Archived Physician Notices

LifeLabs will be undertaking an extensive IT server upgrade from Saturday through Monday, September 3-5 and you will not be able to order laboratory tests from LifeLabs during this time.

We recommend that patients who require elective testing be advised to visit a LifeLabs patient service center (PSC) no later than noon on Friday, September 2 – this will allow us enough time to perform the test and communicate its result before the IT upgrade begins.

Please take the time to communicate this advice to patients who require regular elective testing (e.g., INRs) in anticipation of the Labour Day weekend, to facilitate prompt patient management and care.

Also due to the IT server upgrade:

The results for those tests that are incomplete before the Labour Day weekend will not be available until Tuesday, September 6. Urgent requests or results with critical or alert levels will, however, be communicated to you as per normal procedures;
LifeLabs PSCs will be closed Saturday through Monday, September 3-5;
Courier service will not be provided on Saturday, September 3 for in-office specimen collections. Specimen integrity may be compromised for Microbiology, Hematology, and Chemistry specimens collected in your office that day if they are kept until the Tuesday – we advise you not to collect such specimens or, if they are required, they should be directed to other community laboratories.

To verify the PSC hours of operation over the long weekend or discuss your testing and reporting needs, please call the Customer Care Center at 416-675-3637 or toll free 1-877-849-3637.

June 29, 2011

Renin Analysis: LifeLabs Changes to Method and Reporting

Plasma renin has an important role in the clinical assessment of hypertensive patients and is measured as plasma renin activity assay or as direct renin antigen.

Plasma Renin Activity (PRA)

Measurement of PRA in plasma involves quantitation of Angiotensin I by renin enzymatic activity acting on endogenous or exogenous plasma angiotensinogen. The concentration of Angiotensin I produced is proportional to the amount of active renin in the plasma. Currently, Lifelabs uses the Diasorin PRA radioimmunoassay and reports renin activity in ng/L/s.

Note: the “ng” refers to the amount of Angiotensin I produced.

Direct Renin

Direct renin immunoassays measure the concentration of renin protein in the plasma. These methods are calibrated to the International Reference Preparation of human renin (68/356).

Direct sandwich immunoassays for renin protein offer improved precision and lower limits of detection, compared to PRA methods. These characteristics are particularly important as they provide a more accurate calculation of the Aldosterone/Renin Ratio at a low renin concentration, which is commonly seen in patients with primary aldosteronism.

In June 2011, LifeLabs will implement a direct renin chemiluminescent immunoassay (Diasorin Liaison) and, at that time, will begin to report renin in units of ng/L.

Note: In this case, the “ng” refers to the amount of renin protein.

A patient correlation between the Diasorin PRA RIA method and the Diasorin Liaison direct renin method was conducted. Although a positive overall correlation was demonstrated between the two methods, many samples, particularly those with low results, deviated from the line of best fit. It is important to remember that the two types of assays are measuring very different properties of renin. For these reasons, a universal factor for “converting” results from one method to the other is not available.

Aldosterone/Renin Ratio (ARR)

One of the primary clinical indications for renin measurement is the evaluation of patients with suspected primary aldosteronism (PA). The Endocrine Society, cosponsored by the European and International Societies of Endocrinology and Hypertension, recently published guidelines for diagnosis and management of patients with PA.² The guideline indicates that the ARR is the most reliable available means for screening for PA and is superior to measurement of potassium or aldosterone or of renin in isolation.

The guideline reports that the ARR is most sensitive when used in patients who have had unrestricted dietary salt intake before testing. It is recommended that samples be collected in the morning, after patients have been upright, (i.e. sitting, standing, or walking), for at least 2 hours.

Note: No interpretative guidelines are provided for samples collected from patients in a supine position.

While beyond the scope of this article, the reader may refer to the published guideline for a comprehensive list of factors, including medications, to be considered when preparing the patient and in interpretation of renin results.²

With the introduction of the new direct renin method, LifeLabs will also include calculation and report of the ARR for samples collected from patients in the upright position. ARR results will be calculated using Aldosterone measurements in units of “pmol/L” and Renin in units of “ng/L”. On the lab report, ARR results will be reported as “pmol/ng”.

