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Department of State Health Services

Department of State Health Services. Laboratory Services Section Biochemistry & Genetics Branch Clinical Chemistry Laboratory. DSHS Laboratory Services THSteps and Title V Program. Specimen Collection and Shipping/Mailing Supplies Test results to service providers Telephone consultations.

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Department of State Health Services

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  1. Department of State HealthServices Laboratory Services Section Biochemistry & Genetics Branch Clinical Chemistry Laboratory

  2. DSHS Laboratory Services THSteps and Title V Program • Specimen Collection and Shipping/Mailing Supplies • Test results to service providers • Telephone consultations

  3. DSHS Laboratory Tests • Newborn Screening • Total Hemoglobin • Lead Screening • Hemoglobinopathy Testing • RPR Screening and Confirmation • Cholesterol/Lipid Profile/Glucose/Triple Screen • Hemolytic Disease of the Newborn • Gonorrhea/Chlamydia Infection Screen • HIV Screen • Pap Screen

  4. Testing for five possible disorders in newborns at birth and 10-14 days after birth Congenital Adrenal Hyperplasia (CAH) Phenylketonuria – (PKU) Galactosemia Hemoglobinopathy Congenital Hypothyroidism Newborn Screening

  5. Newborn Screening (NBS-3) Form

  6. Newborn Screening (cont.) • Filter paper collection • Wall Chart- collection technique • Reference chart – Valid specimen • Newborn Screening Program – “Guide to Practitioners”

  7. Testing for evidence of anemia Required 6, 12, and 24 months and 6, 12 and 16 years of age Laboratory procedure: SLS-Hb (sodium lauryl sulfate – metthemoglobin method) Sysmex XT-1800i/KX-21N/pocHi Normal Range: 11-16 g/dL Total Hemoglobin

  8. Sysmex KX-21N

  9. Sysmex XT-1800i

  10. Testing for possible lead intoxication Blood Lead screening required 12 and 24 months. Lead questionnaire required at 6 and 18 months, and at 3, 4, 5, and 6 years of age. Laboratory procedure Blood Lead (Pb) Atomic Absorption Spectrophotometer Graphite Furnace (PE AA600/4100ZL) Expected Results Pb < 10 μg/dL Lead Screening

  11. PE AA600

  12. Testing for sickle cell diseases and other hemoglobin disorders Required at birth and 10 - 14 days after birth Laboratory procedure Isoelectric Focusing (IEF) Citrate Agar Electrophoresis Normal Result: A,A (homozygous) Hemoglobin F may be present in children under 1 year of age. Hemoglobinopathy

  13. Isoelectric Focusing Electrophoresis

  14. Testing for presence of syphilis Optional – no longer required Laboratory procedure 18 mm RPR card test Normal result non-reactive Any (+) RPR is submitted for confirmation Rapid Plasma Reagin (RPR)

  15. RPR Card Test

  16. Glucose Testing • Testing for high levels of blood glucose. • Laboratory procedure: -Enzymatic measure by automated chemistry analyzer. Beckman Synchron CX4 • Desired Results: Random 50-130 mg/dL 1-Hr GTT < 140mg/dL 2-Hr PP < 120 mg/dL 3-HR GTT: Fasting < 105 mg/dL 1-HR < 190 mg/dL 2-HR < 165 mg/dL 3-HR < 145 mg/dL

  17. Testing for potential development of coronary heart disease Blood Cholesterol Screen Children over 2 years of age: -with a parent having a cholesterol > 240 mg/dL -with multiple risk factors (smoking, obesity, hypertension, diabetes, fatty diet) Lipid Profile Test is done only for children over 2 years of age in high risk category. (Family history of heart or vascular disease) Cholesterol Screen & Lipid Profile

  18. Laboratory procedure: Enzymatic measure by automated chemistry analyzer. Beckman Synchron CX4 Desired Results: Cholesterol < 170 mg/dL Triglycerides 30 – 190 mg/dL HDL > 35 mg/dL LDL < 110 mg/dL Cholesterol & Lipid Profile (cont.)

  19. Beckman CX4

  20. Hemolytic Disease of the Newborn(HDN Testing) • Testing for blood type (ABO) and Rh factor. • Antibody Screen • Performed to detect and titer clinically significant antibodies • Antibody Identification • Antibody titer • Immucor Capture Solid Phase

  21. Immucor Capture Solid Phase

  22. Triple Screen Testing • Testing for birth defects: • Down’s Syndrome, • Open Neural Tube Defects – (Open Spina Bifida), • Trisomy 18 • Biochemical Tests include: • hCG - human chorionic gonadotropin • AFP – alpha-fetoprotein • uE3- unconjugated estriol • All three are used for determining risk for Trisomy 18 and 21, while AFP alone is used to determine NTD risk. • Performed during 15-20 weeks and 6 days of gestation. • Beckman Coulter - AccessII

  23. Beckman Coulter Access II

  24. Triple Screen Testing (cont.) Factors used in the calculation of patient risks: • Gestational age is determined by physical exam, dating of last menstrual period, and/or ultrasound dating. • Maternal age • Maternal weight • Maternal non-gestational insulin-dependent diabetic status • Maternal race • Number of fetuses

  25. Recalculation of Triple Screen Test Results • Fax request for recalculation using Request for Recalculation of Prenatal Screening report to 512-458-7139. • Recalculation of Prenatal Triple screen will be performed based on a change in the gestational age only if the change is 10 days or more.

