cytology, Cervicovaginal Pap Smear in the Alphabetical Listing of Cytology and Pathology Tests

DEPARTMENT Cytology

Parasite, Macroscopic Exam ID

COMPUTER ORDER ENTRY LPIDW

SYNONYMS Worm Identification


SPECIMEN REQUIREMENT Worm or segment of worm MUST be submitted in formalin; the Ova and Parasite vial (Parapak pink) may be used.


CAUSES FOR REJECTION Desiccated specimen.


Pertussis

COMPUTER ORDER ENTRY LBORD

SYNONYMS See Bordetella pertussis and Bordetella parapertussis, Real-time DNA PCR


pH, Fluid

COMPUTER ORDER ENTRY FPH


SPECIAL INSTRUCTIONS Indicate fluid type on the requisition.

SPECIMEN REQUIREMENT Fluid: Store specimen in a green top (Lithium heparin) tube to avoid exposure to air. Gastric fluid: Keep specimen (5 mL) in tightly sealed container to avoid exposure to air. Fresh specimen required.



pH, Stool

COMPUTER ORDER ENTRY FPH

SYNONYMS Fecal pH


SPECIAL INSTRUCTIONS Keep the specimen in a tightly sealed container to avoid exposure to air. A fresh specimen is required. Patient should not have had recent enemas or taken laxatives.

SPECIMEN REQUIREMENT Minimum 2g of fresh random stool in a plastic screw cap container. Do not use stool from the toilet.


CAUSES FOR REJECTION Stool contaminated with urine.


pH, Venous

COMPUTER ORDER ENTRY VBG

SYNONYMS See Venous Blood Gases


Phenobarbital Level

COMPUTER ORDER ENTRY PHENB

SYNONYMS PHNO; Phenobarb



Interpretation of results should be done in the context of the overall clinical presentation of the patient, including symptoms, clinical history, data from additional tests and other appropriate information. Anobarbital and nephobarbital cross react with this method.






Phenytoin Level

COMPUTER ORDER ENTRY DILAN

SYNONYMS See Dilantin Level


Phosphorus, Serum

COMPUTER ORDER ENTRY PHOS

SYNONYMS PO4; Inorganic Phosphate


SPECIAL INSTRUCTIONS Patient should fast for 8 hours.








CAUSES FOR REJECTION Specimen collected in EDTA or Sodium Fluoride/Potassium Oxalate (lavender or gray top tubes); hemolysis.


Phosphorus, Urine

COMPUTER ORDER ENTRY UPHOR (random); UPH24 (24 hour collection)


TEST INCLUDES Phosphorus on 24 hour or random urine collection.


SPECIMEN REQUIREMENT 20 mL aliquot from a well mixed random or 24 hour urine collected without preservative.




Pinworm Examination

COMPUTER ORDER ENTRY PINW

SYNONYMS Perianal swab for pinworm (Enterobius vermicularis)


SPECIAL INSTRUCTIONS The sticky side of a SWUBE™ Paddle is applied to the perianal area to collect the specimen. (Specimen ideally collected during the night or in early morning.) Replace the paddle into the tube. One negative result does not exclude a pinworm infection.

NOTE: Positive paddles will be infectious! Take care in handling the SWUBE ™ Paddles and collecting the specimens.

SPECIMEN REQUIREMENT Sticky SWUBE™ Paddle, available from the Laboratory.

STORAGE INSTRUCTIONS Room temperature up to 24 hours; refrigerate (2-8ºC) if > 24 hours.


Platelet Count

COMPUTER ORDER ENTRY PLTI

SYNONYMS PLT


SPECIMEN REQUIREMENT Whole blood from a lavender top (EDTA) tube.


CAUSES FOR REJECTION Clotted specimen; incorrect anticoagulant; frozen specimen.


Pneumocystis Smear

COMPUTER ORDER ENTRY LPNCS

SYNONYMS Pneumocystis carinii smear; PCP (Pneumocystis carinii Pneumonia)


SPECIMEN REQUIREMENT Submit specimen in a steile leakproof container. Induced sputum, bronchial alveolar lavage (BAL), lung tissue, bronchial brush, tracheal aspirates, transtracheal aspirates, body fluids. Sputum specimens are NOT recommended.

Specimen Minimum Volume:

� Brochoalveolar lavage: 10-15 mL � Sputum, bronchial washings, and tracheal secretions: 5-10 mL � Lung tissue and open lung biopsy: rice-sized piece of tissue (0.5-1

mL)

STORAGE INSTRUCTIONS Refrigerate (2-8ºC)

CAUSES FOR REJECTION Swab specimen or specimen submitted in fixative or additive.


Potassium, Serum

COMPUTER ORDER ENTRY K

SYNONYMS K+; Potassium





Stability: Room temp (unspun): optimally up to 1 hour Room temp (spun): up to 8 hours Refrigerated (2-8°C) (spun): up to 4 days



CAUSES FOR REJECTION Hemolysis; specimen collected in EDTA or Sodium Fluoride/Potassium Oxalate.


Potassium, Urine

COMPUTER ORDER ENTRY UKR (random); UK24 (24 hour collection)

SYNONYMS K+ Urine







Prealbumin

COMPUTER ORDER ENTRY PALB



Stability: Refrigerate (2-8°C) (spun): up to 5 days

Ripon Medical Center and all other sites: Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Refrigerate (2-8°C) (spun): up to 5 days




Pregnancy Test, (BhCG) Quantitative

COMPUTER ORDER ENTRY HCGQ

SYNONYMS β-hCG Quantitative; Quantitative Serum Pregnancy Test


SPECIAL INSTRUCTIONS State the week of gestation or date of the LMP. This assay should not be used to diagnose any condition unrelated to pregnancy.

COMMENTS: This test is not to be used for gestational trophoblastic tumor or nontrophoblastic neoplastic conditions � order the Reference Laboratory test. hCG, beta Tumor Marker is also known as Chorionic Gonadotropin, β Subunit (sent to mayo Reference Laboratory).

The following measures, among others, may be used in confirming results from a serum hCG assay which are inconsistent with or unsupported by clinical observations or diagnosis:

� Repeat the hCG test using a different immunoassay platform. � Perform a qualitative hCG urine test. The absence of urinary hCG may

suggest a falsely elevated serum result. � hCG test results should be used in conjunction with other data, e.g.

symptoms, results of other tests, and clinical impressions.









DEPARTMENT Chemistry (Central Laboratory Fond du Lac, Waupun Memorial Hospital)

Pregnancy Test, Serum

COMPUTER ORDER ENTRY BETA

SYNONYMS Human Chorionic Gonadotropin (hCG); hCG, Serum


TEST INCLUDES Qualitative result (positive or negative). (For Pregnancy hCG, Quantitation, see Chorionic Gonadotropin.)

SPECIAL INSTRUCTIONS Positive results are detectable as early as 1 week after implantation or 4-5 days before the next expected menses. Interpret results in light of the clinical situation. Incongruent results should be confirmed by an alternate method or procedure.

INTERFERENCES Some conditions, including trophoblastic and nontrophoblastic neoplasms, not

related to normal pregnancy may cause a positive result. DO NOT use this test to diagnose or monitor these conditions. (Order Chorionic Gonadotropin - Tumor.)




STORAGE INSTRUCTIONS Refrigerate (2-8°C) up to 48 hours. Freeze at -20°C if testing is delayed.

CAUSES FOR REJECTION Plasma specimen.


Pregnancy Test, Urine

COMPUTER ORDER ENTRY PREG

SYNONYMS Human Chorionic Gonadotropin (hCG); hCG Urine


TEST INCLUDES hCG EIA test. Qualitative results (positive or negative).

SPECIAL INSTRUCTIONS The first morning specimen is optimal. False positive results may occur due to unexpected medical conditions. Interpret results in light of the clinical situation. Confirm incongruent results by an alternate method. Do not use this test to diagnose conditions other than gestation.

SPECIMEN REQUIREMENT 10 mL random urine specimen (first morning void is preferred). Collect in a clean screw cap container.



Prenatal Panel

COMPUTER ORDER ENTRY OB

SYNONYMS See Obstetric Panel


Procalcitonin

COMPUTER ORDER ENTRY PROCT


SPECIMEN REQUIREMENT Draw blood in a green (Lithium heparin) PST (full tube). Centrifuge and send specimen in the original tube.

Stability: Refrigerate (2-8ºC) (spun): up to 48 hours Freeze (-25ºC) for longer storage SPECIMEN MINIMUM VOLUME 0.2 mL plasma


CAUSES FOR REJECTION Gross hemolysis.


Progesterone

COMPUTER ORDER ENTRY PROG




SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room temp (unspun): up to 2 hours Room temp (spun): up to 8 hours Refrigerated (2-8°C) (spun): up to 48 hours SPECIMEN MINIMUM VOLUME 0.5 mL serum



Prolactin

COMPUTER ORDER ENTRY PROLA





Stability: Room temp (unspun): up to 2 hours Room temp (spun): up to 8 hours Refrigerated (2-8°C) (spun): up to 48 hours SPECIMEN MINIMUM VOLUME 0.4 mL serum or plasma



Protein Electrophoresis, Serum

COMPUTER ORDER ENTRY SPE

SYNONYMS Serum Protein Electrophoresis; SEP; Electrophoresis

AVAILABILITY Test performed Monday, Wednesday, and Friday on AM shift.

TEST INCLUDES Total Protein, Albumin, Alpha 1, Alpha 2, Beta and Gamma Globulins, and Densitometric Scan with interpretation. Immunofixation and Quantitative Immunoglobulins may be done at an additional charge if indicated.

SPECIAL INSTRUCTIONS Fasting specimen is optimal.

SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Refrigerate (2-8°C) up to 7 days. SPECIMEN MINIMUM VOLUME 0.01 mL serum


CAUSES FOR REJECTION Hemolyzed sample; plasma specimen.


Protein Electrophoresis, Urine – Random or 24 Hour

COMPUTER ORDER ENTRY UPER (random); UPE24 (24 hour collection)

SYNONYMS Urine Protein Electrophoresis; Multiple Myeloma Protein; Light Chain Excretion; Bence Jones Protein

AVAILABILITY Test performed Monday, Wednesday, and Friday on AM shift.

TEST INCLUDES Urine Total Protein and Urine Electrophoresis. Immunofixation may be done at an additional charge if indicated.

SPECIAL INSTRUCTIONS Indicate total volume and collection time for 24 hour urine.

SPECIMEN REQUIREMENT Optimum: 50 mL; minimum: 30 mL. Random or 24 hour urine (no preservative).


STORAGE INSTRUCTIONS Refrigerate (2-8°C) up to 1 week.

CAUSES FOR REJECTION Preservative in urine; bloody urine


Protein/Creatinine Ratio − Urine

COMPUTER ORDER ENTRY TPCR

SYNONYMS Total Protein/Creatinine Ratio, Urine


TEST INCLUDES Urine Total Protein, Urine Creatinine, total Protein/Creatinine Ratio

SPECIAL INSTRUCTIONS Random urine collected without preservative.

INTERFERENCES Presence of stool in urine.

SPECIMEN REQUIREMENT 12 mL aliquot from a well mixed random urine.


CAUSES FOR REJECTION Urine that has not been refrigerated.


Protein, Total

COMPUTER ORDER ENTRY TP (serum); CFTP (CSF); FTP (non synovial fluid); F LPRT (synovial fluid)

SYNONYMS Total Protein; STP (Serum); CFP (Cerebrospinal Fluid Protein)


SPECIMEN REQUIREMENT Blood: Central Laboratory Fond du Lac, Waupun Memorial Hos pital, Dialysis Centers, and Convenient Care: Draw blood in a green (Lithium heparin) PST (full tube). Centrifuge and send specimen in the original tube.




CSF: Submit 1 mL in a plastic container. Fluid: Submit 1 mL from a dark green top (Lithium heparin) tube or with no preservative added. Indicate type of fluid on the requisition.



CAUSES FOR REJECTION Specimen collected in a gray top (Sodium Fluoride/Potassium Oxalate) tube.


Protein, Urine (Quantitative)

COMPUTER ORDER ENTRY UTPR (random); UTP24 (24 hour collection); N24UP (n on-24 hour timed collection)

SYNONYMS UP


TEST INCLUDES Protein on a random, timed, or 24 hour urine collection.


SPECIMEN REQUIREMENT 20 mL aliquot from a well mixed random or 24 hour urine collected with no preservative.




Prothrombin Time

COMPUTER ORDER ENTRY PT

SYNONYMS See INR (PT)


PSA, Total and Free

COMPUTER ORDER ENTRY TFPSA

SYNONYMS Prostate Specific Antigen, Free.


SPECIAL INSTRUCTIONS PSA, Total and Free values obtained with different assay methodologies cannot be used interchangeably in serial PSA Total and Free testing. It is recommended that only one assay method be used consistently to monitor a patient's course of therapy

TEST INCLUDES PSA, Total; PSA, Free; % Free PSA.



SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room temp (unspun): up to 2 hours Room temp (spun): up to 3 hours Refrigerated (2-8°C) (spun): up to 24 hours Frozen (pipette off): up to 72 hours




PSA, Total

COMPUTER ORDER ENTRY PSADI (total diagnostic); PSASC (total annual scree n)

SYNONYMS Prostate Specific Antigen.


SPECIAL INSTRUCTIONS PSA, Total values obtained with different assay methodologies cannot be used interchangeably in serial PSA Total testing. It is recommended that only one assay method be used consistently to monitor a patient's course of therapy



SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room temp (unspun): up to 2 hours Room temp (spun): up to 3 hours Refrigerated (2-8°C) (spun): up to 72 hours Frozen (pipette off): up to 72 hours




PTH Intact

COMPUTER ORDER ENTRY PTHI

SYNONYMS Parathyroid Hormone, Intact


TEST INCLUDES PTH Intact and Calcium.

SPECIAL INSTRUCTIONS Fasting is preferred.



Ripon Medical Center and all other sites: Draw BOTH types of specimens: one green (Lithium heparin) PST (full tube) and one SST. Centrifuge both specimens and send both specimens in their original tubes.




