檢驗醫學部通知
檢字10737
日 期:2018年10月09日
受文者:彰基體系全體同工
主 旨:
1. 轉換血中藥物濃度監測項目及藥物濫用檢驗項目的檢驗儀器及試劑,因此異動血中藥物濃度監測範圍。
2. 修改Phenytoin(FDPENY、FRDENY)採檢容器
3. 停止Serum Tricyclic antidepressants (TCA) screening檢驗(檢驗醫令FRDTCA、FDPTCA)
4. 新增Tacrolimus急作醫令FRDTAC
說 明:
1.自2018年10月12日起,因儀器試劑合約異動,因此血中藥物濃度監測項目及藥物濫用檢驗項目的檢驗儀器由原Siemens Dimension RXL轉換為Beckman Coulter DXC800及Abbott Architect,同時異動相關檢驗試劑。檢驗儀器異動如下表:
檢驗項目
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檢測儀器
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Acetaminophen、Gentamicin、Phenytoin、Phenobarbital、Carbamazepine、Vancomycin、Digoxin、Valproic Acid、Alcohol、Lithium、Theophyline
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Beckman Coulter DXC800
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Benzodiazepine (Urine)、Amphetamines、Opiate、Alcohol
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Beckman Coulter DXC800
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Tacrolimus、Sirolimus、Cyclosporine
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Abbott Architect i system
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2.血中藥物濃度監測項目檢驗儀器及試劑異動,因此重新審查治療區間並照會藥品血中濃度監控小組,異動如下表:
檢驗項目
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異動內容說明
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Acetaminophen
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取消Toxic interval說明
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Gentamicin
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1. 取消Peak therapeutic range說明
2. 新增報告備註說明:
Trough level:
Adult:
Serious infections: 0.5~1.0 µg/mL.
Life-threatening infections: 1.0~2.0 µg/mL.
Synergy against gram-positive organisms: <1.0 µg/mL.
Pediatric:
Traditional dosing: <2.0 µg/mL.
Once daily dosing: < 0.5~1.0 µg/mL.
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Phenobarbital
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取消Toxic interval說明
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Vancomycin
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1. 異動Peak therapeutic range: 20.0~40.0 μg/mL
2. 新增報告備註說明:For complicated infections (eg, bacteremia, endocarditis, osteomyelitis, meningitis, and hospital-acquired pneumonia caused by S. aureus) or infections associated with severe sepsis or septic shock, trough concentrations of 15 to 20 µg/mL are recommended to improve penetration and improve clinical outcomes
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Digoxin
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1. 異動Therapeutic range: 0.50~2.00 ng/mL
2. 新增報告備註說明
Heart failure: 0.5 to 0.9 ng/mL
Adults: 0.8 to 2.0 ng/mL; <0.5 ng/mL probably indicates underdigitalization unless there are special circumstances.
A serum concentration ≥1.2 ng/mL may be associated with increased all-cause mortality in patients with atrial fibrillation (regardless of heart failure)
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Valproic Acid
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Mania: Clinical response seen with trough levels between 50.0~125.0 µg/mL
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Lithium
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1. 取消Toxic interval說明
2. 新增報告備註說明:
治療最低濃度:1.0~1.2 mmol/L(服藥後12小時)
最低有效濃度:0.6 mmol/L
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Theophyline
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1. 異動Therapeutic range 5.0~20.0
2. 新增報告備註說明:
Children: 5.0~15.0 µg/mL;
Adults: 10.0~20.0 µg/mL
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Sirolimus
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1. 異動Therapeutic range: 4.0~15.0 ng/mL
新增報告備註說明:Optimal ranges depend on patients’ clinical state
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Cyclosproine
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1. 異動Therapeutic range: 100~400 ng/mL
2. 新增報告備註說明:(1)Renal transplant:
(A)無公認之可用治療區間;
(B)0~90天之濃度為250~350 ng/mL,>90天之濃度為125~250 ng/mL,>1年之濃度為75~125 ng/mL。
(2)General range of 100~400 ng/mL; refer to institutional protocol for specific therapeutic ranges.
(3)Toxic level: Not well defined, nephrotoxicity may occur at any level.
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Tacrolimus
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1. 新增Therapeutic range: 4.0~20.0 ng/mL
2. 新增報告備註說明:Vary with organ transplantation, patient risk factors, concomitant immunosuppression, and time post-transplant)
1. liver transplant: early post-trasnplant 7~10; over one year 4~6
2. kidney transplant: < 6 months 5~15 ng/mL; > 6 months: 5~10 ng/mL
3. Prevention of graft-versus-host disease: 10~20 ng/mL
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3.修改Phenytoin(FDPENY、FRDENY)採檢容器為3號綠頭管(Lithium heparin tube);得以02號黃頭管(Serum separator tube Ⅱ)代替。
4.因新檢驗儀器試劑合約儀器無Serum Tricyclic antidepressants (TCA)檢驗試劑,因此即日起暫停此檢驗項目(檢驗醫令FRDTCA、FDPTCA)服務,若臨床欲評估Tricyclic antidepressants (TCA)使用情形,可檢測Urine Tricyclic antidepressants (TCA) screening檢驗,可開立Urine Drug Abuse Screening tests panel(檢驗代碼FRDDAT1、FRDDAT2、FRDDAT3)。
5.新增Tacrolimus急作醫令FRDTAC,檢驗時效2小時。
6.檢驗項目採檢相關注意事項,包含病人準備、採檢及傳送方式、報告完成時間及生物參考區間等,請參考本院主網頁檢驗資訊查詢系統(http://www2.cch.org.tw/labsearch/)及各項目網頁採檢手冊說明。
7. 相關問題,請聯絡檢驗醫學部主任醫檢師蕭玉鑫,分機5940。
檢驗醫學部主任 林正修
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