Lymphocyte Proliferation, Mitogens
| 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. Lymphocyte Proliferation, Mitogens | |
| 2. | |
| 3. | |
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| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
LYMIT
Test Workstation :
CINCI
Specimen Type:
Whole Blood
Tube Type:
Green top (Sodium Heparin) tube
Collection Volume:
Call Laboratory Sendouts ext. 34853 for collection volume.
Cause for Rejection:
Specimen rejected: Frozen, clotted, hemolyzed or centrifuged specimens. Specimens collected in anticoagulants other than Sodium Heparin.
Storage:
Ambient
Availability:
Sent to Reference Laboratory
Methodology:
Tritiated thymidine incorporation
Special Instructions:
Call Laboratory Sendouts ext. 34853 between 8:0015:00 for collection volume. Draw Monday Thursday between 10:0013:00. Send specimen in original tube. Do not aliquot. For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).
Lab/Phone:
330-543-4853
TAT:
7 days
CPT Code:
86353 X 3
Synonyms:
Mitogen Stimulation, Mitogen Proliferation, PHA, Con A, ConA, PWM
