DOS Updates. M Pneumoniae DNA PCR QL Discontinued send out test to Mayo. Replaced by Mycoplasma pneumo PCR QL to ARUP, effective December3.

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1 IU Health Pathology Laboratory News Bulletin December 11, 2013 DOS Updates Citrate Platelet Count New hematology test. This test is used to evaluate patients suspected of EDTA mediated platelet clumping. Platelets must present in adequate numbers and have proper function to aid in hemostatis. Hematology prefers that both a Full Blue Top tube and a Lavender with 1 ml minimum be collected and submitted (both unspun and sent room temp) direct to hematology. Cryptococcus Ab Discontinued send out test to ARUP. No replacement. Cryptococcal antibody detection tests are generally less useful than those for antigen detection. Crytococcus Ag, Bld or Cryptococcus Ag, CSF are recommended instead. EGFR Mutation Analysis Effective November 11 th, the IU Health Molecular Pathology Laboratory switched EGFR Mutation Analysis testing to the newly FDA approved Qiagen therascreen EGFR Mutation Analysis Assay. Ordering remains the same and the assay cutoff is Monday at noon for sample receipt. For questions about the assay please contact Dr. Liang Cheng, medical director or the Molecular Pathology Laboratory at M Pneumoniae DNA PCR QL Discontinued send out test to Mayo. Replaced by Mycoplasma pneumo PCR QL to ARUP, effective December3. Mycoplasma pneumo PCR QL new send out test to ARUP, effective Dec 3. Respiratory specimen: Bronchoalveolar lavage (BAL), bronchial brushings, nasopharyngeal swab, sputum, tracheal aspirates or pleural fluid. OR CSF in sterile containers. Swabs must be sent in UTM. Specimen source must be provided. Ship samples frozen. Minimum volume 0.5 ml. Somatostatin Pl QN Must call lab at before collecting sample. Special new container required. Special instructions for collecting and processing sample. Method Chemiluminescent Immunoassay. VZV AB CSF CF Titer Discontinued Test. Effective Nov 21. No replacement, order as a Miscellaneous send out test. Note: An updated Tube Labeling Chart follows and it is also on the directory of services along with the tube labeling guidelines. These are located on the left navigation bar at ContentID=/pathology-lab/nurse-resources/index.xml The updated Hemostasis and Thrombosis Collection Chart is on the last page. It is also on the directory of services at as is the updated requisition at IU Health Pathology Laboratory 350 W 11th Street Indianapolis, IN Fax:

2 Dept of Pathology and Laboratory Medicine CORRECT LABELING Cerner label is placed directly under the cap and lined up with tube manufacturer label, allowing blood level to be viewed. Barcodes must be completely visible once placed in instrumentation pucks. First initial, last name, draw date/time must be written in designated area ONLY! Patient name (and blue line) must be directly under the cap. Writing above the designated area prevents barcodes from working.

3 INCORRECT LABELING Dept of Pathology and Laboratory Medicine Label not placed at the top of the tube Blood level not visible. Barcode is wrinkled. Barcode is twisted. Barcode is horizontal. Label is upside down. Name is at the bottom of the tube, not under the cap. Writing is not in designated area and is on top of bar code.

4 Blood Culture Bottles Do not cover the Blood Collection Barcode label with the Specimen Label Barcode Proper Label; bottle label barcode is Not obscured by the sample label.

