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Client Communications

2019

  • Patients on high dose supplements of biotin (minimum 5-10 mg/day), such as hair/nail/ skin supplements, should refrain from taking them in the 24 hours prior to laboratory test.
  • Supplements may or may not prominently indicate they contain biotin.
  • Patients taking prescribed megadose regimens (>150 mg biotin, usually prescribed for multiple sclerosis) should refrain from taking the supplements for 2-3 days prior to laboratory testing, after consulting with their physician.

THE LEVEL OF BIOTIN TYPICALLY FOUND IN MULTIVITAMIN TABLETS DOES NOT INTERFERE WITH LABORATORY TESTING. *Patients and physicians should review any lab test result that does not match the clinical presentation and consider if biotin interference is present.

Effective November 4, 2019, East Side Clinical Laboratory will no longer offer Helicobacter pylori (H. pylori) serology testing based upon changes in H. pylori testing guidelines of the American College of Gastroenterology and the American Gastroenterology Association. The discontinued antibody tests below will be inactivated in our compendium and will not be orderable. Serological antibody results have poor positive predictive value (PPV) and are no longer considered clinically useful. The alternative noninvasive testing methods demonstrate higher clinical utility, sensitivity, and specificity.

A positive H. pylori IgG, IgA, or IgM result cannot be used to predict the presence of active disease. Since antibodies to H. pylori remain detectable for years following resolution of infection, serologic testing cannot be used to distinguish active from past infection or to document eradication of the organism following successful treatment.

Many insurance companies are no longer reimbursing patients for whom H. pylori serologic testing was performed, as they consider such testing “not medically necessary”. As an alternative, providers are encouraged to collect samples for Urea Breath Test or Stool Antigen Test. Both assays are FDA cleared for use to detect H. pylori infection, and as a test of eradication. Clients should order collection kits as needed with instructions for use.

Discontinued Test With Order Codes:

Order CodeTest
4138H. pylori IgG, IgA, IgM Antibodies
4091H. pylori IgG Antibody
4140H. pylori IgA Antibody
4141H. pylori IgM Antibody

 

Recommended Tests With Order Codes

Order CodeTest
1832H. pylori Antigen, Feces
5173H. pylori Breath Test

If you have any questions please call East Side Clinical Laboratory at 800.455.8440

Or contact your East Side Clinical Laboratory representative.

Effective September 15, 2019 East Side Clinical Laboratories will offer a new collection device, the APTIMA Multitest Orange Swab for Bacterial Vaginosis, Candida, Gonorrhea (GC), Chlamydia (CT) and Trichomonas (Trich) Amplification Testing. This swab can be used in place of the white label APTIMA swab (with the exception of endocervical and male urethral samples)

APTIMA Multitest Orange Swab Utilization

Clinician CollectedESCL Test Code
GC Vaginal4180
CT Vaginal4179
Trichomonas Vaginal5650
GC/CT Vaginal4181
GC/CT Trich Vaginal5780
GC/CT Oral5740
GC/CT Anal5698
Bacterial Vaginosis Panel15700
Bacterial Vaginosis, Candida, Trichomonas16201
Bacterial Vaginosis, Chlamydia/GC16202
Bacterial Vaginosis, Candida, Chlamydia/GC, Trichomonas16203
Candida by PCR15800
Mycoplasma/Ureaplasma  PCR16770
HSV I/II, VZV by  PCR13322
HSV I/II by  PCR5367

 

Specimen Information

Turn Around TimeAnalytic time 2-5 days after receipt
TransportationRoom temperature (15-25°C) or refrigerated (2-8°C)
StabilityAfter inoculation, sample stable in collection device for 60 days
Rejection CriteriaEmpty collection devices, unlabeled samples and leaking samples

 

  Value stated and less thanValue stated and greater than

Amylase

 

 

400

Calcium

 

6

13

CKMB

  • Male

  • Female

 

 

 

7.8

4.4

CO2

 

10

40

CPK

 

 

400

Creatinine

 

 

5

CSF (Cerebral Spinal Fluid)

All Results

 

 

Cultures

  • Acid Fast Culture

  • Blood Cultures

  • Stool Culture*E-Coli 0157*

All Positives

 

 

D-Dimer

 

 

0.51

Glucose

 

50

400

Hemoglobin

 

7

 

Malaria/Babesia on peripheral smear

Call/page all positive or suspicious results

 

 

Platelet

 

20,000

1,000,000

Potassium

 

3

6.5

Potassium (heparin)

 

3

6.5

PT/INR

 

 

5 INR

PTT

 

 

70

Sodium

 

120

160

Therapeutic Drugs

 

 

 

  • Digoxin

 

 

2.1

  • Dilantin

 

 

30

  • Lithium

 

 

2.0

  • Phenobarbital

 

 

50

Total Bilirubin

 

 

5

Troponin

Call/page if abnormal

 

 

WBC-Adult/child

 

1.5

50.0

 

2018

Effective January 1, 2019, East Side Clinical Laboratory (ESCL) will discontinue offering combined testing for high and low risk Human Papillomavirus (HPV). Low Risk HPV will no longer be performed. This change is due to the implementation of newer analytic methods and testing algorithms.

