[MCOH-EH] IGRA

[Kathy.Dayvault at dekalbmedical.org]

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 at dekalbmedical.org




From:   "Swift, Melanie" <melanie.swift at Vanderbilt.Edu>
To:     MCOH/EH <mcoh-eh at mylist.net>, 
Date:   04/25/2016 01:09 PM
Subject:        Re: [MCOH-EH] IGRA
Sent by:        "MCOH-EH" <mcoh-eh-bounces at 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 at 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 at phhealthcare.org
www.phhealthcare.org
 
From: MCOH-EH [mailto:mcoh-eh-bounces at 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 at 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 at phhealthcare.org
www.phhealthcare.org
 
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