5 Antiphospholipid Syndrome Panel: Collect 1 Clear Discard, 2 Full 2.7 ml Blue, and 1 Gold 2. Collect 2 Blue Sodium Citrate - Full Tubes. Double spin and freeze plasma within 4 hrs of collection: For each tube spin at 3000rpm for 15 min. Place top 2/3 of plasma in aliquot tube and spin aliquot at 3000 rpm for 15 min. Take top 2/3 of 2nd spin and put into 2 aliquot tubes. Freeze both aliquots immediately. Label aliquot tubes with patient name, DOB and mark tubes plasma. Send frozen platelet poor plasma. 3. Collect 1 Gold. Spin and separate ASAP. No severely lipemic, contaminated, or hemolyzed specimens. Send refrigerated serum. Bleeding Panel: Collect 1 Clear Discard, 4 Full 2.7 ml Blue, and 1 Lavender 2. Collect 4 Blue Sodium Citrate - Full Tubes. Double spin and freeze plasma within 4 hrs of collection: For each tube spin at 3000rpm for 15 min. Place top 2/3 of plasma in aliquot tube and spin aliquot at 3000 rpm for 15 min. Take top 2/3 of 2nd spin and put into 3 aliquot tubes. Label aliquot tubes with patient name, DOB and mark tubes plasma. Freeze aliquots immediately. Send frozen platelet poor plasma. 3. Collect 1 Lavender Do not spin. Bleeding Panel: Von Willebrand Disease Collect 1 Clear Discard, 5 Full 2.7 ml Blue, and 1 Lavender The samples for this panel must arrive at CPL within 3 hrs of collection and by no later than 1:00 PM. Call special coag lab at prior to collecting. A STAT courier must pick the samples up immediately after collection. 2. Collect 5 Blue Sodium Citrate - Full Tubes. DO NOT SPIN! 3. Collect 1 Lavender Do not spin. Two signatures required on label. Fetal Demise Common: Antiphospholipid Syndrome Panel Collect 1 Clear Discard, 2 Full 2.7 ml Blue, and 1 Gold 2. Collect 2 Blue Sodium Citrate - Full Tubes. Double spin and freeze plasma within 4 hrs of collection: For each tube spin at 3000rpm for 15 min. Place top 2/3 of plasma in aliquot tube and spin aliquot at 3000 rpm for 15 min. Take top 2/3 of 2nd spin and put into 2 aliquot tubes. Freeze both aliquots immediately. Label aliquot tubes with patient name, DOB and mark tubes plasma. Send frozen platelet poor plasma. 3. Collect 1 Gold. Spin and separate ASAP. No severely lipemic, contaminated, or hemolyzed specimens. Send refrigerated serum. Guidelines: 1. The IUHPL laboratory must be called prior to collecting Bleeding Panel: Von Willebrand Disease, Platelet Function (PFA-100), Plt Inh (P2Y12), Plt Inh (Aspirin), Platelet Aggregation, and Risto Dose Response. Call or with questions and ask for Special Coag. 2. Platelet Aggregation, and Risto Dose Response samples must be to IUHPL by 1:00 PM on the day of collection. 3. Platelet Function (PFA-100), Plt Inh (P2Y12) and Plt Inh (Aspirin) and Bleeding Panel: Von Willebrand Disease samples must be to IUHPL by 3:00 PM on day of collection. 4. Mixing Studies require 4x2.7ml Blue, Platelet Agg 6 x2.7ml Blue, PFA-100 2x2.7ml Blue and Risto Dose Response 6x2.7ml Blue 5. Always draw blood by venipuncture do not use needles smaller than 23 gauge. Follow draw order. 6. Always draw a discard tube (clear discard or light blue, 3.2% sodium citrate tube preferred) before drawing coagulation specimens in light blue vacuum tubes (3.2% buffered sodium citrate). 7. Withdrawing blood from intravenous lines or indwelling catheters should be avoided if at all possible. 8. Fill light blue top tubes as far as the vacuum will allow and mix by gentle inversion. 9. In order to produce accurate and valid results, all specimens must be platelet free (<5000/uL) before freezing for shipment. This residual count can be obtained by double-spinning the sample. 