• Laboratory Test Database
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  • New Test Request
  • Normal Range Data
  • Clinical Analyte Unit Conversion
  • SI Unit Dictionary
  • Test Utilization Information
  • General Lab Info
    • Laboratory Operations
    • Specimen Collection
    • Laboratory Inquiries & Reports
    • Transfusion Service & Blood Donor Center
    • Bone Marrow
    • Microbiology
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    • Directory/Abbrev.
• Licensing/Medical Necessity
  • Our Licensing and Accreditation
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    • ICD9 Verification
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• Point of Care/Provider Performed Testing
  • Point Of Care Testing Manual
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• Special Reporting Regulations
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  • Graph Of Recent Viral Isolates
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Laboratory Medicine Residents are available for assistance and consultation 24 hours a day, seven days a week.

1. CONTACTING LABORATORY MEDICINE RESIDENTS

Routine hours: Monday through Friday 8 am - 5 pm

Clinical Chemistry Resident:	Pager: (415) 327-9500
Hematology/Blood Bank Resident:	Pager: (415) 327-9952
Microbiology Resident:	Pager: (415) 327-9695

2. ON-CALL HOURS

At all other times, page the Lab Medicine Resident on call at pager number

(415) 443-6969 or call Clinical Lab General Information, 206-8590, to contact the resident on call.

3. CONSULTATION

The residents and faculty of the Department of Laboratory Medicine are pleased to consult on general or specific problems of test selection and interpretation, and to assist in resolving problems or obtaining unusual laboratory services. Call us if you have questions about the collection and handling of a specimen, the availability of a particular test, or the interpretation of a test result. The Laboratory Medicine Resident can also arrange for laboratory procedures that require advance approval, scheduling, or special handling of the specimens. Please be prepared to give the patient’s name, hospital number and location.

Contact the Laboratory Medicine Resident IMMEDIATELY if you have any questions about test results; for example, if you question whether or not a test result is clinically significant, or if a result is unexpected for the patient’s clinical condition.

4. TEST APPROVAL

A number of laboratory tests, including all procedures not specifically listed in this manual, require advance approval by the Laboratory Medicine Resident (or, in some cases, the Resident or Fellow in a specialty such as Hematology or Endocrinology). It is the responsibility of the requesting physician to call the appropriate Resident for approval. For further information, refer to the Availability section under the ALPHABETICAL LIST OF TESTS, or to the list of “Tests Requiring Approval” .

This requirement for advance approval was instituted to assure that only medically appropriate tests are performed and to encourage the most effective utilization of the limited resources of the department. The approval procedure is supported by the SFGHMC Chiefs of Service. Any questions, comments, or problems related to this policy should be addressed to the Director of the Clinical Laboratory.

5. BLOOD PRODUCT APPROVAL

Transfusion Service (Blood Bank) Orders for Apheresis Platelets, Fresh Frozen Plasma, and Cryoprecipitate Needing Approval of the Laboratory Medicine Resident

All orders for Apheresis (Single-Donor) Platelets, Fresh Frozen Plasma and Cryoprecipitate will be screened by the Blood Bank technologists except for patients in Surgery and the Emergency Department.

A. Apheresis platelet orders will need approval:

1. If platelet count >20,000/µL

Exceptions: 1) Platelet count < 50,000/µL in bleeding patients or in patients pre-invasive procedure (surgery, biopsy, spinal tap, thoracentesis, paracentesis), 2) platelet count < 75,000/µL for patients receiving massive transfusion; i.e., transfusion of at least one blood volume/24 hours, and bleeding uremic patients, or 3) patients with a platelet count < 100,000/µL undergoing any neurosurgical or ophthalmological procedure (7 days before or after surgery).

2. If no platelet count has been obtained within the last 24 hours.

B. Fresh frozen plasma orders will need approval if:

1. The PT/PTT are normal or have not been obtained within the last 24 hours.

2. The INR is < 1.5 and the patient has not been transfused with at least 4 red cell or whole blood units in the last 24 hours.

3. The PTT is < 55 seconds.

4. Exceptions: Patients with a diagnosis of TTP do not require approval.

C. Cryoprecipitate orders will need approval:

If fibrinogen is over 100 mg/dL or not done within last 24 hours.

Exception: Patients with known afibrinogenemia.

6. TESTS REQUIRING APPROVAL

The list below contains frequently requested laboratory tests that must be approved before they are performed. Consult the entry in the Alphabetical List of Tests section for specific instructions for obtaining approval for each test. Obtain approval before the specimen is drawn. Any test not otherwise listed in the Clinical Laboratory Manual requires approval.