  26. Testing for presence of infection by Neiserria gonorrhoeae and Chlamydia trachomatis Physician’s discretion Laboratory procedure DNA probe technology Normal Result: Negative Gonorrhea/Chlamydia Screen

  27. Testing for presence of human immunodeficiency virus Adolescents at risk for HIV infection – CONSENT for confidential screening Include pre- and post test counseling Laboratory procedure Enzymatic Immunoassay (EIA) Western Blot Normal Result: Negative HIV Screen

  28. Pap Screen • Testing for the detection of malignant, premalignant, and infectious disease of the uterine cervix. • Laboratory procedure Pap stain technique • Normal Result Negative • Specimens must be sent to DSHS Women’s Health Laboratories in San Antonio. (210) 531-4596 or Toll-free: 1-888-440-5002

  29. Collection and Shipping Supplies • Supplies for Collection and Shipping of Specimens • Do’s and Don’ts of Specimen Collection • Submission of Specimens • Forms G-1B, G-2A, G-2B, and M-47

  30. Tips for Successful Submission of Specimens • Fill out test request forms accurately and completely. • Patient name on specimen must match name on test request form. • Purple top blood collection tubes should be filled according to manufacturer package insert. • Thoroughly mix blood collected in purple top tubes immediately after collection to avoid specimen from clotting. • Avoid lead contamination from skin when collecting blood specimen for lead testing by washing the puncture site with soap and water.

  31. Tips for Successful Submission of Specimens (cont.) • Purple top specimens submitted for lead, total hemoglobin, and hemoglobin type may be shipped at ambient temperature and tested 21 days from date of collection. • Do NOT freeze whole blood specimens. • Mail specimens same day of collection. • Pack tubes carefully and ensure they are properly capped to avoid specimen leaking in transit. • Place specimens in PLASTIC canister. Wrap plastic canister with form/s and place in cardboard mailing container. • Tips for Successful Specimen Collection: http://www.dshs.state.tx.us/lab/refman.pdf

  32. Specimen Acceptability Criteria Update Becton Dickinson (BD) Microtainer® 250 uL – 500 uL Tube

  33. Specimen Acceptability Criteria Update Becton-Dickinson (BD) 2mL Vacutainer® K2 EDTA 3.6mg Tube

  34. RPR Specimen Submission and Shipping Instructions • Whole blood or serum specimens may be submitted at ambient temperature as long as the specimens are received within 5 days from the time of collection. • Day one is the day the specimen is collected, unless the time of collection is documented on the G-1B form. If the time of collection is provided, the five days are calculated from the actual time of collection. • If serum specimens will not arrive at the laboratory within 5 days: Specimens will be accepted if frozen, but must be shipped overnight on dry ice. • Record the date and time specimens are removed from the freezer on the G-1B form. • Do not ship specimens to the DSHS Laboratory on Friday or the day before a Federally observed holiday.

  35. Cholesterol, Lipid Profile and Glucose Specimen Collection Guidelines • Collect specimens for lipid profile and cholesterol testing in red top tubes. • Serum must be separated from red cells within 2 hours from time of collection and frozen. • Collect specimens for glucose testing in gray top tubes. • Plasma must be separated from red cells within 24 hours from time of collection and frozen.

  36. Cholesterol, Lipid Profile and Glucose Shipping Instructions • Record the date and time the specimen was removed from the freezer on each G-1B form. • Package and ship specimens overnight with enough cold packs or dry ice to maintain specimens at proper temperature until arrival at DSHS Laboratory. • Friday or the day before a Federally observed holiday.

  37. Cholesterol, Lipid Profile, and Glucose Specimen Packing Diagram

  38. Triple Screen Specimen Collection and Shipping Guidelines • Specimens must be collected during the 15–20 week and 6 days of pregnancy. • Collect specimens for triple screen testing in red top tubes. • Serum must be separated from red cells within 2 hours from time of collection and frozen. • Record the date and time the specimen was removed from the freezer on each G-1B form. • Package and ship specimens overnight with enough cold packs or dry ice to maintain specimens at proper temperature until arrival at DSHS Laboratory. • Please do not ship specimens to the DSHS Laboratory on Friday or the day before a Federally observed holiday.

  39. Triple Screen Specimen Packing Diagram

  40. Hemolytic Disease of the Newborn Specimen Collection and Shipping Guidelines • Collect specimens for HDN testing in red top tubes. • Ship specimens overnight at ambient temperature • Specimens that cannot be received by DSHS laboratory within 24 hours from time of collection should be stored at 1-10ºC. • Do not freeze specimens. • Package and ship specimens, including enough cold packs to maintain specimens at the proper temperature until arrival at the DSHS Laboratory, if cold shipment is required. • Do not ship specimens to the DSHS Laboratory on Friday or the day before a federally observed holiday.

  41. The G-1B Laboratory Submission Form • Master form • An instruction page for filling out the form • Descriptions of the DSHS programs listed on the submission form

  42. Specimen Submission Form G-1B

  43. Specimen Submission Form G-2A

  44. Specimen Submission Form G-2B

  45. Specimen Submission FormG-1C

  46. Specimen Submission Form M-47

  47. To Order Master Forms or Change Submitter Information Call 1-888-963-7111 or 512-458-7578 -OR- E-mail LabSubForm@dshs.state.tx.us

  48. 1-888-963-7111 Clinical Chemistry LaboratorySpecimen Submission (512) 458-7680 (512) 458-7598 Newborn Screening Laboratory Billing Information (512) 458-7333 (512) 458-7318 x3819 Ask for Accounts Receivable Lab Reporting (512) 458-7578 Test Results Triple ScreenTesting (512) 458-7300 Newborn Screening 1-800-687-4363 (Voice Response System) (512) 458-7138 (512) 458-7533 fax (512) 458-7139 fax Specimen Collection Supplies (512) 458-7661 THSteps (EPSDT) (512) 458-7331 Newborn Screening (512) 458-7672 fax Laboratory Services SectionPhone Numbers

  49. Comments and Questions

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