Using these units and the methods specifically used by LifeLabs, the following guidelines have been developed to aid in the interpretation:

ARR (pmol/ng)

Interpretation

<40

Aldosteronism is unlikely when the Aldosterone/Renin Ratio (ARR) is less than 40.

40-65

Aldosteronism is possible when the Aldosterone/Renin Ratio (ARR) is between 40 and 65.

>65

An Aldosterone/Renin Ratio (ARR) greater than 65 is significant evidence of aldosteronism.

Author: Peter Catomeris, PhD, FCACB, is a Clinical Biochemist for LifeLabs Ontario.

References

1.      Campbell DJ, Nussberger J, Stowasser M, Jan Danser AH, Morganti A, Frandsen E, and Menard J. Activity Assays and Immunoassays for Plasma Renin and Prorenin: Information Provided and Precautions Necessary for Accurate Measurement. Clin Chem (2009) 55(5): 867 – 877.

2.      Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, Young WF Jr., and Montori VM. Case Detection, Diagnosis, and Treatment of Patients with Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab (2008) 93(9): 3266 – 3281.

June 21, 2011

**IMPORTANT INFORMATION**
Impact of Postal Strike

As a result of the postal workers strike, we are unable to mail out reports through Canada Post. LifeLabs operates its own courier service to enable the pick up and delivery of samples and reports in a timely manner. The postal service is however used for:
• Delivery of reports to some clients
• Delivery of Cancer Care Ontario FOBT testing samples

Although we are using alternate methods such as third-party courier service to deliver your reports, there is a delay in delivery of reports that are normally sent through mail. LifeLabs will continue to communicate all “alert” or “critical” values as well as urgent and fax requests as specified in the OAML Guideline for Reporting Laboratory Test Results. We are doing everything we can to provide the best service under these circumstances and apologize for any delay experienced.

If you are concerned with a patient’s results and want to ensure timely receipt of the results, please indicate your fax number on the requisition and the results will be faxed to you upon completion of testing. If you currently receive your mail through a P.O. Box you will need to contact Lifelabs and advise us of your full office address or fax number so that reports may still be delivered to you.

Colon Cancer Check FOBT Kits:
If a postal strike is launched, Canada Post will likely seal all mailboxes. If the patient has been given an FOBT kit for testing, they will not be able to return the kit by mail. Please advise your patients that they should either drop off the kit in any LifeLabs Patient Service Center or return the kit to your office for pick up by your next regularly scheduled LifeLabs courier. A complete listing of our locations is available on our website at www.lifelabs.com

Please contact our Customer Care Centre at 1 877 849 3637 if you have questions or concerns. Thank you.

June 7, 2011

**Update on Turn Around Times**

Due to technical issues, we are currently experiencing a delay in turnaround time of 7 days for our Chlamydia/GC testing.

April 24, 2011

**Update on Turn Around Times**

Due to technical difficulties at our referral laboratory, we are experiencing an undefined delay in turn around time for Omega 3 Fatty Acids results.

April 19, 2011

**Update on Turn Around Times**

Due to technical difficulties at our referral laboratory, we are experiencing an undefined delay in turn around time for Bile Acid (Total) results.

March 25, 2011

**Update on Turn Around Times**

Due to technical issues at our referral laboratory, we are experiencing a delay in turn around time for some trace metal assays. These include Aluminum, Antimony, Arsenic, Beryllium, Bismuth, Chromium, Cobalt, Copper, Iodine, Manganese, Nickel, Platinum, Selenium, Silver, Tellurium, Zinc and Zinc Protoporphyrins.

January 24, 2011

**Update on Turn Around Times**

Testing has resumed for Omega 3 Fatty Acid testing.

