OUR NEW VICE PRESIDENT OF MEDICAL AFFAIRS

MDS Metro is pleased to welcome Dr. Deborah Griswold to the position of Vice President Medical Affairs. Debbie is a well known and highly respected Hematopathologist with extensive administrative experience in both hospital and private laboratories. She will be primarily responsible for MDS Metro’s external focus. We welcome her on board.

TRICHOMONAS TESTING CORRECTION

A "bug" got into last month’s message about Trichomonas testing so we will try again. Although Trichomonas may be identified by direct microscopy, culture is performed on all specimens with a specific request for Trichomonas as this is the most sensitive method for detection. Please specify "Trichomonas" on the requisition if you wish Trichomonas testing to be done. When investigation for "Trichomonas" is required as well as routine vaginal culture, it is preferable to submit two separate swabs to increase the chance of recovery of the organism.

REQUESTS FOR STATS

We receive many requests for "stat" tests each day. Some of these requests cause difficulties for us in providing timely reports to physicians. We hope that the following will help you and us in dealing with these requests appropriately.

Definition of a "Stat"

MDS Metro defines a "stat" test as one which we will make every effort to complete within four hours of sample collection. We do, of course, expect that such requests will be medically necessary. Faster turnaround times may be possible but cannot be guaranteed. Clearly, a very urgent clinical situation will best be met by a visit to a hospital emergency department.

Reporting "Stats"

We will report stat requests by telephone or fax as requested by the doctor, and will follow up with a printed report in the usual manner. Many problems arise because doctors’ offices are closed by the time the result can possibly be available; e.g. a patient comes to a PSC at 2:00 p.m. with a stat request and the result becomes available at 5:30 p.m. when the doctors’ office is closed. Unless an after-hours telephone number is provided for communicating the result to you or your designate, our staff are left with a dilemma as to what to do. Our policy is that in such a situation if there are two failed attempts to contact the physician or designate, the results will be left for reporting until the next working day, unless the result is within the "critical" range for that test. If the result is critical, our laboratory physician on-call will be contacted and will deal with the problem as appropriate.

When you request a Stat test, we therefore ask the following of you:

1. Please provide an after-hours telephone number on the requisition so that you can be reached with a result even if your office is closed.
   
2. Please urge your patient to come to the collection site as soon as possible after seeing you. (Patients may see their doctor in the morning and visit the lab in the afternoon.)
   
   Note: As an alternative to STAT, a request for "Phone result" will ensure that the report is telephoned as soon as it is complete (usually the same day or first thing next morning).

VANCOMYCIN RESISTANT ENTEROCOCCI

Vancomycin Resistant Enterococci (VRE) have recently become an increasing problem in the health care community worldwide. BC has not been exempt from the appearance of this troublesome organism. Several hospitals in the lower mainland have had cases of VRE identified, with Abbotsford Hospital being the most recent to make the news headlines. Although VRE has primarily been a hospital problem, we must also be vigilant for its appearance in the outpatient population. The concern with VRE is not only the problem of antibiotic resistance, but also the potential for transfer of Vancomycin resistance to other more virulent multi resistant organisms such as S. aureus . Patients who may be at increased risk for VRE include those with a recent history of admission to a hospital outside of Canada, potential contacts of a known VRE case, prior Vancomycin therapy, multiple antibiotic therapy, prolonged hospital stays, immunosuppression, debilitating underlying disease, dialysis patients, and patients with indwelling catheter lines.

The principle reservoir for VRE in humans is the gastrointestinal tract. It can also survive for prolonged periods of time in the environment. Transmission of VRE is by direct patient contact or via carriage on the hands of health care personnel, or contaminated environmental surfaces or patient care equipment.

The level of infection control precautions used for a colonized/infected patient must take into consideration a risk assessment of the likelihood of transmission (level of hygiene, continence, type of illness) and the health care setting (hospital, care facility, outpatient). Screening of high risk patients may be required and appropriate specimens include perineal (+/- rectal) swabs, urine (if a Foley or condom catheter is present), any drain sites, any open wounds, and stool if the patient has diarrhea. It must be specified on the requisition that a particular patient specimen requires screening for VRE. It will take a minimum of 48 hours and often 3 to 4 days for testing to be complete.

SHORT BITS

5HIAA Test for Carcinoid

We will no longer perform the screening test for
5-hydroxy-indole acetic acid (5HIAA) as its false positive and false negative rate are unacceptable. All requests for 5HIAA will be analyzed by a highly specific HPLC method.

Homocysteine

Homocysteine is a recently recognized atherosclerosis risk factor recommended for evaluating high risk patients. Its collection is routinely available. Non-fasting samples are acceptable.

Extreme LDH Levels

Extreme elevations of the LDH without liver or muscle disease is commonly due to Pernicious Anemia.

Tests for Celiac Disease

Antibody tests for the presence of Celiac Disease are now available. Gliadin Antibodies and Endomysial Antibodies are present in the disorder. Negative tests do not rule it out.

Anticardiolipin Antibodies

There are both IgM and IgG antibodies found in the sera of some patients with SLE and often in patients with an inhibitor of coagulation (lupus anticoagulant). These are found in the Anticardiolipin Antibody Syndrome which is a disorder of spontaneous thrombosis and recurrent spontaneous abortions.

Gilbert’s Syndrome

10% of the normal population have slightly raised bilirubin values which rise even higher with a prolonged fast. There is no adverse effect from this condition.

New Requisitions

Our new requisition forms are appreciated by some and disliked by others. Unfortunately, these are MSC mandated and there is little room for modifying them. The "bottom line" is that we must use them or risk being denied payment. Your understanding is appreciated.

CONSULTATION

Don’t forget that the 13 members of our Medical/Scientific staff are always available to provide advice about test selection and interpretation.

The numbers to call are:

Burnaby Reference Lab (604) 431-5005 or toll free 1-800-431-7206

Victoria Reference Lab (250) 881-3100 or toll free 1-800-304-4011

Or, send an email to ASKDOC.