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Result Electrophoresis Tests Result a Serum Protein Electrophoresis Test ....................................................................................................... 2

Result a Urine Protein Electrophoresis Test ........................................................................................................ 7

Result a Hemoglobin Electrophoresis Test .......................................................................................................... 8

Request and Result an IFE test ............................................................................................................................ 9

Pre-Built Electrophoresis Interpretation Phrases .............................................................................................. 11

All of the electrophoresis tests are resulted in a similar manner, but each has its quirks. Please read the section on Serum Protein Electrophoresis for an in depth description of the overall process. You can then look at the other sections for the differences between each test.

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Result a Serum Protein Electrophoresis Test

1. After lab staff have performed the electrophoresis and entered their results, they will bring the print outs to Pathology. To see electrophoresis tests needing interpretation, start at the Outstanding List.

2. Click the Views button. 3. Choose the CP Path Review view.

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4. Select the test you want to interpret. 5. To open Result Entry, double-click the test.

a. You can also select a number of tests, and right-click to choose results.

b. You can also select a test, open the Actions menu, and choose Results.

6. In the Result Entry screen, click Edit on the middle toolbar.

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7. In the Interpretation row, click the piece of paper icon in the Comments column on the far right.

8. The Interpretation comments window opens. 9. There are a number of pre-built interpretations. (See the section at the end of this document for a list

of these phrases.) To search for one of these phrases, click in the SmartText field with the icon and search a part of that phrase. a. If none of the pre-built interpretations fit this specimen, you can also just free-text one in.

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10. From the list that appears, double-click the phrase you want to use.

11. To record yourself as the interpreter, you can use a dot phrase. Enter down a couple of lines. Type a

period, and then begin typing your last name. When you see the correct phrase is highlighted, press Enter.

12. Once the interpretation is complete, click Accept.

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13. You can see that your interpretations were saved because there are lines on the piece of paper icon. 14. To finalize the test and send the results to the chart, click Verify on the activity toolbar.

15. The Verification Wizard window opens. This is where you review the results one last time before sending them to the chart. You can see your interpretation below the numerical results.

16. If you are happy with what you see, click Final Verify. The test is signed off and it falls off of the Outstanding List.

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Result a Urine Protein Electrophoresis Test

1. Find the Urine Protein Electrophoresis test on the Outstanding list, and open Result Entry as described above.

2. Click Edit on the middle toolbar. 3. To open the comments window, click on the red stop sign in the C column at the far right in the Urine

Protein Electrophoresis row.

4. Enter your interpretation and “interpreted by” comment. 5. Verify and Final Verify your test as described above.

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Result a Hemoglobin Electrophoresis Test

1. Find the test on the Outstanding List and open Result Entry as described above. 2. Free-text your interpretation and add your “interpreted by” comment in the white Comments box

below the numerical results. a. You can’t search for the pre-built result comments in this field, but you can still use your

“interpreted by” dot phrase. 3. Verify the test as described above.

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Request and Result an IFE test If a test needs Immunofixation Electrophoresis for further interpretation, you can order the IFE directly from the original electrophoresis test.

1. Enter your interpretation as described above. 2. In the IFE to Follow? Row, click in the Value field. Either type in Yes, or click the magnifying glass to

choose Yes from the category selections. a. Note: You do not have to enter No in this field for tests that don’t require IFE. The row is

colored a pale yellow because it is non-reportable unless a value is entered. An IFE will not be ordered on any test unless you choose it.

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3. When you click Verify, the Reflex Actions box appears, informing you that the new test was added on to the existing specimen. The test will also be added to the lab work list for testing to be performed. Click OK and continue with Final Verification of the original electrophoresis test as described above.

4. When you get the printout back with the IFE results, find the test on the Outstanding List and open Result Entry.

5. Click Edit on the middle toolbar to enter your interpretation. 6. Click on the red stop sign under the C column on the far right to open the comment box.

7. Enter your interpretation and “interpreted by” comments as with other tests. 8. Verify the test as usual.

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Pre-Built Electrophoresis Interpretation Phrases Below is the list of pre-built electrophoresis interpretations. The red text is the “name” of the phrase, and the black text is what will be entered into the chart. Search for one of the words in the name of the phrase to find it.

Serum Electrophoresis SERUM ELECTROPHORESIS-NORMAL PATTERN Normal electrophoretic pattern. SERUM ELECTROPHORESIS-DECREASED ALBUMIN Decreased albumin; the pattern is otherwise within normal limits. SERUM ELECTROPHORESIS-HYPOGAMMAGLOBULINEMIA; OTHERWISE WITHIN NORMAL LIMITS Hypogammaglobulinemia; the pattern is otherwise within normal limits. SERUM ELECTROPHORESIS-BLURRING OF ANODAL MARGIN There is blurring of the anodal margin of the albumin band, which may be seen with azotemia, jaundice, or complexing with a drug, especially heparin or antibiotics. SERUM ELECTROPHORESIS-DECREASED HAPTOGLOBIN Decreased haptoglobin, consistent with hemolysis. SERUM ELECTROPHORESIS-INCREASED ALPHA1 AND ALPHA2 GLOBULINS Increased alpha1 and alpha2 globulins, decreased albumin and transferring, consistent with acute inflammatory response. SERUM ELECTROPHORESIS-POLYCLONAL INCREASE Polyclonal increase in gamma globulins consistent with chronic inflammatory state. SERUM ELECTROPHORESIS-POLYCLONAL INCREASE IN GAMMA GLOBULINS/OLIGOCLONAL BANDING Polyclonal increase in gamma globulins with oligoclonal banding. This pattern may be seen in chronic infections, autoimmune diseases, and lymphoproliferative disorders. SERUM ELECTROPHORESIS-DECREASED ALBUMIN AND HAPTOGLOBIN Decreased albumin and haptoglobin with polyclonal hypergammaglobulinemia and beta-gamma bridging, consistent with liver disease. SERUM ELECTROPHORESIS-MARKED HYPERGAMMAGLOBULINEMIA Marked hypergammaglobulinemia. This may be seen in chronic infections, autoimmune diseases, and, with rare lymphoproliferative disorders, such as angioimmunoblastic T-cell lymphoma. SERUM ELECTROPHORESIS-PROTEIN LOSS PATTERN Protein loss pattern suggesting renal disease or protein-losing enteropathy. SERUM ELECTROPHORESIS-MILD PROTEIN LOSS PATTERN Mild protein loss pattern. Urine IFE is recommended if light chain disease is suspected.