November 17, 2010

**Changes to OHIP Coverage of Vitamin D Testing**

Effective December 1, 2010, OHIP will only cover 25-Hydroxy Vitamin D tests for patients with the following medical conditions:

- Osteoporosis and Osteopenia

- Rickets

- Malabsorption Syndromes

- Renal Disease

- On medication that affects Vitamin D metabolism

The OHIP Laboratory Requisition has been revised to include boxes to indicate whether the 25-Hydroxy Vitamin D is insured or uninsured.

As per the OHIP INFOBulletin #4522 issued on November 12, it is the client’s responsibility to clearly indicate on the requisition if the test is required for your patient who meets the above medical conditions or is for routine testing.

Please note that when there is no indication that the 25-Hydroxy Vitamin D is to be an insured or uninsured service, we must assume the test is for routine purposes (uninsured) and your patient will be charged a fee for the assay. This will also occur with requisitions pre-dating December 1 when the patient presents for specimen collection on or after December 1.

If you are ordering the uninsured 25-Hydroxy Vitamin D, please ensure your patient is aware that LifeLabs will charge a fee when they present for specimen collection. We appreciate your help in communicating this change to your patients.

If you do not have a supply of the revised OHIP Laboratory Requisition these may be obtained by downloading through the Ministry’s website.

Click here for materials to share with your patients.
Click here to access the OHIP InfoBulletin on this change.

June 21, 2010

** Change to Testing Method **

Effective June 8, 2010, the University Health Network reference laboratory has changed their method for Cyclosporine analysis.

For trough level, there will be no change of results
For 2 hours post-dose, some results may be 10-15% higher by the new Architect method

May 25, 2010

**Notice of Changes to Non-Insured Test Prices**

Please be advised that effective June 1, 2010, we will be increasing the price of a select number of our non-insured tests to better reflect the cost of delivering these services.

This represents the first price increases to our non-insured tests in over five years. Over the same period, our operating costs have increased significantly, reflecting increases in the cost of supplies, labour, property leases and gasoline, which are all required so that we may offer patients local access to quality laboratory services and deliver timely test results to physicians.

The new prices will affect roughly 11 percent of our non-insured tests (tests not covered under the provincial health insurance plan – OHIP). Our non-insured tests represent less than 5 percent of the total number of tests we perform for physicians on behalf of their patients. As a result, we estimate that less than 1 percent of LifeLabs patients will be affected by these price increases.

These changes DO NOT affect the price of our OHIP-covered tests, which represent the vast majority (roughly 95 percent) of tests we provide.

We will be informing our patients of these changes by posting notices at all of our collection centres in Ontario. Our call centre staff will also be available to answer any specific questions from patients related to individual tests.

If you would like to inquire about specific tests or would like to request an updated list of our non-insured tests, please contact our call centre at 416-675-3637 or toll free at 1-800-849-3637.

May 7, 2010

**Update on Turn Around Times**

We are currently experiencing normal turn around times on routine chemistry assays performed in the GTA.

April 26, 2010

This message is for:
Clients who collect Histology specimens and route them to LifeLabs for processing and interpretation.

LifeLabs will be transitioning to new Histology biopsy kits in the next few weeks. Improvements to the kits include:

a coloured baggie with a separate pocket for the Histopathology requisition. Please insert the Histology requisition into this pocket to protect against contamination from specimen leakage.
The ‘small’ 5 ml container will change to a 20 ml container. The larger label provides more writing area to record the patient’s full name anda required second identifier (date of birth or health card number).
The ‘medium’ 90 ml container will continue to be provided (containerdimensions unchanged).

The order numbers for the containers are:

20 ml #10114558
90 ml #10114559

Please bring the above to the attention of all staff in your office.
Thank you for your continued support and adherence to these quality improvements.

