June 2022 WML Test Directory Update

Suggested replacement is GLAG [3715150] – Giardia AG, EIA, STOOL

Update to reference range and message.

Reference Range:

COMPONENT                          REFERENCE INTERVAL
Lead, Whole Blood                    < 6 years: <3.5 µg/dL

In 2021, CDC revised the blood lead reference level for
children ages 1-5 years to less than 3.5 ug/dL. Children
with levels at or above this value represent those at the
top 2.5% of blood levels.

CDC recommendations for clinical follow up and lead level
monitoring may vary depending on initial measured lead level
and the child’s age. Local and state health departments also
may have different recommendations for monitoring and clinical
follow up. Please consult your local or state health department,
or the CDC’s website regarding monitoring of lead levels in
children:

https://www.cdc.gov/nceh/lead/acclpp/actions_blls.html

COMPONENT                           REFERENCE INTERVAL
Lead, Whole Blood                       >= 6 years: < 5.0 µg/dL

CDC recommendations for clinical follow up and lead level
monitoring may vary depending on initial measured lead level
and the patient’s age. Local and state health departments
also may have different recommendations for monitoring and
clinical follow up. Please consult your local or state
health department, or the CDC’s website regarding monitoring
of lead levels in adults:

https://www.cdc.gov/niosh/topics/ables/pdfs/

Update to specimen preparation, alternate specimen, and rejection criteria.

Specimen Preparation: Send 0.5 mL urine in a sterile screw capped plastic container.

Alternate Specimen:

Serum: Collect serum in red top or serum separator tube (SST), allow 30 min to clot, centrifuge and send 1.2 mL in a plastic screw capped vial.
Plasma: Collect plasma in Lavender EDTA, green sodium heparin or 3.2% sodium citrate light blue top tube. Centrifuge for 15 minutes and transfer 0.8 mL plasma to a plastic screw capped vial.
CSF/BAL/Other Body fluid: send 0.5 mL in a sterile screw capped container.

Rejection Criteria:  Tissue, sputum, bronchial brushings, stool, fine needle aspiration (FNA), biopsy, tracheal or bone marrow aspirate. Specimens too viscous to pipette, samples in transport media; fixative or
isolator tube

Update to reference range and canned message.

Reference Range:

COMPONENTS                      REFERENCE INTERVAL
Lead, Whole Blood           < 6 years: <3.5 µg/dL
Lead, Whole Blood                  >= 6 years: <5.0 µg/dL

Zinc Protoporphyrin (ZPP)
Whole Blood:                              0 – 69 µmol/mol heme

Zinc Protoporphyrin (ZPP)
Whole Blood:                                       0 – 40 µg/dL

These results should be interpreted in the context of OSHA, CDC, and local and state occupational health requirements.
Additional information is available through the following link:

https://www.cdc.gov/niosh/topics/ables/description.html

For occupational exposure to lead, OSHA requires ZPP whole blood concentration to be reported in units of ug/dL. For adults, conversion of ZPP to units of ug/dL assumes a hemoglobin level of 15 g/dL.

Methodology used in lead analysis is atomic absorption. Methodology used for ZPP is Protofluor Z system manufactured by Helena Laboratories. This test has been modified from the manufacturer’s instructions.

Elevated results may be due to skin or collection-related contamination, including the use of a noncertified lead-free tube,or transfer of sample into a noncertified lead-free tube. If contamination concerns exist due to elevated levels of blood lead, confirmation with a venous specimen collected in a certified lead-free tube is recommended.

The Blood Lead test was developed and the performance characteristics determined by Warde Medical Laboratory. It has not been cleared or approved by the FDA. The laboratory is regulated under CLIA as qualified to perform high-complexity testing. This test is used for patient testing purposes. It should not be regarded as investigational or for research.

Update to patient preparation, specimen preparation, alternate specimen, and stability.

Patient Preparation: This test requires a physician attestation form that patient consent has been received if the ordering medical facility is located in AK, DE, FL, GA, IA, MA, MN, NV, NJ, OR, SD or VT or test is performed in MA. 

Specimen Preparation: Send 5.0 mL whole blood. Do not transfer to other containers. Specimen stability is crucial. Store and ship at room temperature.

Transport Temperature: Room temperature only 

Alternate Specimen: Whole blood: ACD A, ACD B, sodium heparin

Stability:

Room temperature: 8 days
Refrigerated: Unacceptable
Frozen: Unacceptable

Update to patient preparation, alternate specimen, stability, and performed days.

Patient Preparation: This test requires a physician attestation form that patient consent has been received if the ordering medical facility is located in AK, DE, FL, GA, IA, MA, MN, NV, NJ, OR, SD or VT or test is performed in MA.

Alternate Specimen:

Whole blood: yellow ACD B, green sodium
heparin Amniotic fluid (20.0 mL; 5.0 mL minimum)
Cultured Cells
Chorionic villus sampling (20 mg; 10 mg minimum)

Stability:

Whole Blood:
Room temperature: 30 days
Refrigerated: 30 days
Frozen: 30 days

Other specimens:
Room temperature: 48 hours
Refrigerated: Unacceptable
Frozen: Unacceptable

Performed Days: Tuesday

Update to alternate specimen.

Alternate Specimen:

Plasma: Lavender EDTA or green sodium heparin, lithium heparin
Serum: Red top

Update to alternate specimen.

Alternate Specimen:

Plasma: Lavender EDTA, Green sodium heparin or lithium heparin
Serum: Red top

Update to rejection criteria and LOINC.

Rejection Criteria: Grossly hemolyzed or lipemic

Interface Map:

Update to specimen preparation, performed days, and LOINC.

Specimen Preparation: Centrifuge, separate serum cells as soon as possible or within 2 hours and send 1.0 mL serum in ascrew capped plastic vial.

Performed Days: Monday – Sunday

Interface Map:

Update to rejection criteria.

Rejection Criteria: Whole blood, bronchoalveolar lavage, turbid specimens 

Update to specimen collected and LOINC.

Collect: Green sodium heparin or lithium.

Interface Map:

Update to rejection criteria.

Rejection Criteria: Plasma specimens, CSF, hemolyzed/lipemic specimens

Update to alternate specimen.

Alternate Specimen: Plasma: Lavender EDTA, green sodium or lithium heparin, Light blue (sodium citrate)
Serum: Red top

Update to rejection criteria and LOINC.

Rejection Criteria: Plasma, hemolyzed or lipemic

Interface Map:

Update to alternate specimen and LOINC.

Alternate Specimen: Gray top, green (lithium heparin)

Interface Map:

Update to accepted alternate specimens.

Alternate Specimen: Plasma: Lavender EDTA 

Update to reference range and canned message.

Reference Range:

Thyroglobulin Antibodies: <4.0 IU/mL

Thyroglobulin:
Intact thyroid: 1.6-50.0 ng/mL
Athyrotic, post-thyroidectomy (tumor marker): <0.1 ng/mL

Update to stability and LOINC.

Stability: Room temperature: 6 hours
                Refrigerated: 24 hours
                Frozen: 6 months 

Interface Map:

Update to specimen preparation, stability, methodology, reference range, performing days, turnaround time, and performing location.

Patient Preparation: Fasting preferred, but not required.

Stability: Room temperature: 7 days
                Refrigerated: 7 days
                Frozen: 28 days 

Performed Days: Sunday – Saturday 

Performing Location: Quest SJC 

Turnaround Time: 3 – 5 days

Interface Map: