SUBJECT: Flow Cytometry Testing Downtime
Date: 3/26/2024
We regret to inform you that the Flow Cytometry analyzer at St Mary’s Madison is experiencing an unexpected downtime. We will work quickly for resolution but anticipate an extended downtime.
To ensure adequate patient support, we will be re-routing the following tests to our reference lab, ARUP:
  • CD4/CD8 ABSOLUTE + RATIO PANEL [LAB06575]
  • B LYMPHOCYTE SUBSET COUNT (CD19) [LAB05905]
  • T + B LYMPHOCYTE SUBSET PANEL [LAB14156]
ARUP performs testing 7 days per week, with an expected turnaround time of 1-3 days.
There will be no changes to the sample collection requirements.

One change to note: when performed at St Mary’s Madison, a reflex CBC with differential is included with these orders to ensure an accurate WBC count and Lymph%. ARUP utilizes a different instrument methodology, not requiring a CBC with differential. While using the ARUP tests, a reflex CBC with differential will not be included. If one is needed, a separate order will be necessary. Please review all standing orders for accuracy.

Thank you for your patience. We appreciate your support as we work through these challenges.

If you have any questions, please feel free to reach out to Denise Schauer or Dr. Adam Morgan.
Denise Schauer, MHA, MS, C(ASCP) 
Director of Laboratory Services
SSM Health – St Mary's Hospital Madison
Phone: 608-258-6169

Adam Morgan, M.D. | Pathologist
Laboratory Medical Director
SSM Health St. Mary’s Hospital Madison
Phone 608.258.6914

Test Update:
 
A message from Adam Morgan, M.D. (Laboratory Medical Director | SSM Health St. Mary’s Hospital - Madison) ...
cid:image005.png@01D26D76.E2123BE0
Syphilis Total Ab Screen w/Reflex
Notification Date: February 14, 2024
Effective Date: February 20, 2024
SUBJECT: Syphilis Reverse Screening - SYPHILIS TOTAL AB SCREEN W/ REFLEX (LAB12272)

SSM Health Wisconsin will be changing to the reverse algorithm to screen for syphilis to improve turnaround time and to align with system initiatives.

FDL area hospitals and clinics will also be adopting the reverse algorithm in the coming future.

Reverse syphilis testing algorithm starts with an assay to measure IgM and IgG antibodies specific to Treponema pallidum (TP) utilizing the Syphilis TP antibody CMIA assay which will be performed at St. Mary’s Madison. 

   Advantages of utilizing the reverse syphilis screening model
  1. The TP antibody screening test is specific to syphilis (although false positives may occur).
  2. TP antibodies are more sensitive than RPR for detecting both primary and late syphilis.
  3. The TP antibody assay can be performed within the SSM Wisconsin region to improve turnaround time.
Samples which are reactive for TP (syphilis) antibodies will be sent for rapid plasma regain (RPR) confirmation testing to help distinguish between infection with T. pallidum (syphilis) versus a falsely reactive treponemal antibody result. 

The TP antibody test and RPR test can identify persons previously treated for syphilis and those with untreated or incompletely treated syphilis. Discordant results between the syphilis TP antibody assay and RPR will be further reflexed to a second treponemal test, Treponema Pallidum Particle Agglutination (TP-PA) for further evaluation if necessary. 
Please see chart below for interpreting results utilizing the reverse screening model.

Table. Interpretation and follow-up of syphilis reverse screening results
Patient History Syphilis (TP)  IgM/IgG antibody screen CMIA RPR TP-PA Interpretation Follow - up
Unknown history of syphilis
Nonreactive
N/A
N/A		 No serologic evidence of syphilis None, unless clinically indicated (e.g. early/acute/primary syphilis)
Unknown history of syphilis
Reactive
Reactive
N/A		 Untreated or recently treated syphilis See Centers for Disease Control and Prevention treatment guidelines
Unknown history of syphilis
Reactive
Nonreactive
Nonreactive
Probable false-positive screening test		 No clinical follow-up testing, unless clinically indicated (e.g. acute/primary syphilis)
Unknown history of syphilis
Reactive
Nonreactive
Reactive		 Possible syphilis (e.g. early or latent) or previously treated syphilis
Historical and clinical evaluation required
Known history of syphilis
Reactive
Nonreactive
Reactive or N/A		 Past, successfully treated syphilis
None

CMIA – Chemiluminescent microparticle immunoassay; RPR – rapid plasma regain; TP-PA – Treponema pallidum particle agglutination.

 
Please direct specific questions or comments to:

Amy Little Soldier
Laboratory Technical Specialist, Chemistry
SSM Health St. Mary’s Hospital Madison
Office: (608) 258-6910
amy.littlesoldier@ssmhealth.com

Molly Gurney, M.D.
Assistant Laboratory Medical Director, Chemistry
SSM Health St. Mary’s Hospital Madison
Office: (608) 258-6914
molly.gurney@ssmhealth.com

Please communicate to colleagues and staff in your area accordingly.