July 23, 2009

Chlamydia trachomatis and Neisseria Gonorrhoeae

LifeLabs provides testing for both Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) from urine and genital specimens by nucleic acid amplification (NAA) using stand displacement amplification (ProbeTecTM). The sensitivity and specificity compared to patient infected status for females is: CT: 92.8%/98.1% (swabs) and 80.5%/98.4% (urines) and GC: 96.6/99.5% (swabs) and 84.9/99.4% (urine). The sensitivity and specificity for males is: CT: 94.6/94.2% (swabs) and 94.5/91.4 (urine) and GC: 98.1/97.9 (swabs) and 98.1/97.9% (urines). For further information on the indications for testing refer to the LifeLabs Diagnostic Newsletter for Clinicians Spring 2009 (http://www.lifelabs.com/files/InsideDiagnostics/Inside_DX-Spring09-Final.pdf).

The specimen requirements for molecular detection of CT and GC at LifeLabs have not changed. The physician can continue to send a genital swab using the male (blue) or female (pink) BD ProbeTecTM swab or send an urine in a sterile container but must fill out an OHIP requisition. When filling out the OHIP requisition, clearly indicate whether both CT and/or GC are requested and the source of the specimen (eg/ cervix, urethra (males)). If the patient has had a hysterectomy, collect a high vaginal vault specimen and indicate the source and history of hysterectomy. If culture for GC is required, collect using a charcoal swab. Clearly mark on the requisition to do GC culture and provide the source.

Specimen collection:

Specimen source	Test	Kit
Endocervical and male urethral	NAA for CT and/or GC	Female: Pink BD ProbeTec swab Male: Blue BD ProbeTec swab
Urine	NAA for CT and/or GC	Sterile urine container
Endocervical and male urethral (susceptibility testing required)	Culture for GC	Charcoal swab
§ Non-genital source for GC and/or CT (eg/ rectal, pharyngeal, eye, sterile fluid) § sexual assault	Culture for GC	Charcoal swab
	Culture for CT (performed at PHL)	Multi-organism transport kit*
Vaginal swab	Bacterial vaginosis, yeast, trichomonas	Charcoal swab

* available from local PHL

For samples that are sent to PHL for NAA for CT and/or GC, the physician must order a GenProbe® swab or urine collection supplies from the local PHL and an OPHL requisitions must be completed. PHL will not accept specimens collected using the ProbeTec swab or a neat urine as of August 1, 2009.

For test information, contact the medical microbiologist at 1 877 404 0637.

References:

BD Diagnostics. Package Insert BD ProbeTec ET CT/GC Amplified DNA Assay

July 3, 2009

** Update on Turn Around Times **

Due to technical issues, we are currently experiencing a 1-week delay in testing for Copper.

March 24, 2009

**Test No Longer Available**

We are unable to provide Reverse T3 testing. This test has been discontinued by our referral laboratory.

January 9, 2009

Please click here for information on LifeLabs' expanded molecular diagnostic testing for sexually transmitted diseases (STDs) and the associated specimen collection requirements.

December 24, 2008

Please click here for an important update on PSA testing that will come into effect January 1, 2009.

May 9, 2008

Turn Around Times on Biochemistry Tests

As we transition between Chemistry platforms, we have been experiencing intermittent downtime, which has sporadically affected our turn around times, mainly for biochemistry tests. Together with the manufacturer of the equipment, we are taking appropriate action to improve the performance of the analytical system.

In an urgent or serious medical situation, we recommend establishing that we are able to meet the particular requirement of your patient by following a process which is similar to when you are requesting tests on an urgent basis which are not included on the list of those regularly available.

During the implementation of our new analytical platform, we invite you to directly call 1-877-675-4530 x2600 to confirm we are able to deliver what you require in specific clinical circumstances. If we are experiencing a delay in testing, we will post this information on this section of our website.

We are confident that our normal turn around times will be restored and commit to keep you informed of our progress in this regard.

February 25, 2008

Reporting of Different Reference Intervals on Chemistry Tests

As we transition between Chemistry platforms, you may receive reports with different reference intervals quoted for the same test (even if on the same patient). We would like to reassure you that the reference intervals that appear on the patient report and any flagging throughout the report are appropriate for the technology used in the quantitation of each analyte and should be referred to in your interpretation of results.

