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The Essence: The Best of November 2020

By Anne-Margaret Olsson posted 12-09-2020 13:33


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 "Does Your Lab Receive an Overwhelming Number of Calls from Nurses?" to “Should Vaccination of People with Persistent SARS-CoV-2 Antibodies be Temporarily Deferred?”. Read on for our editor’s picks of the best discussions on the Artery in November.

Increased Phone Calls

Initiated by @Shelley D’Attilio, MT (ASCP)

 One lab is being crushed by telephone calls from nursing staff looking for the status of SARS-CoV-2 tests and is wondering if other labs have the same problem and what they’ve done to fix it. Respondents have many suggestions, including: educating nurses about why some patients get rapid tests and others don’t; having the Incident Command Center evaluate and approve nearly all stat SARS-CoV-2 testing, so that other personnel can no longer bully the lab into giving a patient a stat test; and diverting calls to a centralized call center.


QC Rule Selection

 Initiated by @Carleton Anderson, MD 

TEA/CV calculates the sigma metric for choosing quality control rules, but when you have two or three controls in use, is the CV an average of all controls used for the analyte in question or simply the largest CV? One lab medicine professional says that her understanding is that you pick a QC level closest to the medical decision level you are most concerned with. Then you would look at the precision (%CV) over a period of several months.


Are Band Counts Required for the Surviving Sepsis Bundle?

 Initiated by @Charles Beavers, MD

Have any labs been able to sunset the neutrophil band count? One lab is trying, but they’re getting push back from their intensivists, who believe band counts are necessary to meet the requirements for the Surviving Sepsis Campaign. All respondents agree that band counts are unreliable and feel that the requirement for them is an example of guidelines being written without lab input. The Mayo Clinic hasn’t reported band counts for 16 years, and another respondent suggested adopting immature granulocyte % as a substitute. Many labs haven’t been able to sunset this test due to the guidelines, though.


More on Reinfection

Initiated by @Stanley Levinson, Ph.D 

As more research comes out suggesting that reinfection with SARS-CoV-2 is unlikely, an Arterian is wondering if vaccination of people with persistent SARS-CoV-2 antibodies should be temporarily deferred to ensure that higher risk individuals have access to limited vaccine supplies. Respondents agree that this makes sense. However, one respondent thinks that Ig antibodies are not a practical marker for determining who has SARS-CoV-2 immunity, and that it would be more effective to simply say that anyone who has tested positive for SARS-CoV-2 RNA in the past will be vaccinated last.