Texas Department of State Health Services

Biochemistry and Genetics
Blood Lead
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Method: Graphite Furnace Atomic Absorption Spectrophotometer

Reporting

Results Available: 2 - 3 days after receipt of specimens

Contact #: (512) 458-7578 or (888) 963-7111 ext. 7578

Reference

Reference Range: <10.0 μg/dL

Diagnostic Information: Small amounts of blood lead can be damaging to the development of a child.

Note: Any screening Blood Lead Level (BLL) above 10.0 μg/dL must be confirmed with a venous sample.

Interpretation: Blood Lead 10- 14 μg/dL (Class II A)

Test every 3 to 4 months until two consecutive tests are <10.0 μg/dL or three consecutive tests are <15 μg/dL

Blood Lead 15- 19 μg/dL (Class II B)

Confirm capillary results with a venous blood specimen
Conduct an environmental assessment interview (TDSHS form M-100)
If two consecutive follow-up tests, 3 to 4 months apart remain in this range, the parents have been counseled, and the interview completed, proceed according to actions for 20-44 μg/dL. If a follow-up BLL is in this range at least 3 months after initial venous test or BLL's increase, a home visit may be indicated to assess the environment for lead contaminants.
An environmental investigation is needed only when the interview and home visit have failed to identify the source of lead.

Blood Lead 20- 44 μg/dL (Class III)

The repeat venous sample should be done within one week. If confirmed to be > 20 μg/dL; conduct a complete medical evaluation: physical exam, including but not limited to growth assessment, blood pressure, hearing acuity, peripheral nerve function; developmental assessment; and laboratory assessment. Check for serum iron, iron-binding capacity, and ferritin should be measured.
A blood lead > 40 μg/dL should prompt a serum creatinine to assess renal function.

Blood Lead 45- 69 μg/dL (Class IV)

Begin medical treatment and environmental assessment and remediation within 48 hours.
Pharmacologic treatment is indicated and should be conducted under the guidance of a physician experienced in the treatment of lead poisoning.

Blood Lead > 70 μg/dL (Class V)

Considered a medical emergency. Medical treatment and environmental assessment/remediation must begin immediately.

Specimen/Supply Requirements

Specimen Collection: To avoid lead contamination, the patient and the person collecting the specimen, should wash hands and puncture site with soap and water before collection. Preferred Specimen: Venous anti-coagulated whole blood in EDTA (purple top tube). Collect whole blood specimens in specified DSHS blood collection tubes (BD Capillary or Venous purple top tubes). Fill the blood collection tube according to manufacturer stated fill volume. Click for illustration.

Required Request Form: G-1B

Causes for Rejection: Clotting, Quantity Insufficient, Specimen Decomposition, Specimen not tested within 14 days.

Availability: THSteps and Title V.

Specimen Submission

Shipping Requirements: Mail specimens the same day as collected; otherwise refrigerate. Avoid temperature extremes by dropping specimens off at the post office instead of using a drop box. Package specimens according to the guidelines for submission of laboratory specimens through the US Postal System.

Billing

CPT Code: 83655

Fees:$7.00

Biochemistry and Genetics
Blood Typing/Rh factor/Antibody Screen and ID
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Test Includes: ABO type, Rh Factor, Antibody Screen and Antibody Identification

Method/Procedure: Antibody Screen and ID are performed using solid phase technology

Reporting

Results Available: 3 days after receipt of specimen

Contact #: (512) 458-7578 or (888) 963-7111 ext. 7578

Reference

Turnaround Time: 3 working days after receipt of specimen

Interpretation: Blood typing and antibody screening are available to maternity patients to help prevent hemolytic disease of the newborn (HDN). The severity of HDN ranges from mild anemia to stillbirth depending on how many red blood cells are destroyed and the ability of the fetus to compensate by increased production of new cells.

Diagnostic Information: Red blood cells can be classified as A, B, AB, or O according to the presence or absence of highly reactive antigens on the red cell surface. Of all the red blood cell antigens, these are the only ones for which the corresponding antibodies consistently and predictably exist in the blood of normal individuals. Red blood cells are classified as Rh positive or Rh negative according to the presence or absence of the D antigen. Detection of unexpected antibodies in the serum of a patient is accomplished by testing against selected red blood cells possessing between them the common inherited blood group antigens. Antibody identifications are performed on positive antibody screens. Titration studies are performed on any clinically significant antibody identified.

Specimen/Supply Requirements

Specimen Collection: Venipuncture using aseptic technique

Preferred Specimen: 7- 10 mL red top without gel separator

Required Request Form: G-1B Please include whether the patient has received a Rh_o(D) immunoglobulin injection within the past 6 months as well as the date of the injection and weeks gestation.