 

The following tests/order codes will be deleted with this update:

Test NameTest Code
PAP and HPV (high and low risk)4176
PAP with GC/Chlamydia4178
HPV (high and low risk)4196
PAP smear with HPV  Reflex for Ascus/Agus4182

 

HPV low risk will be removed from the following test codes with this update:

Test NameTest Code
PAP with HPV reflex Ascus/Agus and GC Chlamydia4184
PAP with HPV reflex for all abnormalities and GC/Chlamydia4193

As an alternative, ESCL offers Roche high risk HPV testing with genotyping information. Amongst high risk HPV infections, genotypes 16 and 18 are most strongly associated with cervical cancer and severe Dysplasia/CIN3.

For high risk testing with genotype information, we offer the following:

Test NameCode
HPV Genotypes 16 and 189848
HPV Genotypes 16 and 18/4515670
HPV High Risk Genotype 16/18 with reflex PAP10075
HPV mRNA E6/E74174
HPV mRNA Genotpyes 16, 18/4516565
HPV mRNA with reflex to Genotypes 16, 18/4516564
  

High risk HPV:

  • Co-testing is endorsed by the American Congress of Obstetricians and Gynecologists (ACOG) and other authorities for woman 30-65 years of age

     

  • Algorithms adopted by the American Society for Colposcopy and Cervical Pathology (ASCCP) recommend high risk HPV genotyping for types 16 or 18 as an immediate alternative to a return visit for a  pelvic examination and repeat co-testing for those patients found to be high risk HPV positive and PAP negative(see algorithms at www.asccp.org/Guidelines)
  • Genotyping for 16 and 18 can be used to refine management of women 21-29 years of age in certain clinical scenarios

For questions related to HPV testing options, please contact your ESCL account representative.

East Side Clinical Laboratory is pleased to announce the introduction of the QuantiFERON-TB Gold Plus assay which offers optimized analysis with tuberculosis (TB)-specific antigens that elicit both CD4+ and CD8+ T-cell responses. The new 4-tube collection set enables a more comprehensive assessment of cell-mediated immune responses to TB infection

Clients should begin to order QFT - 4 tube kits but may continue to send the 3-tube collection kits until January 1, 2019 when the 3-tube version will be discontinued.

The 4-tube assay requires the same pre-analytical processing steps as the current 3 tube QuantiFERON Gold assay. Immediately after filling the tubes with 1ml blood, shake 10 times just firmly enough to coat the inner surface of the tubes without disrupting the gel.

Please use test code 9884 when ordering the 4-tube assay. Tubes should remain at room temperature for same day transport to ESCL

 

For questions related to TB GOLD Plus testing, please contact your ESCL account representative.

 

Thank you for choosing East Side Clinical Laboratory

2017

NEW TEST ANNOUNCEMENT

Rapid Flu A + B Testing by Molecular Isothermal Nucleic Acid Amplification

Influenza is a viral infection that affects mainly the nose, throat, bronchi and, occasionally, lungs. Seasonal influenza viruses circulate worldwide and can affect anybody in any age group. The viruses cause annual epidemics that peak during winter in temperate regions. Seasonal influenza is a serious public health problem that causes severe illness and death in high risk populations

Rapid and accurate diagnosis of viral infection is critical to reducing the disease burden of influenza and its social and economic consequences. Since taking antiviral drugs within the first 48 hours after first symptoms appear may reduce the length of illness and help prevent more-serious problems with influenza, it is important to get accurate test results early.

East Side Clinical Laboratory will begin offering a molecular nucleic acid amplification method for rapid testing of Influenza A and B.

  • This molecular method increases the likelihood of detection of Flu A + B:
  • Non-molecular methods have lower sensitivity and relies on the quality of the sample collected
  • Molecular methods have increased sensitivity for more reliable detection of infection
  • Molecular amplification increases the likelihood of detection, even in suboptimal collections
  • Molecular test looks for nucleic acid-DNA or RNA to identify molecule while lateral flow uses antibody/antigen response
  • Highly accurate results in 15 minutes from start to finish of testing
  • More accurate testing = better patient care

PLEASE NOTE THAT ACCEPTABLE SPECIMEN REQUIREMENTS FOR THIS TEST ARE:

Nasal eSwab from just inside the nares

Nasopharyngeal swab (which can be supplied by ESCL upon request. These swabs are not normally supplied and might need to be specially ordered resulting in longer turn around time)

Throat swabs ARE NOT an acceptable specimen for molecular flu testing

Please contact your East Side Clinical Laboratory service representative for more information

Immunochemical Fecal Occult Blood

Effective July 19, 2017 East Side Clinical Laboratory has introduced iFOBT as part of its routine testing for screening colorectal cancer. As an immunological test for fecal hemoglobin, iFOBT is more accurate than the conventional guaiac methods.  This test does not show significant cross-reactivity against dietary substances and does not require special restrictions prior to testing.

