LETTERS Comparative Medicine? Arf! To the Editor: Thank you for your excellent comparative medi­cine article, "Veterinary Immunology and Serol­ogy: Clinical Laboratory Diagnostics," in the January 1999 issue (Lab Med. 1999;30:36-40). I have long been tempted to write an informative educational piece to help bridge the information gap between human and animal medicine. This gap has been initially addressed by your three-part series.

My training in clinical laboratory medicine has greatly aided my careers in both human and vet­erinary medicine. Putting my time and money into that training was one of the best investments I have ever made. I consistently urge aspiring med­ical and veterinary medical students who are still in college to pursue medical technology. It is a basic, broad, and useful training for a rewarding career in the laboratory or a foundation for higher medical training. My continued support of the field through yearly renewal of my ASCP registra­tion (medical technologist, medical laboratory technician, and certified laboratory assistant) and faithful reading of Laboratory Medicine serves me well. I look forward to more articles on compara­tive medicine and strongly recommend that ASCP sponsor workshops on the many subjects that could be covered.

Thank you again for the fine effort on behalf of Laboratory Medicine and the medical technology field. Grace Lecara, DVM, MS, MT(ASCP) Apex, NC

To the Editor:

I appreciated the January "Editorial" ("Cat 'Knapp,'" Lab Med. 1999;30:4), the "CE Update" ("Veterinary Immunology and Serology: Clinical Laboratory Diagnostics," 36-40), and "Profiles" ("A Career in Animal Histology: Home on the Range," 72-71). Because so many professional laboratories that historically limited tests to samples from human beings have expanded their services to include veterinary diagnostics, the continuing edu­cation article served as an informative reminder of some commonly available assays and their benefits and limitations. I am proud of my background in medical technology, and the refreshing "Profiles" article reminded me that the careers of many dedi­cated nonveterinarians have facilitated the amazing advancements in veterinary medicine. Almost every issue of Laboratory Medicine contains information that is useful to technologists and clinical patholo­gists in the veterinary profession, but it was partic­ularly invigorating to see the focus of essentially an

Janet Maass, ME, CT(ASCP)HTL, of Fort Collins, Colo, was profiled in the January 1999 issue, which featured several aspects of veterinary medicine.

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Letter Policy While signed letters receive publication priority, we will withhold names from publication on request as long as we can contact the author for editorial questions.

Submission of a letter constitutes permission for the ASCP to edit, abridge, and publish it in Laboratory Medicine. Letters must not duplicate other material published or submitted for publication, and may contain up to 500 words and five references. Financial associations or other possible conflicts of interest must be disclosed.

entire issue directed toward the veterinary aspect of laboratory medicine. Desiree Lipscomb, DVM, MS, MT(ASCP) Resident, Clinical Pathology Department of Pathobiology College of Veterinary Medicine Auburn University Auburn, Ala

Blood Bank Scissors Safety To the Editor: Recent comments in Laboratory Medicine have dis­cussed sampling donor unit segments in the Blood Bank ("Cross-Contamination" [letter]. Lab Med. 1999;30:10-11.) In our hospital blood bank we use a device I invented called the Scissors Shield (Bel-Art Products, Pequannock, NJ). This device fits over standard scissors and creates a splatter shield between the operator and the segment during cut­ting. We cut the segment above the RBC layer to pre­vent RBC contamination of the scissors. We wipe the scissors between testing of different blood types. When we are done testing, the scissors and the shield are rinsed with warm water and are dried on a paper towel. This system seems to work well and is an easy way to prevent blood from splattering on the oper­ator. Brad Noble, MT(ASCP) Blood Bank Supervisor Routt Memorial Hospital Steamboat Springs, Colo I The Marketing Dept at Bel-Art Products reports that the Scissors Shield is being discontinued.—ED.]

The Scissors Shield (Bel-Art Products, Pequannock, NJ) is a safety device that shields laboratory personnel from exposure to spattering blood while cutting open donor tubing segments to extract blood samples. The clear plastic shield is bent away from the user and covers the area of the blood tube segment. The scissors protrude through a molded elastomeric septum near the bottom of the shield which does not impede the cutting action. The shield is 102 mm x 102 mm (4 in x 4 in).

Chemistry Turnaround Time To the Editor: Several months ago Laboratory Medicine printed an article, "Using Lithium Heparin Plasma," about improved turnaround time in chemistry through the use of heparinized plasma instead of serum for stat chemistry analysis {Lab Med. 1998;29:464-465).

My laboratory is looking for ways to improve chemistry turnaround time. The manufacturer of my laboratory's chemistry analyzer does not recom­mend using heparinized plasma for alanine amino­transferase (ALT) and lactate dehydrogenase (LDH) analysis. We have done comparison studies and found no clinical significance between results for serum samples and heparinized plasma samples when testing for these analytes.

The COLA inspector said that using heparinized plasma would be a deviation from the manufac­turer's recommendations and that these tests then would become high-complexity tests instead of moderate-complexity tests.