Thank you,
Adam Morgan, M.D.
Laboratory Medical Director
Pathology, SSM Health St. Mary’s Hospital Madison
700 South Park Street
Madison, WI 53715
Office: (608) 258-6914
 

 
SUBJECT: Flow Cytometry Testing Downtime
Date: 3/26/2024
We regret to inform you that the Flow Cytometry analyzer at St Mary’s Madison is experiencing an unexpected downtime. We will work quickly for resolution but anticipate an extended downtime.
To ensure adequate patient support, we will be re-routing the following tests to our reference lab, ARUP:
  • CD4/CD8 ABSOLUTE + RATIO PANEL [LAB06575]
  • B LYMPHOCYTE SUBSET COUNT (CD19) [LAB05905]
  • T + B LYMPHOCYTE SUBSET PANEL [LAB14156]
ARUP performs testing 7 days per week, with an expected turnaround time of 1-3 days.
There will be no changes to the sample collection requirements.

One change to note: when performed at St Mary’s Madison, a reflex CBC with differential is included with these orders to ensure an accurate WBC count and Lymph%. ARUP utilizes a different instrument methodology, not requiring a CBC with differential. While using the ARUP tests, a reflex CBC with differential will not be included. If one is needed, a separate order will be necessary. Please review all standing orders for accuracy.

Thank you for your patience. We appreciate your support as we work through these challenges.

If you have any questions, please feel free to reach out to Denise Schauer or Dr. Adam Morgan.
Denise Schauer, MHA, MS, C(ASCP) 
Director of Laboratory Services
SSM Health – St Mary's Hospital Madison
Phone: 608-258-6169

Adam Morgan, M.D. | Pathologist
Laboratory Medical Director
SSM Health St. Mary’s Hospital Madison
Phone 608.258.6914

Test Update:
 
A message from Adam Morgan, M.D. (Laboratory Medical Director | SSM Health St. Mary’s Hospital - Madison) ...
Syphilis Total Ab Screen w/Reflex
Notification Date: February 14, 2024
Effective Date: February 20, 2024
SUBJECT: Syphilis Reverse Screening - SYPHILIS TOTAL AB SCREEN W/ REFLEX (LAB12272)

SSM Health Wisconsin will be changing to the reverse algorithm to screen for syphilis to improve turnaround time and to align with system initiatives.

FDL area hospitals and clinics will also be adopting the reverse algorithm in the coming future.

Reverse syphilis testing algorithm starts with an assay to measure IgM and IgG antibodies specific to Treponema pallidum (TP) utilizing the Syphilis TP antibody CMIA assay which will be performed at St. Mary’s Madison. 

   Advantages of utilizing the reverse syphilis screening model
  1. The TP antibody screening test is specific to syphilis (although false positives may occur).
  2. TP antibodies are more sensitive than RPR for detecting both primary and late syphilis.
  3. The TP antibody assay can be performed within the SSM Wisconsin region to improve turnaround time.
Samples which are reactive for TP (syphilis) antibodies will be sent for rapid plasma regain (RPR) confirmation testing to help distinguish between infection with T. pallidum (syphilis) versus a falsely reactive treponemal antibody result. 

The TP antibody test and RPR test can identify persons previously treated for syphilis and those with untreated or incompletely treated syphilis. Discordant results between the syphilis TP antibody assay and RPR will be further reflexed to a second treponemal test, Treponema Pallidum Particle Agglutination (TP-PA) for further evaluation if necessary. 
Please see chart below for interpreting results utilizing the reverse screening model.

Table. Interpretation and follow-up of syphilis reverse screening results
Patient History Syphilis (TP)  IgM/IgG antibody screen CMIA RPR TP-PA Interpretation Follow - up
Unknown history of syphilis
Nonreactive
N/A
N/A		 No serologic evidence of syphilis None, unless clinically indicated (e.g. early/acute/primary syphilis)
Unknown history of syphilis
Reactive
Reactive
N/A		 Untreated or recently treated syphilis See Centers for Disease Control and Prevention treatment guidelines
Unknown history of syphilis
Reactive
Nonreactive
Nonreactive
Probable false-positive screening test		 No clinical follow-up testing, unless clinically indicated (e.g. acute/primary syphilis)
Unknown history of syphilis
Reactive
Nonreactive
Reactive		 Possible syphilis (e.g. early or latent) or previously treated syphilis
Historical and clinical evaluation required
Known history of syphilis
Reactive
Nonreactive
Reactive or N/A		 Past, successfully treated syphilis
None

CMIA – Chemiluminescent microparticle immunoassay; RPR – rapid plasma regain; TP-PA – Treponema pallidum particle agglutination.

 
Please direct specific questions or comments to:

Amy Little Soldier
Laboratory Technical Specialist, Chemistry
SSM Health St. Mary’s Hospital Madison
Office: (608) 258-6910
amy.littlesoldier@ssmhealth.com

Molly Gurney, M.D.
Assistant Laboratory Medical Director, Chemistry
SSM Health St. Mary’s Hospital Madison
Office: (608) 258-6914
molly.gurney@ssmhealth.com

Please communicate to colleagues and staff in your area accordingly.

Thank you,
Adam Morgan, M.D.
Laboratory Medical Director
Pathology, SSM Health St. Mary’s Hospital Madison
700 South Park Street
Madison, WI 53715
Office: (608) 258-6914
 

 
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