Porphyrins, Quantitative Urine
| 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. Porphyrins, Quantitative Urine | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
PORPU
Test Workstation :
MAYO
Specimen Type:
Urine
Tube Type:
Amber Urine container
Collection Volume:
50.0 mL (minimum 15.0 mL) from a 24 hour urine collection
Storage:
Frozen
Availability:
Sent to reference lab
Methodology:
High Performance Liquid Chromatography (HPLC) with Fluorometric Detection/Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Special Instructions:
50.0 mL urine (minimum 15.0 mL) from a wellmixed 24 hour urine collection. Add 5 g of sodium carbonate as preservative at start of collection. Instruct patient on 24 hour urine collection. To begin the urine collection, have the patient void. DISCARD THIS URINE SPECIMEN. This is best done with the first morning specimen. Note the time and record on the requisition. From then on collect all the urine that is voided and place in container. If more than one container is needed, please mark the first as #1 of 2 and retain on the floor until the collection is complete. The final void should be made 24 hours after the first void described earlier. The specimen should be included with the collection. Refrigerate during collection. Protect from light.
Lab/Phone:
330-543-8418
TAT:
2-4 days
Additional Info:
Reference range is available on patient report.
CPT Code:
84110, 84120
