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The Essence: The Best of March 2020

By Anne-Margaret Olsson posted 04-08-2020 15:57

The Artery is your community for finding solutions to your day-to-day clinical chemistry questions. Last month, several answers were found to questions ranging from “How Do You Flag Send-Out Tests in Your EMR?” to “Masking in the Lab?”. Read on for our editor’s picks of the best discussions on the Artery in March.

Hemoglobin A1c Flags and Unusual Results
Initiated by @Matthew Wasco, MD

A lab recently implemented a new HbA1c electrophoresis assay, and one of the flags that has popped up more than others is a broad peak of A1c. What does this finding mean? Respondents say possible causes could include an interfering hemoglobin fragment, a rare post-translational modification, or a low-abundance, perhaps unstable hemoglobin gene product. Those who have experienced the same thing do not report the A1c value. Instead, they either send to a reference lab that uses another method or perform a CBC to check for a hemoglobinopathy.

How Do You Flag Send-Out Tests in Your EMR?
Initiated by @Charles Beavers, MD

One lab wants to flag send-out tests at order entry so that physicians either a) know to expect a delay or b) are guided toward an in-house test. One respondent’s lab does this with a popup message and hard-stop order questions. Another respondent’s lab tags all send-out tests with “-SO” at the end of their name. However, she’s not sure if you can retrospectively flag a test as a send-out after it’s built—and a third respondent points out that if anyone can figure out how to track unbuilt send-out test reports in the EMR, it would be a great boon for assessing utilization.

COVID-19 Serologic Diagnostics
Initiated by @David Alter, MD DABCC

Has anybody heard anything about the possibility of a serologic test for COVID-19? Respondents say that both CDC and Mayo Clinic are developing serology tests. Others caution labs that are considering adopting serology tests from unknown or non-reputable diagnostic companies, as FDA has warned that there are several testing scams out there. Respondents also discussed how serology testing would provide much-needed additional information about COVID-19 related to disease progression, development of immunity, and how much of the population has really been exposed.

Masking in the Lab?
Initiated by @Charles Beavers, MD

Is anyone considering masking their entire lab with droplet masks? Seven out of 10 respondents say that either their lab or entire institute is already requiring masks for all employees, while an eighth respondent’s lab is allowing med techs to wear a mask if they wish. Institutes are using surgical or non-medical masks for lab staff, while N95 masks are limited to direct clinical interactions with COVID patients. The number of masks given to each person in the lab (one per day vs. one per week) varies based on the institute.