14 Laboratory Referrals, Version 2.0
Content
This is a non-controlled copy of a controlled document
LABORATORY REFERRALS I. Referral laboratories are used to perform analyses not routinely provided by the Toxicology Laboratory including clinical diagnostic testing requested by the Office of the Medical Examiner. A. A list of commonly used referral laboratories and their specialty is provided in the attached Referral Lab and Specimen Selection Matrix. II. Responsibilities A. Evidence Registrar - The Evidence Registrar usually coordinates requests for reference laboratory referrals, prepares related paperwork, pulls specimens, and packages and ships specimens prepared by the analyst. B. Toxicology Chemist - The analyst typically has responsibility for reviewing the request, verifying appropriateness of the specimen and the referral laboratory, logging specimen out, aliquoting specimen into appropriate tubes, documenting the specimen sent on the original container and related paperwork, packaging and sealing the specimens for release, logging in specimens, and re-racking original containers. C. The Section Secretary has responsibility for tracking referral lab requests, distributing and filing results, and processing invoices for services. III. Process A. Referral lab requests are typically processed daily. B. A request for referral lab testing may be submitted by 1. OME a) Requests for infectious disease testing or other clinical diagnostic testing are submitted using on an Infectious Disease Exposure Request form, the Medical Examiner’s Request for Toxicology form, email, or phone. 2. Toxicology staff a) Toxicology staff reviews the service request form, investigative information provided, and testing results to determine when referral laboratory testing is indicated. C. Questions about referral laboratory samples should be referred to a supervisor prior to preparation of specimens. D. Appropriate specimens are checked out using Tox-Lims or manual chain of custody. E. A referral laboratory service requisition form or service request letter is prepared including the case name, case number, date specimen prepared, identity of specimen submitted, test requested, analyst name or initials, and other relevant information. 1. Usually the red top tube (D) is selected for clinical laboratory testing. 2. A gray top tube is usually selected for drug testing. 3. Additional information regarding submission of specimens may be found in the Referral Lab and Specimen Selection Matrix appendix to this procedure. F. The analyst marks the new aliquot container with a unique lab number: either the IFS case number or the referral lab requisition number. 1. If the referral lab requisition number is used, this is also placed on the original specimen tube as a reference and should appear on the Toxicology Laboratory copy of the requisition slip. G. The appropriate specimen is transferred to the new aliquot container.
Dallas County Institute of Forensic Sciences Toxicology Laboratory 1 Reference Laboratory Referral Version 2.0
This is a non-controlled copy of a controlled document
1. If serum was removed from the original container, the original container is marked “serum removed” to advise other users that the composition of the tube has been altered. H. The container is placed in a biohazard transport bag and properly sealed. I. If the specimen requisition form contains a chain of custody section, it is completed. J. The original specimen requisition form or letter is inserted into the outside of the biohazard transport bag and sent with the specimen. K. The Toxicology Laboratory retains a copy of the requisition form or letter which is placed in the case file. L. A notation is made of all reference lab sendouts in the “Drug Send Out” line of the Quality Control form. The name of the test sent out is noted and a requisition form specimen identification sticker is attached as applicable. M. On some occasions, the original specimen container and its contents are sent to the reference lab. 1. A note is made on the original specimen receipt form (Medical Examiner’s Request for Toxicology) that the original container was released, by whom, and the date. 2. In addition, this information is placed on the Toxicology Lab’s copy of the requisition sheet or letter. 3. A notation is made in Tox-Lims if applicable. N. Original specimens are logged back in. IV. Sample Handling and Shipping A. Lockbox – Specimens to be sent to the clinical laboratory vendor are placed into a lock box for courier pickup. B. Personal delivery – Specimens may be delivered to the referral lab in person; for example, insulin specimens are transported to the UT-Southwestern Diabetes Laboratory. C. Overnight package delivery service 1. Specimens should not be sent by overnight package delivery on Friday or before a holiday. 2. The biohazard bag containing the specimen is placed into another fluid resistant bag with a liquid absorbent to contain an unexpected leak in transit. 3. The packaged specimen is placed into a shipping container such as a foam box with cold pack, if appropriate, and placed into a plastic, shipping bag such as a FedEx diagnostic specimen envelope. 4. Shipping documents are prepared and package pickup is arranged. D. Questions regarding proper shipping preparation should be directed to the package carrier such as FedEx. V. Distribution of Referral Laboratory Reports A. The Toxicology Lab copy of the requisition form or letter is transferred to the Section Secretary for entry into the Referral Log. B. The secretary matches service requests with lab results, files the Toxicology Lab copy of the service request and the original outside lab report in the case file, distributes copies of results as appropriate, and processes invoices for payment. 1. Results of referral toxicology testing are reviewed by a supervisor prior to distribution to the submitter (typically the Medical Examiner).