Causes for Rejection: Quantity insufficient, No Red Cells Received, Hemolysis

Availability: Maternity patients

Specimen Submission

Shipping Requirements: DSHS Laboratory must receive specimens within 24 hours from time of collection. Specimens not received at DSHS Laboratory within 24 hours should be stored at 1° - 10°C and shipped cold. Ship specimens overnight at ambient temperature. Specimens not received within 24 hours from time of collection must be shipped overnight with enough cold packs to maintain refrigerated temperature until arrival at DSHS Laboratory. Do not freeze. Please see the RHOGAM (HDN) Packing and Shipping Instructions.

Billing

CPT Code: 86900, 86901, 86850, 86870, 86886

Fees: $32.00 up to $46.00 if Antibody Identification and Antibody Titer are performed as a result of a positive Antibody Screen.

Biochemistry and Genetics
Cholesterol/Lipid Profile
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Test Includes: Lipid Profile includes total cholesterol, triglyceride, High Density Lipoproteins (HDL) and Low Density Lipoproteins (LDL)
Method/Procedure: Enzymatic measure using UV/Visual Spectrophotometry
Reporting
Results Available: 3 working days after receipt of specimen
Contact #: (512) 457-7578 or (888) 963-7111 ext. 7578
Reference
Reference Range: Adults - Cholesterol............................<200 mg/dL Triglyceride ...........................30- 190 mg/dL HDL Cholesterol................... >35 mg/dL LDL Cholesterol.....................<130 mg/dL	Children- Cholesterol......................<170 mg/dL Triglyceride......................30- 190 mg/dL HDL Cholesterol..............>35 mg/dL LDL Cholesterol...............<110 mg/dL
Diagnostic Information: Cholesterol measurements are used in the diagnosis of metabolic disorders involving lipids and lipoproteins. Triglyceride measurements are used in diagnosis and treatment of patients with diabetes mellitus, nephrosis, liver obstruction, other diseases involving lipid metabolism or various endocrine disorders. HDL cholesterol is inversely related to the risk of developing coronary artery disease. The higher the HDL cholesterol the less chance of developing coronary heart disease. LDL cholesterol is calculated using the Friedwald equation.
Specimen/Supply Requirements
Specimen Collection: Venipuncture using aseptic technique. Preferred Specimen: Red top. Collect specimen for cholesterol or lipid profile in a red top tube. Remove serum from clot within 2 hours of collection. Transfer at least 1 mL of serum to another plastic transport tube and freeze. Plastic transport tube can be a plain blood collection tube.
Required Request Form: G-1B
Causes for Rejection: Hemolysis, Quantity Insufficient
Limitations: Lipid profile requires a fasting specimen. THSteps non-fasting specimens receive a total cholesterol. Fee for Service non-fasting specimens receive a total cholesterol and an HDL cholesterol.
Specimen Submission
Shipping Requirements: Ship specimens overnight with enough cold packs or dry ice to maintain specimens at proper temperature until arrival at DSHS Laboratory. On each G-1B submission form, record the date and time that specimens were removed from the freezer for shipment. Batching of specimens for shipment is recommended. Click for detailed shipping instructions.
Billing
CPT Code: 80061
Fees:$21.00

Biochemistry and Genetics
Diabetes/Glucose
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Method/Procedure: Enzymatic measure using UV/Visual Spectrophotometry
Reporting
Results Available: 3 working days after receipt of specimen
Contact #: (512) 458-7578 or (888) 963-7111 ext. 7578
Reference
Reference Range: Random:.............50- 130 mg/dL 1-Hr. GTT: ........<140 mg/dL 2-Hr PP:..............<120 mg/dL	3-Hr GTT: Any 2 of the following greater than expected Fasting:.............<105 mg/dL 1-Hr:.................<190 mg/dL 2-Hr:.................<165 mg/dL 3-Hr:.................<145 mg/dL
Diagnostic Information: Glucose measurements are used in the diagnosis and treatment of carbohydrate metabolism disorders including diabetes mellitus, hypoglycemia, gestational diabetes and pancreatic islet cell carcinoma. Glucose concentrations are measured using a timed endpoint method and hexokinase reagent.
Specimen/Supply Requirements
Specimen Collection: Venipuncture using aseptic technique. Collect specimens for glucose testing in gray top tubes containing sodium fluoride/potassium oxalate. Plasma must be separated from red blood cells within 24 hours from time of collection. Transfer plasma from red cells and place in another plastic transport container and freeze.
Preferred Specimen: Gray top containing Sodium Fluoride/Potassium Oxalate
Required Request Form: G-1B
Causes for Rejection: Not collected in Sodium Fluoride/Potassium Oxalate blood collection tube, Hemolysis, Quantity Insufficient
Specimen Submission
Shipping Requirements: Ship specimens overnight with enough cold packs or dry ice to maintain specimens at proper temperature until arrival at DSHS Laboratory. On each G-1B submission form, record the date and time that specimens were removed from the freezer for shipment. Batching of specimens for shipment is recommended. Click for detailed shipping instructions.
Billing
CPT Code: 82947, 82952 for each additional tolerance test
Fees:$5.00 up to $19.00 for 3-Hour glucose tolerance test

