Fibrinogen
| 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. Fibrinogen | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
FBG
Test Workstation :
MACG1
Specimen Type:
Blood
Tube Type:
Lt 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 (1.8 mL or 2.7 mL tube)
Minimum Volume:
1.8 ml using 1.8 ml tube
Preferred Volume:
2.7 ml using 2.7 ml tube
Cause for Rejection:
Sample hemolyzed, clotted, diluted with IV fluid; contaminated with heparin; improperly filled; received 4 hrs after collection
Storage:
Ambient
Availability:
Daily, 24 hours; STAT
Methodology:
Optical Light Scatter Detection Clotting Assay (Clauss)
Special Instructions:
Indicate clearly if a specimen has been drawn from an arterial line or from a line that has been rinsed with heparin. Please indicate if the patient is currently receiving anticoagulant therapy.
For offsite locations, call a STAT courier for specimen to be delivered to laboratory. Specimen is only stable for 4 hours.
Lab/Phone:
330-746-9623
TAT:
4 hours
Additional Info:
Reference range: 150-410 mg/dL
CPT Code:
85384
Synonyms:
Clottable Fibrinogen; Factor I