Dallas County Institute of Forensic Sciences Toxicology Laboratory 2 Reference Laboratory Referral Version 2.0
This is a non-controlled copy of a controlled document
2. Results of clinical testing are distributed to the Medical Examiner without review. C. A copy of all infectious disease (HIV, hepatitis, and RPR/syphilis) reports are also distributed to the Chief Field Agent for review and submittal to the local health authority as appropriate. D. Submitters receive a copy of the referral laboratory report. 1. Results of outside laboratory testing are not transcribed into the Toxicology Report. VI. Procedure: Infectious Disease Submission Criteria for ViroMed Labs A. ViroMed/LabCorp will not analyze specimens received outside the following collection windows: 1. Refrigerated specimen within 5 days of collection a) 81337 Hepatitis B Core Antibody total 2. Refrigerated specimen within 7 days of collection a) 81347 Hepatitis B Surface Antigen b) 81351 Hepatitis C Virus Antibody c) 81204 HIV ½ Antibody d) 81300 RPR (syphilis) e) Panel 76504: HIV ½ Antibody, Hepatitis B Surface Antigen, Hepatitis C Antibody, RPR f) Panel 76502: HIV ½ Antibody, Hepatitis B Surface Antigen, Hepatitis C Antibody 3. Frozen specimen within several months of collection a) All tests listed above B. To respond to this policy the following will be implemented 1. The Evidence Registrar will review infectious disease requests on the day they are received. 2. Requests received which are outside these collection windows (greater than 5 or 7 days) will not be tested. 3. The Evidence Registrar will a) Write “Lab unable to test; specimen outside acceptable collection window” on the infectious disease request form. b) Give a copy to the applicable Medical Examiner c) Give the original to the Section Secretary. 4. Requests received which are at the collection window will be communicated that day to the Tox Chemist assigned to send-outs. a) Tox Chemist will spin down sample and freeze serum in a plastic tube and then send for testing. 5. The Tox Chemist assigned send-outs will process infectious disease send-outs daily. 6. If a specimen is noted to be at or near the cut-off, it will be spun down and serum frozen in plastic prior to sending to Viro-Med/LabCorp.
Dallas County Institute of Forensic Sciences Toxicology Laboratory
3
Reference Laboratory Referral Version 2.0
This is a non-controlled copy of a controlled document
Referral Lab and Specimen Selection Matrix Test Standard clinical tests Laboratory Recommended Specimen serum: thyroid panel, LabCorp place specimens in lockbox lipid panel, glucose, for transport antibodies 972-566-7500 blood: hemoglobin fractionation, sickle www.labcorp.com cell prep Comments Refer to bid for test codes. Refer to www.labcorp.com for specimen requirements. Hemoglobin A1C, hemoblobin fractionation, or sickle cell prep: Place blood in purple top tube. Refrigerated specimens must be received within 5 days of collection to be acceptable for testing. Serum should be frozen before shipping if the hold period will be exceeded. 76504: RPR, HIV, HBSAG, HCV 76502:HIV, HBSAG, HCV 81337: HBCore Ab 81347: HBSAG 81351: HCV 81204: HIV 81300: RPR 81182: Western Blot
Infectious disease testing
LabCorp/Viromed 6101 Blue Circle Drive Minnetonka, MN 55343 800-582-0077 www.viromed.com
Serum is recommended; blood may be sent if serum is not available.
