LifeBridge Health  |  Find a Physician  |  Careers  |  Directions  |  Community Calendar  |  Contact
Physician Portal  |  Board Portal
Call 410-601-WELL (9355) to Schedule an Appointment



  • Medical Services
    Sinai Hospital Medical Services

    Anesthesia
    Dialysis Access Center
    Emergency Medicine
    Medicine
       • Allergy and Immunology
       • Cardiology
       • Critical Care Medicine
       • Cancer/Medical Oncology 
       • Dermatology
       • Endocrinology and Metabolism
       • Family Medicine
       • Gastroenterology
       • General Internal Medicine
       • Geriatric Medicine
       • Infectious Diseases
       • Nephrology (kidneys)
       • Pulmonary Medicine
       • Rheumatology (joints, tendons)

     

    Neurology
    Neurosurgery
    Obstetrics and Gynecology
    Ophthalmology (Eye Care)
    Oral and Maxillofacial Surgery and Dentistry
    Orthopedic Surgery
    Otolaryngology (Ear, Nose & Throat)
    Pathology
    Pediatrics
    Pharmacy
    Physical Medicine and Rehabilitation
    Psychiatry
    Radiation Oncology
    Radiology
    Sleep Center
    Surgery
    Urology

      Sinai Hospital Centers of Excellence

    Adult Hydrocephalus
    Brain & Spine Institute
    Cancer Institute
    Cardiovascular Institute
    Children's Hospital
    CyberKnife® Center
    ER-7 Emergency Center
    Geriatric Surgery
    Joint Preservation and Replacement
    Krieger Eye Institute
    Limb Lengthening
    Rehabilitation
    Rubin Institute for Advanced Orthopedics
    Spine Center

     

    Stroke Center
    Vascular Institute
    William E Kahlert
    Regional Cancer Center

    Women's Services

  • About Sinai Hospital
    About Sinai Hospital

    About Sinai Hospital
    Campus Map
    FAQs
    Hackerman-Patz House at Sinai Hospital
    Insurance Plans Accepted
    Nursing At Sinai
    Population Health
    Sinai Hospital Auxiliary
    Visitor Guide (PDF)
    Visitor & Patient Information
    Wireless Internet Access

      Sinai Hospital Management

    Sinai Hospital Board of Directors
    Sinai Hospital Management Team
    Sinai Hospital Division Chiefs

      About Our Centers

    LifeBridge Health
    Sinai Hospital
    Northwest Hospital
    Carroll Hospital
    Levindale


    About Sinai Hospital
  • Locations
    LifeBridge Health Locations

    Sinai Hospital of Baltimore Northwest Hospital Carroll Hospital Levindale Hebrew Geriatric Center and Hospital  LifeBridge health & Fitness
    Sinai Hospital of Baltimore Northwest Hospital Carroll Hospital

    Levindale Hebrew Geriatric Center and Hospital

    LifeBridge Health
    & Fitness

    Additional Centers
    LifeBridge Health  Practice Dynamics, Inc, PDI  VSP  ExpressCare  

    LifeBridge Health

    Practice Dynamics, Inc, PDI

    VSP

    ExpressCare
     
  • GME
    Graduate Medical Education

    ACGME-Accredited
    Residency Programs

    General Surgery
    Internal Medicine
    Obstetrics and Gynecology
    Ophthalmology
    Pediatrics
    Physical Medicine and Rehabilitation

      Fellowship Programs

    Joint Replacement and Reconstruction Fellowship
    Limb Lengthening and Reconstruction Fellowships
    American Society of Ophthalmic and Plastic Reconstructive Surgery Oculofacial Fellowship

      Medical Education

    Information for Residency Applicants
    New Resident Credentialing Application Information
    Electronic Residency Application Service (ERAS)
    Rotating to Sinai
    Medical Student Electives


    Medical Education Office
    Sinai Hospital of Baltimore
    2401 W. Belvedere Avenue
    Baltimore, MD 21215
    410-601-7639 (V)
    410-601-6308 (fax)

    Other Educational Programs

    LifeBridge Clinical Pastoral Education
    Northwest Hospital Minimally Invasive Surgery Fellowship
    Sinai Hospital Pharmacy Residency

       
    Graduate Medical Education
  • Giving & Volunteering
    Giving Opportunities

    LifeBridge Health Development
        Contact Us
        Development News
        Donate Now
        Grateful Patient Stories
        Special Events
        Ways to Give

      Volunteering

    Volunteer at Sinai Hospital
    Volunteer at Northwest Hospital
    Volunteer at Carroll Hospital
    Volunteer at Levindale