The test is recommended for:

  • Routine physical examination
  • Monitoring bleeding in patients
  • Screening colorectal carcinoma

Due to improved sensitivity and specificity of this method, only one sample collection from a single bowel movement is required for testing.

Patients can submit their specimen by mail by following the instructions for the iFOB collection device, or they may collect the sample in sterile container and drop off at any of our patient service centers.

Comparison of iFOB vs Chemical Guaiac based method

iFOBTGuaiac Based Method
Immunoassay test using antibodies to detect human hemoglobin protein in stoolChemical Test
Highly specific for human hemoglobinPotential fals positives from food and medications
Detects as low as 50ng/mL human specific hemoglobinDetects 90,000ng/mL or higher of non-specific hemoglobin
No dietary or drug restrictions or preparationsDiet and drugs can interfere ; seveal days of preparation required
Only one sample is requiredThree samples are required
Intended Use1
  • An aid in the diagnosis of individuals suspected of having congestive heart failure
  • Risk stratification of patients with acute coronary syndrome and congestive heart failure
  • Use as an aid in the assessment of increased risk of cardiovascular events and mortality in patients at risk for heart failure who have stable coronary artery disease
72-hour Sample Stability2NT-proBNP is stable in EDTA plasma for three days at room temperature or longer at 4°C
Practical Considerations for Use of Natriuretic Peptide Testing3
 

In patients presenting with acute dyspnea:

  • Natriuretic Peptide(NP) levels should be interpreted as a continuous variable.
  • The knowledge of each individual patient’s baseline NP level may further improve physician diagnostic accuracy.
  • Elevations in NT-proBNP levels may be observed in states other than left ventricular congestive failure, including: acute coronary syndromes, right heart strain/failure (including pulmonary embolism and corpulmonale), critical illness, renal failure and atrial fibrillation as well as advanced age.
  • Low NP levels in patients with or without heart failure may be observed with increasing body-mass index.

 

In patients admitted to hospital with decompensated heart failure:

  • Studies have shown NP levels should be measured routinely on admission and prior to discharge when the patient is considered optivolemic.
  • While a drop in NP level in response to treatment is important, the final NP level seems to be the most accurate predictor of death or readmission.
Natriuretic Peptide Levels Across Stages of Heart Failure4BNP and NT-proBNP values (median, 25th – 75th percentile) in patients classified according to AHA/ACC classification
Prognostic Value of Changes in NT-proBNP in Patients with Chronic Heart Failure5Rising peptide levels predict a higher likelihood of HF-related complications and death, while falling levels are associated with decreased risk. Trend information of peptide levels over time provide a more comprehensive picture of patient risk than single tests.
References1 proBNP II Package Insert (2015-02, V 8.0) 2 Yeo KT et al. Multi-center evaluation of the Roche NT-proBNP assay and comparison to the Biosite Triage BNP assay. Clinica Chimica Acta. 2003; 338:107-115.. 3 Maisel A et al. State of the art: Using natriuretic peptide levels in clinical practice. European Journal of Heart Failure. 2008;10:824-839. 4 Emdin M, et al. Comparison of BNP and NT-proBNP for early diagnosis of heart failure. Clin. Chem. 2007; 53:1289-1297. 5 Masson, S., et al.: Prognostic Value of Changes in N-Terminal ProBNP in Val-Heft (Valsartan Heart Failure Trial). JACC. 2008;52:997-1003.

 

Enter body of accordion

BNP has been switched to NT-ProBNP

It is important to note that the numerical results and reference ranges for previous BNP and NT ProBNP are not interchangeable.

 

Pro B Natriuretic Peptide (NT-ProBNP) Blood Level: Test Code 5285

Replacing: 9401 BNP (Brain Natriuretic Peptide)

Specimen Requirements: 1 ml Serum from SST. Refrigerate. Stable 6 days refrigerated.