Tryptase
Dr. Lawrence Schwartz Division of Rheumatology, Allergy and Immunology Virginia Commonwealth University MCV Campus 1112 East Clay Street McGuire Hall, Room 4110 Richmond, VA 232980263 804-828-6322
1-2 ml blood
Dallas County Institute of Forensic Sciences Toxicology Laboratory
4
Reference Laboratory Referral Version 2.0
This is a non-controlled copy of a controlled document
Test Drugs/chemicals
Laboratory
National Medical Services 3701 Welsh Road Willow Grove, PA 190900437 800-522-6671 www.nmslab.com Insulin UT-Southwestern Diabetes Laboratory G.5.246 214-648-2868 Steriods Dr. David L. Black Aegis Analytical Laboratories 345 Hill Ave Nashville, TN 37210 615-255-2400 www.aegislabs.com Metabolic testing Pediatrix PO Box 219 90 Emerson Lane Bridgeville, PA 15017 412-220-2300 www.pediatrix.com Venom antibody Johns Hopkins University tests Asthma and Allergy Ctr. DACI Reference Laboratory Room 1A20 5501 Hopkins Bayview Circle Baltimore MD 21224 800-344-3224 www.hopkinsmedicine.org /allergy/daci/index.html
Recommended Specimen Blood from gray top usually sent. LSD usually screened in urine; wrap in foil to protect from light. 2 ml serum
Comments Refer to NMS Directory of Services for test numbers and specimen requirements: www.nmslab.com
urine or blood
blood
Use specimen submission cards and packaging.
serum
Covers all common wasps and bees in developed world: anti-yellow jacket, honey bee, yellow hornet, white faced hornet, Polistes wasp, fire ant, bumble bee (note: yellow jacket has some cross reactivity with yellow hornet and white faced hornet)
Other
Mayo Medical Laboratory 3050 Superior Drive NW Rochester, MN 55901 800-533-1710 www.mayomedicallaborato ries.com
Dallas County Institute of Forensic Sciences Toxicology Laboratory
5
Reference Laboratory Referral Version 2.0
This is a non-controlled copy of a controlled document
Factor V Leiden and prothrombin
Molecular Diagnostics Lab UT-Southwestern 214-648-5105/4075
blood less than 5 days old, frozen tissue (liver/kidney/lung)
Dallas County Institute of Forensic Sciences Toxicology Laboratory
6
Reference Laboratory Referral Version 2.0
LABORATORY REFERRALS I. Referral laboratories are used to perform analyses not routinely provided by the Toxicology Laboratory including clinical diagnostic testing requested by the Office of the Medical Examiner. A. A list of commonly used referral laboratories and their specialty is provided in the attached Referral Lab and Specimen Selection Matrix. II. Responsibilities A. Evidence Registrar - The Evidence Registrar usually coordinates requests for reference laboratory referrals, prepares related paperwork, pulls specimens, and packages and ships specimens prepared by the analyst. B. Toxicology Chemist - The analyst typically has responsibility for reviewing the request, verifying appropriateness of the specimen and the referral laboratory, logging specimen out, aliquoting specimen into appropriate tubes, documenting the specimen sent on the original container and related paperwork, packaging and sealing the specimens for release, logging in specimens, and re-racking original containers. C. The Section Secretary has responsibility for tracking referral lab requests, distributing and filing results, and processing invoices for services. III. Process A. Referral lab requests are typically processed daily. B. A request for referral lab testing may be submitted by 1. OME a) Requests for infectious disease testing or other clinical diagnostic testing are submitted using on an Infectious Disease Exposure Request form, the Medical Examiner’s Request for Toxicology form, email, or phone. 2. Toxicology staff a) Toxicology staff reviews the service request form, investigative information provided, and testing results to determine when referral laboratory testing is indicated. C. Questions about referral laboratory samples should be referred to a supervisor prior to preparation of specimens. D. Appropriate specimens are checked out using Tox-Lims or manual chain of custody. E. A referral laboratory service requisition form or service request letter is prepared including the case name, case number, date specimen prepared, identity of specimen submitted, test requested, analyst name or initials, and other relevant information. 1. Usually the red top tube (D) is selected for clinical laboratory testing. 2. A gray top tube is usually selected for drug testing. 3. Additional information regarding submission of specimens may be found in the Referral Lab and Specimen Selection Matrix appendix to this procedure. F. The analyst marks the new aliquot container with a unique lab number: either the IFS case number or the referral lab requisition number. 1. If the referral lab requisition number is used, this is also placed on the original specimen tube as a reference and should appear on the Toxicology Laboratory copy of the requisition slip. G. The appropriate specimen is transferred to the new aliquot container.
