FK506
| 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. FK506 | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
FK5CC
Test Workstation :
E8011
Specimen Type:
Blood
Tube Type:
Purple top (EDTA) tube: Whole Blood, Store samples protected from light.
Collection Volume:
2.0 mL (minimum half the tube)
Minimum Volume:
1 mL
2 EDTA Microtainer tubes (If only 1 microtainer is collected repeat analysis will be unable to be performed.)
Preferred Volume:
2 mL
Cause for Rejection:
Centrifuged, clotted.
Storage:
Shipping- Send Refrigerated; Storage- Room Temp: 5 days; Refrigerated: 7 days; Frozen: 30 days
Availability:
7 days/week Dayshift
Methodology:
Roche-ECLIA sandwich principle
Special Instructions:
Specimens in lab by 12:00. Results by 16:00. Available STAT with the approval of the Medical Director.
Patients should be on a specified dose of Tacrolimus for at least 48 hours prior to sample collection. Trough levels should be collected just prior to the next dose.
Lab/Phone:
330-543-8418
TAT:
4 hours
Additional Info:
Reference range:
5.0-20.0 ng/mL
Critical: >25.0 ng/mL
CPT Code:
80197
Synonyms:
Tacrolimus