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SERUM ELECTROPHORESIS-HYPOGAMMAGLOBULINEMIA Hypogammaglobulinemia. Quantitative immunoglobulins, serum IFE, and urine IFE are suggested. SERUM ELECTROPHORESIS-MONOCLONAL GAMMOPATHY Monoclonal gammopathy present. Urine IFE is suggested. Serum IFE to follow for identification. SERUM ELECTROPHORESIS-TINY RESTRICTION BAND NOTED A tiny restriction band is noted in the gamma region. Serum IFE to follow for identification. Urine IFE is suggested. SERUM ELECTROPHORESIS-MONOCLONAL GAMMOPATHY/NO SIGNIFICANT CHANGE FROM PREVIOUS Monoclonal gammopathy persists with no significant change from previous study on _____. SERUM ELECTROPHORESIS-MONOCLONAL GAMMOPATHY PERSISTS/INCREASED FROM PREVIOUS Monoclonal gammopathy persists and is increased from the previous study on _____. SERUM ELECTROPHORESIS-MONOCLONAL GAMMOPATHY PERSISTS/DECREASED FROM PREVIOUS

Monoclonal gammopathy persists and is decreased from the previous study on _____.

Urine Electrophoresis URINE ELECTROPHORESIS-WITHIN NORMAL LIMITS Within normal limits. Negative for Bence Jones protein. URINE ELECTROPHORESIS-SLIGHT NONSPECIFIC PROTEINURIA Slight nonspecific proteinuria with small albumin band. Random urine microalbumin is suggested if early onset of nephropathy in a diabetic patient is suspected. URINE ELECTROPHORESIS-PROTEINURIA WITH GLOMERULAR LOSS Proteinuria with glomerular loss pattern. URINE ELECTROPHORESIS-PROTEINURIA WITH TUBULAR LOSS Proteinuria with tubular loss pattern. URINE ELECTROPHORESIS-PROTEINURIA WITH NONSELECTIVE PATTERN Proteinuria with nonselective pattern indicative of combined glomerular and tublular damage. URINE ELECTROPHORESIS-FREE MONOCLONAL LIGHT CHAIN Free monoclonal light chain present. Urine IFE to follow. URINE ELECTROPHORESIS-FREE MONOCLONAL CHAIN PERSISTS/NO SIGNIFICANT CHANGE FROM PREVIOUS Free monoclonal light chain persists with no significant change from previous study on _____. URINE ELECTROPHORESIS-FREE MONOCLONAL LIGHT CHAIN PERSISTS/INCREASED FROM PREVIOUS Free monoclonal light chain persists and is increased from the previous study on _____. URINE ELECTROPHORESIS-FREE MONOCLONAL LIGHT CHAIN/DECREASED FROM PREVIOUS Free monoclonal light chain persists and is decreased from the previous study on _____.

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URINE ELECTROPHORESIS-NO EVIDENCE PREVIOUSLY DETECTED FREE MONOCLONAL LIGHT CHAIN

No evidence of previously detected free monoclonal light chain.

Hemoglobin Electrophoresis HEMOGLOBIN ELECTROPHORESIS-NORMAL HEMOGLOBIN A AND A2 Normal hemoglobin A and A2 pattern. HEMOGLOBIN ELECTROPHORESIS-NORMAL HEMOGLOBIN A, A2 AND F, NEONATE Normal hemoglobin A, A2, and F pattern for neonate. HEMOGLOBIN ELECTROPHORESIS-HBS, SICKLE CELL DISEASE HbS present consistent with sickle cell disease. HEMOGLOBIN ELECTROPHORESIS-HBS AND HBA HbS and HbA present, but with a higher proportion of HbA than HbS. This pattern could be seen with sickle cell trait, sickle-alpha-thalassemia, or patients with sickle cell disease who have received hydroxyurea or transfusion therapy. Quantitative HbS and F is suggested for therapeutic monitoring of patients who have received hydroxyurea or transfusion therapy. HEMOGLOBIN ELECTROPHORESIS-HBS AND HBF HbS and HbF present. This pattern could be seen with sickle cell disease, sickle-beta0-thalassemia (hereditary persistence of fetal hemoglobin), or sickle-HPFH. Assessment of red cell distribution of HbF is suggested for further investigation. HEMOGLOBIN ELECTROPHORESIS-HBA, HBS AND HBF HbA, HbS, and HbF present, but with a higher proportion of HbS than HbA and HbF. This pattern is most likely sickle- beta+-thalassemia. HEMOGLOBIN ELECTROPHORESIS-HBC TRAIT HbC present, but with a higher proportion of HbA than HbC. This pattern is consistent with HbC trait. HEMOGLOBIN ELECTROPHORESIS-INCREASED HBA2 Increased HbA2 suggesting beta-thalassemia minor. Quantitation of HbA2 by HPLC is suggested for confirmation. INCREASED ELECTROPHORESIS-INCREASED HBF Increased HbF. This may be seen with hereditary persistence of fetal hemoglobin. Assessment of red cell distribution of HbF is suggested for further investigation.