Dallas County Institute of Forensic Sciences Toxicology Laboratory 1 Reference Laboratory Referral Version 2.0
This is a non-controlled copy of a controlled document
1. If serum was removed from the original container, the original container is marked “serum removed” to advise other users that the composition of the tube has been altered. H. The container is placed in a biohazard transport bag and properly sealed. I. If the specimen requisition form contains a chain of custody section, it is completed. J. The original specimen requisition form or letter is inserted into the outside of the biohazard transport bag and sent with the specimen. K. The Toxicology Laboratory retains a copy of the requisition form or letter which is placed in the case file. L. A notation is made of all reference lab sendouts in the “Drug Send Out” line of the Quality Control form. The name of the test sent out is noted and a requisition form specimen identification sticker is attached as applicable. M. On some occasions, the original specimen container and its contents are sent to the reference lab. 1. A note is made on the original specimen receipt form (Medical Examiner’s Request for Toxicology) that the original container was released, by whom, and the date. 2. In addition, this information is placed on the Toxicology Lab’s copy of the requisition sheet or letter. 3. A notation is made in Tox-Lims if applicable. N. Original specimens are logged back in. IV. Sample Handling and Shipping A. Lockbox – Specimens to be sent to the clinical laboratory vendor are placed into a lock box for courier pickup. B. Personal delivery – Specimens may be delivered to the referral lab in person; for example, insulin specimens are transported to the UT-Southwestern Diabetes Laboratory. C. Overnight package delivery service 1. Specimens should not be sent by overnight package delivery on Friday or before a holiday. 2. The biohazard bag containing the specimen is placed into another fluid resistant bag with a liquid absorbent to contain an unexpected leak in transit. 3. The packaged specimen is placed into a shipping container such as a foam box with cold pack, if appropriate, and placed into a plastic, shipping bag such as a FedEx diagnostic specimen envelope. 4. Shipping documents are prepared and package pickup is arranged. D. Questions regarding proper shipping preparation should be directed to the package carrier such as FedEx. V. Distribution of Referral Laboratory Reports A. The Toxicology Lab copy of the requisition form or letter is transferred to the Section Secretary for entry into the Referral Log. B. The secretary matches service requests with lab results, files the Toxicology Lab copy of the service request and the original outside lab report in the case file, distributes copies of results as appropriate, and processes invoices for payment. 1. Results of referral toxicology testing are reviewed by a supervisor prior to distribution to the submitter (typically the Medical Examiner).
Dallas County Institute of Forensic Sciences Toxicology Laboratory 2 Reference Laboratory Referral Version 2.0
This is a non-controlled copy of a controlled document
2. Results of clinical testing are distributed to the Medical Examiner without review. C. A copy of all infectious disease (HIV, hepatitis, and RPR/syphilis) reports are also distributed to the Chief Field Agent for review and submittal to the local health authority as appropriate. D. Submitters receive a copy of the referral laboratory report. 1. Results of outside laboratory testing are not transcribed into the Toxicology Report. VI. Procedure: Infectious Disease Submission Criteria for ViroMed Labs A. ViroMed/LabCorp will not analyze specimens received outside the following collection windows: 1. Refrigerated specimen within 5 days of collection a) 81337 Hepatitis B Core Antibody total 2. Refrigerated specimen within 7 days of collection a) 81347 Hepatitis B Surface Antigen b) 81351 Hepatitis C Virus Antibody c) 81204 HIV ½ Antibody d) 81300 RPR (syphilis) e) Panel 76504: HIV ½ Antibody, Hepatitis B Surface Antigen, Hepatitis C Antibody, RPR f) Panel 76502: HIV ½ Antibody, Hepatitis B Surface Antigen, Hepatitis C Antibody 3. Frozen specimen within several months of collection a) All tests listed above B. To respond to this policy the following will be implemented 1. The Evidence Registrar will review infectious disease requests on the day they are received. 2. Requests received which are outside these collection windows (greater than 5 or 7 days) will not be tested. 3. The Evidence Registrar will a) Write “Lab unable to test; specimen outside acceptable collection window” on the infectious disease request form. b) Give a copy to the applicable Medical Examiner c) Give the original to the Section Secretary. 4. Requests received which are at the collection window will be communicated that day to the Tox Chemist assigned to send-outs. a) Tox Chemist will spin down sample and freeze serum in a plastic tube and then send for testing. 5. The Tox Chemist assigned send-outs will process infectious disease send-outs daily. 6. If a specimen is noted to be at or near the cut-off, it will be spun down and serum frozen in plastic prior to sending to Viro-Med/LabCorp.
