ONLINE TEST GUIDE: CONTACT US: http://byblos.labmed.washington.edu/bcard/search.asp TEL: FEE SCHEDULE: EMAIL: Call Reference Lab Services at 1-800-713-5198 WEB: 1-800-713-5198 December 2010 commserv@u.washington.edu www.depts.washington.edu/labweb VIROLOGY NEWSLETTER: www.depts.washington.edu/rspvirus NON-PROFIT ORG. U.S. POSTAGE PA I D SEATTLE, WA PERMIT NO. 62 Reference Lab Services University of Washington PO Box 15290 Seattle, WA 98115-0246 U N I V E R S I T Y O F WA S H I N G T O N ADDRESS SERVICE REQUESTED December 2010 TEST CHANGE Alpha 1 Antitrypsin, Stool Sample Amylase Reflexive Testing BCR/ABL, p210 Quantitative New Bone Marrow, Wright’s Stain Collection Fructosamine Tube Type Glucose Testing Collection Heavy Metal Screening CPT Codes AMYLASE Hemoglobin, Plasma Tube Type Note: Herpes Simplex Typing CPT Codes, Reporting IL28 Genotype HCV IFN Response New Influenza PCR Panel, Epidemic Sample Levetiracetam Reference Range Manganese Reference Range Parvovirus B19 by PCR, Quantitative Units Troponin Reference Range Tryptase Reference Range NOTE: NO COURIER SERVICE There will be no courier service and our Call Center office will be closed on Christmas Eve day (Friday, December 24th) and New Year’s Eve day (Friday, December 31st). ALPHA 1 ANTITRYPSIN, STOOL Specimen Collection: Random fecal specimens only. Test Order Code: RSA1A Note: For 24 hour samples, please order the Alpha 1 Antitrypsin Clearance, Feces & Serum If the total amylase activity is > 100 U/L, a reflexive fractionation by Immunoinhibition is performed which reports both pancreatic and salivary amylase activities. BCR/ABL, P210 QUANTITATIVE New Method for Quantitative BCR/ABL Testing for CML Patients with b3:a2 or b2:a2 Fusion Genes (p210 Fusion Protein) On December 1, 2010, the Molecular Hematopathology Laboratory will be changing the methodology for our test for monitoring patients who are being treated for chronic myeloid leukemia (CML) and are known to have the b3:a2 or b2:a2 fusion gene producing the p210 fusion protein. Our new method is a BCR-ABL real-time RT-PCR assay performed on the Cepheid GeneXpert Diagnostic system. This methodology will allow us to provide faster turn around times and a greater than one log increased sensitivity over our previous method. The presence or absence of BCR-ABL mRNA will be reported. If the result is positive, the level of BCR-ABL mRNA is reported as a ratio of BCR-ABL to total ABL expressed as a percentage. We will issue a cumulative report including historical data for the patient. Blood is the preferred specimen for this assay. While most patients show similar BCR-ABL levels in concurrent blood and bone marrow specimens, some patients have consistent differences in levels between blood and bonwe marrow. Therefore, alternating specimen types during monitoring can be misleading. Of note, this test will detect only the b3:a2 and b2:a2 fusion genes, which encode the p210 protein. Other fusion forms are not detected, including the e1:a2, which encodes the p190 fusion protein associated with Philadelphia chromosome-positive acute lymphoblastic leukemia. We will continue to offer our previous quantitative methodology for patients known to have the e1:a2 fusion gene. This test is not designed as a screening method for BCR-ABL fusion genes at the time of diagnosis. Our qualitative BCR-ABL assay is more appropriate for that purpose since it detects and can distinguish the fusion genes encoding either the p210 or p190 protein. References: Hughes, Timothy, et al. Monitoring CML patients responding to treatment with tyrosine kinase inhibitors: review and recommendations for harmonizing current methodology for detecting BCR-ABL transcripts and kinase domain mutations for expressing results, Blood, 1 July 2006, Vol. 108, No. 1, pp. 28 - 37. Branford, Susan, et al. Desirable performance characteristics for BCR-ABL measurement on an international reporting scale to allow consistent interpretation of individual patient response and comparison of response rate between clinical trials, Blood, 15 October 2008, Vol. 112, No. 8, pp. 3330 – 3338. Radich, Jerald P. How I monitor residual disease in chronic myeloid leukemia, Blood, 15 October 2009, Vol. 114, No. 16, pp. 3376 - 3381. 2 UW Laboratory Medicine December 2010 Specimen Collection: 10 mL blood in Lavender Top (EDTA) tubes or 1 - 2 mL Bone Marrow (EDTA). Unacceptable: Specimens in green top tubes (heparin) or specimens anticoagulated with heparin. Specimen must be labeled with two identifiers (i.e. name, date of birth, or patient ID number.) GLUCOSE TESTING INFLUENZA PCR PANEL, EPIDEMIC Glucose: Plasma or serum collected in green, gold or red top tubes should be separated from the cells within 2 h and stored refrigerated. Glucose in such specimens is stable up to 16 h after collection. Glucose specimens collected in gray top tubes are stable up to 24 h without separation or refrigeration. Collection: Nasal swab, nasal wash, BAL or Tracheal aspirate (ETT) are acceptable samples. Please refrigerate specimens. Samples other than