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PTH, Intraoperative
Test CodeORPTH, ORPT2
Alias/See Also
IPTH, PTH, Intraoperative PTH, PTHB, PTH5, PTH10, PTHA1, PTHA2
CPT Codes
83970 for each collection time
Includes
Baseline PTH, 5 minute PTH, 10 Minute PTH, Additional Specimens
Preferred Specimen
EDTA (LAV)
Patient Preparation
CRMC Location: INTRAOPERATIVE iPTH WORKFLOW
- Call LAB: 52041
- Give the OR room and phone number where the patient’s results can be called STAT.
- Order in EPIC the test “Intraoperative PTH (ORPTH)”
- Draw a Small Lavender top tube Baseline specimen (properly filled and mixed). Make sure that the proper label (Marked “BASE”) is on the tube with initials and time legibly marked.
- Call Lab (let them know a specimen is being sent).
- Tube specimens to the lab, to tube location# 122 or 123.
- Further specimens should be treated the sameway
- It is important that the specimen be labeled properly so that there is no confusion over which specimen is analyzed. (Fill tube properly; Label; Call Lab; Tube to 122 or 123).
- Baseline (BASE); 5 Minute (5MIN); 10 Minute (10MIN)
- Any Random additional specimens (A1 and A2)
- Collection Time is critical and must be legible
- Initials of the person drawing the specimen must be legible
- Do not write over anything printed on the label
FHSH Location
- Surgeon’s office calls to schedule surgery with the FHSH scheduling department.
- The pathologists are notified the day before with both an email and Fax that a Frozen section has been scheduled.
- Fax goes to 326-2801
- Email goes to Pathologists@communitymedical.org
- Day of procedure: Lab provides lab assistant for specimen transport to the LAB and to help coordinate the processing and testing.
Instructions
EDTA plasma is the preferred sample type.
Collect blood by venipuncture (21) into EDTA tubes or plain tubes (without anticoagulant), avoiding hemolysis, then separate the plasma or serum from the cells. It is important to keep the serum sample cold throughout the collection and separation process. Studies have shown that intact PTH is stable in whole blood when collected in EDTA tubes for up to 72 hours at room temperature (15–28°C),(23) therefore collection in EDTA tubes minimizes the need to keep the sample cold throughout this process. Note that EDTA collection tubes must be filled to their capacity. Failure to completely fill the tube will result in excess concentration of EDTA, which will interfere with the assay causing a false depression in values.
For plain serum tubes, let the specimen clot at 2–8°C. Then separate the serum from the cells, using a refrigerated centrifuge if possible. It is important to keep the serum sample cold throughout the collection and separation process.
When used intraoperatively to verify a decline in PTH production after resection, it is recommended that two or more samples be collected at least 5–10 minutes apart.
Collect blood by venipuncture (21) into EDTA tubes or plain tubes (without anticoagulant), avoiding hemolysis, then separate the plasma or serum from the cells. It is important to keep the serum sample cold throughout the collection and separation process. Studies have shown that intact PTH is stable in whole blood when collected in EDTA tubes for up to 72 hours at room temperature (15–28°C),(23) therefore collection in EDTA tubes minimizes the need to keep the sample cold throughout this process. Note that EDTA collection tubes must be filled to their capacity. Failure to completely fill the tube will result in excess concentration of EDTA, which will interfere with the assay causing a false depression in values.
For plain serum tubes, let the specimen clot at 2–8°C. Then separate the serum from the cells, using a refrigerated centrifuge if possible. It is important to keep the serum sample cold throughout the collection and separation process.
When used intraoperatively to verify a decline in PTH production after resection, it is recommended that two or more samples be collected at least 5–10 minutes apart.
Specimen Stability
EDTA Samples: EDTA whole blood may be stored at room temperature for up to 72 hours. For longer storage, centrifuge, remove plasma, aliquot and freeze up to 2 months at –20°C.
Serum: Keep samples on ice and assay as soon as possible; or aliquot and freeze without delay. Up to 8 hours at 2–8°C or 2 months at –20°C.
Serum: Keep samples on ice and assay as soon as possible; or aliquot and freeze without delay. Up to 8 hours at 2–8°C or 2 months at –20°C.
Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
Lipemic, hemolyzed, icteric or grossly contaminated samples may give erroneous results. The use of an ultracentrifuge is recommended to clear lipemic samples.
Methodology
Immunlite
Beckman Access/DXI
Setup Schedule
M-F, 8 am- 5 pm
Reference Range
- PTHB (Baseline): 14-64 pg/mL
- PTH5 14-64 pg/mL
- PTH10 14-64 pg/mL
- PTA1 14-64 pg/mL
- PTA2 14-64 pg/mL
Clinical Significance
Rapid intraoperative PTH assays are primarily used to determine whether all hyperfunctioning parathyroid tissue has been removed from the patient. Preoperative localization of hyperfunctioning parathyroid tissue is crucial to the success of these procedures.
On the day of operation and preferably just prior to incision, a baseline rapid PTH level is obtained. The abnormal gland is located and removed. Time elapses to allow the circulating PTH to degrade, and a second rapid PTH level is collected and sent for rapid analysis. A significant drop (50–70% from baseline) in the post-resection PTH levels can give the surgeon confidence that further exploration is unnecessary. Failure of PTH serum levels to decline promptly after removal of an abnormal parathyroid gland\ indicates that either (1) the presence of residual hyperfunctioning parathyroid tissue was missed by preoperative localizing studies, or (2) the tissue removed was not the abnormally functioning parathyroid gland.
On the day of operation and preferably just prior to incision, a baseline rapid PTH level is obtained. The abnormal gland is located and removed. Time elapses to allow the circulating PTH to degrade, and a second rapid PTH level is collected and sent for rapid analysis. A significant drop (50–70% from baseline) in the post-resection PTH levels can give the surgeon confidence that further exploration is unnecessary. Failure of PTH serum levels to decline promptly after removal of an abnormal parathyroid gland\ indicates that either (1) the presence of residual hyperfunctioning parathyroid tissue was missed by preoperative localizing studies, or (2) the tissue removed was not the abnormally functioning parathyroid gland.
Performing Laboratory
CRMC Laboratory
FHSH Laboratory