10. Double spin and freeze plasma within 4 hrs of collection: Spin all three at 3000rpm for 15 min. Place top 2/3 of plasma in aliquot tube and spin aliquots at 3000 rpm for 15 min. Take top 2/3 of 2nd spin and put into one clean aliquot tube for each test ordered. See website for amount of plasma required for each test ordered. Label aliquot tubes with patient name, DOB and mark plasma. Freeze aliquots immediately. Send frozen aliquots of platelet poor plasma. 11. Hemolysis and heparin anticoagulant (Green and Lt Green tubes) interfere with coagulation studies and cannot be used. 12. Label all tubes including aliquots with patient name and DOB, MRN or SS number. IUHPL Hemostasis and Thrombosis Collection Chart Fetal Demise Less Common: Collect 1 clear discard, 4 Full 2.7 ml Blue, 1 Lt. Green and 3 Lavender 2. Collect 4 Blue Sodium Citrate - Full Tubes. Double spin and freeze plasma within 4 hrs of collection: For each tube spin at 3000rpm for 15 min. Place top 2/3 of plasma in aliquot tube and spin aliquot at 3000 rpm for 15 min. Take top 2/3 of 2nd spin and put into 5 aliquot tubes. Label aliquot tubes with patient name, DOB and mark tubes plasma. Freeze 5 aliquots immediately. Send frozen platelet poor plasma. 3. Collect 1 Lt Green. Spin, separate and freeze plasma within 1 hour of collection. Label aliquot tube with patient name, DOB and mark tube green plasma. Send frozen plasma. 4. Collect 3 Lavender Do Not Spin. Send refrigerated whole blood. Lupus Anticoagulant: Collect 1 Clear Discard and 2 Full 2.7 ml Blue 2. Collect 2 Blue Sodium Citrate - Full Tubes. Double spin and freeze plasma within 4 hrs of collection: For each tube spin at 3000rpm for 15 min. Place top 2/3 of plasma in aliquot tube and spin aliquot at 3000 rpm for 15 min. Take top 2/3 of 2nd spin and put into 2 aliquot tubes. Freeze both aliquots immediately. Send frozen platelet poor plasma. Mixing Study: Factor(s) Deficiency/Inhibitor Collect 1 Clear Discard and 4 Full 2.7 ml Blue 2. Collect 4 Blue Sodium Citrate - Full Tubes. Double spin and freeze plasma within 4 hrs of collection: For each tube spin at 3000rpm for 15 min. Place top 2/3 of plasma in aliquot tube and spin aliquot at 3000 rpm for 15 min. Take top 2/3 of 2nd spin and put into 3 aliquot tubes. Freeze aliquots immediately. Send frozen platelet poor plasma. Venous Thrombosis Panel: Collect 1 Clear Discard, 5 Full 2.7 ml Blue, 1 Gold, 1 Lt Green, and 1 Lavender 2. Collect 5 Blue Sodium Citrate - Full Tubes. Double spin and freeze plasma within 4 hrs of collection: Spin all three at 3000rpm for 15 min. Place top 2/3 of plasma in 3 aliquot tubes and spin aliquots at 3000 rpm for 15 min. Take top 2/3 of 2nd spin and put into 7 aliquot tubes. Freeze all 7 aliquots immediately. Send 7 frozen aliquots of platelet poor plasma. Also send refrigerated RBC s from one blue tube. 3. Collect 1 Gold. Spin and separate ASAP. No severely lipemic, contaminated, or hemolyzed specimens. Send refrigerated serum. 4. Collect 1 Lt. Green - Spin, separate and freeze plasma within 1 hour of collection. Label aliquot tube with patient name, DOB and mark tube green plasma. Send frozen plasma. 