PTT

COMPUTER ORDER ENTRY PTT

SYNONYMS APTT; Partial Thromboplastin Time, Activated


SPECIAL INSTRUCTIONS CAUTION! Tube must be full draw, do not overfill or underfill.

SPECIMEN REQUIREMENT Draw blood in a light blue top (Sodium Citrate) tube.

STORAGE INSTRUCTIONS Store at room temperature on cells for up to 8 hours. If delivery to the Laboratory exceeds 8 hours, centrifuge for 15 minutes, place plasma into a plastic transfer tube capped tightly for transport, and freeze.

CAUSES FOR REJECTION Improper volume (low or high); clotted specimen; extreme hemolysis.


Rapid Strep A

COMPUTER ORDER ENTRY RSSTR (with Strep only culture); RSTHR (with full t hroat culture); RSTNC (no culture); RSMIS (non-throat with culture)

SYNONYMS Rapid Strep A Antigen


TEST INCLUDES Streptococcus A Antigen. Negative antigen specimens are cultured for Beta Strep or full throat as ordered.

SPECIAL INSTRUCTIONS Swab the posterior pharynx (throat) and tonsils, avoid the tongue and uvula, using a double (red cap) BBL™ CultureSwab™. Beta Strep cultures are only set up on negative specimens (added charge, see Cultures, Throat for Beta Strep).

SPECIMEN REQUIREMENT Use a double culturette (rayon or dacron tipped swabs with a plastic shaft). DO NOT use Calcium Alginate, cotton tip, or wooden shafted swabs. Specify source on the requisition (other body sites have not been FDA approved for this test).

STORAGE INSTRUCTIONS Room temperature up to 24 hours. Do not refrigerate.

CAUSES FOR REJECTION Delayed transport; inappropriate or desiccated swab.


RBC Folate

COMPUTER ORDER ENTRY LFOLA

SYNONYMS See Folate, Erythrocytes (RBC)


Renal (Kidney) Function Panel

COMPUTER ORDER ENTRY RENAL


TEST INCLUDES Sodium, Potassium, Chloride, CO2, Glucose, Urea Nitrogen (BUN), Creatinine, Phosphorus, Calcium, and Albumin. Also includes Glomerular Filtration Rate (calculated) on patients 18 years or older.



Stability: Room temp (unspun): optimally up to 1 hour

Room temp (spun): up to 8 hours Refrigerated (2-8°C) (spun): up to 16 hours


Stability: Room temp (unspun): optimally up to 1 hour Room temp (spun): up to 8 hours Refrigerated (2-8°C) (spun): up to 24 hours SPECIMEN MINIMUM VOLUME 0.5 mL serum or plasma

STORAGE INSTRUCTIONS See above. Keep tube stoppered until analysis.



Respiratory Virus Panel Multiplex RT, Amplified Probe, Nasopharynx

COMPUTER ORDER ENTRY RVPNL

SYNONYMS Respiratory Viral Panel, Influenza subtypes

AVAILABILITY Test performed daily; all shifts; available STAT. Expected turnaround time is 3 hours from the time of arrival at Central Laboratory of Fond du Lac.

TEST INCLUDES Influenza A, includes subtypes H1, H3 and 2009 H1N1; Influenza B, RSV A and RSV B.

NOTE: � Viral nucleic acid may persist in vivo, independent of virus viability.

Detection of viral material does not imply that the corresponding viruses are infections, nor are the causative agents for clinical symptoms.

� There is a risk of false negative results due to sequence variants in the viral targets of this assay, procedural errors, amplification inhibitors in the specimen, or inadequate viral concentration for amplification.

� There is a risk of false positive results due to cross-contamination by target viruses, their nucleic acids or amplified product, or from non-specific signals in this assay.

� This assay has not been evaluated for patients without signs and symptoms of upper respiratory infection or for monitoring treatment of influenza or RSV infection.

� This assay has not been established in individuals who received nasally administered or injectable influenza vaccine.

� This performance of this assay has not been established in immunocompromised individuals.

� The performance of this assay with viruses infecting swine and other animal hosts has not been established.

� If infection with a novel Influenza A virus is suspected based on current clinical and epidemiologic screening criteria recommended by public health authorities, specimens should be collected with appropriate infection control precautions for virulent influenza viruses and sent to state or local health departments for testing. Work with local and state authorities if a novel virus is suspected.

SPECIMEN REQUIREMENT Nasopharyngeal:

Collect one nasopharyngeal swab. Place the swab in BD™ Universal Viral Transport media.

� Use flocked swabs or swabs with a synthetic (nylon or rayon) and an aluminum or plastic shaft. Swabs with cotton tips and wooden shafts are not recommended. Calcium alginate swabs are NOT acceptable.

STORAGE INSTRUCTIONS Transport to laboratory ASAP. Refrigerate (2-8ºC) or keep on wet ice while in

transit up to 72 hours. Freeze (-70ºC) for longer storage.

CAUSES FOR REJECTION Calcium alginate swab. Specimens not transported in viral transport medium (UTM).

DEPARTMENT Microbiology (Central Laboratory of Fond du Lac)

Reticulocyte Count

COMPUTER ORDER ENTRY RETA (automated)

SYNONYMS Retic




CAUSES FOR REJECTION Clotted or hemolyzed specimen.


Rh Subtypes

COMPUTER ORDER ENTRY RHSUB

SYNONYMS D, C, c, E Typing; Rh Phenotype; Rh Phenotyping, Complete


TEST INCLUDES Blood Type for D, C, c, and E. (Tests may be individually requested.)

INTERFERENCES A positive Antiglobulin test may interfere with the testing.

SPECIMEN REQUIREMENT Draw blood in a 7 mL plain red top tube (no additive).




Rh Type

COMPUTER ORDER ENTRY RH

SYNONYMS See ABO & Rh Type


Rheumatoid Factor (RA)

COMPUTER ORDER ENTRY RF

SYNONYMS RF; Rheumatoid Arthritis Factor


SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room temp (spun): up to 8 hours Refrigerated (2-8°C) (spun): up to 72 hours SPECIMEN MINIMUM VOLUME 0.1 mL serum

STORAGE INSTRUCTIONS See above. DO NOT FREEZE.

CAUSES FOR REJECTION Gross lipemia or hemolysis.


ROM, Rupture of Membranes

COMPUTER ORDER ENTRY ROM

SYNONYMS ROM; Amnisure; Rupture of Membranes


SPECIAL INSTRUCTIONS Call Laboratory (Fond du Lac: ext. 5800; Waupun: ext. 6502; Ripon: ext. 3310) for sample kit when test is requested.

NOTE: Immunochromatography is used to detect PAMG-1 � This test is intended to be used to evaluate patients with clinical

signs/symptoms of fetal membrane rupture. � Significant blood on the swab may result in test malfunction. This is not

recommended for swabs with more than trace blood. � A false negative result may occur, in very rare cases, when a sample is

taken more than 12 hours after a rupture � Test performance in patients without signs or symptoms of rupture of

membranes is unknown. � Results should be used in conjunction with other clinical information. � Failure to detect membrane rupture does not assure absence of

membrane rupture. � The performance of this test has not been established in the presence of

antifungal creams or suppositories, K-Y Jelly, Monistat, Baby Powder, Replens, Baby Oil or meconium in the amniotic fluid.

� Do not use a collection kit if damaged.

SPECIMEN REQUIREMENT Amniotic fluid is collected by nursing staff, using the sterile polyester swab that is provided with the kit. 1. Remove the sterile swab from its package following instructions on the

package. The polyester tip should not touch anything prior to insertion into vagina.

2. Hold the swab in the middle of the stick and, while a patient is lying flat on her back, carefully insert the polyester tip of the swab into the vagina until the fingers contact the skin no more than 2-3 inches (5-7 cm) deep.

3. Withdraw the swab from the vagina after 1 minute. 4. Rinse the swab in AmniSure solvent vial for one minute. 5. After the one minute mixing, discard the swab in an appropriate biohazard

container. 6. Cap the solvent vial and send it with the rest of the ROM kit at ambient

temperature to the lab immediately.

STORAGE INSTRUCTIONS Specimen must be sent to the Lab as soon as it is collected.



Rotavirus Antigen

COMPUTER ORDER ENTRY ROTA


TEST INCLUDES Immunoassay for identification of Rotavirus antigen from human stool.

SPECIAL INSTRUCTIONS Collect specimen during the acute phase of gastroenteritis. Samples collected more than 7 days after onset of symptoms may not contain enough rotavirus antigen to be detected.

SPECIMEN REQUIREMENT 5-10g stool collected in a clean, dry, detergent free screw top container with no additives.


CAUSES FOR REJECTION Stool placed in a container with preservative.


RPR Serology

COMPUTER ORDER ENTRY RPRWR

SYNONYMS Rapid Plasma Reagin; Serologic Test for Syphilis; STS


TEST INCLUDES Quantitative titer of reactive tests.

SPECIAL INSTRUCTIONS A reactive RPR result will reflex to an order for Treponema pallidum particle agglutination testing.


Stability: Refrigerated (2-8°C) (spun): up to 5 days





RPR Serology – No Reflex

COMPUTER ORDER ENTRY RPR

SYNONYMS Rapid Plasma Reagin; Serologic Test for Syphilis; STS


TEST INCLUDES Quantitative titer of reactive tests.

SPECIAL INSTRUCTIONS Confirmatory testing is necessary to verify reactive results. Notify the Laboratory within 2 weeks so a sample can be submitted for further testing if appropriate.


Stability: Refrigerated (2-8°C) (spun): up to 5 days





RSV Amplified Probe, Nasopharynx

COMPUTER ORDER ENTRY RSVAP

SYNONYMS Respiratory Syncytial Virus, RSV

AVAILABILITY Test performed daily; all shifts; available STAT. Expected turnaround time is 3 hours from the time of arrival at Central Laboratory of Fond du Lac.

TEST INCLUDES RSV A and RSV B by amplified nucleic acid test.

SPECIAL INSTRUCTIONS Orders for Rapid RSV or RSV Antigen from facilities other than Ripon Medical Center ED will be converted to RSV, Amplified Probe.

SPECIMEN REQUIREMENT Nasopharyngeal:

Collect one nasopharyngeal swab. Place the swab in BD™ Universal Viral Transport media.

� Use flocked swabs or swabs with a synthetic (nylon or rayon) and an aluminum or plastic shaft. Swabs with cotton tips and wooden shafts are

not recommended. Calcium alginate swabs are NOT acceptable.

STORAGE INSTRUCTIONS Transport to laboratory ASAP. Refrigerate (2-8ºC) or keep on wet ice while in transit up to 72 hours. Freeze (-70ºC) for longer storage.

CAUSES FOR REJECTION Calcium alginate swab. Specimens not transported in viral transport medium (UTM).

DEPARTMENT Microbiology (Central Laboratory of Fond du Lac)

RSV Antigen, Rapid (Ripon Medical Center ONLY)

COMPUTER ORDER ENTRY RSV1

SYNONYMS Respiratory Syncytial Virus Antigen Testing

AVAILABILITY Test performed daily; all shifts; available STAT. Testing available for ED or hospitalized patients only . All other requests should be sent to the Central Lab of Fond du Lac for RSV Amplified Probe Testing.

TEST INCLUDES Immunochromatographic sandwich assay for RSV antigen from a clinical specimen.

SPECIAL INSTRUCTIONS Transport the specimen on wet ice. Intended for pediatric and neonatal patients. Test has not been validated on adults. For patients older than 18 years, order a RSV culture or PCR testing.

SPECIMEN REQUIREMENT Nasopharyngeal (NP) swabs placed in viral transport medium (Remel M4RT®). Nasopharyngeal washes (3-4 mL) and aspirates (3-4 mL) in saline are the specimens of choice. NP swabs are the only specimens collected by the Laboratory associate. Obtain the specimen prior to Albuterol treatment or wait 1-2 hours after the treatment before collecting the specimen.

STORAGE INSTRUCTIONS Refrigerate (2-8°C) up to 48 hours. Freeze up to 1 week at -20°C.

CAUSES FOR REJECTION Specimen left at room temperature after collection.

DEPARTMENT Ripon Medical Center

Rubella Immune Status (German Measles, Qualitative)

COMPUTER ORDER ENTRY RUBEL

SYNONYMS Rubella IgG Antibodies; German Measles Antibody


SPECIAL INSTRUCTIONS Recommended for immune status determination. Antibody levels in the equivocal range for this assay may be insufficient to protect against illness upon exposure to the Rubella virus. Recommend a new specimen be obtained within 3 months for retesting.





Rubeola IgG, Qualitatitive

COMPUTER ORDER ENTRY RUBEO

SYNONYMS See Measles Immune Status (Rubeola IgG, Qualitative)

DEPARTMENT Special Chemistry (Central Laboratory of Fond du Lac)

Salicylate Level

COMPUTER ORDER ENTRY SALIC

SYNONYMS Salicylic Acid; ASA; Aspirin Level


SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room temp (unspun): up to 2 hours Room temp (spun): up to 4 hours Refrigerate (2-8°C) up to 48 hours




Sed Rate (ESR)

COMPUTER ORDER ENTRY ESR

SYNONYMS Erythrocyte Sedimentation Rate

AVAILABILITY Test performed; all shifts.

INTERFERENCES Hemolysis may modify the ESR.

SPECIMEN REQUIREMENT Draw blood in a black top (Citrate) tube or a lavender top (EDTA) tube. Ripon Medical Center requires a lavender top (EDTA) tube

NO capillary specimens.

STORAGE INSTRUCTIONS Room temperature up to 6 hours (black top tube) or 12 hours (lavender top tube).

CAUSES FOR REJECTION Clotted specimen; under filled or overfilled tube.


Semen Analysis, Infertility

COMPUTER ORDER ENTRY SEMEN or SEMN

SYNONYMS Sperm Count


TEST INCLUDES Sperm Count, Motility, Morphology, Volume, pH, Viscosity, Appearance, and Speed of Sperm.