New Interpretive Ranges:

AgeHeart Failure Likely
<50 years≥ 450 pg/mL
50 -75 years≥ 900 pg/mL
>75 years≥ 1800 pg/mL
If NT-ProBNP is less than 300pg/mL, heart failure is unlikely for all ages.
  • Proven to be better of early heart failure in multiple studies
  • Zero percent cross reaction with Natrecor (recombinant BNP) allowing the usage of NTproBNP to observe patient response while infusion is in progress.
  • Inactive adn stable part of the natriuretic molecule; therefore, present in bloodstream longer (half-life of 2 hours) versus BNP half-life of 18 minutes.
  • In-vitro strability of 6 days, refrigerated/ 
  • Values for NO-ProBNP are generally 8 to 10 times higher than BNP.

Please refer to www.esclab.com for additional information.

Dear ESCL Client:

Effective May 1, 2017, be East Side Clinical Laboratory will offer high sensitive cardiac Troponin T  as a replacement for current Troponin I  testing.

High sensitivity (hs) cardiac Troponin T (cTnT) has been validated on the Roche cobas® platform as an Electrochemiluminescent Immunoassay (ECLIA) and orders will be migrated to Troponin T beginning May 1, 2017

Gimenez MR, et. al. measured the diagnostic and prognostic accuracy of cTnT and cTnI using clinically available high sensitivity assays (Roche hs-cTnT vs. Abbott hs-cTnI). Patients at presentation, early presenters (< 3 hours since onset of chest pain), late presenters and prognostic accuracy were evaluated.

The findings demonstrated:

  • Diagnosis at presentation performance was similar for both hs-cTnT and hs-cTnI.
  • Diagnosis of early presenters showed slightly higher accuracy for hs-cTnI.
  • Diagnosis of late presenters showed superior performance for hs-TnT.
  • Prognostic accuracy for all-cause mortality was significantly higher for hs-cTnT.

Diagnostic performance of high-sensitivity cardiac troponins I and T. Receiver-operation-characteristic curves show the diagnostic accuracy of high-sensitivity cardiac troponins I and T for non-ST segment myocardial infarction at presentation to the emergency department with acute chest pain in the overall cohort (A) and in patients with a chest pain onset with 3hrs (B)

Diagnostic performance of high-sensitivity cardiac troponins I and T.

Diagnostic performance of high-sensitivity cardiac troponin T and I within time. Receiver-operation-characteristic curves displaying the diagnostic accuracy for non-ST segment myocardial infarction of serial sampling of high-sensitivity cardiac troponin I vs. high-sensitivity cardiac troponin T.   Prognostic performance of high-sensitivity cardiac troponin T and I. Receiver-operation-characteristic curves displaying the prognostic accuracy for all-cause mortality during the 24-month follow-up of high-sensitivity cardiac troponin I and high sensitivity cardiac troponin T.    

Diagnostic performance of high-sensitivity cardiac troponin T and I within time.

 Diagnostic performance of high-sensitivity cardiac troponin T and I within time. Receiver-operation-characteristic curves displaying the diagnostic accuracy for non-ST segment myocardial infarction of serial sampling of high-sensitivity cardiac troponin I vs. high-sensitivity cardiac troponin T. 

Prognostic performance of high-sensitivity cardiac troponin T and I.

 Prognostic performance of high-sensitivity cardiac troponin T and I. Receiver-operation-characteristic curves displaying the prognostic accuracy for all-cause mortality during the 24-month follow-up of high-sensitivity cardiac troponin I and high sensitivity cardiac troponin T. 

The bleeding time test has been available for many years as a means of evaluating platelet function during hemostasis. Under controlled conditions an incision is made in the skin and the duration of bleeding measured using a modified template device.

Although several modifications of this test have been devised to improve it, the test is still highly operator-dependent, plagued by a lack of clinical reproducibility, and affected by numerous technical factors such as location of the incision, pressure applied, operator experience, and patient factors such as age, gender, diet, hematocrit, skin laxity and medications. Over the past decade, studies have shown the bleeding time is not reliable as a screening test for perioperative bleeding or as a diagnostic test for bleeding disorders (Arch Path Lab Med, 1996; 120:353-56; Arch Surg, 1998; 133:134-39; Clin Chem 2001; 47: 1204-1211).

Accordingly, East Side Clinical Laboratory has made the decision to discontinue offering the bleeding time test.  In the absence of the bleeding time, a careful clinical history including family, dental, obstetric, surgical, traumatic injury, transfusion, and drug history is recommended. In addition, the most common hemostatic disorders can be ruled out by performing screening tests of coagulation (PT and aPTT), a platelet count, and ruling out von Willebrand’s disease (Factor VIII, von Willebrand factor Antigen, Ristocetin Cofactor). If these tests are negative the possibility of a platelet function disorder can be investigated by performing platelet aggregation testing.

 

Please contact us at 401.455.8400 if you have any further questions.

 

Sincerely,

Walther M. Pfeifer, MD

Laboratory Director

East Side Clinical Laboratory