2016

The diagnostic gap for HIV-testing has decreased from 12 to 6 weeks. Prerequisite for this is the use of serological HIV screening of the 4th generation (concurrent evidence of anti-HIV-1 and anti-HIV-2 as well as HIV-p24 antigen). If the antigen-antibody-combination test is negative, HIV-infection can be ruled out with high probability, if last potential HIV-exposure was more than 6 weeks ago.
There are two, nearly non-relevant exclusions of this decrease in testing time, which are:

• Infection with HIV-2
  • Antigen-evidence could be false-negative (in Germany extremely rare, 0,3 % of diagnosis)
  • Immune suppression / immune defect
    • There may be timely delay in antibody-formation in patients with antibody-formation disturbances.

In case of reactive or borderline HIV-screening results, confirmation testing to rule out non-specific reaction, is required.

• Antibody-based confirmation
  • The classic confirmation test is the detailed evidence of antibodies in the immune blot. Differentiation between HIV-1 and HIV-2 is possible. In conspicuous screening result and negative/questionable immune blot, nucleic acid evaluation should be sought to confirm or rule out fresh infection.
  • Nucleic acid evaluation
    • Nucleic acid evaluation (for instance as PCR) can be sought for confirmation now.

Abnormal screening results and negative or non-definite nucleic acid evaluation should be followed up by an immune blot as the result is not reliable in case of low viral load or HIV-2-infection.

Rapid analysis, also those with p24-antigen evaluation, the diagnostic window remains at 12 weeks. Due to the rapid analysis not having the required high sensitivity, it only reacts approximately a few days later than the screening test.

Dear colleagues,

so far, parallel analysis of human thyroglobulin and thyroglobulin recovery rate was used for monitoring of patients after thyroid resection. The determining of the thyroglobulin recovery rate was used to ensure, that no false low or false negative thyroglobulin values, which were caused by thyroglobulin antibodies were seen.

As the determining of the thyroglobulin recovery rate alone however is relatively susceptible to faults, both the American Thyroid Association (ATA) as well as the European Association of Nuclear Medicine (EANM), recommend direct evaluation of the thyroglobulin antibodies. Due to this, with the parallel analysis of thyroglobulin and thyroglobulin antibodies, false low thyroglobulin values are also identified. Faults caused by other influencing factors do not occur any longer. In addition to this, the thyroglobulin antibody can also function as so-called “surrogate tumor marker”.

With immediate effect, our laboratory automatically carries out parallel evaluation of thyroglobulin and thyroglobulin antibodies instead of the recovery rate.

Should you have any further questions, please contact Dr. Juliane Fazio on tel. +49 5222 8076-207.

_{Literature:
Haugen et al.: “2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer”, Thyroid, Volume 26, Number 1
Verburg et al.: “Why the European Association of Nuclear Medicine has decline to endorse the 2015 American Association management guidelines for adult patients with thyroid nodules an differentiated thyroid cancer”, Eur J Nucl Med Mol Imaging, 2016 Jun;43(6):1001-5}

Dear colleagues,

Company Abbott has informed us, that there may be cross-reactions under Fulvestrant, in the analysis of 17-ß-estradiol.

In women, who receive Fulvestrant for therapeutic reasons due to advanced mamma carcinoma, false high 17-ß-estradiol values are seen. This may lead to wrong therapeutic decisions.

Evaluations by LC/MS (Liquid chromatography/mass spectroscopy) are not affected by cross-reactions. In women with Fulvestrant-therapy, in whom increased 17-ß-estradiol levels were measured, further testing by LC/MS is recommended.

Please note the desired method LC/MS clearly on your request form.

Should you have any further questions, please contact Dr. Juliane Fazio on tel. +49 5222 8076-207.

Rational hepatitis A diagnostics

• Hepatitis A serology comprises only parameters anti-HAV-IgG and anti-HAV-IgM.
• On suspicion of an acute infection, IgG and IgM should be requested!
• For immunity checks, IgG is sufficient.