SPECIAL INSTRUCTIONS Test must be performed within 1 hour of collection. Deliver promptly to the Laboratory.

Patient should abstain from sexual activity for 3 (but not more than 5) days prior to collection.

SPECIMEN REQUIREMENT Semen (total ejaculate). Collect the specimen in a container obtained from the Laboratory.

STORAGE INSTRUCTIONS Keep specimen warm. DO NOT REFRIGERATE.

CAUSES FOR REJECTION Specimen received > 1 hour after collection.


Semen Analysis, Post Vasectomy

COMPUTER ORDER ENTRY SEMPA

SYNONYMS Post Vas


TEST INCLUDES Presence or absence of sperm.

SPECIAL INSTRUCTIONS Specimen must be delivered to the Laboratory within 12 hours of collection. See Semen Analysis for collection instructions.



CAUSES FOR REJECTION Specimen received > 12 hours after collection; specimen received in a container not issued by the Laboratory.


Semen Analysis, Post Vasectomy Count

COMPUTER ORDER ENTRY POSCT

SYNONYMS Post Vas Count, Post Count


TEST INCLUDES Presence or absence of sperm and sperm count; motility when appropriate.

SPECIAL INSTRUCTIONS Test must be performed within one hour of collection.



CAUSES FOR REJECTION Unable to report motility if specimen is received more than one hour after collection; specimen received in a container not issued by the Laboratory.


Sex Hormone Binding Globulin

COMPUTER ORDER ENTRY SHBG

AVAILABILITY Test performed daily; all shifts; available STAT



SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerated (2-8˚) (spun): up to 48 hours Frozen (pipette off): up to 5 days SPECIMEN MINIMUM VOLUME 0.4 mL serum STORAGE INSTRUCTIONS See above.


Sickle Cell

COMPUTER ORDER ENTRY LHGBS

SYNONYMS Hemoglobin Solubility; Hgb S; Hemoglobin S; Sickledex™


TEST INCLUDES A qualitative determination of the presence of hemoglobin S

SPECIMEN REQUIREMENT Draw blood in a lavender-top (EDTA) tube. Do not centrifuge. Stability: Room Temp: up to 14 days Refrigerated (2-8˚) or frozen: up to 14 days SPECIMEN MINIMUM VOLUME 0.1 mL whole blood STORAGE INSTRUCTIONS See above.


Sodium, Serum or Plasma

COMPUTER ORDER ENTRY NA



Stability: Room temp (unspun): up to 2 hours Room temp (spun): up to 8 hours Refrigerate (2-8°C) up to 5 days





CAUSES FOR REJECTION Specimen collected in a gray top (Sodium Fluoride/Potassium Oxalate) tube.


Sodium, Urine

COMPUTER ORDER ENTRY UNAR (random); UNA24 (24 hour collection)

SYNONYMS Urine NA







Specific Gravity, Fluid

COMPUTER ORDER ENTRY FLSG


SPECIMEN REQUIREMENT Random urine or body fluid. Indicate fluid type on the requisition.



Staph aureus Nasal Complete

COMPUTER ORDER ENTRY NASAL

SYNONYMS Test routinely ordered on patients scheduled for joint replacement or heart valve procedures.


TEST INCLUDES MRSA and MSSA

SPECIAL INSTRUCTIONS Must use the FDA approved Copan (LQ Stuart) “scored” double swab.

1) Have patient blow nose.

2) Ask patient to tilt head back. Insert both dry swabs approximately 1-2 cm into each nostril.

3) Apply slight pressure with a finger on the outside of the nose to help assure good contact between the swab and the inside of the nose. Rotate the swabs against the inside of the nostril for 3 seconds.

4) Using the same swabs, repeat for the second nostril, trying not to touch anything but the inside of the nose.

5) Remove and discard the cap from the plastic transport tube. Place the swabs into the plastic transport tube. The swabs should go all the way into the tube until they rest on top of the sponge at the bottom of the tube. Make sure the red cap is on tightly.

INTERFERENCES Potential interferences include nasal decongestants as Anefrin spray and Neosynephrine; nasal steroids including Zicam nasal gel, Nasonex, Flonase, Rhinolast and NasalCrom; saline moisturizing spray, mucous and blood.

SPECIMEN REQUIREMENT Copan (LQ Stuart) “scored” double swabs (red cap). Collect using the procedure in the Special Instructions listed above.


CAUSES FOR REJECTION Incorrect swab; source other than nasal


Stool WBC

COMPUTER ORDER ENTRY WBCST

SYNONYMS See WBC, Stool


Streptococcus pneumonia Urinary Antigen

COMPUTER ORDER ENTRY PNEUMO

SYNONYMS Strep pneumo Urine Antigen; Strep pneumonia Antigen; Rapid Strep pneumono; Pneumococcal UAT


SPECIAL INSTRUCTIONS Patients should not have received Streptococcus pneumonia vaccine within 5

days of specimen collection. The accuracy of this test has not been proven in young children.

TEST INCLUDES Rapid immunochromatographic assay for the detection of Streptococcus pneumonia antigen in urine of patients with S. pneumo pneumonia

INTERFERENCES Grossly bloody or heavily pigmented urine may interfere with test.

SPECIMEN REQUIREMENT Urine collected in a standard container.

SPECIMEN MINIMUM VOLUME 1 mL urine

STORAGE INSTRUCTIONS Room temperature (15-30°C) up to 24 hours; refrigerate (2-8°C) up to 2 weeks.

CAUSES FOR REJECTION Room temperature specimen >24 hours; refrigerated specimen >2 weeks; mislabeled or unlabeled specimen.


T3, Free

COMPUTER ORDER ENTRY FT3

SYNONYMS T3 Free; Triiodothyronine, Free


SPECIAL INSTRUCTIONS Sample should not be collected during or soon after the administration of heparin.

INTERFERENCES Patients on heparin therapy may have elevated free T3 levels due to release of non-esterified fatty acids, which can alter the relationship between free and bound hormones.

SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room temp (unspun): up to 2 hours Room temp (spun): up to 8 hours Refrigerate (2-8°C) up to 48 hours


Stability: Room temp (unspun): up to 2 hours Room temp (spun): up to 8 hours Refrigerate (2-8°C) up to 48 hours



CAUSES FOR REJECTION Severe icterus.


T4, Free

COMPUTER ORDER ENTRY FRT4

SYNONYMS Free T4; Thyroxine Free T4




Ripon Medical Center and all other sites: Draw blood in a SST. Centrifuge

and send specimen in the original tube. Stability: Room temp (unspun): up to 2 hours Room temp (spun): up to 8 hours Refrigerate (2-8°C) up to 5 days

SPECIMEN MINIMUM VOLUME 0.4 mL serum or plasma; 0.8 whole blood (1 full microtainer)


CAUSES FOR REJECTION Severe icterus.


TB Culture

COMPUTER ORDER ENTRY CXTB

SYNONYMS See Culture, AFB (TB)


TB Gold Blood Assay

COMPUTER ORDER ENTRY TB

SYNONYMS TB blood test; QuantiFERON® test (and variations); TB Gold

AVAILABILITY Test performed on Wednesday. NOTE: The first stage of the testing procedure is a 16-24 hour incubation of the tubes at 37ºC which allows the white cells to react to the antigen coated tubes. Therefore, if the tubes are not received at the Central Laboratory of Fond du Lac by 5pm on Tuesday, they would not be included with the Wednesday second stage testing and would be tested on the following Wednesday.

SPECIAL INSTRUCTIONS Specimen must be received in the Laboratory within 12 hours of collection to allow for 2 hours of processing. Outreach sites should consider time requirements when drawing the patient.

SPECIMEN REQUIREMENT 1. Collect 1 mL of blood into each of the 3 “QuantiFERON®” tubes. � The order of draw is: Gray-Red-Purple (use the word GRAPE to

remember the order of draw). � Expect the tubes to fill very slowly. � Leave tube(s) on the needle for 2-3 seconds after the flow of blood

has stopped. � When upright, blood MUST meet the small black mark on the label. � Use of a butterfly needle is not recommended. If absolutely necessary,

use a discard tube to remove air from the butterfly line. Then collect the three QTB tubes.

� Blood can be collected using a syringe and then transferring 1 mL to each of the three tubes. Safely remove the syringe needle. Remove the caps from the three QTB tubes and add to the black mark on the side of the tube label. Securely replace the tube caps.

2. Mix the tubes firmly.

� Hold the tubes vertically in your hand and move your arm up and down in a vertical motion 10 times.

� Entire inner surface of tube must be coated with blood. � Blood should be frothy after shaking. � Apply patient label just below the QuantiFERON® band and leave the

black mark on the side of the tube visible.

STORAGE INSTRUCTIONS Keep ambient; DO NOT refrigerate or freeze. DO NOT centrifuge.

CAUSES FOR REJECTION Use of any other tube type or brand (must be the three QuantiFERON® tubes); under filled tubes; excessive time lapse before receiving the tubes at the Central Laboratory (> 12 hours); transport temperature other than ambient.


Tegretol

COMPUTER ORDER ENTRY CARBA

SYNONYMS See Carbamazepine


Testosterone, Free (calculated)

COMPUTER ORDER ENTRY FREET


TEST INCLUDES Total Testosterone, Sex Hormone Binding Globulin and Calculated Free Testosterone.





Testosterone, Total

COMPUTER ORDER ENTRY TESTT


TEST INCLUDES Total Testosterone





Theophylline Level

COMPUTER ORDER ENTRY THEO

SYNONYMS Aminophylline




SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 4 hours Refrigerated (2-8˚) (spun) up to 48 hours




Therapeutic Phlebotomy

COMPUTER ORDER ENTRY RXPHL

AVAILABILITY Procedure performed Monday through Friday 9AM to 2PM or by special request.

SPECIAL INSTRUCTIONS Order should include the following: � Indication for procedure (i.e. hemochromotosis) � Interval and frequency of phlebotomy(i.e. weekly, monthly) � Target hemoglobin and hematocrit or total number of phlebotomies.

Call the Outpatient Lab to schedule


Thiamin (Vitamin B1)

COMPUTER ORDER ENTRY LTHIA


SPECIAL INSTRUCTIONS Specimen should be collected before breakfast in the morning and prior to any medication.


SPECIMEN MINIMUM VOLUME 0.5 mL of whole blood.

STORAGE INSTRUCTIONS Draw blood. Do NOT separate. Analyte is light sensitive, minimize exposure to light during storage and transport. Transfer whole blood to amber plastic transport tube and freeze .


Thyroglobulin Antibodies

COMPUTER ORDER ENTRY ATG

SYNONYMS See Antithyroglobulin Antibodies


TIBC

COMPUTER ORDER ENTRY IBC

SYNONYMS Total Iron Binding Capacity. Reported as % Saturation when Iron and Transferrin are ordered.

TEST INCLUDES Serum Iron and Transferrin with Calculated % Saturation. See separate test listings for Iron and Transferrin.


Tissue Transglutaminase Antibody, IgA

COMPUTER ORDER ENTRY LTTIA



STORAGE INSTRUCTIONS Refrigerate (2-8°C). Minimum volume 0.5 mL (1 mL recommended)


Tissue Transglutaminase Antibody, IgG

COMPUTER ORDER ENTRY LTTG



STORAGE INSTRUCTIONS Refrigerate (2-8°C). Minimum volume 0.5 mL (1 mL recommended)


Tobramycin Level

COMPUTER ORDER ENTRY TOBRP (peak); TOBRR (random); TOBRT (trough)


SPECIAL INSTRUCTIONS Trough : Draw 30 minutes before dose. Peak: Draw 30 minutes after the completion of an infusion (IV dose) or 60 minutes after IM dose.

INTERFERENCES Patients taking Cephalothin, Lincomycin, Tetracycline, or Trimethoprin will cross-react with this method.



SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 4 hours Refrigerated (2-8˚) (spun): up to 48 hours




Toxigenic C. diff

COMPUTER ORDER ENTRY CDIFF

SYNONYMS See C. difficile by PCR


Transferrin

COMPUTER ORDER ENTRY TRF

SYNONYMS TFN



SPECIAL INSTRUCTIONS To screen for hemochromatosis, a fasting morning specimen is preferred.

SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (spun): up to 8 hours Refrigerated (2-8˚) (spun): up to 72 hours SPECIMEN MINIMUM VOLUME 0.1 mL serum


CAUSES FOR REJECTION Gross hemolysis; grossly lipemic sample which cannot be clarified by centrifugation.


Trichomonas vaginalis by PCR

COMPUTER ORDER ENTRY TRICH

SYNONYMS Trichomonas (NAAT)





ThinPrep® Liquid Cytology Collection kit Cervical or endocervical ThinPrep® Liquid Cytology Collection kit

Vaginal Swab Specimen Collection Instructions








STORAGE INSTRUCTIONS APTIMA swab: room temperature (2-30°C) up to 60 days; ThinPrep® Liquid Cytology container: 2-30°C up to 30 days (Cannot be added if the vial has been used to prepare a Pap Smear)



Triglycerides, Blood or Fluid

COMPUTER ORDER ENTRY TRIG (serum); FTRIG (body fluid)


SPECIAL INSTRUCTIONS Fasting for 12 hours. Alcohol should not be consumed for 24 hours before specimen is drawn.


Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerated (2-8˚) (spun): up to 5 days

Ripon Medical Center and all other sites: Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerated (2-8˚) (spun): up to 4 days Body fluid: Indicate type on the requisition.

SPECIMEN MINIMUM VOLUME 0.3 mL serum or plasma STORAGE INSTRUCTIONS See above.

CAUSES FOR REJECTION Use of collection tubes having stoppers lubricated with glycerol; specimen collected in tube a containing Sodium Citrate or Sodium Fluoride/Potassium Oxalate (light blue or gray top tube).


Troponin I

COMPUTER ORDER ENTRY TROPO



Interpretation of results should be done in the context of the overall clinical presentation of the patient, including symptoms, clinical history, data from

additional tests and other appropriate information.

