Lab: Difference between revisions

From Guide to YKHC Medical Practices

 
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== Laboratory Services ==
The Bethel lab is able to process most standard, routine labs including cultures, comprehensive chemistries, and blood counts.  Viral loads and some specialized tests need to be sent to Lab Corp and are not quickly available.
The Laboratory Department provides acute and out-patient testing services and reports to all clinicians and departments associated with the Yukon-Kuskokwim Health Corporation for patients ranging in age from newborn to geriatric. Testing services and their associated reports are also provided upon written request for those non-YKHC physicians within the State of Alaska with non-beneficiary clients on the Delta. The Laboratory department interfaces with other accredited health care organizations for those tests not analyzed in-house.


Laboratory services consist of hematology and coagulation; serology; microbiology; DNA probes; chemistry, special chemistry and blood gases; urinalysis, screening for drugs of abuse; blood bank; venipuncture, clerical, sendouts; support of the Sub-Regional Clinic and support of Point of Care Testing within the hospital and CHA/Ps. The CHA/Ps draw lab specimens and forward them for processing at the lab at YKDRH. The Laboratory is open 24 hours a day, 7 days a week.
==Miscellaneous Labs==
YKHC Commonly uses LabCorp for sendout labs.  If you are ordering a lab that is not in the electronic medical record, complete the [https://intranet.ykhc.org/mdocs-posts/downtime-lab-requisition/ Downtime Lab Requisition Form]. 
 
Include a Test# and CPT# from LabCorp ([https://www.labcorp.com/test-menu/search LabCorp Test Menu Search]) to prevent confusion about the requested lab.
 
==Village Clinic Labs==
Point of Care tests include, rapid strep, urine HCG, urine analysis, hemoglobin, hemoglobin A1C, glucose. 
 
Other basic labs can be drawn and sent to Bethel.
 
==Sub-regional Clinic (SRC) Labs==
The Sub-regional Clinics have an onsite lab that runs many tests. 
*The SRC labs may do CBC, BMP, CMP, HGB A1C, lipids, quantitative troponin, UA, urine micro, wet preps, RST/cultures, urine HCGs.
*For questions about the lab please contact Aniak SRC Lab Director (907-675-4556).
 
==Lab Anacronyms/Panels==
In PowerChart/FirstNet you can order many lab panels in PowerPlans for specific diagnoses.  If interested in individual components of lab panels, right click the order, and select Reference Information.
{| class= "wikitable"
|-
|CBC||Complete Blood Count
|-
|ABG||Arterial Blood Gas
|-
|BMP||Na, K, Chloride, CO2, BUN, Creatinine, glucose, calcium
|-
|Hep B Carrier Panel||AFP, SGOT, SGPT, HepBsAg
|-
|CMP||BMP and LFT’s
|-
|LFTs||Total protein, albumin, total bili, direct bili, SGOT, SGPT, Alk phos
|-
|Quad Screen||HCG, AFP, UE 3, DIA (used to be called the triple screen)
|-
|Acute Hepatitis Panel||HepA Ab IgM, HepB Core IgM, HepBs Ag, HepC Ab
|-
|Iron Profile||Iron, Unsaturated Iron-Binding Capacity , Ferritin, Transferrin, Calculated TIBC, Calculated Iron Saturation
|-
|[[CSF Meningitis/Encephalitis Panel]]||CSF Multiplex
|-
|[[Gastrointestinal Panel]]||Gastrointestinal (GI) Multiplex PCR test
|-
|[[Blood Pathogen Panel (BPP)]]||a PCR test reflexively performed on positive blood cultures
|-
|[[Group B Strep (GBS) PCR or Xpert GBS]]||a rapid GBS screening tool specifically for pre-term labor patients and those who have not had prenatal care
|}
 
==Pap smears==
For Pap smears, YKHC uses ThinPrep (see [https://www.hologic.com/sites/default/files/DS-05867-001_002.pdf Protocol: endocervical brush/spatula Quick Reference Guide] for collection instructions.  If you leave the broom brush or spatula in the vial, it will be rejected).  We are doing high grade HPV testing per Pap guidelines.  The appropriate testing is found in the Pap orders.
 
==Blood Bank==
===Group A Liquid Plasma===
The Blood Bank currently has two units of Group A Liquid Plasma available for use in the event of a massive transfusion protocol or major trauma:
#Patients with loss of 50% of total blood volume (Class IV by the Advance Trauma Life Support definitions of hemorrhage) with ongoing blood loss.
#An adult patient or pediatric patient weighing ≥ 40 kg who arrives in the ED in profound shock or who has a hemoglobin value of ≤ 7 gm/dl, and who’s bleeding has not been controlled.
 
Almost all group A plasma in the U.S. comes from male donors. In men, the titer of anti-B in group A plasma is generally low, <128 (due to the lack of stimulation by incompatible fetal RBCs during pregnancy), making it less likely the antibody will harm the RBCs of group B or group AB recipients. Transfused anti-B is diluted into the patient’s much-larger total blood volume, and as a result, it comprises only a small quantity of the total circulating ABO antibodies.
 
'''Indications:''' Liquid Plasma is indicated for the initial treatment of patients who are undergoing massive transfusion because of life-threatening trauma/hemorrhages and who have clinically significant coagulation deficiencies.
 
