PATHOLOGY ACCREDITATION
The reaccreditation of our new pathology laboratory was undertaken recently by the National Association of Testing Authorities [NATA]. As you may be aware, all pathology laboratories are required to be accredited by NATA. Our laboratory is accredited as a GX category which is staffed and supervised by pathologists on a full time basis and offers services which are usually of the broadest range. This is the sixth time that Launceston Pathology has been accredited in the past 15 years. A team of 7 experienced pathology examiners from Victoria, Western Australia and South Australia, including 2 NATA representatives, review and check all quality systems, methods and documentations within the laboratory. This is a very rigorous examination to ensure that the standard and quality of the test results are within NATA / RCPA requirements.The assessors were very impressed with the standard of testing undertaken in our laboratory and commended all staff for the very high standards and quality systems operating in our pathology practice. The assessors again stressed the importance of having correct patient identification on all specimen tubes, i.e. Christian name, surname and date of birth should be clearly written. The quality system requires 2 forms of patient identification on all specimen tubes.
IONISED (FREE) CALCIUM
Launceston Pathology can now provide testing for ionised calcium (with ion-selective electrode). In blood virtually all the calcium is in plasma, existing in three physicochemical states - approximately 50% is free or ionised (the biologically active form), its concentration tightly regulated by PTH and 1,25-dihydroxyvitamin D; 40% is bound to plasma proteins and 10% complexed with small anions. Interpretation of total calcium level is complicated by its association with proteins and calculations are used to correct for variations in protein concentration (usually albumin) with reporting of so-called "corrected calcium". Calcium status, however, is more accurately determined by measured free or ionised calcium particularly in clinical situations where the balance of physiochemical states of calcium may be altered - such as in hospitalised patients with acute medical or surgical illness, patients with acid-base disturbance, renal disease, altered concentrations of proteins or abnormal proteins (e.g. multiple myeloma). Ionised calcium has been reported to be more useful than total calcium in the diagnosis of hypercalcaemia in subsequently surgically proven primary hyperparathyroidism and in hypercalcaemia associated with malignancy.
Specimen Collection Requirements
As specimen requires the blood to be collected into a specific heparinised syringe and tested promptly outpatients need to attend the laboratory/collection centre at 71 Frederick Street, during routine hours for specimen collection. Our staff will collect specimens from hospital inpatients.
Reference Range
1.13 - 1.32 mmol/L (Note: reported level adjusted to pH 7.40)
CHLAMYDIA TESTING
Launceston Pathology tests for the presence of Chlamydia trachomatis DNA using Polymerase Chain Reaction, this technique is extremely sensitive and will detect DNA in viable as well as non-viable organisms.It is therefore important NOT to ask patients to return for follow-up testing before 4-6 weeks have passed since positive results may still be obtained following successful therapy.
GENITAL INFECTIONS
Suggested treatment regimens for Chlamydia trachomatis [Therapeutic Guidelines Version 12, 2003] are as follows:Azithromycin 1g orally, as a single dose OR
Doxycycline 100mg orally 12 hourly for 10 daysSexual partners of individuals with chlamydial infection should be treated empirically to prevent re-infection and chlamydial salpingitis.A second course of antibiotics, together with further investigation of the aetiology, may be required if symptoms persist.Suitable samples are endocervical swabs, urethral swabs or first catch urine samples when patients should refrain from voiding 1-2 hours prior to collection of urine.
EYE INFECTION
Successful treatment requires systemic therapy.
Adults and children >6 kg:Azithromycin 1g [children >6kg: 20mg/kg up to 1g] orally, as a single dose.
Neonates and children <6 kg:Erythromycin 10mg/kg orally, 6 hourly for 3 weeks
The PCR method for eye swabs has not been validated by the manufacturer, however there is a research protocol, which we follow. NOTE:
Care should be taken that the swabs collected are appropriate; we still receive brown-top LCx swabs which are 3 years out of date. Swabs for Chlamydia, Herpes and Pertussis PCR are clearly marked and a separate swab is required for each assay.