SPECIMEN REQUIREMENT Draw blood in a green (Lithium heparin) PST (full draw). Centrifuge and send specimen in the original tube.

Stability: Room Temp (unspun): up to 2 hours Refrigerated (2-8˚) (spun): up to 24 hours Frozen (pipette off): up to 72 hours



Troponin I (Point of Care)

COMPUTER ORDER ENTRY TRPED








TSH Reflex

COMPUTER ORDER ENTRY TSHRF

SYNONYMS Thyroid Stimulating Hormone Reflex to Free T4; TSH Reflex to FT4


TEST INCLUDES If TSH result is abnormal, a Free T4 will be performed at an additional charge.





Ripon Medical Center and all other sites: Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerated (2-8˚) (spun): up to 5 days

SPECIMEN MINIMUM VOLUME 0.5 mL serum or plasma; 0.8 mL whole blood (2 full microtainers)



TSH, Ultrasensitive

COMPUTER ORDER ENTRY TSH

SYNONYMS Thyroid Stimulating Hormone






Ripon Medical Center and all other sites: Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerated (2-8˚) (spun): up to 5 days

SPECIMEN MINIMUM VOLUME 0.5 mL serum or plasma; 0.8 mL whole blood (2 full microtainers)



Type and Screen

COMPUTER ORDER ENTRY TS


TEST INCLUDES ABO & Rh; Antibody Screen

SPECIAL INSTRUCTIONS For potential crossmatch, the patient must be banded with a Blood Bank armband by Laboratory or other appropriately authorized associate.

Specify if and when the patient has been pregnant or transfused.

SPECIMEN REQUIREMENT Draw blood in a one 6 mL or two 3 mL lavender top (EDTA) tubes (unless otherwise instructed by the patient label).





Type & Screen, Prenatal

COMPUTER ORDER ENTRY TS

TEST INCLUDES Test includes ABO & Rh Type and Antibody Screen.


UF Heparin Anti Factor Xa (Unfractionated) – INPATI ENTS ONLY

COMPUTER ORDER ENTRY UFHEP

SYNONYMS For patients with a continuous intravenous heparin infusion

AVAILABILITY Test performed daily; all shifts; available STAT. Performed at Central Laboratory Fond du Lac only.


SPECIMEN REQUIREMENT Draw blood in a light blue top (Sodium Citrate) tube (full tube). A 7 mL red top tube should be drawn and discarded prior to drawing the blue top tube. When drawing a specimen with a syringe, the blue top should be filled first.


STORAGE INSTRUCTIONS Submit the entire unopened sample. Store at room temperature. If delivery to the Laboratory will exceed 1 hour, centrifuge for 15 minutes, pipette the plasma into a plastic transfer tube capped tightly for transport, and freeze. Plasma must be platelet poor, platelet count < 10

CAUSES FOR REJECTION Improper volume (overfilled or underfilled); clotted; extreme hemolysis


Urea Nitrogen, Urine

COMPUTER ORDER ENTRY UUNR (random); UUN24 (24 hour collection)

SYNONYMS UUN






Uric Acid

COMPUTER ORDER ENTRY URIC (serum); FURIC (body fluid)


SPECIMEN REQUIREMENT Blood: Central Laboratory Fond du Lac, Waupun Memor ial Hospital, Dialysis Centers, and Convenient Care: Draw blood in a green (Lithium heparin) PST (full tube). Centrifuge and send specimen in the original tube.

Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerated (2-8˚C) (spun): up to 5 days

Ripon Medical Center and all other sites: Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (unspun): up to 2 hours

Room Temp (spun): up to 8 hours Refrigerated (2-8˚C) (spun): up to 5 days Body fluid: Indicate type on the requisition.



CAUSES FOR REJECTION Specimen collected in a gray top (Sodium Fluoride/Potassium Oxalate) tube; moderate hemolysis.


Uric Acid, Urine

COMPUTER ORDER ENTRY UUAR (random); UUA24 (24 hour collection)


SPECIAL INSTRUCTIONS Indicate total volume and collection time period on the requisition.

SPECIMEN REQUIREMENT 20 mL aliquot from a well mixed random (no preservative) or 24 hour urine.



Urinalysis, Complete

COMPUTER ORDER ENTRY UACOM

SYNONYMS UA; Urinalysis


TEST INCLUDES Appearance, Color. Dipstick: Glucose, Bilirubin, Ketones, Specific Gravity, Occult Blood, pH, Protein, Urobilinogen, Leukocyte, and Nitrite. Microscopic examination of sediment. Automated methods are used whenever possible.

SPECIMEN REQUIREMENT 12 mL urine.




Urinalysis, Culture if Indicated

COMPUTER ORDER ENTRY UACUL


TEST INCLUDES A complete urinalysis will be performed. (See above.) UA will reflex to culture if Leukocyte is positive, > 5 WBCs/HPF, positive Nitrite, moderate or many bacteria, or yeast present.

SPECIMEN REQUIREMENT 12 mL urine. Specimens for culture must be refrigerated within 30 minutes. See specimen requirements of Culture, Urine and Cytology, Urine.




Urinalysis, Dipstick Only

COMPUTER ORDER ENTRY UADIP

SYNONYMS Urinalysis without Microscopy


TEST INCLUDES Appearance, Color. Dipstick: Glucose, Bilirubin, Ketones, Specific Gravity, Occult Blood, pH, Protein, Urobilinogen, Nitrite, and Leukocytes.





Urinalysis, Dipstick with Reflex to Microscopic Exa m

COMPUTER ORDER ENTRY UDIPR


TEST INCLUDES Appearance, Color. Dipstick: Glucose, Bilirubin, Ketones, Specific Gravity, Occult Blood, pH, Protein, Urobilinogen, and Nitrite. If appearance is other than clear or if Protein, Leukocytes, Occult Blood, or Nitrates are not negative, a microscopic examination of sediment is performed.




DEPARTMENT Urinalysis Urine Strep pneumo Antigen

COMPUTER ORDER ENTRY PNEUMO

SYNONYMS See Streptococcus pneumoniae Urinary Antigen


Vaginal Infection, DNA Probe

COMPUTER ORDER ENTRY VAGPR

SYNONYMS Vag, Wet

AVAILABILITY Test performed daily; available STAT for Central Campus providers.

INTERFERENCES There is NO evidence of interference from vaginal lubricants, douches, menses or spermicides.

SPECIAL INSTRUCTIONS Follow the BD Affirm VPIII Collection and Transport Chart. This collection is specific for this test. Collect a separate swab for culture, Chlamydia, N. gonorrhoeae or other tests.

TEST INCLUDES Trichomonas vaginalis, Candida species, Gardnerella vaginalis

SPECIMEN REQUIREMENT Vaginal specimens collected using the Affirm VPIII Ambient Temperature Transport System.

STORAGE INSTRUCTIONS Specimens collected in the Affirm VPIII Ambient Temperature Transport System are stable up to 72 hours at room temperature (15-30°C) or refrigerated (2-8°C).

CAUSES FOR REJECTION Specimens not properly collected using the Affirm VPIII ambient Temperature Transport System; specimens > 72 hours old.


Valproic Acid (Depakene)

COMPUTER ORDER ENTRY VALP

SYNONYMS Depakote




SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 4 hours Refrigerated (2-8˚C) (spun): up to 48 hours



DEPARTMENT Chemistry (Central Laboratory Fond du Lac and Ripon Medical Center)

Vancomycin Level

COMPUTER ORDER ENTRY VANC1 (peak 1 hr); VANC2 (peak 2hr); VANCR (random) ; VANCT (trough)


SPECIAL INSTRUCTIONS Trough : Draw 30 minutes before dose. Peak: Draw 1 hour after completion of 60 minute infusion, or 2 hours after completion of 60 minute infusion. (2 hour recommended.)



SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 4 hours Refrigerated (2-8˚C) (spun): up to 48 hours




Varicella-Zoster IgG (Qualitative)

COMPUTER ORDER ENTRY VZIG

SYNONYMS Chicken Pox; Shingles


SPECIAL INSTRUCTIONS Test is used for immune status determination.



STORAGE INSTRUCTIONS Refrigerate (2-8°C) up to 5 days.

CAUSES FOR REJECTION Plasma specimen; gross lipemia; obvious microbial contamination.


Venous Blood Gases, Whole Blood

COMPUTER ORDER ENTRY VBG


TEST INCLUDES pH, pCO2, HCO3, tCO2, and Base Excess.

SPECIAL INSTRUCTIONS Fill the tube completely. Avoid exposure to atmosphere. DO NOT remove stopper.

SPECIMEN REQUIREMENT Draw blood in a dark green top (Lithium heparin) (full draw) tube or a heparinized syringe (minimum 1 mL). NOTE: The heparin tube must have a fill line that is near the top of the tube. There must be minimal air space in the tube after the sample is collected, otherwise results may be compromised.

STORAGE INSTRUCTIONS Send immediately to the Laboratory at room temperature. Specimen should

be analyzed within 30 minutes of collection.



Vitamin B1 (Thiamin)

COMPUTER ORDER ENTRY LTHIA

SYNONYMS See Thiamin (Vitamin B1)


Vitamin B12

COMPUTER ORDER ENTRY B12

SYNONYMS Cobalamin

SPECIAL INSTRUCTIONS Patient should be fasting at least 8 hours.




SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerated (2-8˚C) (spun): up to 24 hours Frozen (pipette off): up to 48 hours SPECIMEN MINIMUM VOLUME 0.4 mL serum


CAUSES FOR REJECTION Hemolysis


Vitamin D (25 Hydroxy Vitamin D)

COMPUTER ORDER ENTRY 25VD

AVAILABILITY Test daily; all shifts

TEST INCLUDES Vitamins D2 and D3 SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerated (2-8˚C) (spun): up to 7 days


STORAGE INSTRUCTIONS Refrigerate (2-8°C) up to 7 days.



WBC, Stool (Lactoferrin, Qualitative)

COMPUTER ORDER ENTRY WBCST

SYNONYMS Stool for WBC; Fecal Leukocytes

SPECIAL INSTRUCTIONS Collect fecal specimen in a clean, leak proof container with no preservatives.


INTERFERENCES Fecal specimens from breast fed infants. Please note on the order or requisition if an infant is breast fed. If needed order a gram stain confirmation will be performed to confirm positives if the infant is breast fed.

TEST INCLUDES Test detects elevated levels of lactoferrin released from fecal leukocytes as a marker of intestinal inflammation.

SPECIMEN REQUIREMENT Unpreserved stool.

STORAGE INSTRUCTIONS Room temperature or refrigerated (2-8°C) up to 2 weeks.

CAUSES FOR REJECTION Specimen received in transport media or preserved in 10% formalin, Merthiolate formalin, Sodium Acetate formalin (SAF), Polyvinyl Alcohol (PVA) or other fixatives.

DEPARTMENT Microbiology (Central Laboratory Fond du Lac)

Wet Prep

COMPUTER ORDER ENTRY WET

SYNONYMS Wet Mount


TEST INCLUDES Examination for Yeast, Trichomonas, and Clue Cells on vaginal or cervical sources only.

SPECIAL INSTRUCTIONS Vaginal or cervical secretions collected with a single or double culturette swab. Collect specimen by speculum exam without the use of lubricant.


CAUSES FOR REJECTION Culturette with charcoal; desiccated swab.


Worm Identification

COMPUTER ORDER ENTRY LPIDW

SYNONYMS See Parasite, Macroscopic ID


Zika Virus Testing ** as of 5/25/16

COMPUTER ORDER ENTRY Pending – Miscellaneous Lab Test

NOTE: Testing should be coordinated by the provider with the Health Department, especially since the guidelines are evolving. If a provider suspects a case of Zika virus and would like testing performed for Zika virus, please contact Diep (Zip) at Phone (608) 267-0249/ Fax (608) 261-4976 or [email protected]. Once Zip approves testing she will provide your laboratory with a form that must be completed and accompany the specimen.

Recommendations for Health Care Providers and Publi c Health Practitioners :

• Collect urine samples within 14 days post symptom onset along with patient-matched serum samples for those who match CDC Zika virus clinical and/or epidemiological testing criteria for Zika virus infection.

• Perform Zika virus rRT-PCR testing on urine, in conjunction with testing of serum using the appropriate molecular (up to about one week after symptoms) or serologic assay (after that – a second, “convalescent” sample may be appropriate after a few weeks to ensure that the first serologic test wasn’t too early), based on days post symptom onset.

Additional Considerations:

• Further investigation is needed to determine the sensitivity and utility of Zika virus rRT-PCR on urine specimens collected ≥14 days after onset of symptoms: limited data in pregnant women suggest that viremia in serum might be prolonged in pregnancy (4, 5).

For More Information:

• General information about Zika virus and disease: http://www.cdc.gov/zika/ • Zika virus information for clinicians: http://www.cdc.gov/zika/hc-providers/index.html • Memorandum – Revised diagnostic testing for Zika, chikungunya, and dengue viruses in US Public Health

Laboratories (not updated with urine guidance): http://www.cdc.gov/zika/state-labs/index.html • Diagnostic testing: http://www.cdc.gov/zika/hc-providers/diagnostic.html • Collection and submission of body fluids for Zika virus testing: http://www.cdc.gov/zika/hc-providers/body-

fluids-collection-submission.html

Zinc, Serum/Plasma

COMPUTER ORDER ENTRY LZINC


SPECIMEN REQUIREMENT Royal blue top (EDTA) or plain red top tube. SST tube is NOT ACCEPTABLE.

SPECIMEN MINIMUM VOLUME 0.6 mL of serum or plasma

STORAGE INSTRUCTIONS Separate serum from cells within 45 minutes of collection and transfer to a plastic transport tube. Plasma may be separated immediately and transferred to a plastic transport tube for shipment to the Laboratory. Maintain specimen at room temperature.


Alphabetical Listing of Cytology and Pathology Test s

Cytology, Cervicovaginal Pap Smear - ThinPrep®

SYNONYMS Pap Smear

AVAILABILITY Test performed Monday through Friday. Results available in 5 working days.

