Post on 27-Mar-2015
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
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
Newborn Screening
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 (NBS-3) Form
Newborn Screening (cont.)
Filter paper collection Wall Chart- collection technique Reference chart – Valid specimen Newborn Screening Program – “Guide to
Practitioners”
Total Hemoglobin 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
Sysmex KX-21N
Sysmex XT-1800i
Lead Screening
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
PE AA600
Hemoglobinopathy
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.
Isoelectric Focusing Electrophoresis
Rapid Plasma Reagin (RPR)
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
RPR Card Test
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
Cholesterol Screen & Lipid Profile 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 & Lipid Profile (cont.)
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
Beckman CX4
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
Immucor Capture Solid Phase
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
Beckman Coulter Access II
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
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.
Gonorrhea/Chlamydia Screen
Testing for presence of infection by Neiserria gonorrhoeae and Chlamydia trachomatis
Physician’s discretion Laboratory procedure
DNA probe technology Normal Result: Negative
HIV Screen 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
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
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
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.
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
Specimen Acceptability Criteria Update
Becton Dickinson (BD) Microtainer® 250 uL – 500 uL Tube
Specimen Acceptability Criteria Update
Becton-Dickinson (BD) 2mL Vacutainer® K2 EDTA 3.6mg Tube
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.
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.
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.
Patient specimen Transport tube
Canister Freezer
IcePack
IcePack
Styrofoam Box
StyrofoamLid
Fiberboard BoxG-1BForms
Place two ice packs onthe top of the canister(s) inthe styrofoam box
G-1B forms go on top ofthe closed styrofoam box
in the fiberboard outer box
Record Date and timespecimen(s) were takenout of freezer on the G-1Bform
Styrofoam Box holds up to4 canisters
Airbill
Place Airbill insleeve located ontop of fiberboardbox
Cholesterol Lipid and Glucose Packing Diagram
Cholesterol, Lipid Profile, and Glucose Specimen Packing Diagram
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.
Triple Screen Specimen Packing Diagram
Patient specimen Blue Top Tube
Canister Freezer
Ice PackIce Pack
Styrofoam Box
Styrofoam Lid
Fiberboard BoxG-1CForms
Place two ice packs on thetop of the canister(s) in thestyrofoam box
G-1C forms go on top of theclosed styrofoam box in the
fiberboard outer box
Record Date and timespecimen(s) were taken outof freezer on the G-1C form
Styrofoam Box holds up to4 canisters
Airbill
Place Airbill insleeve located ontop of fiberboardbox
Triple Screen Packing Diagram
Biohazard
Biohazard Bag
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.
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
Specimen Submission Form G-1B
Specimen Submission Form G-2A
Specimen Submission Form G-2B
Specimen Submission Form G-1C
Specimen Submission Form M-47
To Order Master Forms or Change Submitter Information
Call 1-888-963-7111 or 512-458-7578
--OROR--
E-mail LabSubForm@dshs.state.tx.us
Laboratory Services SectionPhone Numbers
1-888-963-7111
Clinical Chemistry Laboratory Specimen 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
Comments and Questions