Body fluid

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  • #447761
    John L Allen
    Participant

    Does the system “body fluid” really exclude peritoneal, synovial, and pleural fluid?

    Many hospitals/EHRs report certain fluid tests (e.g. nucleated cell count in a body fluid) using the same code, regardless of whether the body fluid is pleural, peritoneal, etc.  They identify the type of fluid in a separate value.  (This is similar to the way some report ABG and VBG values using the same codes, using a ‘specimen type’ value to distinguish between the two.)

    I had always assumed the codes in the system “body fluid” represented these unspecified fluid type codes, but upon looking at any body fluid code, the part description for “body fld” states:

    The LOINC “Body fld” System represents any body fluid that does not already have its own named System in LOINC, such as cochlear fluid or chyle. “Body fld” is not a high-level concept that includes all body fluids.

    As both pleural and peritoneal fluid have their own LOINC system, per this definition, they are excluded from “Body fluid”.

    I feel that the “body fluid” system actually IS commonly being used to represent all body fluids (at least body fluids that aren’t blood or urine).  The rank of the various “body fluid” labs strongly argue against these values representing things like cochlear fluid / chyle.   If we shouldn’t be using body fluid codes for unspecified fluids, which codes should we use?

    #447763
    Pam Banning
    Moderator

    Hi John

    I appreciate your asking this. I hadn’t realized there was an “exclusion” statement in the User’s Guide, or we would have had a conversation earlier. LOINC development keeps in mind there are multiple ways to build a database and express specimens. I agree that sites can built one body fluid type data element for an observation, and have an accompanying specimen type field that delineates which specimen was used. A site that had a more granular build, with multiple LIS elements for different specimens of the same analyte, would be using the specific pericardial, peritoneal system LOINCs. Whenever we provided LOINC services for a client, we would explain that we’d never ask them to rebuild their database in order to map to LOINC. There’s something there for everyone.

    In the past three years, there’s been more emphasis for the IVD vendors to provide the LOINCs, which is “upstream” from the healthcare/hospital provider systems and their LIS. I’ll bring the Body Fluid statement in the User’s Guide up to Regenstrief and Lab LOINC committee for clarification.

    Thank you,

    Pam Banning

    Lab LOINC co-chair

    #447979
    Pam Banning
    Moderator

    Hi John,

    The Lab LOINC committee met this morning (9/17) and agreed there needed to be editing to the Part Description of Body Fluid, and to the User’s Guide. You’ll find these edits in the anticipated December release 2020. You may proceed with using body fluid LOINC codes, and are requested to provide supporting information of the actual specimen, either in an accompanying OBX of the Specimen Source, or in the SPM segment of the HL7 message. Most LIS’s we’ve worked with have the additional result field stating the specimen (going into HL7 OBX from there).

    All the best,

    Pam Banning

    Lab LOINC co-chair

    #454553
    François Macary
    Participant

    Question related to this topic: Some labs have tests dedicated to fluid coming from cysts: pancreatic cyst, ovarian cyst, or unspecified cyst. For instance carcinoembryonic antigen on fluid from ovarian kyst.

    Is there any value more specific than “Body fluid” for representing this kind of specimen?

    Thanks

     

    #454554
    Pam Banning
    Moderator

    Hello Francois!  LOINC’s intent is not to be the sole source of all possible information, including source and methodology. It is intended to work alongside other standards.

    Two thoughts from the specimen arena: 1. A lot of work has been performed on a Specimen Cross Mapping table through the American Public Health Laboratories’ Lab Community of Practice workgroup. This table incorporates other portions of the HL7 message format to provide additional information. This is augmentary to the LOINC specimen attribute of Body Fluid. You can find some information on it at https://www.cdc.gov/labhit/paper/2016-standardization-of-laboratory-test-coding—phi-conference.pdf  If you are interested in seeing the latest release of the Specimen CMT, I will locate that for you.

    2. The LOINC term 31208-2 Specimen source identified is the most commonly used LOINC term. This demonstrates laboratories using one additional field to portray more information about the specimen used in this assay.

    If your site is not using HL7 or a laboratory information system, the above options may not help record a specimen such as “fluid from an ovarian cyst”.