TEST INCLUDES Screening by licensed Cytotechnologist. If indicated, hierarchical review by a Pathologist. An additional charge is incurred for Pathologist review of abnormal paps. When appropriate, request HPV genotyping which will be performed at CLW.

SPECIAL INSTRUCTIONS Completed GYN Cytology requisition including pertinent clinical history, LMP, date of birth, collection date and Clinician. This information is required by Federal regulations. Medicare patients must sign the Advanced Beneficiary Notification. Avoid obtaining smears during menses. Do not use lubricants on the speculum unless absolutely necessary. Warm water may be used. If not otherwise avoidable, a small amount of K-Y® Jelly may be used, avoiding the speculum tip. Do not get lubricant on the cervix or other tissue that will be sampled. The preparation may become unsatisfactory in the presence of lubricant. NOTE: The pap test has an inherent false negative rate and is a screening test not intended for definitive diagnosis.

INTERFERENCES Patient should be counseled to avoid douching, vaginal medications, lubricants or menstruating, contraceptives, intercourse 48 hours prior to pap test. Such activities could disrupt fragile dysplastic cells and result in a false negative test.

SPECIMEN REQUIREMENT The requisition may be completed for ASCUS reflex HR-HPV testing, HR-HPV or HPV 16, 18/45, Chlamydia, Gonorrhea, and Trichomonas testing by selecting the appropriate box. ThinPrep® Pap test: label vial with patient's name and 8-digit date of birth. Obtain an adequate sampling from the cervix using either the broom or brush and spatula. The combination of spatula and brush are preferred. The Cytobrush® should not be used in pregnant patients or for endometrial sampling. Quickly rinse the brush in PreservCyt® solution. Tighten the cap so that the torque line on cap passes the torque line on the vial. See diagram on the following page.

STORAGE INSTRUCTIONS Room temperature, in fixative.

CAUSES FOR REJECTION Unlabeled, mislabeled, or leaking vial; mislabeled or incomplete requisition.

DEPARTMENT Cytology

ThinPrep ® Pap Test Quick Reference Guide Endocervical Brush/Spatula Pr otocol

Obtain... ...an adequate sampling from the ectocervix using a plastic spatula.

Rinse... ...the spatula as quickly as possible into the PreservCyt® Solution vial by swirling the spatula vigorously in the vial 10 times. Discard the spatula.

Obtain... ...an adequate sampling from the endocervix using an endocervical brush device. Insert the brush into the cervix until only the bottommost fibers are exposed. Slowly rotate 1/4 or 1/2 turn in one direction. DO NOT OVER-ROTATE.

Rinse... ...the brush as quickly as possible in the PreservCyt Solution by rotating the device in the solution 10 times while pushing against the PreservCyt vial wall. Swirl the brush vigorously to further release material. Discard the brush.

Tighten... ...the cap so that the torque line on the cap passes the torque line on the vial.

Record... ...the patient's name and ID number on the vial. …the patient information and medical history on the cytology requisition form.

Place... ...the vial and requisition in a specimen bag for transport to the laboratory.

www.cytyc.com

ThinPrep ® Pap Test Quick Reference Guide Broom-Like Device Protocol

Obtain... ...an adequate sampling from the cervix using a broom-like device. Insert the central bristles of the broom into the endocervical canal deep enough to allow the shorter bristles to fully contact the ectocervix. Push gently, and rotate the broom in a clockwise direction five times.

Rinse... ...the broom as quickly as possible into the PreservCyt® Solution vial by pushing the broom into the bottom of the vial 10 times, forcing the bristles apart. As a final step, swirl the broom vigorously to further release material. Discard the collection device.

Tighten... ...the cap so that the torque line on the cap passes the torque line on the vial.

Record... ...the patient's name and ID number on the vial. ...the patient information and medical history on the cytology requisition form.

Place... ...the vial and requisition in a specimen bag for transport to the laboratory.

www.cytyc.com

Cytology, Anal Rectal Cytology

AVAILABILITY Test performed Monday through Friday. Results available in 48 hours.

TEST INCLUDES Specimen processing, Pathologist interpretation.

SPECIAL INSTRUCTIONS Surgical Pathology/Medical Cytology requisition must be filled in completely. Check “Cytology box” and write “Anal Cytology”. In clinical history box provide pertinent information about the patient risk factors for anal squamous cell carcinoma and pap test history.

SPECIMEN REQUIREMENT Women: dorsal lithotomy. Men: lateral recumbent position. Do not use cotton swab or any type of wooden shaft.

1. Insert Dacron or rayon tipped flexible shaft (pre-moistened acceptable or endocervical brush may be used) 5-6cm into the rectum.

2. Use firm lateral pressure and slowly rotate the swab 360º against the wall of the ano-rectal transition zone.

3. With pressure, draw the device in a cone shaped arc. 4. Agitate device in the ThinPrep® PreservCyt® solution (ThinPrep® Pap

vial). 5. Discard collection device after transferring cells. 6. Securely recap the vial. 7. Properly label the vial with the patient’s full name and 8 digit date of

birth.


CAUSES FOR REJECTION Unlabeled, mislabeled, or broken slides; unlabeled, mislabeled, or incomplete requisition; unlabeled, mislabeled, or leaking vial; specimen received in wrong fixative.

DEPARTMENT Cytology

Cytology, Fine Needle Aspiration or Brushings

SYNONYMS FNA

AVAILABILITY Test performed Monday through Friday. Results for uncomplicated cases available in 48 hours.


SPECIAL INSTRUCTIONS Pathologists are available to perform or assist with the FNA. Please call 920-926-3895 to schedule an appointment. Complete the Surgical Pathology/Medical Cytology requisition and label slides (in pencil on frosted end of 2 glass slides) with patient name and 8-digit date of birth. Properly label the CytoLyt® fixative vial with specimen source, patient name and 8-digit date of birth.

SPECIMEN REQUIREMENT FNA: Gently express small drop of aspirated material on center of slide, quickly and gently spread drop with another slide. Immediately fix one slide with Cytospray or in 95% Reagent Alcohol. Allow other smear to air dry and label "A.D.” with a pencil. Express remaining material in 30 mL of CytoLyt® fixative. Brushings: Roll brush gently down the center of 2 slides; place one in 95% Reagent Alcohol or fix with Cytospray fixative. Leave other slide to air dry and label as "A.D." with a pencil. Forcibly roll brush along edges of CytoLyt® container 10 times to dislodge cells into CytoLyt® preservative. Discard brush. Tightly seal container.


CAUSES FOR REJECTION Unlabeled, mislabeled, or broken slides; unlabeled, mislabeled, or incomplete requisition; unlabeled, mislabeled, or leaking vial; specimen received in wrong fixative.

DEPARTMENT Cytology

Cytology, Fluid

SYNONYMS Fluid from any body site: pleural, pericardial, ascites, CSF, bladder washings, synovium, breast cysts, or bronchs.

AVAILABILITY Test performed Monday through Friday. Results for uncomplicated cases available in 48 hours.


SPECIAL INSTRUCTIONS Completed Surgical Pathology/Medical Cytology requisition, including pertinent clinical history. Label fluid container with specimen source, patient name and 8-digit date of birth. Specimens for noncytologic tests (i.e. Microbiology, Chemistry) should be submitted separately (unfixed) with appropriate requisition.

SPECIMEN REQUIREMENT Place 30 mL of fluid (or if smaller volume, all of specimen), in 30 mL of CytoLyt® fixative. Reserve remainder of fluid unfixed. Submit both fixed and unfixed fluid. Keep both specimens refrigerated. Additional, subsequent specimens from body cavities may have better cell preservation and therefore improved diagnostic utility. See specimen requirements of Cytology, urine.

NOTE: Specimens for Microbiology should be submitted unfixed. CSF Cytology can be performed on the first tube from a collection, and should be submitted unfixed immediately.

STORAGE INSTRUCTIONS Refrigerate (2-8°C), in fixative.

CAUSES FOR REJECTION Unlabeled or mislabeled specimen or requisition; specimen received in the wrong fixative or no fixative at all.

DEPARTMENT Cytology

Cytology, Nipple Discharge Smears


TEST INCLUDES Specimen preparation, Pathologist interpretation.

SPECIAL INSTRUCTIONS Completed Surgical Pathology/Medical Cytology requisition, including pertinent clinical history. Label frosted ends of slides with pencil. Indicate "right" or "left" as well as "air-dried" or "fixed", patient’s name and 8-digit date of birth. Label specimen container with patient’s full name, 8 digit date of birth and specimen source.

CAUTIONARY NOTE: Nipple Cytology has a low sensitivity and specificity for breast Pathology and should only be used in conjunction with breast examination, duct studies, and mammography.

SPECIMEN REQUIREMENT Smear specimen on a glass microscopic slide and fix immediately with Cytospray fixative or in 95% Reagent Alcohol. Place pencil-labeled slide in plastic slide holder or alternately express nipple secretions into PreservCyt® vial.


CAUSES FOR REJECTION Mislabeled, unlabeled or broken slides; mislabeled or incomplete requisition; mislabeled or unlabeled vial; specimen received in wrong fixative.

DEPARTMENT Cytology

Cytology, Sputum


TEST INCLUDES Specimen processing, Pathologist interpretation. Special stain for Pneumocystis carinii if requested (added charge).

SPECIAL INSTRUCTIONS Have patient rinse mouth several times with water. Patient must expectorate deeply. Induced sputums are of superior quality. Early morning sample preferred. Complete Surgical Pathology/Medical Cytology requisition. Indicate if presence of Pneumocystis is to be evaluated. Label specimen container with patient’s name, 8-digit date of birth and specimen source.

SPECIMEN REQUIREMENT Add sputum to 30 mL of CytoLyt® fixative. Gently mix.

NOTE: Specimens for Microbiology should be separately submitted with appropriate requisition.


CAUSES FOR REJECTION Specimen contaminated by saliva or foreign material, i.e. food particles, or not felt to be indicative of pulmonary origin; unlabeled or mislabeled specimen or requisition; improperly preserved specimen.

DEPARTMENT Cytology

Cytology, Urine



SPECIAL INSTRUCTIONS Completed Surgical Pathology/Medical Cytology requisition, including pertinent clinical history. Must include if specimen was voided or obtained with catheter. Specimens for noncytologic tests should be submitted separately with appropriate requisition. Label specimen cup with source, patient name and 8-digit date of birth.

SPECIMEN REQUIREMENT At least 20 mL of freshly voided urine (clean catch), not first morning specimen, or a 24 hour collection. Add to vial containing 30 mL of CytoLyt® fixative. Females should collect midstream portion of void.


CAUSES FOR REJECTION Unlabeled or mislabeled specimen or requisition; improperly preserved specimen.

DEPARTMENT Cytology

Dermatopathology

SYNONYMS See Surgical Pathology Specimens, Routine

SPECIAL INSTRUCTIONS Consultants Laboratory offers complete Dermatopathology services. Specimens are managed as routine Surgical Pathology cases. Clinical history and, if needed, proper orientation are especially vital in dermatologic cases.

DEPARTMENT Histology

Frozen Section / Intraoperative Gross Exam

SYNONYMS Intraoperative Examination

AVAILABILITY Test performed Monday through Friday, 8-5pm. Results available in 20 minutes. NOTE: After 5pm and weekends or holidays call ext. 5800 to page the Pathologist. Allow a 25 minute response time.

Ripon Medical Center: RMC Surgery Department will schedule the procedure and ensure that a pathologist will be on-site.

TEST INCLUDES Immediate assessment of tissues and verbal report to surgeon.

SPECIAL INSTRUCTIONS Call the following numbers: � 929-9300 ext. 3862. Alert Histology Department that a fresh specimen

is being sent, AND

� 801-4130, Surgical Pathology pager. (Enter the Surgery Room extension.) Tell them the name of the patient and the surgeon, patient diagnosis, and reason for intraoperative examination.

NOTE: Surgical cases that anticipate Frozen Sections should be noted in the surgical schedule. Call 929-9300 ext. 3862 to set up Frozen Sections on Outpatients. Ripon Medical Center: See Availability Section.

SPECIMEN REQUIREMENT Completed Surgical/Medical Cytology requisition and blue Frozen Section/Gross Assessment Form. Specimen must be fresh, may be moistened with sterile saline. Bone and some foreign materials cannot be processed as a frozen section. There should be a clear indication that an immediate diagnosis is necessary for patient management. If the Pathologist judges that the specimen will be compromised by the frozen section technique, one will not be performed.

CAUSES FOR REJECTION Mislabeled or unlabeled specimen or requisition; fixed specimen. See specimen requirements above.


HPV (Human Papillomavirus) 16, 18/45

COMPUTER ORDER ENTRY H1618

AVAILABILITY Test performed as needed.

TEST INCLUDES High risk HPV DNA; Types 16, 18/45.

SPECIMEN REQUIREMENT Cervical specimen collected using the ThinPrep® vial containing PreservCyt®. Solution. See Cytology, Cervicovaginal Pap Smear for complete collection instructions.

STORAGE INSTRUCTIONS Room temperature or refrigerated (2-8°C) You may request the test up to 30 days after collection on properly stored specimens.

CAUSES FOR REJECTION Unlabeled, mislabeled, or leaking vial.


HPV (Human Papillomavirus) mRNA Detection

COMPUTER ORDER ENTRY HPVH

SYNONYMS HPV High Risk Types

AVAILABILITY Test performed on Tuesdays and Fridays on AM shifts.

TEST INCLUDES High risk HPV DNA; Types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68. HPV Genotypes 16, 18/45 may be ordered separately when the HPV HR screen is positive.

SPECIMEN REQUIREMENT Cervical specimen collected using the ThinPrep® vial containing PreservCyt®. Solution. See Cytology, Cervicovaginal Pap Smear for complete collection instructions.

STORAGE INSTRUCTIONS Room temperature or refrigerated (2-8°C). You may request the test up to 30 days after collection on properly stored specimens.

CAUSES FOR REJECTION Unlabeled, mislabeled, or leaking vial.


