Should a patient with a history of hematology/oncology consultation and improved hemoglobin level follow up with SPEP, IFE, sFLC, and Neogenomics Compass test upon discharge from a Skilled Nursing Facility (SNF)?

Yes, Schedule These Tests Upon Discharge

Your patient should absolutely follow up with the ordered hematology/oncology tests (SPEP, IFE, sFLC, and Neogenomics Compass) after SNF discharge, as timely completion of diagnostic workup for suspected monoclonal gammopathies is critical for appropriate treatment planning and preventing disease progression. 1, 2

Why These Tests Cannot Wait

The hematology/oncology specialist ordered this specific panel to evaluate for monoclonal gammopathies (such as multiple myeloma, MGUS, or related disorders), and delaying this workup could result in:

• Missed or delayed diagnosis of potentially serious conditions requiring prompt intervention 3
• Clinical decompensation if an underlying malignancy progresses without appropriate monitoring 1
• Treatment delays that may adversely affect outcomes in hematologic malignancies 1, 2

The Diagnostic Value of This Test Panel

The combination of SPEP + IFE + sFLC provides superior diagnostic accuracy compared to individual tests:

• SPEP alone detects only 85.5% of monoclonal proteins, while IFE detects 93.9% 4
• Adding sFLC increases detection to 96.3% of cases, making it significantly more sensitive than conventional methods 3, 4
• The complete panel (SPEP + IFE + sFLC) can detect all cases of myeloma in studied populations 3
• sFLC abnormalities provide prognostic information: patients with extreme sFLC ratios (≥100 or ≤0.01) have significantly worse survival outcomes 5, 4

Coordination Strategy for Post-Discharge Testing

Schedule the follow-up appointment with hematology/oncology within 7-14 days of SNF discharge to ensure timely completion of the ordered workup 6, 1:

• Verify the appointment is scheduled before discharge from the SNF, as this is a critical component of care transition 6, 2
• Coordinate with the outpatient hematology/oncology clinic to arrange laboratory testing either immediately before or at the time of the follow-up visit 2
• Ensure bidirectional communication between the SNF and the receiving hematology/oncology provider, including documentation of the improved hemoglobin (10.9) and any relevant clinical events during the SNF stay 6

Practical Implementation

Since your SNF has limited laboratory capabilities:

• Contact the hematology/oncology clinic directly to arrange for the patient to have labs drawn at their facility or a reference laboratory they use 2
• Most hospital-affiliated or commercial laboratories can perform SPEP, IFE, and sFLC as these are standard tests for monoclonal gammopathy evaluation 3
• The Neogenomics Compass test is a specialized genomic panel that will need to be coordinated through the hematology/oncology office, as it requires specific specimen handling and submission to Neogenomics 2

Common Pitfalls to Avoid

• Do not delay testing until symptoms worsen, as the improved hemoglobin does not rule out underlying hematologic malignancy requiring further evaluation 1
• Avoid inadequate communication between facilities, which can lead to missed appointments and care gaps 6
• Do not assume the patient will independently arrange testing—active coordination by SNF staff significantly improves follow-up completion rates 2

Documentation for Discharge Summary

Include in your discharge communication to the receiving provider 6:

• Current hemoglobin of 10.9 and trend during SNF stay
• Pending hematology/oncology workup with specific tests ordered (SPEP, IFE, sFLC, Neogenomics Compass)
• Scheduled follow-up appointment date and time with hematology/oncology
• Any relevant clinical changes during the SNF stay that might impact interpretation of results