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Wellington SCL Newsletter & Clinical Update

27th April 2016  -  Please forward this email to all clinical staff

Please find this month's  latest update from your laboratory provider, Wellington SCL. In this newsletter we cover :
  • Changes to Hepatitis A testing
  • PSA tests
  • Discontinuation of Remel Viral swabs (VTM)
  • Update on reporting of Nil Haemolysis comment
  • Collection Centres Hours of Operation

Hepatitis A Testing

We wish to inform you of a change to the way hepatitis A serology is being performed at Wellington SCL.
The first line test now will be a combined Total IgG (immunity) and IgM (acute infection) test. A negative test rules out both acute infection and evidence of natural or vaccine-induced immunity.
If the combined test is positive then a specific IgM test will be performed automatically. Most IgM tests will be negative, indicating immunity.
We will not be able to routinely test specifically for IgG, and in fact this test should seldom be requested: post vaccination tests are not routinely recommended.
It is critical to document on the request the reasons for testing, we can provide greater help if we know whether the person has raised transaminases and a travel history for example.

 Example report formats

Dr Michelle Balm FRACP, FRCPA
Infectious Diseases Physician and Clinical Microbiologist
Capital and Coast DHB and Wellington SCL

Changes in reporting of Prostate Specific Antigen and availability of Free PSA

The Ministry of Health has recently published a new guideline on prostate cancer testing and management in primary care, including defined pathways for referral to specialist care.
This guidance has been endorsed by:
  • The Royal New Zealand College of General Practitioners
  • The Prostate Cancer Foundation
  • The Urological Society of Australia and New Zealand
  • The New Zealand Urological Nurses Society
  • The New Zealand Society of Pathologists
From April 2016, Wellington SCL will incorporate the recommendations of the guideline in reports of PSA, as requested by the Ministry of Health. This will be through a standard comment, indicating abnormal levels of PSA, as defined in the guideline.

Previously, PSA has been reported with age-adjusted reference intervals. These intervals are not normal ranges but represent the range of values seen in the central 95% of men within the age interval. Levels within or outside these intervals are not necessarily predictors of absence or presence of prostate cancer. These intervals will remain on reports for general information but do not represent the referral guideline.

The new guideline defines the level of PSA which should be considered abnormal at various ages. Confirmation of these abnormal levels indicate that referral for specialist assessment is required. The levels have been chosen according to the likelihood of prostate cancer being present, but also take into account that the benefits of early diagnosis of prostate cancer decrease with age.
At each age interval the definition of abnormal PSA is determined solely by total PSA, as shown below. Free PSA is not used to refine the predictive value of the total PSA. Thus Wellington SCL will no longer reflex to free PSA for initial results of total PSA between 4-10ug/L. In a letter separate from the guideline, the Ministry of Health have recommended that free PSA be restricted to specialist use only. At present, we are not going to rigorously enforce this recommendation but we will be auditing requests and adding comments to results to guide appropriate use of the test. Free PSA are now analysed in batches and the turnaround time is weekly.

Definitions of screening PSA level by age at which routine referral should occur, according to Ministry of Health guideline
Age Abnormal PSA level (µg/L)
 ≤ 70 years ≥ 4.0
 71 – 75 years ≥ 10.0
 ≥ 76 years ≥ 20.0
Patients should have repeat PSA after 6 – 12 weeks to confirm the abnormal levels.  Confirmation indicates a routine referral to a Urology service is required [seen in 6-8 weeks]. When a repeat PSA is less than the threshold for abnormal, the patient should be followed up according to the algorithm on page three of the guideline.

The algorithm also defines other situations when more urgent referral is indicated, in men with abnormal PSA at various thresholds and with red flag clinical signs and symptoms consistent with prostate cancer.

PSA levels may increase in non-malignant prostate conditions including benign prostatic hypertrophy or prostatitis. In addition, digital rectal examination (DRE), ejaculation or cycling may cause a temporary increase in PSA. It recommended that PSA should not be checked within 2 days of a DRE or within 3 days of ejaculation or cycling.
Michael Crooke                                          Carol Siu
Chemical Pathologist                                  Chemical Pathologist

Discontinuation of Remel Viral Transport Media Tubes (VTM)

We will no longer be processing the Remel M4RT Viral Transport Media Tubes (VTM) for Bordetella Pertussis PCR, Influenza PCR and Varicella zoster PCR, Measles PCR or Rubella PCR or any other PCR testing as of now.
These swabs have expired and should be discarded immediately. The VTM swabs will be replaced with the UTM RT-Mini swabs. Please contact the WSCL store to order the replacement UTM RT – mini swabs.
What you have to do:
  • Discard any Remel M4RT VTM swabs
  • Contact WSCL stores on or fax order through on 04 471 0882 to order UTM RT – Mini swabs.

      Remel M4RT VTM swabs
      REPLACED WITH       UTM RT-Mini swabs

Please note testing for Chlamydia and Gonorrhoea are done on the Aptima swabs, DO NOT use the UTM RT-Mini swabs for Chlamydia and N. gonorrhoeae testing.

Notification of Negative Haemolysis comment

We have received feedback from community referrers regarding the necessity of reporting negative haemolysis.

From March we no longer report these notifications to referrers.

Collection Centre Hours of Operation

Commencing 1st May, our collection centres will be accepting their last patient 10 minutes prior to closing time.

Please note this is not a change to our advertised hours of operation, it is to ensure that we are efficiently processing and transporting specimens at the end of the day.

Our operating hours for our collection centres  can be found on our website at
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Wellington SCL
Level 5, CSB
Riddiford Street, Newtown
Wellington 6021
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Aotea Pathology Limited · CMC Building · 89 Courtenay Place · Wellington, Wgn 6011 · New Zealand

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