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SA Pathology Newsletter (Formerly SA Pathology Will Be Explicitly Moving the IMVS Newsletter)

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SA Pathology Newsletter (Formerly SA Pathology Will Be Explicitly Moving the IMVS Newsletter) 2013 1 s Newsletter Reference interval changes 2 Significance of ANCA 4 Type 1 diabetes 6 INSIDe Clinical Utility of Bone Turnover Markers 8 Ulysses Syndrome – is it the liver? 10 Test ordering standardisation 11 Order of Draw Quick Guide 12 DNA $ INRTroponineGFR $LDESR CBE HDLPCR $ $ PCRMBA LFT LFTMC&SPSARNA $ HbA1cRCF $ TFT For our Capatients and our population www.sapathology.sa.gov.au From the inside transport improvement, will enable us to Complement method change From the Executive Director meet future challenges and maintain our hard earned reputation. To improve turnaround times for complement C3 and C4 results, As part of a highly regarded health system SA Pathology changed the method that provides outstanding patient care, and analyser platform to the integrated research and teaching activities ADVIA 2400 on 26 August 2013. we aim to continually improve the depth Results for both C3 and C4 using the and breadth of our services whilst returning new method are approximately value for money to South Australian 10% higher than those of the old taxpayers. method. The reference interval has As a clinical support service SA Pathology changed to reflect this shift and a recognises that it needs to positively paediatric range is included. IMVS IS headed by ProfeSSor ruth SaloM a MedIcal graduate respond to the changing clinical landscape who haS SPecIalISed aS a in order to meet the needs of hospitals, C3 SurgIcal PathologISt. clinicians and the community. We also recognise the need to manage demand and <4 weeks 0.58 to 1.08 g/L budget pressures, while ensuring our plans <3 months 0.67 to 1.24 g/L are consistent with the major developments <6 months 0.74 to 1.38 g/L MR KEN BARR IS EXECUTIVE that are occurring within the health system, DIRECTOR OF SA PATHOLOGY including the new Royal Adelaide Hospital <9 months 0.78 to 1.44 g/L and the South Australian Health and <10 years 0.80-1.50 g/L Medical Research Institute (SAHMRI), plus the major research and teaching goals >10 years and 0.85-1.60 g/L of the three universities. i am delighted to present this edition adults of the SA Pathology Newsletter (formerly SA Pathology will be explicitly moving the IMVS Newsletter). SA Pathology away from the ‘one hospital, one C4 0.12-0.36 is proud to be the public provider of laboratory’ model as advances in analytical, pathology services within South Australia transport and IT technology provide to ensure all our population, communities new opportunities for us to build a more DGA reference interval change and patients have 24/7 access to a flexible, efficient and effective state-wide comprehensive range of services, pathology network. SA Pathology changed the irrespective of their income and location. Deaminated Gliadin Antibody (DGA) Be assured that our services will continue method and analyser platform on The priorities and direction contained to be clinically led, and that patient safety 9 December 2013. Whilst the new within our 2013-16 strategic plan and improving health outcomes remains outline our clear intention to build on method is clinically identical to the our primary goal. We look forward to current method the results will be a longstanding record of quality and working with you so that we can continue considerably different. excellence as a regulated and accredited to provide the very best pathology service pathology service across all disciplines to support our patients and our population. New reference interval and our expanding Point of Care Testing The new reference interval for DGA network. Our plans for service, IT and Mr Ken Barr will be: <11 U/mL. If you have any questions SA Pathology Newsletter Design Published by SA Pathology Sue Dyer Design regarding these changes Editorial Committee Photography please contact the John Bahnisch, Mark Fitz-Gerald, Ming Qiao, SA Pathology Photo and Imaging Immunology Consultant Dianne Zurcher and David Johnston Printing via SA Pathology enquiries Contact Fivestar Print on (08) 8222 3000 [email protected] cover: Ulysses and the Sirens ISSN 2203 – 2339 Print by John William Waterhouse 1891 ISSN 2203 – 2347 Online See page 10 for Ulysses syndrome SA Pathology Newsletter > 1 – 2013 PAGE 2 DID YOU Red Blood Cell Folate (RCF) Q: What do I need to do KNOW? differently? SA Pathology has moved from serum folate to Red Blood Cell Folate (RCF) A: You will need to collect an testing as the standard measurement EDTA specimen (purple top). Citrate Blood Tubes to assess folate nutritional status. When collecting blood into Q: Can I specifically request citrate tubes (blue tops) you Due to the 120 day average lifespan serum folate testing? must fill to the indicator line. of the red cell, RCF folate is less Yes. Serum folate levels will susceptible to rapid changes in diet A: continue to be available on compared with serum folate, and will request. provide more reliable and accurate results. In practice this change will: Q: Can I request tests to n identify