    Giving and Volunteering at LifeBridge Health
  • Patient Information
    Sinai Hospital Patient Information

    Advance Directives
    Billing and Financial Considerations
    Campus Map
    Caregivers
    CarePages
    Chaplaincy
    Community Services
    Dining - Patient Room Menus
    Dining - Retail
    Directions
    Discharge Information
    Donations
    E-Cards

     

    Escort and Security Service
    Ethics Committee
    FAQs
    Hackerman-Patz House
    Important Phone Numbers
    Insurance Plans Accepted
    Interpreter Services
    Local Accommodations
    Meals and Nutrition Services
    Medication Information
    Outpatient Pharmacy
    Parking Information
    Patient Forms

     

    Patient Pain Management
    Patient Personal Items and Valuables
    Patient Quality Care
    Patient's Rights & Responsibilities
    Pay Your Bill
    Resolving Concerns
    Retail Shops
    Request Medical Records
    Telephone Service
    Television Services
    Visiting Hours
    Visitor Guide
    Wireless internet


      My LifeBridge Health
    Patient Portal


    Click to access the portal

    My LifeBridge Health Patient Portal
  • Resources
    Sinai Hospital Resources

    Apps
    Awards
    Blog
    Campus Map
    CarePages - Sinai Hospital Patient Websites
    Community Calendar
    Contact Sinai Hospital
    Directions to Sinai Hospital
    Health Library
    Healthstream
    Important Information
    Infographics
    Insurance Plans Accepted
    LifeBridge Health Business Partners
    LifeBridge Health Magazine
    Local Accommodations
    Maryland Health Connection
    My LifeBridge Health Patient Portal

     

    News Room
    Parking Information
    Patient E-Cards
    Outpatient Pharmacy
    Recorded Webinars
    Sitemap
    Social Media
    Vendor Resources
    Web Nursery
    WBAL-AM Videos

      Additional Resources at Sinai Hospital

 

In This Section
footer
FIND A PHYSICIAN
line
ONLINE APPOINTMENT REQUEST
line
MY LBH PATIENT PORTAL
line
VISITOR & PATIENT INFORMATION
line
CONTACT US
line
PAY YOUR BILL ONLINE
Home buttonBack button Printer Friendly Version Print this Page Email A Friend Email to a Friend Increase Text Size Decrease Text Size Font Size

 

Sinai > Medical Services > Pathology Lab Users Guide > Clinical Pathology

Clinical Pathology

Clinical Pathology

LifeBridge Health - Department of Pathology

Clinical Pathology

CLINICAL PATHOLOGY
TABLE OF CONTENTS

Medical and Technical Staff
Order Entry
Patient Identification
Hours of Service
Specimen Rejection Policy
Biohazard and Infectious Specimens
Clinical Pathology Reports
General Result Inquiry
Critical Value Reporting
Myocardial Profiles

Medical and Technical Staff

top

Christian Hansen, MD Chairman (NWHC) 521 – 5910
Robert E. Wenk, MD Chief of Clinical Pathology 601 – 5090
David Bennett Director of Laboratory 601 – 5067
Sidney Yoho Manager, Clinical Pathology (SHB 601 – 5095
Donna Marquess Manager, Blood Bank 601 – 9503
Paul Griffey Manager, Outpatient / Outreach Services 601 – 5786
Tammy Hiller Manager, Microbiology - Core 601 – 4019
     
Sheri Hoffmann Team Leader, Hematology, Special Hematology & 601-5852
  Special Hematology 601-5082
  Flow Cytometry – Core Lab 601-9003
Lordes Madamba Team Leader,Manual Procedures – Core Lab 601-5935
  Team Leader, General Lab (NWHC) 521 – 5902
Ndy Mbah Coordinator, Lab Information System 601 – 8550
Ann Bengzon Coordinator, Bedside Testing / PI 601 - 9397

top

Order Entry: STAT and routine tests may be requested using the hospital information system. Stat blood requests should be entered into the hospital information system with the priority code of STAT. The sample is to be collected and immediately transported to the laboratory specimen receiving department for processing. If the hospital information system is not operational, use the downtime form and list all the tests needed. The downtime procedure is at all nursing stations. If a test is not listed in this manual, please call the specimen processing area for more information.

Tests requests - Outpatient areas: STAT and routine tests may be requested using a paper requisition available from Belvedere Pathology Associates (BPA). For STAT test requests, the sample is to be collected and immediately transported to the laboratory specimen receiving department for processing. Call 410.601.8338 for a courier to pick up the sample. Routine tests may be bundled and transported together. Refer to this manual for test collection and transportation information. If a test is not listed in this manual, please call BPA area for more information.