Dallas County Institute of Forensic Sciences Toxicology Laboratory
3
Reference Laboratory Referral Version 2.0
This is a non-controlled copy of a controlled document
Referral Lab and Specimen Selection Matrix Test Standard clinical tests Laboratory Recommended Specimen serum: thyroid panel, LabCorp place specimens in lockbox lipid panel, glucose, for transport antibodies 972-566-7500 blood: hemoglobin fractionation, sickle www.labcorp.com cell prep Comments Refer to bid for test codes. Refer to www.labcorp.com for specimen requirements. Hemoglobin A1C, hemoblobin fractionation, or sickle cell prep: Place blood in purple top tube. Refrigerated specimens must be received within 5 days of collection to be acceptable for testing. Serum should be frozen before shipping if the hold period will be exceeded. 76504: RPR, HIV, HBSAG, HCV 76502:HIV, HBSAG, HCV 81337: HBCore Ab 81347: HBSAG 81351: HCV 81204: HIV 81300: RPR 81182: Western Blot
Infectious disease testing
LabCorp/Viromed 6101 Blue Circle Drive Minnetonka, MN 55343 800-582-0077 www.viromed.com
Serum is recommended; blood may be sent if serum is not available.
Tryptase
Dr. Lawrence Schwartz Division of Rheumatology, Allergy and Immunology Virginia Commonwealth University MCV Campus 1112 East Clay Street McGuire Hall, Room 4110 Richmond, VA 232980263 804-828-6322
1-2 ml blood
Dallas County Institute of Forensic Sciences Toxicology Laboratory
4
Reference Laboratory Referral Version 2.0
This is a non-controlled copy of a controlled document
Test Drugs/chemicals
Laboratory
National Medical Services 3701 Welsh Road Willow Grove, PA 190900437 800-522-6671 www.nmslab.com Insulin UT-Southwestern Diabetes Laboratory G.5.246 214-648-2868 Steriods Dr. David L. Black Aegis Analytical Laboratories 345 Hill Ave Nashville, TN 37210 615-255-2400 www.aegislabs.com Metabolic testing Pediatrix PO Box 219 90 Emerson Lane Bridgeville, PA 15017 412-220-2300 www.pediatrix.com Venom antibody Johns Hopkins University tests Asthma and Allergy Ctr. DACI Reference Laboratory Room 1A20 5501 Hopkins Bayview Circle Baltimore MD 21224 800-344-3224 www.hopkinsmedicine.org /allergy/daci/index.html
Recommended Specimen Blood from gray top usually sent. LSD usually screened in urine; wrap in foil to protect from light. 2 ml serum
Comments Refer to NMS Directory of Services for test numbers and specimen requirements: www.nmslab.com
urine or blood
blood
Use specimen submission cards and packaging.
serum
Covers all common wasps and bees in developed world: anti-yellow jacket, honey bee, yellow hornet, white faced hornet, Polistes wasp, fire ant, bumble bee (note: yellow jacket has some cross reactivity with yellow hornet and white faced hornet)
Other
Mayo Medical Laboratory 3050 Superior Drive NW Rochester, MN 55901 800-533-1710 www.mayomedicallaborato ries.com
Dallas County Institute of Forensic Sciences Toxicology Laboratory
5
Reference Laboratory Referral Version 2.0
This is a non-controlled copy of a controlled document
Factor V Leiden and prothrombin
Molecular Diagnostics Lab UT-Southwestern 214-648-5105/4075
blood less than 5 days old, frozen tissue (liver/kidney/lung)
Dallas County Institute of Forensic Sciences Toxicology Laboratory
6
Reference Laboratory Referral Version 2.0