'''Contraindications:''' Do not use Liquid Plasma as the treatment for coagulation factor deficiencies where other products (Thawed Fresh Frozen Plasma) are available with higher factor concentrations.
 
This Liquid Plasma will be available immediately without the necessary thawing process.
 
Group AB Fresh Frozen Plasma will still available if requested by the physician and should be used after the initial treatment of liquid plasma.
 
===Resources/Documents===
*[https://ykhc.ellucid.com/documents/view/12771 Massive Transfusion Protocol Notification Worksheet]
*[https://ykhc.ellucid.com/documents/view/19873 Blood Transfusion Consent]
*[https://ykhc.ellucid.com/documents/view/12737 Massive Transfusion Protocol (MTP)]
*[https://ykhc.ellucid.com/documents/view/11015 Massive Transfusion Policy]
*[https://ykhc.ellucid.com/documents/view/12579 LAB_BB_FORM0045 - Transfusion Observation Checklist]
 
[[category:Ancillary_Services]]

Latest revision as of 21:36, 12 November 2021

The Bethel lab is able to process most standard, routine labs including cultures, comprehensive chemistries, and blood counts. Viral loads and some specialized tests need to be sent to Lab Corp and are not quickly available.

Miscellaneous Labs

YKHC Commonly uses LabCorp for sendout labs. If you are ordering a lab that is not in the electronic medical record, complete the Downtime Lab Requisition Form.

Include a Test# and CPT# from LabCorp (LabCorp Test Menu Search) to prevent confusion about the requested lab.

Village Clinic Labs

Point of Care tests include, rapid strep, urine HCG, urine analysis, hemoglobin, hemoglobin A1C, glucose.

Other basic labs can be drawn and sent to Bethel.

Sub-regional Clinic (SRC) Labs

The Sub-regional Clinics have an onsite lab that runs many tests.

  • The SRC labs may do CBC, BMP, CMP, HGB A1C, lipids, quantitative troponin, UA, urine micro, wet preps, RST/cultures, urine HCGs.
  • For questions about the lab please contact Aniak SRC Lab Director (907-675-4556).

Lab Anacronyms/Panels

In PowerChart/FirstNet you can order many lab panels in PowerPlans for specific diagnoses. If interested in individual components of lab panels, right click the order, and select Reference Information.

CBC Complete Blood Count
ABG Arterial Blood Gas
BMP Na, K, Chloride, CO2, BUN, Creatinine, glucose, calcium
Hep B Carrier Panel AFP, SGOT, SGPT, HepBsAg
CMP BMP and LFT’s
LFTs Total protein, albumin, total bili, direct bili, SGOT, SGPT, Alk phos
Quad Screen HCG, AFP, UE 3, DIA (used to be called the triple screen)
Acute Hepatitis Panel HepA Ab IgM, HepB Core IgM, HepBs Ag, HepC Ab
Iron Profile Iron, Unsaturated Iron-Binding Capacity , Ferritin, Transferrin, Calculated TIBC, Calculated Iron Saturation
CSF Meningitis/Encephalitis Panel CSF Multiplex
Gastrointestinal Panel Gastrointestinal (GI) Multiplex PCR test
Blood Pathogen Panel (BPP) a PCR test reflexively performed on positive blood cultures
Group B Strep (GBS) PCR or Xpert GBS a rapid GBS screening tool specifically for pre-term labor patients and those who have not had prenatal care

Pap smears

For Pap smears, YKHC uses ThinPrep (see Protocol: endocervical brush/spatula Quick Reference Guide for collection instructions. If you leave the broom brush or spatula in the vial, it will be rejected). We are doing high grade HPV testing per Pap guidelines. The appropriate testing is found in the Pap orders.

Blood Bank

Group A Liquid Plasma

The Blood Bank currently has two units of Group A Liquid Plasma available for use in the event of a massive transfusion protocol or major trauma:

  1. Patients with loss of 50% of total blood volume (Class IV by the Advance Trauma Life Support definitions of hemorrhage) with ongoing blood loss.
  2. An adult patient or pediatric patient weighing ≥ 40 kg who arrives in the ED in profound shock or who has a hemoglobin value of ≤ 7 gm/dl, and who’s bleeding has not been controlled.

Almost all group A plasma in the U.S. comes from male donors. In men, the titer of anti-B in group A plasma is generally low, <128 (due to the lack of stimulation by incompatible fetal RBCs during pregnancy), making it less likely the antibody will harm the RBCs of group B or group AB recipients. Transfused anti-B is diluted into the patient’s much-larger total blood volume, and as a result, it comprises only a small quantity of the total circulating ABO antibodies.

Indications: Liquid Plasma is indicated for the initial treatment of patients who are undergoing massive transfusion because of life-threatening trauma/hemorrhages and who have clinically significant coagulation deficiencies.

Contraindications: Do not use Liquid Plasma as the treatment for coagulation factor deficiencies where other products (Thawed Fresh Frozen Plasma) are available with higher factor concentrations.

This Liquid Plasma will be available immediately without the necessary thawing process.

Group AB Fresh Frozen Plasma will still available if requested by the physician and should be used after the initial treatment of liquid plasma.

Resources/Documents