Patient Identification: This is the most important aspect of laboratory testing To assure proper patient identification, match the name and number on the armband to the name and number on the order each time a specimen is obtained. The initial and clock number of the employee drawing the blood should be written on the label and attached to the sample. The label should also have the test codes, and the date and time of collection.

Add-On Tests: Tests that are to be added to a sample already sent to the lab are to ordered on a "Downtime / Add-On" requisition and tubed to the lab. Do not add tests to an accession number via Cerner order entry.

Downtime Testing: During periods of computer downtime, tests can still be ordered by means of the "Downtime / Add-On" requisition and tubed with the specimen to the lab. Do not use the Cerner order entry system during announced downtime as duplicate orders could be produced.

top


Hours of Service:

CLINICAL PATHOLOGY:
Automation - Hematology; Chemistry; Coagulation; Microbiology; Blood Bank; and Blood Gas Laboratory is open 24/7. Telephone 601-5116.

Flow Cytometry: Open from 7:00am to 6:00pm Monday through Thursday, and 07:00am to 8:00pm Friday. No Weekends or Holidays. Telephone 601 - 9003.

Manual Procedures – Special Chemistry; Immunology Laboratory is open from 07:00 to 17:00 Monday through Friday, and 07:00 to 15:30 PM Saturday and Sunday. Telephone 601 - 5935.

Pathologist-on-call - 24 hours per day, seven days per week. The on call list is posted in the main laboratory and available through the Sinai operator.

BPA - Outpatient phlebotomy is available in Suite 11 of the Hoffberger Building. Hours and days of operation are 07:00 to 17:00 Monday through Friday. Telephone 601- 8338.

Laboratory specimens: To insure the accuracy of results, we insist on your cooperation in the proper labeling of specimens.

top

Specimen Rejection Policy: Specimen integrity is crucial in laboratory testing. The physical condition of the specimen has a direct impact on the validity of certain types of analyses. A new specimen must be requested for testing if the specimen in hand is unacceptable for testing.

QNS: Quantity varies with test ordered.

  1. The lab will notify the caregiver that a new specimen is required.

  2. The order will be canceled with a coded comment (quantity not sufficient).

  3. The name of the person notified and the time will be appended to the comment.

HEMOLYSIS: May not affect all tests ordered.

  1. If all of the tests ordered are affected, the care giver will be notified that a new specimen is required.

  2. The order will be canceled with a coded comment (Unable to test due to hemolysis).

  3. The name of the person notified and the time will be appended to the comment.

  4. If not all of the tests are affected, the tests unaffected by hemolysis will be run. The test(s) that are affected by hemolysis will be canceled as in 2 & 3 above.

LIPEMIA: May not affect all tests ordered.

  1. The steps above will be followed using a coded comment (Unable to test due to lipemia).

ICTERIC: May not affect all tests ordered.

  1. The steps above for hemolysis and lipemia will be followed using a coded comment (Unable to test due to icteric interference).

CLOTTED: Affects all tests.

  1. The steps for QNS (above) will be followed, substituting a coded comment (Specimen Clotted).

BUBBLES: For Blood gases and whole blood analyzers.

  1. The steps for QNS (above) will be followed, using a coded comment (air bubbles present).

NEEDLES: Must be removed and replaced with a dead-end cap. Syringes are acceptable only for blood gas whole blood electrolyte samples. Recapping by hand is prohibited. Needles must be removed using a Kelly or other instrument. Transfer all other specimens obtained in a syringe into appropriate containers.
top
Biohazard and Infectious Specimens: All specimens are treated with universal precautions when received in the laboratory. We suggest double bags and leak proof containers be used when transporting samples to the laboratory. All samples in transport must be contained.

Clinical Pathology Reports: Laboratory results are available in the hospital information system as soon as laboratory verification occurs. Written laboratory reports are printed by the hospital information system each day and distributed to the appropriate areas.

General Result Inquiry: The laboratory is required not to release results to patients. If patients inquire the laboratory for results, they will be referred to the physician of record. Results are stored in the hospital information system. Archive results may be obtained from medical records or the hospital information system. Specimen processing will release results to the proper health care giver upon request, this method should be used when the hospital information system is not operational.

Critical Value Reporting: The laboratory will call critical value results to the health care giver, the physician of record, or the service/nursing station.