Cumulative reports will reflect the appropriate reference interval based on the methodology used to quantitate the analyte. If the reference interval has changed, the test result will appear on a separate line on the cumulative report.

The appearance of a “banner” at the top of a patient report indicates that the analysis was completed using the new technology. A list of the analytes that have required reference interval changes is included in the banner message.

The delivery of reports with different reference intervals on Chemistry test results is temporary and will end once we have completed our transition to the new platform.

We apologize for the delay in service to you and your patients and for any inconvenience caused by the delivery of different reference intervals. We will update you once we have fully transitioned to the new platform.

Click here to view tables showing current reporting guidlines.

November 1, 2007 MDS Diagnostic Services is Now LifeLabs

October 2007

Specimen Identification Requirements

Patient specimens for laboratory analysis must be labeled with two unique identifiers in order to be tested. The correct interpretation or analytical result on a specimen attributed to the wrong individual may be most difficult to detect and investigate. Consequently, we request that you or your staff ensure that all specimens are labeled with:

Patient Full name – Full first name and full last name (as it appears on their Healthcard)
One other identifier such as the patient’s Date of Birth or Healthcard number

Our experience is that computer generated labels are ideal, provided that they comply with the above requirements.

LifeLabs, along with all Ontario licensed laboratories must achieve compliance with mandatory Ontario Laboratory Accreditation (OLA) requirements to promote patient safety.

Effective January 1, 2008 LifeLabs will reject specimens that do not meet the above labeling requirements.

Specimens cannot be returned to your office so please ensure that they are correctly labeled prior to submission for testing.

Public Health Requisitions

The Public Health Laboratory does not accept OHIP requisitions. Therefore, a completed Public Health Laboratory requisition must accompany all specimens submitted directly by you for all tests performed by Ontario Public Health Laboratories. The information requested by Public Health Laboratories may be of a sensitive and private nature; therefore it is very important that the requisitions be completed by the practitioner ordering the tests. Importantly, this removes the potential for an error during transcription or misordering of uncommon tests. Therefore, LifeLabs can no longer transcribe information on your behalf because this introduces an unnecessary point of error and may impact patient safety.

Effective, January 1, 2008, LifeLabs will not process Public Health test requests without a separate completed Public Health Laboratory test requisition.

If you do not have a supply of Public Health Laboratory test requisitions these may be obtained by calling the Laboratory Services Branch Supply Services at (416) 235 – 5737.

Please bring this notice to the attention of your office staff responsible for the procurement and labeling of laboratory specimens.

September 2, 2008

Appropriate testing for Listeriosis

At LifeLabs we are experiencing substantial increase in the number of blood cultures sent for Listeriosis. We wish to remind the clinicians about the guidelines for testing for Listeriosis. Please order blood cultures only if the patient is symptomatic. There is no role for screening for Listeriosis. The ordering of blood cultures for screening will impact a laboratory’s ability to deliver optimal service to patients requiring tests for diagnosis and management.

Listeriosis is a foodborne illness that starts after ingestion of contaminated food. Recently a number of cases were detected in Ontario started in June 2008.

Symptoms include: flu-like symptoms, nausea, vomiting, cramps, diarrhea, headache, constipation and persistent fever. Symptoms usually appear within 2 to 30 days and up to 70 days after consuming contaminated food.
The very young, elderly or those with poorly functioning immune systems are the most susceptible. Flu-like symptoms may be followed by a brain or blood infection, either of which can result in death.
A woman who develops listeriosis during the first three months of pregnancy may miscarry. If she develops listeriosis later in the pregnancy, her baby may be stillborn or acutely ill.
If the patient has symptoms of fever or invasive disease, appropriate samples include blood cultures and spinal fluid. Document the patient’s symptoms on the OHIP requisition. Stool cultures for Listeria are tested only at the Ontario Public Health Laboratory and requires approval of the OPHL Medical Microbiologist (1 800 640 7221) prior to testing. LifeLabs will continue to accept stool for routine culture.

Click here to see the Ontario Public Health Laboratories “Labstract” on this topic.