IBD sgi Diagnostic
| PATIENT INFO |
| Patient Name: |
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| BD: / / Sex: F M |
| PHYSICIAN INFO |
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| Additional Report to: |
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| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. IBD sgi Diagnostic | |
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| SPECIMEN INFO |
| Collection Date & Time: |
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Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube AND lavender(EDTA) tube
Collection Volume:
5.0 mL Red Top - Serum and
2.0 mL Lavender Top (EDTA) - Whole Blood
Cause for Rejection:
Must have both Red top and Lavender top
Storage:
Refrigerate
Availability:
Sent to Reference Laboratory
Methodology:
A quantitative analysis of serologic, genetic and inflammation markers combined with the Prometheus Smart Diagnostic Algorithm (pattern-recognition technology) for IBD prediction and differentiation
Special Instructions:
Send to Prometheus lab.
Lab catalog number 1800
Lab/Phone:
330-543-8418
TAT:
3-4 days
CPT Code:
83520x6, 82397x4,86140,88346,88350,81479x4
Panel Includes:
ASCA IgA ELISA, ASCA IgG ELISA, Anti-OmpC IgA ELISA, Anti-CBir1 IgG ELISA, Anti-A4-Fla2 IgG ELISA, Anti-FlaX IgG ELISA, IBD-specific pANCA, AutoAntibody ELISA, IF A Perinuclear Pattern, DNAse Sensitivity, ATG16L1 (SNP (rs2241880), ECM1 (SNP (rs3737240), NKX2-3 (SNP (rs10883365 ), STAT3 (SNP (rs744166), ICAM-1, VCAM-1, VEGF, CRP, SAA