Clinical Chemistry Resident:	Pager (415) 327-9500
Endocrinology Service:	206-8239
Endocrinology Fellow:	Long Range Pager 719-9535
Microbiology Resident:	Pager (415) 327-9695
Hematology/Blood Bank Resident	Pager (415) 327-9952

• After hours call 206-8590 or pager (415) 443-6969

Tests Requiring Residents Approval

TEST	APPROVAL SOURCE
Adrenocorticotrophic Hormone (ACTH)	Endocrinology / Clinical Chemistry
Amino Acids, Fractionated	Clinical Chemistry Resident
Anti-ENA (Extractable Nuclear Antigen)	Rheumatology / Clinical Chemistry
Antibacterial Assay, Serum (Serum Cidal Test)	Microbiology Resident
Anti-Glomerular Basement Membrane Antibodies	Clinical Chemistry Resident
Antimicrobial Susceptibility for bacteria, fungi: Tube Dilution, Synergy, Combination antibiotics	Microbiology Resident
Anti-Sjogren's Antibodies (SSA=RO,SSB=LA)	Rheumatology / Clinical Chemistry
Antithrombin III	Hematology / Blood Bank Resident
Anti-Yo	Clinical Chemistry Resident
Arsenic (Quantitative)	Clinical Chemistry Resident
Arsenic, Urine	Clinical Chemistry Resident
BCR/ABL Gene Rearrangement Study	Hematology / Blood Bank Resident
Bile Acids, Total and Deoxycholic Acid	Clinical Chemistry Resident
Blood Components	Hematology / Blood Bank Resident
Bone Marrow Aspiration (Includes bone marrow hemosiderin and H & E sections. Bone marrow biopsy is performed when indicated.)	Hematology Fellow (Consult Clinical Hematology Service)
Bordetella pertussis PCR	Microbiology Resident
Cancer Antigen (CA 19-9)	Clinical Chemistry Resident
Cardiolipin Antibodies	Hematology / Blood Bank Resident
Catecholamines (Epinephrine, Norepinephrine)	Endocrinology / Clinical Chemistry
Chromosome analysis: Requires these forms, pre-approved: ARUP Patient History Form UCSF Marker Study Request	Hematology / Blood Bank Resident
Cyanide, Blood	Clinical Chemistry Resident
Cytomegalovirus, Blood	Microbiology Resident
Cytomegalovirus, Bone marrow	Microbiology Resident
Darkfield Exam for Treponema pallidum	Microbiology Resident
Epstein Barr Virus Antibody Panel	Microbiology Resident
Erythropoietin	Hematology / Blood Bank Resident
Erythrocyte Enzymes (other than G6PD)	Hematology / Blood Bank Resident
Estriol, Estrone	Clinical Chemistry Resident
Factor Assays (Coagulation)	Hematology / Blood Bank Resident
Fecal Fat (24, 48 or 72 hours, total)	Clinical Chemistry Resident
Fibrinogen - Immunological	Hematology / Blood Bank Resident
Flow Cytometry (not CD4/CD8)	Hematology / Blood Bank Resident
Free Cortisol, Urine	Endocrinology / Clinical Chemistry
Fungal Susceptibility Testing	Microbiology Resident
Glucagon	Endocrinology / Clinical Chemistry
Hemoglobin, Plasma	Hematology / Blood Bank Resident
Hepatitis B E-Antibody	Clinical Chemistry Resident
Hepatitis B E-Antigen	Clinical Chemistry Resident
Hepatitis C Viral RNA, Genotype	Microbiology Resident
Histoplasma Antigen	Microbiology Resident
HLA-B27	Rheumatology / Clinical Chemistry
Homovanillic Acid, Urine	Clinical Chemistry Resident
Human Placental Lactogen	Clinical Chemistry Resident
Hydroxyproline, Total (Urine)	Clinical Chemistry Resident
Insulin Antibody	Endocrinology / Clinical Chemistry
Lupus Anticoagulant	Hematology / Blood Bank Resident
Lyme Disease Serology	Microbiology Resident
Methylmalonic acid (urine)	Clinical Chemistry Resident
Mixing Studies (inhibitor screen)	Hematology / Blood Bank Resident
Organic Acids, Qualitative, Urine	Clinical Chemistry Resident
PCR for viruses	Microbiology Resident
Phenylalanine > 10 yrs old <10 yrs old - no approval required	Clinical Chemistry Resident
Plasminogen	Hematology / Blood Bank Resident
Platelet Aggregation	Hematology / Blood Bank Resident
Pregnanediol or Pregnanetriol	Endocrinology Service
Protein C	Hematology / Blood Bank Resident
Protein S	Hematology / Blood Bank Resident
Reptilase Time	Hematology / Blood Bank Resident
Ristocetin Cofactor	Hematology / Blood Bank Resident
Rotavirus Enzyme Linked Assay	Microbiology Resident
Rubella Culture	Microbiology Resident
Russell’s Viper Venom Test, Dilute	Hematology / Blood Bank Resident
Serum Cidal Test (or Serum Killing Level)	Microbiology Resident
Somatomedin-C	Endocrinology / Clinical Chemistry
Syphilis (Treponema pallidum) Darkfield	Microbiology Resident
Thrombin Time	Hematology / Blood Bank Resident
Thrombosis Risk Factors Mutations	Hematology / Blood Bank Resident
Toxoplasma IgM	Microbiology Resident
Tube Dilution Antimicrobial Susceptibility, Synergy	Microbiology Resident
Urine Hemosiderin	Hematology / Blood Bank Resident
Urobilinogen (quantitiative)	Clinical Chemistry Resident
Vanillylmandelic Acid (VMA)	Endocrinology / Clinical Chemistry
Viral Susceptibility Testing	Microbiology Resident
Vitamin B6	Clinical Chemistry Resident
Von Willebrand Antigen	Hematology / Blood Bank Resident
Von Willebrand Multimers	Hematology / Blood Bank Resident