Surgical Pathology Specimens

SYNONYMS Histology Specimen; Biopsy; Tissue specimen; Pathology

AVAILABILITY Test performed Monday through Friday. Results for uncomplicated cases available in two business days. Complicated specimens are generally completed within 3 to 5 business days.

SPECIAL INSTRUCTIONS Submit the specimen in an adequate amount of 10% formalin (20 times the volume of tissue). Tissue trap devices need to be opened and placed on formalin. Be certain the container lid is properly closed. Label the container with the patient’s identifying information and the type of specimen before the patient leaves the room. Remove the specimen with the requisition from the patient’s room before the next patient is taken into the room. Do not allow specimens to remain in surgery after hours.

Place in a biohazard bag, with the completed requisition and enumerated specimens in the side pocket. Small containers at the Agnesian Central Campus can be submitted via the tube system routed to Pathology or brought directly to the Laboratory. Specimen can be submitted via the tube system or brought directly to the Laboratory (Specimen Processing Department after hours or on weekends.) Most formalin fixed specimens at off sires are picked up by a routine courier unless other arrangements are made.

ALWAYS CALL ext. 3862 (days) or ext. 3881 WHEN SPEC IMENS ARE SUBMITTED FOR THE FOLLOWING:

Breast: � Record the time that the breast specimen was removed from the patient

and the rime that it was placed in formalin (less than one hour interval). � Core biopsies must be received in formalin on the day of the biopsy. � Breast excisions (non-mammoplasty) must be received in the Laboratory

as soon as possible after removal from the patient (ideally within one hour after obtaining the specimen).

� Excision and mastectomy specimens from sites other than St. Agnes Hospital should be transported in formalin STAT to the Central Laboratory as soon as they have been removed from the patient and imaged if indicated. Arrange for special courier transport to be available and waiting when the specimen is excised. These 10% formalin fixed specimens must be at the Central Laboratory within one hour of excision.

� Specimens with mammographic localizations should be accompanied by a copy of the specimen film, with the area of concern identified on the film and orienting marks on the specimen.

Bronchoscopy specimens: see also Cytology and Microbiology entries. Biopsies are fixed in formalin as usual.

Extremities/Amputations: Large amputations are transported double bagged, fresh in red biohazard bags.

Fresh tissue for Culture, Cytogenetics or Metals: � Call ext. 3862 or 3881 when sending at Central Laboratory � Submit with a requisition for the special studies if needed. � For culture, indicate routine, fungal TB, etc. � Transport STAT unless in media. � Frozen Sections: see separate entry.

Lymph nodes or other tissues submitted with lymphom a or other hematologic disorders suspected: Submit fresh, STAT. Remote sites should prearrange a STAT courier to be available for when the specimen is taken from the patient.

POC (special orders in addition to pathology: � Cytogenetics: Obtain a 1cc sample of muscle/fascia from the thigh and

from the placenta, including chorionic villi. Place each specimen in a screw-capped sterile container with sterile Hank’s Balanced Salt Solution. Transport STAT to the Central Laboratory.

� Culture: Sterilely dissect a 1cm portion of fetal membranes and cotyledons, Place in a sterile container and submit with orders for Microbiology. Transport STAT to the Central Laboratory.

� Liver biopsies (for elevated liver function): Core biopsies that are at least 18 gauge (at least 2 or 3 cores 1.5cm long) placed in 10% NBF.

SAH: In addition, the following specimens at St. Agnes Hospital should be sent fresh to the Laboratory (call when sending): � Cold conizations for cervical dysplasia/neoplasia � Uteri for carcinoma, hyperplasia or dysplasia � Large whole organs with central lumen/cavity such as colons, small

bowels, stomach, urinary bladder kidneys � Spleens (except for trauma), prostates, tested for tumor, ovary for

tumor or lungs should be placed in formalin and sent to the Central Laboratory STAT so that the specimen arrives within one hour of removal. Alert Histology (ext. 3862) to notify them when these specimens are coming.

Ambulatory Surgery, RMC, WMH: should open the tissue if appropriate and fix in 10% formalin prior to transport to the Central Laboratory for same day delivery. These weekend specimens should be: � Transported to the Central Laboratory the day of surgery. � Large whole organs with a central lumen/cavity such as colons, small

bowel, stomach, urinary bladder kidneys should be opened in surgery and then placed in formalin at WMH and RMC prior to transport.

� Spleens (except for trauma), prostates, testes for tumor, ovary for tumor or lungs should be placed in formalin and sent to the Central Laboratory STAT so that the specimen arrives within two hours of removal. Alert Histology (ext. 3862) to notify them when these specimens are coming.

� Unfixed, freshly transported specimens from sites other than SAH should always be preceded by a call to Pathology (ext. 3862) and received at the Central Laboratory within 30-60 minutes of removal from the patient. Small tissues should be kept moist by gently folding in a saline moistened Telfa (not gauze)

Contact the Histology Department or Surgical pathol ogist prior to

submission of the following tissues:

Abdominal fat aspirate for amyloid : Schedule through Pathology Transcription (ext. 3895) Bone marrow biopsies : Heme/Oncology schedules through Hematology (ext. 3889) Fine needle biopsies (FNA): Medical Imaging schedules Pathologist assistance (ext. 3895) for thyroid and imaging procedures. All other palpable lesions are scheduled through Pathology (ext. 3895). Muscle biopsies for neuromuscular disorders: Schedule several days in advance through Histology (ext. 3862). Ideally obtain the specimen in the morning Monday through Thursday. Contact the Laboratory (ext. 3862) prior to procedure for instructions regarding the biopsy technique,

Specimen requirement: 2-3 cylindars, each 0.4-0.5 cm in diameter and at least 1cm long. Submit to Laboratory STAT, wrapped in saline moistened gauze.

Renal biopsies: Schedule through Medical Imaging. Medical Imaging will coordinate with Pathology

If uncertain as to management or fixation of tissue call ext. 3862.

SPECIMEN REQUIREMENT Submit an appropriately completed Surgical Pathology requisition with pertinent clinical history. Absence of this history may delay reports and may make results less optimal for addressing clinical questions. All tissues removed from patients must be sent to pathology except those that have been specifically exempted by the medical staff of that hospital. Each hospitals medical staff determines these exceptions. See Special Surgical Pathology Specimens. Certain tissues acquired from hospital patients may be exempt from submission. Contact the appropriate medical staff body for that information.

STORAGE INSTRUCTIONS Room temperature and as above for special circumstances.

CAUSES FOR REJECTION Mislabeled or unlabeled specimen containers or requisitions; no formed elements (see Cytology entry)


Tzanck Prep

SYNONYMS Tzanck Smear; Herpes Smear


TEST INCLUDES Specimen processing, Hematology, and Pathologist interpretation.

SPECIAL INSTRUCTIONS Herpes culture and/or PCR testing should be used to supplement this test, especially in cases with high clinical suspicion and a negative Tzanck Test.

SPECIMEN REQUIREMENT Submit completed Laboratory requisition. Include all pertinent patient history. All slides and specimen containers must be labeled with patients full name and 8-digit DOB.

Specimen collected by clinician/submitting provider. Do not use a cotton-tipped swab for collection.

Oral lesion: Rinse patient’s mouth with water. Vigorously scrape lesion with a tongue depressor pre-moistened with saline. Immediately smear material on a pencil labeled slide and fix immediately with Cyto®spray.

Intact Vesicle (of skin): Clean surface with sterile saline. Aspirate material into a TB syringe. Unroof vesicle with the needle, roll material onto a pencil labeled slide. Fix immediately with Cyto®spray.

Non-intact Vesicle (of skin): Rub base and margins of lesion with a sterile saline-moistened swab. Gently roll onto a pencil labeled slide and fix immediately with Cyto®spray.

Other collection method: Samples can also be obtained from the lesion using an endocervical brush or plastic spatula by scraping the base of the ulcer or lesion in question. Rinse material in a Preserv®Cyt vial by vigorously swirling the utensil used.

NOTE: Microbiology cultures must be submitted separately and received unfixed in appropriate transport media.


CAUSES FOR REJECTION Unlabeled or mislabeled slides or specimen containers.

DEPARTMENT Cytology / Hematology

CLW Test or Phrase Abbreviation List The following lists indicate abbreviations that may be seen on Consultants Laboratory requisitions and/or patient reports. The corresponding expanded form of the test, phrase, or unit of measure follows the abbreviation. Note that reports from outside Reference Laboratories may include abbreviations not listed or similar abbreviations in a different context. Call our Customer Service Department for assistance in these situations.

Abbreviation ## = abnormal result flag, non-numeric % TRF SAT = percent transferring saturation Ab = antibody ABG = arterial blood gas Ach = acetylcholine ACT = activated clotting time ACTH = adrenocorticotropic hormone AFB = acid fast bacillus AFP = alpha-fetoprotein African Amer. = African American AFS = acid fast stain Ag = antigen AHG = antihuman globulin Alb/Glob = albumin/globulin ratio Alk Phos = alkaline phosphatase ALT (SGPT) = alanine aminotransferase a.m. = before noon Amphet semi-quant = amphetamine semi-quantitative Amp. Probe = amplified probe ANA = Antinuclear Antibody Antid = Antidepressants (e.g. Tricylcic antidepressant) AntiTPO (thyr.perox) = antothyroperoxidase AO = aorta ARC = American Red Cross Art = arterial AST (SGOT) = aspartate aminotransferase Auto = automated Ave = Average Band = band neutrophil Barb = barbituate Baso = basophil Basophil# = basophil absolute number BB = Blood Bank BE = base excess Benzo = benzodiazepine Bili = bilirubin Bilirubin D = bilirubin direct Bilirubin T = bilirubin total Bld = blood B-Natriuretic Pep (BNP) = brain-natriuretic peptide BUN = blood urea nitrogen C = critical result flag C. diff = Clostridium difficile C. diff Tox A and B = Clostridium difficile Toxin A and B CA 125 = Cancer Antigen 125 Ca, Ion (Adj) = calcium, ionized, adjusted for ph Ca, Ion (Unadj) = calcium, ionized unadjusted for pH (calc.) = calculated Cannab = cannabinoids Cath = catheterized CBC = complete blood count CEA = Carcinoembryonic Antigen

Chol = cholesterol Chol/HDL = cholesterol/high density lipoprotein ratio CK-MB = creatine kinase – MB fraction CLOtest® = Campylobacter-like Organism Test CMV = cytomegalovirus CO2 = carbon dioxide CPK (CK) = creatine phosphokinase Creat = creatinine CRP = C reactive protein CRYO = cryoprecipitate Crypto = cryptococcus CSA = cryptosporidium specific antigen CSF = cerebrospinal fluid DAT = DCT = direct antiglobulin test Deoxyhemogl (fHHB) = deoxyhemoglobin (fraction HHB) detec = detected DFS = direct fluorescent antibody DHEA-SO4 = dehydroepiandrosterone dulfate Dip = dipstick DK YEL = dark yellow DOB = Date of Birth EIA = enzyme immunoassay Eosin = eosinophil Eosin# = eosinophil absolute number Equiv. = equivocal ESR = erythrocyte sedimentation rate Est = estimated or estimate fact = factor FA = femoral artery Fact. = factor fCOHb = carboxyhemoglobin (Fraction COHb) FFP = Fresh Frozen Plasma fld = fluid FLU = influenza fO2Hb = oxyhemoglobin (Fraction Oxyhemoglobin) FSH = follicle stimulating hormone FyA = Duffy a antigen FyB = Duffy b antigen GC = gonorrheal cocci GC/MS = gas chromatography / mass spectrometry GFR = glomerular filtration rate GGTP = gamma glutamyl transpeptidase GSA = giardia specific antigen H = high result flag HBsAB (anti-HBs) = hepatitis B surface antibody HCG Quant = human chorionic gonadotropin hormone quantitative HCO3 (act) (calc) = bicarbonate (actual) (calculated) HCT = hematocrit HDL = high Density Lipoprotein Hep B Core Ab (IgM) = hepatitis B core antibody IgM = Anti-HBc (IgM) = HB Ab Hep B Surface Ag = hepatitis B surface antigen = HbsAg Hgb = hemoglobin HIV = human immunodeficiency virus HLA = human leukocyte antigen homogen = homogeneous hpf = high power field H. pylori = Helicobacter pylori hr = hour ID = identification IFA = indirect fluorescent antibody