Biochemistry and Genetics
Hemoglobin Electrophoresis
(Also known as Hemoglobinopathy, Hemoglobin Type, or Sickle Cell Screening)
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Method: Isoelectric focusing

Reporting

Results Available: 2-3 days after receipt

Contact #: (512) 458-7578 or (888) 963-7111 ext. 7578

Reference

Diagnostic Information: Heel stick, finger stick, or venous blood dropped on filter paper is screened by the use of isoelectric focusing for clinically significant hemoglobinopathies and thalassemias, including sickle cell anemia.

Turnaround Time: 2-3 days after receipt

Reference Range:   Birth to ~6 months = F,A,A
                                   ~6 months to 1 year = A,A,F
                                  Over 1 year = A,A

Interpretation: Results for Hemoglobin Electrophoresis that are outside of the Expected Range should be confirmed with a second specimen at a different laboratory.

Specimen/Supply Requirements

Specimen Collection: Heel stick, finger stick, or venous blood.
Required Specimen: Dried filter paper blood spots
Volume/Amount Required: 2-3 dried blood spots

Specimen Collection Card: The required specimen, effective November 1, 2007, is the Texas DSHS Snap-Apart filter paper card. The Snap-Apart filter paper card may be ordered from Container Prep at (512) 458-7661 or (888) 963-7111 ext. 7661 and is only valid for Hemoglobin Electrophoresis testing.

Specimen Collection Card Shelf Life: The expiration date is printed on the flap near the filter paper collection area. Do Not Use Expired Cards.

Specimen Collection Card Storage (prior to use): Store in original wrapping and stack in a manner (vertically) to avoid compression of the filter paper.

Specimen Collection Instructions:

Wear powder-free disposable gloves when handling collection card and collecting sample.
Never touch the specimen collection area.
Write in name of patient and date of collection where indicated.
To open the card, grasp thumb notches printed on the card between thumb and forefinger of each hand and snap card apart. The instruction sheet will detach from the card. If the card does not “snap apart,” it may be separated by tearing at the perforated lines.
Holding cover away from specimen collection paper, fill at least 2-3 circles with blood following standard procedures.
Holding card at thumb notch near collection area, slightly bend collection card away from cover to allow air to flow beneath the collection paper and place card on flat surface to dry.
When sample has dried, fold cover at score line, over sample, and tuck into flap.
Complete G-1B form and submit with specimen.
Ship Hemoglobin Electrophoresis filter paper specimens in THSteps (Texas Health Steps) mailing containers with other specimens for THSteps testing. Specimens are to be shipped to DSHS at ambient temperature. Do not batch specimens; mail specimens the day of collection or the day after collection.

Storage Instructions: Allow specimen to air-dry completely at ambient temperature before mailing; mail specimen as soon as possible.

Causes for Rejection: The Hemoglobin Electrophoresis specimen has to be received by the laboratory by the 13^th day after collection on a non-expired form and should have at least 2-3 adequately filled circles, patient name/date of collection, and a complete and accurate G-1B request form.

Additional Causes for Rejection include:

Insufficient blood has been submitted,
Specimen is contaminated or discolored,
Missing or invalid patient demographic information,
Specimen is too old upon receipt (received 14 or more days following collection),
No blood samples received with request form,
Improper specimen submitted (i.e., EDTA whole blood),
Serum separation due to improper drying or collection, or
Laboratory accident.

Specimen Submission

Required Request Form: G-1B

Shipping Requirements: Mail specimens the day of collection or the next day. U.S. Postal regulations require double containment of dried blood filter paper specimens. Ensure specimens are thoroughly dried prior to placing in mailing container.

1^st containment: Use the attached wrap-around cover with printed universal biohazard symbol.

2^nd containment: Use THSteps mailing container for shipping Hemoglobin Electrophoresis specimens.

Notes: Ship specimens at room temperature within 24 hours of specimen collection. Avoid temperatures greater than 100° F.