Rational hepatitis B diagnostics

• HBs-antigen is the outer surface antigen of HBV. It is a marker for infectivity.
• Anti-HBc is produced at any contact with the virus, but not after vaccination!
• Anti-HBs is the marker for immunity, it is aimed against the HBs-antigen. It is the only positive parameter after vaccination.
• HBe-antigen and anti-HBe are additional markers for the estimation of infectivity.

Rational hepatitis C and hepatitis D diagnostics

• For hepatitis C and D, only combined tests (IgG and IgM) are available.
• The question of possible immunity does not make sense, as hepatitis C gets chronic in 80 % of cases, and a previous infection does not provide protection from re-infection. Hepatitis D only occurs in connection with hepatitis B.
• There are no vaccinations for hepatitis C and D.
• Tests only inform of exposure, infectivity has to be clarified by PCR.
• Guideline serological hepatitis diagnostics for medical assistant staffWhich parameters have to be requested/marked when?

Conclusion: For screening of hepatitis B infection, HBs-antigen, anti-HBs and anti-HBc should be tested, for checks following vaccination only anti-HBs (serum for each test).

Our standardized way of sending results is in written format. You will receive a structured compilation of findings, sometimes even in graphic format.

Within the catchment area of our house-own courier service labcar-owl, the results will usually be delivered by the same courier that collects your new samples, the next working day after determination of the findings.  At the same time all required collection-material that you may have requested will be delivered.

Outside of the catchment area of the courier service, you will receive the results by mail within the normal delivery times of the “Deutsche Post”.

Telefax

We transmit results electronically directly after validation to your practice by telefax. Please be aware that the nominated fax machine should always be ready to receive (even outside of your working hours or opening times).

Telephone

Highly pathological results will be telephoned through without due delay.

Remote Data Transfer

In case of remote data transfer, the results in LDT format will be put into a mailbox as soon as they are ready.

The display of the results on the IT system may differ from the printed version. This is dependent on the individual systems used in each practice. Data is collected by the practice as and when required and as technical set-up allows:

• By modem via the telephone connection- analog or by ISDN
• By Client via the internet, made available by the laboratory free of cost, encrypted
• Via the web-portal as LDT-file

The latter ensures that results will be available directly in your practice system as quickly as possible. We will be happy to assist with the implementation of the installation.

Web-portal

The required results can also be viewed or printed by you via the commonly used internet-browsers, such as Internet Explorer, Mozilla Firefox, Chrome etc. This also allows the production of PDF-prints. Of course, data security of patient information is imperative to us and therefore secured by up-to-date security- and encryption mechanisms.

iPhone/Android App

If you have a smart phone, you can access your laboratory results at any time online by using our free mobile client on our iPhone or android App for up to one year.

As with all our services, data protection of patient information is secured by modern security- and encryption mechanisms. To guarantee this, your connection will automatically be disconnected after a time of inactivity with no remaining memory traces of the retrieved data on your smartphone. This means best possible data protection, even in case of the loss of your smartphone.

You can find our app in the AppStore or in the PlayStore.

An infection with the Zika virus as lately especially apparent in South- and Central America can lead to symptoms such as fever, skin rash, headache, aching joints- and muscles as well as conjunctivitis. There is the assumption that Zika virus infections during pregnancy could lead to congenital malformation.

Virus transmission happens through the bite of the Aedes mosquito, especially the yellow fever mosquito Aedes aegypti. The only human-to-human transmissions that have been identified are by sexual contact or at childbirth.

As symptomatic is similar to Dengue- or yellow fever virus (all three belong to the Flaviviridae family), a laboratory diagnostic differentiation should be obtained.

Possible evaluations:

• Direct pathogen evidence in the serum/plasma (2 ml) up to three days after onset of symptoms, in the urine up to two weeks
• Evidence of IgG- and IgM- antibodies in the serum (2 ml) or liquor (0,5 ml) after the first week of illness in case of acute symptoms

Recommendations for travelers as well as further information can be found here:

• Robert Koch Institut, Zikavirus-Infektionen
• Bernhard-Nocht-Institut für Tropenmedizin, Zika-Virus-Epidemie in Amerika
• Bundesministerium für Gesundheit, Informationen zum Zika-Virus