5. Collect 1 Lavender Do Not Spin. Send refrigerated whole blood. IU Health Pathology Lab Client Services: or Fax: Draw blood in the following order. Clear Discard ml Draw discard tube prior to collecting coagulation testing (blue sodium citrate) and/or when using butterfly needle. Blue Sodium Citrate ml - Full Tube. B/P/F Blue/Plasma/Frozen: Double spin and freeze plasma within 4 hrs of collection: Spin at 3000rpm for 15 min. Place top 2/3 of plasma in aliquot tube and spin aliquot at 3000 rpm for 15 min. Take top 2/3 of 2nd spin and put in another aliquot tube. Mark tube plasma. Freeze immediately. Send frozen platelet poor plasma. B/P/F** - Follow instructions for platelet poor plasma. Send both frozen plasma and refrigerated RBC s. B/W/RT Blue/Whole Blood: Do not spin. Send room temp whole blood. B/W/RF Blue/Whole Blood: Do not spin. Send refrigerated whole blood. Blue Griener ml - Full Tube. BG/W/RT* Blue Griener/Whole Blood: Special blue tube. An * after see DOS for specific instructions. Red - 6 ml R/S/RT Red/Serum/RoomTemp: Spin and separate ASAP. No severely lipemic, contaminated, or hemolyzed specimens. Mark tube serum. Send room temp serum. Gold SST- 5 ml G/S/RF Gold/Serum/Refrigerated: Spin and separate ASAP. No severely lipemic, contaminated, or hemolyzed specimens. Send refrigerated serum. Lt Green Li Heparin PST 4.5 ml LG/P/RF Lt Green/Plasma/Refrigerated: Spin and separate within 1 hour of collection. Mark tube plasma. Send refrigerated plasma. Lavender EDTA - 5 or 6 ml L/W/RF Lavender/WholeBlood/Refrigerated: Do not spin. Send refrigerated whole blood. L/W/RT Lavender/WholeBlood/Room Temp: Do not spin. Send room temp whole blood. An * after see DOS for specific instructions. Yellow ACD - 10 ml Y/P/RT Yellow/Plasma/Room Temp: Double spin within 4 hrs of collection. Spin at 3000rpm for 15 min. Place top 2/3 of plasma in aliquot tube and spin aliquot at 3000 rpm for 15 min. Take top 2/3 of 2nd spin and put in another aliquot tube. Mark tube plasma. Send room temp plasma. Y/W/RF Yellow/Whole Blood/Refrigerated: Do not spin. Send refrigerated whole blood. November 2013 Test Name Sample Requirements aptt B/P/F APC Resistance B/P/F** Alpha 2 Antiplasmin Pl QN B/P/F Antiprothrombin Abs IgG/M B/P/F Anti-Xa Enoxaparin Level B/P/F Anti-Xa Fondaparinux Level B/P/F Anti-Xa Heparin (UFH) Level B/P/F ATIII Functional (Activity) B/P/F ATIII Functional (Antigen) B/P/F B2 Glycoprotein 1, IgG/M Ab G/S/RF Cardiolipin IgG/IgM (acl) G/S/RF Chromogenic Factor X B/P/F Collagen Binding B/P/F D-Dimer B/P/F DRVVT B/P/F Factor Assays B/P/F II, V, VII,VIII,X,IX, XI, XII Factor XIII QL B/P/F Factor V Leiden PCR L/W/RF Factor VIII Inhibitor (Bethesda Titer) B/P/F Factor IX Inhibitor B/P/F Factor Assay, Fitzgerald B/P/F Factor Assay, Fletcher B/P/F Fibrinogen (Functional) B/P/F Fibrinogen Ag B/P/F Heparin Level (see Anti-Xa above) Heparin Induced Antibody (HIT) B/P/F Homocysteine SerPl QN LG/P/RF Mixing Studies 4 B/P/F MTHFR Mutation Bld L/W/RF Platelet Function Analyzer (PFA-100) 2 B/W/RT*^^ Plasminogen-1 Inhib (PAI-1) Ag B/P/F PAI-1 Mutation Bld PCR L/W/RT* Phosphatidylcholine Abs(aPC) R/S/F Phosphatidylethanolamine(aPE) R/S/F Phosphatidylserine Abs(aPS) R/S/F Plasminogen Activity B/P/F Platelet Aggregation 6 B/W/RT*^ Plate GlycoIIb/IIIa Mutat B/W/RF Plt Inh Aspirin BG/W/RT*^^ Plt Inh P2Y12 BG/W/RT*^^ Protein C Activity B/P/F Protein C Antigen B/P/F Protein S Antigen B/P/F Protein S Free B/P/F Protein S Clottable (Functional) B/P/F PT Gene Mutation PCR L/W/RF PTINR B/P/F Ristocetin Dose Response 6 B/W/RT*^ Silica Clotting Time (SCT) B/P/F Staclot LA (Hexagonal Phase) B/P/F Thrombin-Antithrombin B/P/F Thrombin Time (TCT) B/P/F Tissue Plasminogen Activator Ag (TPA Ag) B/P/F vw Factor Activity Screen B/P/F vw Factor Antigen B/P/F Von Willebrand Multimers B/P/F Warfarin Sensitivity L/W/RF* KEY B=Blue P= Plasma RF=Refrigerate BG=Blue Griener S= Serum RT= Room Temp G=Gold W= Whole Blood F= Freeze L=Lavender LG=Lt Green **= Send cells with plasma R=Red *= See IUHPL Directory of Services for details Y= ACD ^ Must be to IUHPL by no later than 1:00 PM ^^Must be to IUHPL by no later than 3:00 PM