Are linearity standards available for the verifica­tion of plasma specimens? I work in a large clinic and find very few specimens with elevated ALT and LDH results, so dilution of a high specimen is not an option.

I would appreciate any input on this subject. Mary M. Lay, MT(ASCP) South Texas Medical Clinic Wharton, Tex

In Response:

Thank you for your letter. I will address your ques­tions and concerns in order.

For the question about ALT and LDH analysis, first determine why the manufacturer does not rec­ommend analysis on heparinized plasma. Has the manufacturer found a problem with using plasma? Perhaps a study of serum vs plasma has not been done. Because your correlation found no significant clinical discrepancy, I suspect the latter is the case. The representative who said plasma should not be used may simply have been following his or her company's guidelines for answering that type of question.

Though I am unfamiliar with COLA's guidelines, I don't see how using a different specimen type that has been proven to correlate to the manufacturer's recommendation could warrant a change in test classification. Your particular inspector may be fol­lowing the letter of the regulation, not the spirit. I find it helpful to be aware of the difference between regulatory guidelines and quality laboratory

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Collecting specimens in tubes with l i thium heparin (mint green, left) instead of gold-top tubes (center) or red-top tubes (right) improved turnaround t ime on stat chemistry tests at A.O. Fox Memorial Hospital in Oneonta, NY.

practices. They are not always the same. Consider appealing to a supervisor in the COLA system.

Finally, the type of calibration verification stan­dards used (plasma-based or serum-based) is irrele­vant if the correlation between the two sample types is good. Because you lack any high values in your correlation data, it may be prudent to wait until you have a few patient values to verify the high end of your serum-plasma correlation. Maybe you could ask some neighboring laboratories to be on the lookout for you. After that is confirmed, initial or periodic calibration verification studies can be done with the serum-based product.

An alternative approach would be to treat the serum-based product with heparin before per­forming the calibration verification. Although this approach doesn't duplicate a true plasma-based product, it addresses the effect of heparin on the analytes. Douglas L. Bailey, MT(ASCP) Chemistry Supervisor A.O. Fox Memorial Hospital Oneonta, NY

Multiple Chemical Sensitivity To the Editor The article "Solvent/Detergent-Treated Plasma Inactivates Viruses," reported by Veronica Johnston in the July "News & Views" (Lab Med. 1998;29:395) raises another area of concern: Is there any potential for allergic or anaphylactic reactions to traces of the solvent/detergent remaining after treatment? What are the solvents/detergents used in this process? Have they been animal tested for safety? Many chemicals in common cosmetics and hair products,

for example, have never been tested. The incidence of asthma and multiple chemical sensitivity (MCS) is increasing nationally and internationally. Some­thing is awry.

I am a pathologist who became very respiratory sensitive (laryngospasm) to limonene, the citrus (orange peel) terpene in Histoclear (National Diag­nostics, Adanta), Americlear (Stephen's Scientific, Wayne, NJ), and other products. I have firsthand knowledge of what even minute traces of this chem­ical can cause with subsequent exposure.

Limonene was touted as the safe xylene substi­tute. It was considered so safe that it was reportedly placed in punch bowls at national histology prod­ucts meetings in the '80s. Vendors even offered sam­ples to drink because it was so safe.

Aside from its use in the histology and pathology laboratories, limonene is used as an extender in per­fumes and a key ingredient in citrus-smelling clean­ing products and fabric softeners. It is also a degreaser in the computer chip and aviation parts industries. Because we are concerned and inquisitive laboratorians, we have to educate ourselves about sensitivities to chemical ingredients, especially those we are exposed to in our everyday hospital and lab­oratory work.

I worked as a pathologist, but I had never even heard of MCS before my personal experience. The information is available, but not widely known in pathology circles.

The Agency for Toxic Substances and Disease Registry (ATSDR), a division of the US Public Health Service, Atlanta, has a 100-page draft report on the subject of MCS. Entitled "The Interagency Workgroup Report on Multiple Chemical Sensitiv­ity: Predecisional Draft," it is available free from ATSDR [(888)-422-8737, or (888) 42-ATSDR].

I have lost my hospital pathology career due to this sensitivity. I have heard of histologists and pathologists who get asthmatic-type respiratory attacks and/or an allergic contact dermatitis when they handle specimens in recent contact with Histoclear.

Safer alternatives to xylene and limonene are available. It is time to learn, question, and prevent more products with unrealized, potentially life-affecting or life-threatening side effects from com­ing to the marketplace. Constance L. Archambault, MD Pathologist Emeritus Midstate Medical Center, formerly Veterans

Memorial Medical Center Meriden, Conn

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^n Your Comments? We welcome letters about articles recently published in Laboratory Medicine or about topics of general interest to laboratorians. Send your letter, address, and phone number to: Paul Phillip Sher, MD, Editor, Laboratory Medicine, 2100 W Harrison St, Chicago, IL 60612; by fax to (312) 738-0101; or by e-mail: labmed@ascp.org

The thoughts expressed in published letters rep­resent those of the author. Publication of any given letter does not constitute endorsement by the ASCP.

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