IgE = immunoglobulin E IgG = immunoglobulin G IgM = immunoglobulin M immat = immature Imfix = immunofixation inconclus = inconclusive ind = indicated (e.g. IF ind = IF indicated) INR = International Normalized Ratio interpr = interpretation JkA = Kidd a antigen JkB = Kidd b andtigen KOH = potassium hydroxide L = low result flag Lab = Laboratory Lactofer = lactoferrin LCR = ligase chain reaction LDL = low density lipoprotein LDH = lactate dehydrogenase Legionella Ag UR = Legionella antigen urine lft = left LH = luteinizing hormone lpf = low power field LR = leukoreduced LV = left ventricle Lymph = lymphocyte Lymph# = lymphocyte absolute number M = message; subsequent letters appear after M9, alphabetically MCH = mean corpuscular hemoglobin MCHC = mean corpuscular hemoglobin concentration MCV = mean corpuscular volume Meta = metamyelocyte Methamphet Screen = Methamphetamine Screen Methemogl (fMetHb) = Methemoglobin (Fraction MetHb) MIC = minimal inhibitory concentration Micro = microscopic Microalb/Cre Ratio = microalbumin/creatinine ratio min = minute Mono = monocyte Mm/hr = millimeters per hour Mono# = monocyte absolute number Mono Test = mononucleosis test MPV = mean platelet volume MRA (MRN) = medical record number MRSA = Methicillin Resistant Staphylococcus aureus Myelo = myeloycte N = no NA/K ratio = sodium/potassium ratio Nasoph. Asp. = nasopharyngeal aspirate NEG = negative Neut = neutrophil NCEP = National Cholesterol Education Program Neut = neutrophil Neut# = neutrophil absolute number nonreact = nonreactive non-WHO = non World Health Organization O2 = Oxygen O2 Sat (calc.) = oxygen saturation, calculated OB = Obstetrics Occ = Occult PA = pulmonary artery

pacracen = paracentesis Path review = Pathologist review pCO2 = partial pressure carbon dioxide PCP = phencyclidine PCR = polymerase chain reaction pericard = pericardial PLT = platelet PLTS = platelets p.m. = after noon PMN = polymorphonuclear Pnl = panel pO2 = partial pressure of oxygen POC = Point of Care POC = parasites, ova, cysts POC = products of conception POS = positive Post Vas Sperm = post vasectomy sperm PP = post prandial PRBC = packed red blood cells preg = pregnancy presum pos = presumptive positive PRN = as needed prod = products Progran = progranulocyte Protein Elec Serum = Protein electrophoresis, serum PSA = prostate specific antigen Pt = patient PT = Prothrombin time PTH = parathyroid hormone PTT = APTT = partial thromboplastin time Qual (QL) = qualitative Quant = quantitative rand = random RBC = red blood count RDW = red cell distribution width Reduc Subst/Direct = reducing substances direct Reduc Subst/Hydrol = reducing substances hydrolyzed Retic, Auto = reticulocyte, automated Retic, Manual = reticulocyte, manual RF = rheumatoid factor Rh = Rhesus RHIG (Rhogam) = Rh immune globulin Rho(D) RPR = rapid plasma reagin RSV = respiratory syncytial virus Rt = right S = Ser = Serum Scrn = screen SDA = strand displacement amplification Sex Hormone Bind Glob = sex hormone binding globulin SGOT (AST) = Serum glutamic oxaloacetic transaminase SGPT (ALT) = Serum glutamic pyruvic transaminase sp = species SPE = serum protein electrophoresis Spec Grav = sp gr = s.g. = Specific gravity stl = stool Strep = Streptococcus susp = suspect T3 = triiodothyronine T4 = thyroxine TB = tuberculosis

tCO2 = total carbon dioxide temp = temperature THC = tetrahydrocannabinol (marijuana) Toxo Interpr = toxoplasmosis Interpretation TP / Creat Ratio = total protein / creatinine ratio Troponin-I, Interp = Troponin I, interpretation TSH = thyroid stimulating hormone U = UR = Ur = urine UA = Urinalysis UPE = urine protein electrophoresis Vas = vasectomy VCLA = VCP = variable content leukoreduced apheresis platelets V = ven = venous Vita = vitamin VLDL = very low density lipoprotein W = with WB = whole blood WBC = White Blood Count XM = Crossmatch Y = Yes

Consultants Laboratory Units of Measure List The following is a list of reporting units of measure for tests performed at Consultants Laboratory. Tests that Consultants Laboratory refers to outside Laboratories may have different reporting units. Call our Customer Service Department if there are questions in these situations.

Units of Measure

% = percent

% SAT = % Saturation

/100 WBC = per 100 white blood cells

10^3/uL = times 1000 per microliter

10^6/uL = times 1,000,000 per microliter

cells/hpf = cells per high power field

cfu/mL = colony forming units per milliliter

fL = femtoliter

g/dL = grams per deciliter

IU/mL = International Units per milliliter

m^2 = square meters

mEq/24 = milli equivalents per 24 hours

mEq/L = milli equivalents per liter

mg/24h = milligrams per 24 hours

mg/dL = milligrams per deciliter

mIU = milli International Units

mL = milliliter

mm/hr = millimeters per hour

mmHg = millimeters of Mercury

mmol/L = millimoles per liter

mOsm/kg = milli osmols per kilogram

ng/dL = nanograms per deciliter

ng/mL = nanograms per milliliter

nmol/L = nanomoles per liter

per hpf = per high power field

per lpf = per lower power field

pg = picograms

pg/mL = picograms per milliliter

sec = seconds

U/24hr = Units per 24 hours

U/L = Units per liter

ug/dL = micrograms per deciliter

ug/min = micrograms per minute

ulU/mL = micro International units per milliliter

uL = microliter

UmL = Units per millimeter

umol/L = micromoles per liter

Prioritization of Lab Tests (Hospital Locations) Life Threatening

• Used only in situations in which there is an immediate threat to the patient’s life or limb. • Applicable to Code Heart/Adult, Code Heart/Pediatric, Code Heart Newborn, Code Stroke, Code Critical,

Trauma Blue patient work and intraoperative or PAC emergencies. • Prioritized ahead of ALL other lab work, including STATs. • Tests available for order are STAT List Tests. (See page – I – .) • Order as STAT, then label the specimen as “Life Threatening”. • Results are called or transmitted immediately upon completion. • TAT for most analytes should be within 30 minutes (20 minutes for Code Strokes) or less from the order to

result, but in all cases should be as fast as humanly possible to give the patient the best chance for survival.

STAT

• Results available within one hour for uncomplicated specimens and/or draws. • TAT for St. Agnes Hospital ED stats are 45 minutes for the order to result (60 minutes for the Waupun and

Ripon Medical Center ED). • Only those tests on the STAT List (page A12) can be ordered this way. • Results are called or transmitted immediately upon completion.

Timed

• The timing of the phlebotomy is determined by clinical factors (e.g. antibiotic peak and trough levels). • Results available in 1-2 hours or after the next usual batch run. • Results are transmitted upon completion.

Routine (Today)

• Drawn after Life Threatening, STAT, or Timed orders; usually within 2 hours. • Specimens are analyzed with the routine workload and electronically transmitted to the ward as completed.

Routine (next day, early AM)

• Drawn with the next morning phlebotomy round starting at 0330 for ICU and as early as 0500 for St. Agnes Hospital and Waupun Memorial Hospital and 0530 at Ripon Medical Center.

• Results Agnes Hospital of routine Chemistry, Hematology, and Coagulation are electronically transmitted by 0600 to ICU, 0700 to surgical wards, and 0730 to other wards. Results of all work are transmitted electronically by 0700 for all wards at WMH and 0730 for all wards at RMC. All other samples drawn at that time are run routinely.

Prioritization of Lab Tests (Nursing Home / Assiste d Living Clients) Routine

• Drawn on next scheduled service day. • Orders must be set up in advance of service day. • Specimens are analyzed with the routine workload and results transmitted upon completion.

Timed • The timing of the phlebotomy is determined by clinical factors (e.g. antibiotic peak and trough levels; TDM

form is required). • Results transmitted upon completion.

STAT

• May only be ordered as STAT by the physician, not for the convenience of the facility. • Lab will respond within two hours of receiving the request. • Specimens are analyzed as priority.

Assisted Living Facilities are charged a service fee for all same day, STAT, weekend or holiday phlebotomy requests

CLW STAT Test List Revised: September 2016 The following Laboratory procedures are available form Consultants Laboratory on a STAT basis 24 hours a day, 7 days a week. Tests ordered STAT which are not on this list require app roval from a Pathologist at the time of order. Conta ct the Laboratory to clarify or pursue this approval if patient care mand ates otherwise. ABG (Arterial Blood Gases) Lactic Acid ABO Group and Rh (Type and Screen) LDH Acetaminophen Level Legionella Urinary Antigen – CL only Alcohol (ETOH) Lipase Ammonia Lithium Level – CL only Amylase Liver (hepatic) panel (or components) Beta HydroxyButyrate CL only Magnesium

Bicarbonate blood Malaria Smear (Preliminary report only) Bilirubin (Direct and/or Total) Metabolic Basic Panel (or individual component) B-Natriuretic Peptide (BNP) Metabolic Comprehensive Panel (or individual component) BUN Methemoglobin – CL only Calcium Monospot Calcium, Ionized – CL and RMC only Mycoplasma IgM – CL only Carbamazepine (Tegretol) Level – CL only Myoglobin – CL only Carbon Monoxide CL only NA (Sodium) CBC (or individual component) Occult Blood CBC & Auto Diff/Manual Diff (or individual component) Osmolality – CL only Cholesterol pH Clostridium difficile toxin A, B EIA – CL only Phenobarbital Level – CL only Cord Blood Gases Phosphorus Cord Blood Studies (ABO, Rh, DAT) Platelet Count Cortisol – CL only Pregnancy Tests CPK (CK) Prenatal Panel (see HBsAg & HIV-1 for special circumstances) CPK-MB (CKMB) Procalcitonin CL only Creatinine Protime (INR) Cross Match PTH, Intact – CL only CRP – CL only (including hs CRP) PTT Cryptococcus Ag – CL only Rapid Strep A CSF Glucose Reducing substances CL only CSF Protein Renal Function Panel D-Dimer Respiratory Syncytial Virus Ag – CL only Digoxin Level Reticulocyte count – CL only Dilantin (Phenytoin) Level – CL only Salicylate Level Direct Coombs test Specific Gravity Electrolytes (or individual component)(Na, K, Cl, CO2) Tegretol (Carbamazepine) Level – CL only ESR Theophylline – CL only Fetal Fibronectin – CL only Thyroxine (free) (T4) Fibrinogen – CL only Tobramycin Level – CL onl y Fluid Chemistries (TP, GLU, PH, TRIG) CL only Triglycerides Fluid Counts (RMC CSF only) Troponin – I Gentamicin Level – CL and RMC only TSH Glucose Type and Screen Gram Stain Uric Acid HCG-Quant. (not tumor) (AKA BHCG Quant) Urinalysis (and reflex micro) HBsAg – on OB who is about to deliver and has not had previous prenatal work. TAT should be < 8 hours- CL only

Urine Drug Screens

HIV-1 rapid (for significant exposure or OB who is about to deliver with no prenatal work.

Vaginal infection DNA probe – CL only

Influenza Panel Test, PCR (hospital inpatient and ED patients only) – CL only

Valproic Acid Level – CL and RMC only

Iron Vancomycin Level Joint Crystals – CL only Venous Blood Gases K (Potassium) WBC stool by Lactoferrin- CL only KOH – CL only Wet Prep

CL = Central Lab Fond du Lac, RMC = Ripon Medical C enter, WMH = Waupun Memorial Hospital

Blood Component Availability and Requirements

Red Cell Products: Tests required: Type & Screen (ABO, Rh, Ab Screen), Product Order. Indicate quantity.

Product Availability BB Armband STAT TAT once

Specimen Received in BB

Special Actions

Packed Red Cells

Routinely Stocked Required 45 min. unless antibodies present

Send copy of order to Blood Bank.

Red Cell Products with Special Requests

Product

Availability

BB Armband

STAT TAT once Specimen

Received in BB

Special Actions

Autologous Red Cells Special Order Required 45 min. unless antibodies present

Physician must order autol. draw prior to need (min. 1 week in advance).

Emergency Rele ase of uncrossmatched Red Cells

Routinely Stocked

Required (will release units prior to receipt of specimen if necessary)

5-10 min. Notify BB STAT and ask for uncrossmatched blood . Obtain banded specimen STAT.

Packed Red Cells – CMV Neg – Irradiated – CMV Neg, Irrad.

Special Order Required 3-4 hours unless antibodies present

Call Blood Bank. Send copy of order to Blood Bank.

Red Blood Cells – Washed



Red Blood Cells – Frozen/Banked

Special Order Required Variable Call Blood Bank. Send copy of order to Blood Bank.

Red Blood Cells – Whole Blood



Platelet Products

Test Required Availability Special Circumstances BB Armband ABO, Rh

We stock 2 A pheresed units. Type specific platelets will be ordered as needed (2-3 hours)

Call Blood Bank.

Blood Component Availability and Requirements (cont .)

Fresh Frozen Plasma (FFP) , (FP24) and Cryoprecipitate (CRY)

Test Required Availability Special Circumstances BB Armband ABO Routinely stocked. Please allow

20 to 30 minutes after ABO type is determined for thawing.

Required. Call Blood Bank.

FFP Emergency Release – Ask for Emergency release Type AB, issued within 25 minutes

Rhogam

Test Required Availability Special Circumstances BB Armband Rh, Antibody Screen. If 26 weeks or more, test for Fetal Maternal Hemorrhage.

Obtain from Pharmacy Not required.

STOOL COLLECTION CONTAINERS

PLEASE POST AND KEEP AS REFERENCE

Fill ONLY to the line indicated;

Do not overfill or underfill

The following test(s) MUST be collected in this Cary Blair (GREEN CAP) container:

CULTURE W/SHIGA TOXIN 1 & 2 (STOOL CULTURE) [CXST1] � Room temperature up to 24 hours; refrigerate up to 2 days (preferred)

CRYPTOSPORIDIUM SPECIFIC ANTIGEN [CSA] � NOTE: Para-Pak (gray & pink cap) also acceptable � Refrigerate up to 2 weeks

GIARDIA SPECIFIC ANTIGEN [GSA] � NOTE: Para-Pak (gray & pink cap) also acceptable � Refrigerate up to 2 weeks

Fill ONLY to the lines indicated;

Do not overfill or underfill

The following test(s) MUST be collected in these two Para-Pak (GRAY &PINK CAPS) containers:

OVA & PARASITES [LOPEX] � Room temperature up to expiration date on vial

CRYPTOSPORIDIUM SPECIFIC ANTIGEN [CSA] � NOTE: Cary Blair (green cap) also acceptable � Refrigerate up to 2 weeks

GIARDIA SPECIFIC ANTIGEN [GSA] � NOTE: Cary Blair (green cap) also acceptable � Refrigerate up to 2 weeks

Minimum of 2 teaspoons needed

The following test(s) MUST be collected in a sterile container (WHITE CAP) without preservative:

CLOSTRIDIUM DIFFICILE BY PCR [CDIFF] � Room temperature up to 24 hours; refrigerate up to 5 days

ROTAVIRUS ANTIGEN [ROTA] � Refrigerate up to 3 days

WBC,LACTOFERRIN (LEUKOCYTES) [WBCST] � Room temperature or refrigerate up to 2 weeks

H. PYLORI ANTIGEN [HPSA] � Refrigerate up to 3 days

NOROVIRUS [LNORW] � Refrigerate or freeze up to 7 days

FECAL FAT [LFAT (qualitative), LFFAT (quantitative)] � Refrigerate up to 14 days

OSMOLALITY [OSMFE] – liquid specimen only � Refrigerate up to 24 hours

PH [STLPH] � Refrigerate up to 24 hours

The following test MUST be collected as per the instructions in the FOBT mailer:

FECAL OCCULT BLOOD TEST [FITSC (screen)] [FITDI (diagnostic)] � Room temperature up to 15 days; refrigerate up to 30 days

Microbiology Cultures – Containers and Transport NOTE: White cap = single swab; Red cap = double swab; Green cap = wire mini-tip swab

Refer all questions to Microbiology (920) 929-9300 ext. 3879

AFB Cultures

Container / Specimen Type How to Transport

Sterile, leak proof container Refrigerate (2-8°C). Transport within 1 hour (ideally) of collection, otherwise within 24 hours.