    Best regards & Happy New Year!

    #454555
    Pam Banning
    Moderator

    Hello Francois!  LOINC’s intent is not to be the sole source of all possible information, including source and methodology. It is intended to work alongside other standards.

    Two thoughts from the specimen arena: 1. A lot of work has been performed on a Specimen Cross Mapping table through the American Public Health Laboratories’ Lab Community of Practice workgroup. This table incorporates other portions of the HL7 message format to provide additional information. This is augmentary to the LOINC specimen attribute of Body Fluid. You can find some information on it at https://www.cdc.gov/labhit/paper/2016-standardization-of-laboratory-test-coding—phi-conference.pdf  If you are interested in seeing the latest release of the Specimen CMT, I will locate that for you.

    2. The LOINC term 31208-2 Specimen source identified is the most commonly used LOINC term. This demonstrates laboratories using one additional field to portray more information about the specimen used in this assay.

    If your site is not using HL7 or a laboratory information system, the above options may not help record a specimen such as “fluid from an ovarian cyst”.

    Best regards & Happy New Year!

    #454556
    François Macary
    Participant

    Thank you Pam, my best wishes to you for this new year.

    I’m fully aware of the articulation of LOINC with HL7 standards V2, CDA and FHIR, and have a precise view of the SPM segment, of the former specimen CMET in V3, and of the Specimen resource in FHIR, being the initiator of the SpecimenDefinition resource. I’ve set in place the ongoing French translation of LOINC 10 years ago, and collaborated on several occasions with Daniel Vreeman in the past.

    In my example of a European lab performing CEA on various body fluids, the ultimate goal is to have unambiguous order messages as well as CDA lab reports. The lab would like to have, beside the ‘CEA on Body fluid’  LOINC code (12515-3), another code with a meaning ‘CEA on a body fluid obtained by puncture from a cyst or an organ’. That would require the presence of such a SYSTEM, somewhat less generic than Body fluid.

    Hence my question: Is there, among the more than 2,800 existing SYSTEM parts, a value approaching what I’m looking for.

    In any case, I’m very much interested in the latest release of the CMT. Could you please point me to it?

    Thanks.

    Regards

    #454561
    Pam Banning
    Moderator

    Hello Francois,

    We have a colleague and friend in common! Riki Merrick is the lead of our Lab Community of Practice, and I understand you are her IHE PaLM co-chair. She started emailing responses with you, but for the sake of the Forum, I’ll insert a link to the Specimen Cross Mapping table and a note of current development.

    The latest version of the specimenCMT is on Manjula’s (CDC) computer in a dB format – we are working through the good old spreadsheet that has outstanding questions on the LabMCoP calls on Thursdays, COVID permitting. That spreadsheet is on the APHL sharepoint site:

     https://www.aphlweb.org/aphl_departments/Strategic_Initiatives_and_Research/IPMG/ConfigMgt/LabMCoP/Shared%20Documents/SpecimenCrossMap_UseAfter20191010.xlsx

     

    Riki is working with SNOMED International on getting to host the final product.

    Best regards, Pam

    #454564
    François Macary
    Participant

    Tank you so much, Pam!

    #454571
    François Macary
    Participant

    Having checked the Specimen CMT of APHL, there is a specimen type for a cyst fluid sample, in both HL7 and  SNOMED:

    Fluid, Cyst – CST – HL70487 equivalent to 258453008 |Cyst fluid sample (specimen)| SNOMED CT.

    This concept can feed SPM-4, however it would make sense to me to have this specimen type also coded in the SYSTEM axis of LOINC, so as to be able to create LOINC terms for tests performed on this kind of specimen, more precise than Body fluid.

    Does it make sense?

    #454601
    Swapna Abhyankar
    Participant

    Hi everyone,

    In addition to “Body fld”, we also have a System “Asp”, which represents the fluid withdrawn during an aspiration procedure from an abnormal collection of fluid, such as from an abscess or cyst. “Asp” is used for abnormal fluid collections that are aspirated, while “Body fld” is used for named body fluids, such as synovial fluid or peritoneal fluid, that are not inherently pathologic.

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