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September 2014

Put It on the Board, 9/14

September 2014—Simple blood tests, colossal contrasts on price: California hospitals have a pricing range for common blood tests so wide that it brings to mind the vast span of that state’s world wonder, the Golden Gate Bridge. Among the 150 hospitals whose blood test charges were examined in a recent study, the price for a basic metabolic test ranged from $35 to $7,303, depending on the hospital, with a median charge of $214. The biggest price difference was in charges for a lipid panel.

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Q & A Column, 9/14

September 2014—Occasionally on certain patients, when we draw for a CBC in the early morning, we get a low Hgb of 6 or 7 g/dL. We draw the same patient for a CBC in the afternoon and we get a higher Hgb by at least 1–1.5 g/dL. Can you explain the reason for this difference? We would like to standardize reference ranges throughout our system of regional facilities, using our main laboratory to establish the ranges. How does the CAP view using the transference process as described in CLSI document C28-A3C, Defining, Establishing, and Verifying Reference Intervals in the Clinical Laboratory; Approved Guideline? Is this an approved method for establishing reference ranges? Is it an acceptable process once the laboratory director approves it?

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Newsbytes, 9/14

September 2014—Why LIS limitations shouldn’t inhibit genomic testing: Many community-based hospitals don’t have the resources to perform complex genomic testing, but they shouldn’t let that deter them. By being creative in overcoming the limitations of their lab information systems, pathology departments can ensure that clinicians and their patients benefit from the latest advances in next-generation sequencing, says Lynn Bry, MD, PhD.

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Anatomic Pathology Selected Abstracts, 9/14

September 2014—Cytokeratin 17: an adjunctive marker of invasion in anal squamous neoplastic lesions: Diagnosing anal squamous cell carcinoma, which is often preceded by anal intraepithelial neoplasia, may be challenging in small biopsies. Cytokeratin 17 (CK17) is a basal/myoepithelial cell keratin induced in activated keratinocytes and associated with disease progression in squamous cell carcinoma (SCC) of the uterine cervix, esophagus, and oral cavity.

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Clinical Pathology Selected Abstracts, 9/14

September 2014—Potential link between vitamin D and subclinical cerebrovascular disease: Vitamin D deficiency has been associated with several diseases, including hypertension, diabetes mellitus, and stroke. A recent prospective population-based study of cardiovascular disease showed that subclinical infarcts and white matter hyperintensities (WMHs) are commonly seen on brain magnetic resonance image scans of older adults and are associated with cardiovascular disease risk factors and prior stroke. The lesions are also associated with reduced functioning on cognitive tests.

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New push for standard approach to critical values

September 2014—Newly reported survey data that show widely varying international practices on managing critical values may demonstrate the need for a new guideline—already in development—to help laboratories formulate evidence-based policies. The new data from European labs were presented during a session at the American Association for Clinical Chemistry’s Annual Meeting and Clinical Expo in Chicago (“Critical Result Management Practices: Global Perspectives and Recommendations for Best Practices”). The session also provided a preview of a forthcoming draft guideline from the Clinical and Laboratory Standards Institute that represents the organization’s first formal attempt to advise laboratories around the world on critical values reporting.

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From the President’s Desk: Premium PT—and more to come in 2015, 9/14

September 2014—Even as a newly minted pathologist, I knew that the CAP Surveys were critical tools to ensure patient safety and test validity. Still, I didn’t give them much thought. There was already a lot to learn; something already so well established just wasn’t on my radar. But over time and with experience, I learned that our Surveys program of proficiency testing, which had its roots in a demonstrated need for interlaboratory comparison 60 years ago, had evolved organically into an engine of scientific advancement in our specialty.

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A laboratory on the trail of troubling TSH results

September 2014—It would be a nightmare for any laboratory professional: a misdiagnosed and mistreated patient owing to an aberrant test result. Julia C. Drees, PhD, a scientific director for chemistry at TPMG Regional Reference Laboratory, Kaiser Permanente Northern California, found herself facing that situation two years ago. She and colleague Judy Stone, PhD, then a Kaiser scientific director who is now at UCSD, discovered that faulty TSH results from their laboratory had led to multiple patients being misdiagnosed, and some even treated inappropriately.

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