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Akron Children's > For Healthcare Professionals > Lab Tests : Akron | Mahoning Valley

Anti-Glomerular Basement Membrane by Western Blot

PATIENT INFO
Patient Name:
Medical Record #:
BD:       /      /         Sex:   F   M

PHYSICIAN INFO
Physician Name :
Address:
Ph: (      )      -          Fax: (      )      -       
Additional Report to:
Ph: (      )      -          Fax: (      )      -       

TESTS REQUESTED
Test Name: ICD9 Code: (required)
1. Anti-Glomerular Basement Membrane by Western Blot  
2.  
3.  
4.  
5.  
6.  

SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
AGBM
Test Workstation :
MASSA
Specimen Type:
Blood
Tube Type:
Gold top SST (serum separator tube, no anticoagulant)
Collection Volume:
5 mL
Cause for Rejection:
Specimen not sent on dry ice.
Storage:
Frozen
Availability:
Sendout to Massachusetts General Hospital.
Methodology:
Western Blot, ELISA
Special Instructions:
Western Blot analysis performed MonFri and ELISA's performed as required. Send sample on dry ice by overnight delivery (MonThur). Deliveries to Massachusetts General Hospital after 6 p.m. go to Cytology refrigerator adjacent to Warren 125.
Lab/Phone:
330-543-8418
TAT:
1-3 days
Additional Info:
  • Reference range:
  • Western Blot: Negative
  • ELISA: > 5 ELISA EU/mL is considered positive
  • CPT Code:
    8418186021

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