Billing

CPT Code: 83020

Fees: $6.00

Biochemistry and Genetics
RPR Card Test
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Method: 18 mm RPR Card Test (agglutination)

Reporting

Results Available: 2- 3 days after receipt of specimens

Contact #: (512) 458-7578 or (888) 963-7111 ext. 7578

Reference

Reference Range: Nonreactive

Diagnostic Information: The rapid plasma reagin (RPR) card test is a macroscopic, non-treponemal flocculation test for the qualitative and semi-qualitative serological detection of syphilis. Nontreponemal tests for syphilis become reactive 4-6 weeks after infection with titers peaking during secondary to early latent stage. Treatment in the primary or secondary stages usually results in a rapid decline in titer. Treatment given in latent or late stages has less effect on antibody titers and the test may remain reactive at low titers indefinitely. The reagin-type antibody binds with the antigen that is composed of a complex of cardiolipin, lecithin and cholesterol particles with activated charcoal; the result of this antigen-antibody reaction is a macroscopic flocculation that shows up as black clumps against the white card. The RPR-Card test is a screening test and without some other evidence for the diagnosis of syphilis, a reactive non-treponemal test does not confirm Treponema pallidum infection. The RPR-Card test does not distinguish between syphilis and other treponematoses such as yaws, pinta and bejel. The semi-qualitative RPR-Card Test may be used as a method to follow response to treatment. A four-fold or greater drop in titer between pre- and post-treatment specimens is indicative of response to therapy. Test is performed daily.

Limitations: May not detect a recent infection, or infection in a person with a severely compromised immune system.

Interpretation: Nonreactive indicates that the patient does not have detectable antibody to the infectious agent. Reactive indicates that the patient has detectable antibody to the infectious agent, and depending on the clinical picture, may have a current or past infection.

Specimen/Supply Requirements

Specimen Collection: Venipuncture using aseptic technique

Specimens collected in a red-top blood collection tube should be centrifuged within two hours of collection to separate the serum from the red blood cells (clot). Pipette serum from the clot, transferring the serum to the serum transport tube. Keep specimen cold until shipping. Discard red top tube.
or
Specimens collected in a serum separator tube with clot activator and gel (SST) should be centrifuged within two hours of collection to separate the serum from the red blood cells (clot). Keep specimens cold until shipping.

Serum specimens may be frozen with the exception of the serum separator tubes (SST). Do not freeze SST.

Specimen Type: Serum

Volume/Amount Required: minimum 1 mL of serum

Preferred Specimen: Single Serum

Collection/Preservation: Red top tube or Tiger/Gold top serum separator tube with clot activator and gel (SST)

Storage Instructions: Separated serum (serum transport tube with serum only and SST) may be held at 2-8°C (cold); or (serum transport tube with serum only) may be held at -20°C (frozen)

Causes for Rejection: Gross hemolysis, quantity insufficient of serum for testing, whole blood specimen submitted, specimen not received, specimen delayed in transit, specimen not received cold, specimen collected in expired tube.

Specimen Submission

Shipping Requirements: Package serum transport tube/SST in cold shipping box with sufficient cold packs to ensure specimen arrives cold within 5 days from the date of collection. Ship specimens overnight via UPS next day air. On each G-1B submission form, record the date and time that specimens were removed from the refrigerator/freezer for shipment.

Do not ship specimens on Friday, Saturday or the day before a federally observed holiday.

Transport Temperature: Serum transport tube with serum only and SST (cold); or serum transport tube with serum only (frozen).

Required Request Form: G-1B

Availability: THSteps and Title V. Test performed daily.

Billing

CPT Code: 86592

Fees: $4.50

Biochemistry and Genetics
Total Hemoglobin
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Method: SLS-methemoglobin (SLS-HB) for Total Hemoglobin

Reporting

Results Available: 2-3 days after receipt of specimen

Contact #: (512) 458-7578 or (888) 963-7111 ext. 7578

Reference

Diagnostic Information: Whole blood specimens are screened for hemoglobin concentration using a photometric method. Decreased levels of hemoglobin can indicate iron-deficiency and other forms of chronic anemia.

Turnaround Time: 2-3 days after receipt of specimen

Reference Range: 11-16 ug/dL

Specimen/ Supply Requirements

Specimen Collection: EDTA (Purple top tube) anticoagulated whole blood. Submit specimens in DSHS specified blood collection tubes (Capillary/Venous). Fill blood collection tube according to manufacturer stated fill volume.

Storage Instructions: Room temperature, may be refrigerated to avoid heat and freezing temperatures.

Causes for Rejection: Specimen decomposition, clotted, insufficient quantity, Specimen not tested within 10 days.

Specimen Submission

Required Request Form: G-1B

Shipping Requirements: Mail specimens the same day as collected. To avoid temperature extremes, drop specimens off at the post office instead of using a drop box. Package specimens according to the guidelines for submission of laboratory specimens through the U.S. Postal System.

Billing

CPT Code: 85018

Fees: $4.00

MRS Clinical Chemistry Tests