NP swab, nasal wash, BAL or Tracheal aspirate must be approved by the Lab Medicine resident. (206) 598-6190. Test Order Code: GLU Test Order Code: FLUPCR Glucose, Fasting: Plasma or serum collected in green, gold or red top tubes for fasting glucose should be separated from the cells within 1 h and stored refrigerated. Glucose in such specimens is stable up to 16 h after collection. Glucose specimens collected in gray top tubes are stable up to 24 h without separation or refrigeration. Please include the most recent white blood cell count. Specimen Transport: Entire sample, refrigerated (do not freeze). Send specimen in a labeled, leak-proof tube. Wrap the tube in absorbent material and place in a crush proof container. Complete and send a Hematopathology requisition in a separate plastic bag in the shipping container. Specimens should be received within 24 hours of collection. We strongly recommend against sending specimens that will arrive Friday afternoons. Ship to: Hematopathology Laboratory, Room G7-800 SCCA Building 825 Eastlake Ave. E Seattle, WA 98109 Test Order Code: CPT codes: 83891, 83902, 83900, 83901, 83896 x2, 83912 – CPHDQ New CPT Code: 83015 83902, 83900, 83901, 83896 x2, 83912 – CPHDQA Old CPT Codes: 82300, 83018x2, 83655 Price: $453.00 – CPHDQ $391.00 – CPHDQA Test Order Codes: CPHDQ, CPHDQA (add on testing) BONE MARROW, WRIGHT’S STAIN Collection: Test order Code: Bone Marrows must be scheduled with Hematology laboratory by calling 206-598-6229 (UW) or 206-744-3128 (HMC). Please call for all Marrows, including procedures where assistance is not needed. BMWROS FRUCTOSAMINE Specimen Collection: We will only accept serum (red top or SST) for this test as of 12/1/2010. We can no longer process green top tubes. Test Order Code: RFRUCT LEVETIRACETAM Reference Range: 12.0-46.0 mcg/mL (trough concentration) Test Order Code: RLEVET MANGANESE Reference Range: 0-15 years: NEST (Not Established) >15 years: 0.6 - 2.3 ng/mL Plasma or serum should be separated from the cells within 2 h and stored refrigerated. For storage stability, see individual analytes. Gray top tubes are unacceptable. Test Order Code: RMANG BMP, COMP, COMPHF Reference Range: Units will now be reported as IU/mL. Previous units were “copies per mL” Test Order Code: B19PCQ Test Order Code: GLUF Glucose, Panel HEAVY METAL SCREENING PARVOVIRUS B19 BY PCR, QUANTITATIVE TROPONIN Reference Range: HEMOGLOBIN, PLASMA > 0.4 ng/mL indicates likely myocardial infarction. Specimen Collection: Preferred: 3 mL of blood in a lavender top tube. TRYPTASE Acceptable:3 mL blood in a blue top (citrate) tube. Reference Range: <11.5 ng/mL for both sexes. Test Order Code: PLHB Test Order Code: RTRYPT Note: This test is designated by the performing laboratory as being for investigational use only. Results should not be used for diagnosis without confirmation of the diagnosis by another medically established diagnostic product or procedure. HERPES SIMPLEX TYPING Reference Range: We will now report HSV-1 and HSV-2 as separate results with an interpretive report. CPT Codes: 87529 x 2 Test Order Code: HSVTYP IL28 GENOTYPE HCV IFN RESPONSE Specimen Collection: 5 mL blood in Lavender top tube. Unacceptable: Green Top tubes Specimen Transport: 5 mL whole blood (min. 1 mL); room temperature. The laboratory must receive the sample within 48 hours of draw. Frequency: Once a week. Test Order Code: IL28 CPT Codes: 83891, 83898 x2, 83912 Price: $493.00 3 ONLINE TEST GUIDE: CONTACT US: http://byblos.labmed.washington.edu/bcard/search.asp TEL: FEE SCHEDULE: EMAIL: Call Reference Lab Services at 1-800-713-5198 WEB: 1-800-713-5198 December 2010 commserv@u.washington.edu www.depts.washington.edu/labweb VIROLOGY NEWSLETTER: www.depts.washington.edu/rspvirus NON-PROFIT ORG. U.S. POSTAGE PA I D SEATTLE, WA PERMIT NO. 62 Reference Lab Services University of Washington PO Box 15290 Seattle, WA 98115-0246 U N I V E R S I T Y O F WA S H I N G T O N ADDRESS SERVICE REQUESTED December 2010 TEST CHANGE Alpha 1 Antitrypsin, Stool Sample Amylase Reflexive Testing BCR/ABL, p210 Quantitative New Bone Marrow, Wright’s Stain Collection Fructosamine Tube Type Glucose Testing Collection Heavy Metal Screening CPT Codes AMYLASE Hemoglobin, Plasma Tube Type Note: Herpes Simplex Typing CPT Codes, Reporting IL28 Genotype HCV IFN Response New Influenza PCR Panel, Epidemic Sample Levetiracetam Reference Range Manganese Reference Range Parvovirus B19 by PCR, Quantitative Units Troponin Reference Range Tryptase Reference Range NOTE: NO COURIER SERVICE There will be no courier service and our Call Center office will be closed on Christmas Eve day (Friday, December 24th) and New Year’s Eve day (Friday, December 31st). ALPHA 1 ANTITRYPSIN, STOOL Specimen Collection: Random fecal specimens only. Test Order Code: RSA1A Note: For 24 hour samples, please order the Alpha 1 Antitrypsin Clearance, Feces & Serum If the total amylase activity is > 100 U/L, a reflexive fractionation by Immunoinhibition is performed which reports both pancreatic and salivary amylase activities.