Post-Transplant Engraftment (Chimerism), DNA Assay

Molecular Diagnostics - : DNA

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. Post-Transplant Engraftment (Chimerism), DNA Assay
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

LAB4801

Specimen Type:

Blood
Bone Marrow

Collection Volume:

Blood or Bone Marrow: 2 mL collected in a Purple Top- EDTA Tube (0.5 mL minimum)

Cause for Rejection:

Quantity Not Sufficient
Specimen Not Received
Specimen Mislabeled
Specimen Not Labeled
Broken/Spilled in Transport
Hemolyzed
Specimen Clotted
Unacceptable Type or Source Submitted
Wrong Container
Improperly Preserved/Processed
Sample Stored at Incorrect Temperature
Sample Exceeds Holding Time

Storage:

Ambient

Availability:

Mon-Fri (7:30-16:00)

Methodology:

Polymerase Chain Reaction (PCR), Capillary Electrophoresis

Lab/Phone:

330-543-8722

TAT:

7-14 days

CPT Code:

81265 (pre-transplant); 81267 (post-transplant)

Synonyms:

Chimerism
Post-Engr

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Post-Transplant Engraftment (Chimerism), DNA Assay

Molecular Diagnostics - : DNA

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