Porphyrins, Quant Random 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, Quant Random Urine | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
POQRU
Test Workstation :
MAYO
Specimen Type:
Urine
Tube Type:
Amber Urine container
Collection Volume:
50mL (minimum 15 mL)
Storage:
Frozen, protect from light
Availability:
Sent to Reference Laboratory
Methodology:
High-Performance Liquid Chromatography (HPLC) with Fluorometric Detection
Special Instructions:
Protect from light
Lab/Phone:
330-543-8418
TAT:
2-4 days
Additional Info:
Reference Range:
UROPORPHYRINS, OCTA:
< or =30 nmol/L
HEPTACARBOXYLPORPHYRINS:
< or =7 nmol/L
HEXACARBOXYLPORPHYRINS:
< or =2 nmol/L
PENTACARBOXYLPORPHYRINS:
< or =5 nmol/L
COPROPORPHYRINS, TETRA:
< or =110 nmol/L
PORPHOBILINOGEN:
< or =1.3 mcmol/L
CPT Code:
84120, 84110
Panel Includes:
Uroporphyrins, Octa;
Heptacarboxylporphyrins;
Hexacarboxylporphyrins;
Pentacarboxylporphyrins;
Coproporphyrins, Tetra;
Porphobilinogen
