Factor XIII Screen
| 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. Factor XIII Screen | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
FXIII
Test Workstation :
SPCOG
Specimen Type:
Blood
Tube Type:
Blue top (sodium citrate) tube
Collection Volume:
2.7 mL (minimum 1.8 mL)
Must use appropriate sodium citrate tube based on volume of blood drawn (2.7 mL or 1.8 mL tube)
Cause for Rejection:
Sample hemolyzed, clotted, diluted with IV fluid; contam with heparin; improperly filled; received > 1 hour after drawn
Storage:
Whole Blood- Ambient
Availability:
Daily (0700-1530)
Methodology:
Fibrin clot stability in 5M urea
Special Instructions:
Indicate clearly if a specimen has been drawn from an arterial line or a line that has been rinsed with heparin.
If collected at an offsite location, send Whole Blood by a STAT Courier to Akron Childrens Lab. Must be received within 4 hours.
Lab/Phone:
330-543-8416
TAT:
24 hours
Additional Info:
Reference range: Normal Study
CPT Code:
85291
Synonyms:
Fibrin Stabilizing Factor
