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Recommendations for investigating liver chemistry abnormalities are unworkable

October 2017—A new guideline on the evaluation of abnormal liver chemistries was published in the January 2017 issue of the American Journal of Gastroenterology (AJG).1 The guideline, developed by the American College of Gastroenterology’s practice parameters committee, is based on three resources, the first of which is a review of published research. The other two resources are notably similar and largely based in expert opinion.

DIY or Survey? Identifying interfering substances

October 2017—The interfering substance: Whether it’s in-laws on your doorstep or lipemia in your specimen, it has to be addressed. Ask Michelle K. Zimmerman, MD. These days, Dr. Zimmerman uses the CAP Interfering Substance Survey to detect the presence of hemolysis, lipemia, and icterus in clinical chemistry samples at Indiana University School of Medicine, where she is an assistant professor of pathology and laboratory medicine. But before her laboratory started using the Survey, how did it handle those interferences?

Primary pulmonary adenocarcinoma with an unusual molecular profile of the EGFR gene at initial presentation

October 2017—CAP TODAY and the Association for Molecular Pathology have teamed up to bring molecular case reports to CAP TODAY readers. AMP members write the reports using clinical cases from their own practices that show molecular testing’s important role in diagnosis, prognosis, and treatment. The following report comes from the University of Massachusetts Medical School-Baystate, Springfield. If you would like to submit a case report, please send an email to the AMP at For more information about the AMP and all previously published case reports, visit

NGS checklist takes in infectious disease testing

October 2017—The CAP issued its first accreditation checklist for next-generation sequencing in 2014, as NGS was becoming a tool used in a growing number of clinical laboratories. The list of requirements, which was a new section in the molecular pathology checklist, focused on constitutive (germline) testing and oncology testing.

Sigma analysis, role and limitations: development of a QC program for the Beckman Coulter AU5812

October 2017—The challenge for all clinical laboratories is to produce the highest quality in vitro diagnostic results in the most efficient manner. Fortunately, high quality and high efficiency are not mutually exclusive, and the direct correlation between the two is well documented.1,2 As the quality of processes increases, so does process efficiency, which ultimately drives down costs.

Turning points in transgender medicine

September 2017—The intricacies of transgender medicine are many. They are unique; they are universal. A la Walt Whitman, they contain multitudes: identities, challenges, questions, even fears. But the first step toward comprehending them can be simple. Tim Cavanaugh, MD, started with a cup of coffee. Dr. Cavanaugh, of Fenway Health, Boston, began delving into the topic about a decade ago, when an assistant administrator at his previous job, at a small community health center in Rhode Island, told the center’s leaders that the transgender population was medically underserved.

New tests, new wrinkles in HIV algorithm

September 2017—Three years—including a total eclipse of the sun—have sped by since the Centers for Disease Control and Prevention and the Association of Public Health Laboratories recommended a new HIV diagnostic testing algorithm for laboratories. In 2014, the algorithm was seen as bringing HIV test ordering up to speed with the advances in HIV test technology and increasing the accuracy and reliability of HIV screening and diagnosis. Have laboratories made the adjustment, and is the CDC/APHL algorithm proving workable and worthwhile?

Advanced parameters offer faster, surer guidance to cancer care

September 2017—After a career spent studying malignancies in the bone marrow and monitoring the effects of chemotherapy on the bone marrow and neoplastic cells contained therein, Cheryl Hirsch-Ginsberg, MD, stepped out from the bone marrow realm and into the faster-paced world of high-volume hematology.

Market based? A view of PAMA process, pricing

September 2017—Under the Protecting Access to Medicare Act of 2014, Medicare rates for laboratory tests will be recalculated to reflect “market-based pricing” as reported by “applicable laboratories.” But are labs going to get a market-based price, or is the Centers for Medicare and Medicaid Services “gaming the system to ensure there will be a cut to the fee schedule”?

New requirement, updates in transfusion checklist

September 2017—Like an old friend with a new facelift, or a high-mileage car with a thorough tune-up, the 2017 edition of the CAP transfusion medicine checklist has undergone a significant number of small changes—none of which is startling in itself, but all of which combine to produce a fresh and streamlined effect. More than 90 of the checklist’s requirements have been revised, many in the name of alignment with FDA requirements.