Protein Electrophoresis, 24 hr., 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. Protein Electrophoresis, 24 hr., Urine | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
EP24U
Test Workstation :
MAYO
Specimen Type:
Urine
Tube Type:
Urine container
Collection Volume:
60.0mL (minimum 25.0 mL) from a 24hr collection
Cause for Rejection:
24 hr urine not collected
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Turbidimetry, Agarose Gel Electrophoresis, Immunofixation
Special Instructions:
Collect a 24hour urine specimen, no preservative. 24Hour volume is required.
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 24 hour urines during collection. Do not use urine preservatives. Mark each container with patient information and date and time collection started and finished. Deliver specimens promptly to lab.
Lab Refrigerated 24Hour volume is required Aliquot 60mL bottle for protein electrophoresis and 5mL tube for protein, total
Lab/Phone:
330-543-8418
TAT:
4-6 days
Additional Info:
Reference Range:
PROTEIN, TOTAL: <229 mg/24 hours
Reference values have not been established for patients <18 years of age.
Reference value applies to 24-hour collection.
ELECTROPHORESIS, PROTEIN
The following fractions, if present, will be reported as mg/24 hours:
Albumin
Alpha-1-globulin
Alpha-2-globulin
Beta-globulin
Gamma-globulin
CPT Code:
84166, 84156,86335 (if appropriate)