an additional 5% of differentiate between B12 patients with folate deficiency with and folate deficiencies? INDICATOR LINE spuriously high serum levels A: Yes. Specific tests to identify n more accurately reflect and differentiate between the patient’s folate status over the B12 and folate deficiencies, preceding 2 to 3 months. such as homocysteine and methylmalonic acid levels, BLOOD will continue to be performed. For B12 and RCF please collect both serum (white top) and whole blood (purple top). ANTICOAGULANT Did you know? > Mandatory folate The reason is that the ratio of fortification of flour blood to anticoagulant is critical has been in place since 2009 in Australia. for clotting tests. An under-filled tube will have too much citrate making results Clinically related questions invalid; similarly, overfilling Please contact Professor Luen Bik To, Haematology Clinical Director on the tube dilutes the citrate (08) 8222 3633 or Dr Penelope Coates, Chemical Pathology Clinical Director concentration invalidating the on (08) 8222 3391. result. Collection by vacuum is the method preferred as this takes Warfarin reversal guidelines To aid decision making in this patient the correct amount of blood. group the recently updated Warfarin However if the tubes are old the In-patients receiving warfarin and Reversal Guidelines are now available vacuum may be reduced resulting experiencing bleeding is a relatively on the SA Pathology internet site. in under filling; please replace old common event, with approximately From the Home page go to: For or defective tubes. 2-3% of such individuals having a Clinicians | Quick Guide for Clinicians major complication each year. | Emergency Information. Over or under filled samples will be rejected and a new sample will Patients on warfarin will also often Further advice can be obtained be required. This applies to all have high INR values without from the duty haematologist on-call tube sizes. clinically evident bleeding. Guidelines through the RAH switch board, for the management of both bleeding phone (08) 8222 4000. For additional information please and non-bleeding patients with call the Haemostasis Reference an elevated INR result have been Laboratory on (08) 8222 3918. developed by the Australian Society of Haemostasis and Thrombosis. SA Pathology Newsletter > 1 – 2013 PAGE 3 www.sapathology.sa.gov.au Significance of ANCAANCAANCA Dr TATjAnA BAnovic – CONsULTANT pATHOLOGIsT – ImmUNOLOGY Anti neutrophil cytoplasmic antibodies (ANCA) are associated with a spectrum of systemic vasculitic conditions affecting small and medium vessels throughout the body. The syndromes of small vessel False positive results have been vasculitides (SVV) systemic reported in a variety of disorders vasculitides are characterised by: including infections, drug-induced vasculitis, other autoimmune diseases, n overlapping clinical and histological malignancies and inflammatory bowel features with frequent involvement disease (IBD). Conversely, negative of major organs results have been reported in patients n the need for aggressive with biopsy proven vasculitides. immunosuppressive treatment Results therefore should always be n serious morbidity and a significant evaluated in the context of other mortality. laboratory and clinical findings and should not be used as the principal The management of these vasculitides indication for treatment. often requires critical and timely decision making to prevent the There are three major patterns consequences of disease and the associated with a positive ANCA the aNCA group of autoantibodies are directed hazards of mistreatment. The screen: against cytoplasmic components in human importance of understanding the neutrophilis 1 Cytoplasmic or cANCA tests for ANCA used in the diagnosis cannot be overemphasised. 2 Perinuclear or pANCA Confirmation 3 Atypical-ANCA pattern There are many different antigen Screening specificities in the ANCA group The limits of ANCA testing need The atypical ANCA pattern has of autoantibodies but only two to be understood. To maximise the been reported in IBD, cystic fibrosis, have proven clinical associations, predictive value of ANCA screening autoimmune liver disease, drug- anti proteinase 3 (PR3) and anti it should only be performed on induced ANCA and rheumatic myeloperoxidase (MPO) antibodies. appropriately selected patients. diseases. In rheumatoid arthritis the Tests for other ANCA specificities The clinical indications of suspected prevalence of atypical-ANCA has been are not currently clinically useful ANCA-associated vasculitis include: detected in 20 – 70% of patients and and none have been proven specific been associated with more severe or diagnostically important for any n glomerulonephritis and long-standing disease. particular disease. Therefore all n pulmonary haemorrhage positive ANCA screens must have n cutaneous vasculitis, especially their identity confirmed to PR3 and with systemic features MPO antibodies. n multiple lung nodules n chronic destructive disease of the upper airways; long standing Results should be evaluated sinusitis or otitis in context of other laboratory n subglottic tracheal stenosis n retro-orbital mass.
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