Cardiac Marker Testing:

top

MYOCARP
(Myocardial Panel)
LABORATORY MARKERS OF
MYOCARDIAL INJURY

MARKER EFERENT
RANGE
SPECIFICITY COMMENTS INTERFERENCE
Troponin  I 0.01-1.5 ng/mL Most specific of
the markers.
Rises slowly.
Peak: 8.9 hrs
Plateau or slow
Decline.
Remains increased
For up to 96hrs
after MI
Myocardium injuries can
release the marker: Chest
surgery; myocarditis
ischemia; cardiac
contusion
Rare

Intense jaundice
(>5 mg/dL)
Blocking
antibodies in
serum
Myoglobin 10.5-95.5 ng/mL 2 normal
findings within
4-8hrs of chest
pain can r/o MI
with 99% surety.
Rises quickly.
First to reach peak
Concentration.
Apex averages 3.4 hrs.
At 4-8 hrs=20x
Upper limit.
Usually down by
24 hrs.
>Sensitive, but non-
specific. (Increased in
skeletal muscle
Disorders)
Turbidty

Notes:

  1. Serial measurements are necessary. Single measurements do not r/o MI so panel must be ordered every 4 hours. Extend q 4 hr draws as long as there is suspicion of MI.
  2. Available-7 days/24 hours.
  3. Turnaround- 30 minutes from receipt in Lab.

  4. Collection-Dark green top-heparinized vacuum tube with 5mL of blood.

  5. Do not use tests to measure size of infarction.

Characterization of Myocardial Infarction with MYOCARP

RE Wenk MD, J Quartner MD, D Meyers MD, M Goldstein MD,
C Cummings MD, B Dubois MD and D Dembo MD

    Historically, myocardial infarction (MI) has been marked by characteristic release of myocardial proteins into plasma. The proteins showed an early increase above the normal range, an apex or peak, and a late decreased concentration over time. Even when proteins (e.g., enzyme activities such as total LDH) were not specific to myocardial tissue, the time-concentration sequence curve was considered diagnostic. When more specific markers of cardiac tissue became available (e.g., creatine kinase), the time-concentration paradigm did not change: the rise and fall of cardiac markers denote the acute injury that occurs in MI. The same paradigm applies to the most recent and most specific markers. Myoglobin and Troponin I all show increases, peaks and decreases following heart injury.

     After myocardial infarction, myoglobin reaches its peak concentration first, probably because it is a small, abundant protein that is readily released from heart muscle. Myoglobin is a sensitive but nonspecific marker that is found in all striated muscle. It demonstrates small, extended and reinfarctions better than the other markers. The apex of its increase occurs at a mean of 3.4 hours from the time of the first blood sample collected from a MI case. Caution is warranted because it is possible to fail to observe the myoglobin curve when the patient's visit to the Chest Pain Emergency Room (CPER) is delayed after the MI or if there is delay in collecting blood samples.

     The apex of CK-MB occurs at a mean of 8.6 hours, but is more heart-specific. The CK MB mass measurement analyzes the antigenic structure of the enzyme instead of its catalytic activity (measured with an assay that is now obsolete). The new CK MB mass test avoids the problem of interference by "macro CK", an autoantibody-CK BB complex found in 1-2% of hospital patients.

     Troponin I, the most specific test of cardiac muscle damage, will peak at an average of 8.9 hours after collection of the first blood sample. Despite its specificity for cardiac muscle, troponin I can be released in other disorders affecting myocardium (cardiac trauma, cardiomyopathies, following therapeutic interventions, unstable angina, etc.) Troponin I tends to remain elevated for hours to days after MI. The slow decline of troponin I concentration allows the test to replace the total LDH and LDH isoenzyme tests as late indicators of MI.

     Diagnosis of MI is most certain after observing typical time sequences of the curves of all three MYOCARP markers. Although there is evidence to suggest that the peak values of the three markers' results indicate size of infarction, the tests should not be used for this purpose. The MYOCARP order should be used for diagnosis or to rule out MI. Rarely, a patient with MI may show a late rise in values (myoglobin first) or atypical time sequences of the expected curves. This is apt to occur when there are therapeutic interventions or complicating diseases. Clinical and laboratory observations (q 4 hours) should be extended for as long as there is suspicion of MI.

 

LifeBridge Health | Sinai Hospital | Northwest Hospital | Carroll Hospital | Levindale | LifeBridge Health & Fitness

 

Sinai Hospital
2401 W. Belvedere Ave.
Baltimore, MD 21215
Contact Us: 410-601-9000

Directions

    Sinai Hospital Map - Click here for directions.

Join LifeBridge Health on: Facebook Twitter YouTube LBH Blog LinkedIn Instagram

Terms of Use  |  Privacy Policy  |  HIPAA Notice of Privacy Practices  |  Transportation Policy |
Nondiscrimination Notice and Foreign Language Assistance

Loading... Loading...