Blood Cultures

Container / Specimen Type How to Transport BacT/ALERT® bottles: Green top bottle and orange top bottle: 5-10 mL Yellow top bottle: 2-4 mL

Must be in Lab within 6 hours of collection. Keep at room temperature.

Vascular Cath Tip, Picc Tip


Sterile leak proof container Room temperature; send to Lab IMMEDIATELY.

Fluids / Tissues

Container / Specimen Type How to Transport Syringe (without needle) Sterile leak proof container Sterile red top tube (no additive) White cap, red cap, blue cap (last resort) swabs

Room temperature up to 24 hours.

CSF – sterile screw capped tube Tissue − sterile leak proof container

Room temperature; send to Lab IMMEDIATELY.

Full Throat and Strep Only Cultures; Rapid Strep A Antigen

Container / Specimen Type How to Transport Red cap swab Room temperature up to 24 hours.

Fungus Culture / Fungal Smear (KOH)

Container / Specimen Type How to Transport Sterile leak proof container (hair, nails, skin scrapings) Clean envelope (fingernails, toenails) White cap swab Red cap swab Syringe (without needle) CSF tube Isolator™ tube

Room temperature up to 24 hours. Refrigerate sputum.

Microbiology Cultures – Containers and Transport (c ont.) NOTE: White cap = single swab; Red cap = double swab; Green cap = wire mini-tip swab


General Swabs – Wounds, Abscess, etc.

Container / Specimen Type How to Transport White cap swab (aerobic only) Red cap swab (aerobic only) Blue cap swab (anaerobic)

Room temperature up to 24 hours.

Influenza Panel Test, PCR


Viral Transport Media Universal Viral Transport media (red)

Room temperature up to ½ hour; refrigerate (2-8°C) up to 3 days

Respiratory Virus Panel or RSV Amplified Probe, Nasopharynx

Container / Specimen Type How to Transport BD™ Universal Viral Transport Media (red) Wet ice or refrigerate (2-8ºC) up to 72

hours

Nasopharyngeal, Ear, and Eye Cultures

Container / Specimen Type How to Transport Green cap swab White cap swab Red cap swab

Room temperature up to 24 hours

Ova, Parasites, Cysts

Container / Specimen Type How to Transport Para Pak (gray and pink vials) Room temperature

Pinworm Examination

Container / Specimen Type How to Transport Pinworm SWUBE™ Paddle (NOT TAPE) Room temperature up to 24 hours.

Sputum, Broncho Washings, Tracheal Aspirate

Container / Specimen Type How to Transport Sterile leak proof container Room temperature if sent to Lab within 2

hours; after 2 hours, refrigerate (2-8°C) up to 24 hours. Sputum (first morning sputum best)

Microbiology Cultures – Containers and Transport (c ont.) NOTE: White cap = single swab; Red cap = double swab; Green cap = wire mini-tip swab


Urines


Sterile leak proof container Refrigerate (2-8°C); must be in Lab within 24 hours. Urine specimens CANNOT be at room temperature longer than 30 minutes.

Vaginal, Cervix, Uterus, Wet P rep, KOH

Container / Specimen Type How to Transport White cap swab Red cap swab Female urogenital cultures (NOT wet prep/KOH) – black cap Male urethral cultures (NOT wet prep/KOH) – orange cap

Room temperature up to 24 hours; DO NOT refrigerate or freeze.

Vaginal - APTIMA Vaginal Swab Collection kit or ThinPrep® Liquid Cytology Collection kit Male Urethral - APTIMA Unisex Swab Collection kit Cervical or endocervical - ThinPrep® Liquid Cytology Collection kit

APTIMA® swab: room temperature (2-30°C) up to 60 days. Urine: room temperature (2-30°C) up to 24 hours; ThinPrep® Liquid Cytology container: 2-30°C up to 30 days (Cannot be added if the vial has been used to prepare a Pap Smear)

Purple cap UTM Transport - Herpes culture (sent to Reference Laboratory)

Refrigerate (2-8°C). Specimen must be received at Reference Lab within 72 hours.

Affirm VPIII, Ambient Temperature Transport System − Vaginal Infection, DNA Probe

Room temperature or refrigerate (2-8°C) up to 72 hours

Microbiology Antibiograms

CLW Specimen Collection Chart

Description Picture / Cap Color Use Storage / Stability

(after collection)

Culture I Single Swab

White cap

� Aerobic culture � Wet Prep


Anaerobe Clear Gel

Blue cap

� Anaerobic culture � DO NOT use for rapid

tests


Culture II

Double Swab

Red cap

� Rapid Strep, throat � Aerobic culture � Wet prep


Aluminum wire

Minitip Green cap

� Nasopharyngeal (NP) Pertussis PCR

� Ear culture � Eye culture � General culture use


BD™ Universal Viral

Transport Medium for

Viruses, Chlamydia,

Mycoplasmas and

Ureoplasmas and

Nasopharyngeal (NP) Swab

Red Cap

� Influenza Panel Test, PCR (Influenza A&B, 2009 H1N1)

� RSV, Amplified Probe (RSV A&B)

� Respiratory Virus Panel, Multiplex (Influenza A&B, H1N1subtypes, RSV A&B)

Wet ice or refrigerate (2-8ºC) up to 72 hours

Female

Urogenital Black cap

� Genital culture (female) � NOT for Wet Prep


Male

Urethral

Orange cap

� Genital culture (male) � Pertussis culture or PCR


APTIMA® vaginal swab

device

� GC (Gonorrhea) - FEMALE

� Chlamydia – FEMALE � Trichomonas - FEMALE

Room temperature up to 60 days

APTIMA® Unisex swab kit

USE BLUE SWAB ONLY

� GC (Gonorrhea) - MALE � Chlamydia – MALE

[Call FDL Processing

Department for swabs]

Room temperature up to 60 days


(after collection)

Herpes Copan UTM-RT

(Universal Transport Medium)

Purple cap

� Herpes Refrigerate (2-8°C). Must be received at Reference Lab within 72 hours.

Copan Swab

Red cap

� MRSA, Amplified Probe (Genexpert® System)

Room temperature up to 24 hours Refrigerate (2-8°C) up to 5 days

Pertussis

� Pertussis (LabCorp)

Room temperature up to 5 days Refrigerate (2-8°C) up to 1 week

Specimen cups, Sterile

(Orange or White cap)

� Urine specimens � Other specimens that

must be placed in a sterile container

Urines : refrigerate (2-8°C) up to 24 hours. Specimen cannot be at room temperature Other sources : See Alphabetical Listing of Tests for storage specific to the source

Empty vial for Stool

STOOL for: � Clostridium difficile by

PCR � Rotavirus Antigen � WBC, Lactoferrin

(leukocytes) � H. pylori Antigen � Norovirus � Fecal Fat � Osomality - liquid

specimen only � pH

NOTE: See the Stool Collection Chart on page 170 for stabilities


(after collection)

Para Pak Ova & Parasite

Kit

NOTE: Fill only to the

line indicated on the vials

Grey and Pink Caps

� Stool identification of ova & parasites (O&P) and cysts

� Stool for GSA (Giardia Specific Antigen)

� Stool for CSA (Cryptosporid-ium Specific Antigen)

Ova, Parasites, Cysts: room temperature or refrigerate until expiration date on vial GSA or CSA: room temperature or refrigerate (2-8°C) up to 2 months

Cary Blair Stool Culture

Vial

NOTE: Fill only to the line indicated on the vial

Green Cap

� Stool for enteric pathogens culture

� Stool for GSA (Giardia Specific Antigen)

� Stool for CSA (Cryptosporidium Specific Antigen)

Culture: room temperature up to 24 hours; refrigerate (2-8°C) up to 2 days GSA or CSA: refrigerate (2-8°C) up to 2 weeks; freeze for up to 2 months

BD Affirm VPIII

� Vaginal infection by DNA probe. Tests for Trichomonas vaginalis, Candida species and Gardnerella vaginalis

Room temperature or refrigerate (2-8°C) up to 72 hours

Occult Blood

Fecal Immuno-chemical Test

(FIT)

� Stool for Occult Blood

Room temperature up to 15 days Refrigerate (2-8ºC) up to 30 days


(after collection)

ThinPrep®

� Cervico- vaginal Pap Smear � GC, Chlamydia, or

Trichomonas by PCR � HPV, GT 16, 18/45

Room temperature 20 mL PreservCyt® solution. CAUTION: Solution is poisonous and flammable.

CytoLyt® fixative in specimen cup (White cap)

� Transport of specimens for Cytology studies

Room temperature 30 mL Cytolyt® solution. CAUTION: Solution is poisonous and flammable.

Transport tube and pipette

� Specimen processing and transport

Cleansing Towelettes

� For use with clean catch urine collections

Kidney Stone Collection Kit

� Kidney stone collection and filtering

� Dispense with Patient Brochure CLW 789)

Room temperature

Description Picture / Cap Color Features Application / Handling

BD Vacutainer®

1.8 mL

Clear Blue

3.2 % Sodium citrate

(plastic)

Do not overfill or underfill. Gently invert tube 3-4 times to mix.

BD Vacutainer®

2.7 mL

Light Blue

3.2 % Sodium citrate

(plastic)

Do not overfill or underfill. Gently invert tube 3-4 times to mix.

PLAIN GREEN BD Vacutainer®

4.0 mL

Green

Lithium heparin,

75 USP Units (plastic, non-gel)

Gently invert tube 8-10 times to mix. For plasma, centrifuge promptly for 10 minutes and transfer plasma to a transport tube labeled “Plasma”. For WHOLE BLOOD SPECIMENS, do not centrifuge; send tube unopened.

BD Vacutainer® 2.0 mL

Gray

Sodium fluoride

Potassium oxalate 5mg / 4 mg

(plastic)

Gently invert tube 8-10 times to mix. For PLAMA: centrifuge promptly for 10 minutes and transfer plasma to a transport tube labeled “Plasma”. For WHOLE BLOOD SPECIMENS: do not centrifuge; send tube unopened. Tube may be used for Lactic Acid and Glucose assays.


Lavender

K2 EDTA

5.4mg (plastic)

Gently invert tube 8-10 times to mix. For plasma, centrifuge promptly for 10 minutes and transfer plasma to a transport tube labeled “Plasma”. For WHOLE BLOOD SPECIMENS, do not centrifuge; send tube unopened.

PLAIN RED BD Vacutainer®

7.0 mL

Red

Clot activator (plastic)

Allow blood to clot in an upright position for 30 minutes. “Centrifuge for 10 minutes within 1 hour of collection. If applicable, transfer serum to a labeled plastic transport tube. DO NOT SEPARATE BLOOD BANK SPECIMENS.

eXcyte® ESR Vacuum Tube

Black

0.13 M Sodium

Citrate (glass)

Gently invert tube 15 times to mix. Blood level must be between 2 fill lines on tube. Note: Outreach clients should not use this tube due to limited stability.

PST

Greiner Bio-One Vacuette®

5mL

Green w/ Yellow ring

Lithium heparin (plastic gel)

Gently invert tube 8-10 times to mix. Centrifuge promptly for 10 minutes and transfer plasma, if needed, or preferably send in original tube.

PST


Light green w/

Gray center

Lithium heparin and gel for plasma

separation

Gently invert tube 8-10 times to mix. Centrifuge promptly for 10 minutes and transfer plasma, if needed, or preferably send in original tube.

Description Picture / Cap Color Features Application / Handling

SST

Greiner Bio-One

Vacuette® 5mL

Red w/ Yellow ring

Silicone

serum separator/ clot activator

(plastic)

Gently invert tube 5 times to mix. Allow to clot for 30 minutes. Centrifuge promptly for 10 minutes and transfer plasma, if needed, or preferably send in original tube.

SST

BD Vacutainter® 5mL

Yellow w/ Red ring

Clot activator and gel for serum separation

Gently invert tube 5 times to mix. Allow to clot for 30 minutes. Centrifuge promptly for 10 minutes and transfer serum, if needed, or preferably send in original tube.

QuantiFERON® TB Gold

Gray w/ white ring Red w/ white ring

Purple w/ white ring (GRaPe)

Set of three tubes (kit)

Lithium heparin

TB antigens

Neg Nil Pos Mitogen

FOR TB GOLD (QUANTIFERON)

TEST ONLY Follow instructions as listed in the Alphabetical Listing of Tests. Shake vigorously for 5 seconds.

BD™ microtainer lavender

K2 EDTA

Fill tube between fill marks. Over or under filling of tube may result in clotting and/or erroneous test results. Gently invert tube 8-10 times to mix.

BD™ Microtainer mint green

Lithium heparin and gel for

plasma separation

Fill tube between fill marks. Over or under filling of tube may result in clotting and/or erroneous test results. Gently invert tube 8-10 times to mix. Centrifuge promptly for 10 minutes and transfer plasma, if needed, or preferably send in original tube.

BD™ Microtainer gold

Clot activator and gel for

serum separation

Gently invert 8-10 times to mix. Allow blood to clot for 30 minutes. Centrifuge for 10 minutes and transfer serum, if needed, or preferably send in original tube.

Documents

Directory of Services Reference Book - Agnesian HealthCare