TSPOT counts WBC's.... even in Immunocompromised
populations it provides a result or lets you know there were not enough
cells.
Kathy Dayvault, RN, BSN, MPH, COHN-S/CM
Manager, Occupational Health and
Safety
WorksWell Onsite
Dekalb Medical 2701 North
Decatur Road
Decatur, GA 30033
ph: 404.501.4972 Fax:404-501-2045
kathy.dayvault@dekalbmedical.org
From:
"Swift, Melanie"
<melanie.swift@Vanderbilt.Edu>
To:
MCOH/EH <mcoh-eh@mylist.net>,
Date:
04/25/2016 01:09 PM
Subject:
Re: [MCOH-EH]
IGRA
Sent by:
"MCOH-EH"
<mcoh-eh-bounces@mylist.net>
I think the same principles
would apply.
First make sure you have
plenty of blood (2 tubes) as you need about a million cells for the best
test.
Then look at the quantitative
results – were the number of spots exactly the same on both tests?
Finally, again look at that
CDC guidance on these tricky situations when you actually may find value
in placing a TST. If the TST were negative in your low risk person without
exposure, then I’d call it negative.
Melanie Swift, MD
Director, Vanderbilt Occupational
Health Clinic
http://occupationalhealth.vanderbilt.edu
From: MCOH-EH [mailto:mcoh-eh-bounces+melanie.swift=vanderbilt.edu@mylist.net]
On Behalf Of Senior, Cathy (Employee Health)
Sent: Monday, April 25, 2016 12:06 PM
To: 'MCOH/EH'
Subject: Re: [MCOH-EH] IGRA
Thank you. I was
referring to a T-Spot not an IGRA.
Cathy Senior RN BSN
CDE
Employee Health Director
Penn Highlands DuBois
100 Hospital Avenue
P.O. Box 447
DuBois Pa 15801
Phone 814-375-3392
Fax 814-372-2610
cesenior@phhealthcare.org
www.phhealthcare.org
From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net]
On Behalf Of Swift, Melanie
Sent: Monday, April 25, 2016 12:58 PM
To: MCOH/EH
Subject: Re: [MCOH-EH] IGRA
Cathy,
By your use of the term “borderline”
I’m guessing you use T-Spot. But in case you were using it in a more generic
sense, there is a good article by Wendy Thanassi et al delineating a retesting
zone for QFT-GIT using the 0.35 – 1.11 IU/ml results. Wendy spoke at our
AOHC a couple of weeks ago and shared a helpful algorithm using 1.1 as
the cutoff for the first test and 0.7 as the cutoff for the retest. Again,
that probably won’t help you much if you are using T-spot.
The CDC lists this situation
as a time when you might want to do both a TST and an IGRA. If the TST
is negative and the person is low risk and the IGRA remains borderline,
it’s less like to be an LTBI case than if the TST is positive also.
You really should sit down
with your medical director and develop a protocol based on the quantitative
result, and the specific IGRA you use (T-Spot or QTF-GIT.) Hopefully he
or she participates on this listserve also!
Here are some references
that may be helpful in writing your protocol:
http://www.hindawi.com/journals/pm/2012/291294/
https://labmed.oxfordjournals.org/content/45/3/207
http://www.atsjournals.org/doi/abs/10.1164/rccm.201305-0831OC
Melanie Swift, MD
Director, Vanderbilt Occupational
Health Clinic
http://occupationalhealth.vanderbilt.edu
From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net]
On Behalf Of Senior, Cathy (Employee Health)
Sent: Monday, April 25, 2016 11:12 AM
To: 'MCOH/EH'
Subject: [MCOH-EH] IGRA
We use Interferon Gamma
Release Assays ( IGRA) to test for tuberculosis on all new employees. I
have one new employee that I have tested twice (with approx one month in
between testing) and both times the results were borderline. Has
anyone else had this come up and if so what did you do next? This
employee has no symptoms and no high risk activity such as traveling outside
the country or having contact with anyone with known Tb.
Cathy Senior RN BSN
CDE
Employee Health Director
Penn Highlands DuBois
100 Hospital Avenue
P.O. Box 447
DuBois Pa 15801
Phone 814-375-3392
Fax 814-372-2610
cesenior@phhealthcare.org
www.phhealthcare.org
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