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March 2017

New rays on blood safety

March 2017—The language of blood banking experts, as they talk about irradiators, transfers easily to a car dealership. How reliable are the newer models? Are you willing to replace it every 10 years or so? Do you keep running it until it dies? What parts are likely to burn out? What will repairs run? And then the word “terrorism” pops up.

Lower HbA1c seen with sickle trait, but questions remain

March 2017—Perhaps unusually for news about clinical diagnostics research, an article in the Feb. 7 issue of JAMA created a mild stir with findings that HbA1c results in patients with sickle cell trait, the most common hemoglobin variant in the U.S., may systematically underestimate past glycemia (Lacy ME, et al. 317[5]:507–515).

Cell-free DNA screening blooms in expansion to low-risk pregnancies

March 2017—Something about having the letters “DNA” in a test’s name may make the test seem like the last word, the key to a black-and-white, definitive diagnosis. That connotation has been problematic for cell-free DNA sequencing used for noninvasive prenatal testing, because the test is not intended or designed for diagnosis, but only for screening. It’s for that reason, in fact, that some maternal-fetal medicine specialists and clinical geneticists prefer to use the term “noninvasive prenatal screening,” with the acronym NIPS.

Hemophilia diagnosis: how to test, what to know

March 2017—True, hemophilia is no longer commonly known as the “royal disease” (as it was when several generations of European rulers suffered from it). But in a January webinar, Dorothy M. Adcock, MD, gave some royally important suggestions regarding the laboratory diagnosis of hemophilia A and B.

From the President’s Desk: We all need a safe place, 3/17

March 2017—Students of history tell us that a durable paradigm shift most often involves a long gestation, typically under the radar and recognized by a precious few. What they frequently fail to tell us is that the vast majority of prognosticators often turn out to be both flat-out wrong and invisible when the “future” arrives. Either way, however, the prevailing narrative points to uncertainty in the greater health care environment.

HbA1c in CVD treatment: farewell to one size fits all

March 2017—Anchor. Central pillar. Cornerstone. It would be hard to find a weighty synonym for “linchpin” that hasn’t been used to describe HbA1c’s role in diabetes diagnosis and management since 2010, when the assay was recognized by key standard-setting organizations as the equal of fasting glucose and oral glucose tolerance testing in diabetes and prediabetes testing.

Latest TB testing guide set forth by ATS, CDC, IDSA

March 2017—Testing for latent Mycobacterium tuberculosis infection and active tuberculosis disease remained relatively unchanged for many years. Screening for latent infection depended on an initial positive tuberculin skin test, and evidence for active TB required a positive culture for M. tuberculosis complex. New tests altered this picture in the past five years. For diagnosis of latent infection, interferon-gamma release assays have taken a major role. And nucleic acid amplification testing is becoming a mainstay for establishing a diagnosis of TB.

Liver injury patterns: pitfalls and pointers

March 2017—Keep eyes wide open to everything and describe everything because there might be a number of different factors playing into a patient’s disease. That was the reminder Robert M. Najarian, MD, opened with last fall in his CAP16 presentation on common patterns of liver injury.

Dashboard eases performance analysis and prep

March 2017—Crystal Sands, MBA, MT(ASCP)SM, manager of quality, regulatory, and safety at NorDx Laboratories in Scarborough, Me., has a new favorite product, and she’s not shy about saying so. “Oh my gosh, I’ll be playing with it for a long time,” she says. “Every time I use it, I find different ways to slice and dice.”

Clinical Pathology Abstracts, 3/17

February 2017—Preventing genetic testing order errors via a lab utilization management program: Diagnostic errors, or failure to provide an accurate and timely diagnosis, impact an estimated 12 million outpatient care visits annually in the United States. These errors can often be attributed to the testing process, including test selection, ordering, retrieval, and interpretation. Literature about diagnostic errors has primarily focused on the outpatient setting; study of diagnostic error in the inpatient setting has been limited.