Pyridoxal 5-phosphate, CSF
| 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. Pyridoxal 5-phosphate, CSF | |
| 2. | |
| 3. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
FP5PC
Test Workstation :
MAYO
Specimen Type:
Cerebral Spinal Fluid
Tube Type:
Contact Lab-Medical Neurogenetics collection kit(MCL T657). One set of tubes is
required per patient.
Collection Volume:
4.5mL
Cause for Rejection:
Specimens other than CSF in special collection kit(MCLT657)
Storage:
Frozen
Availability:
Sent to Reference Laboratory
Methodology:
HPLC/ Electrochemistry/Fluorescence
Special Instructions:
COLLECTION PROTOCOL:
CSF should be collected from the first drop into the tubes in the numbered order.
1)Fill each tube to the marked line with the required volumes.
Tube 1: 0.5 mL
Tube 2: 1.0 mL
Tube 3: 1.0 mL (contains antioxidants necessary to protect the sample integrity)
Tube 4: 1.0 mL
Tube 5: 1.0 mL
If sample's not blood contaminated, the tubes should be placed on dry ice at bedside
If samples are blood contaminated, the tubes should immediately be centrifuged (prior to freezing) and the clear CSF transferred to new similarly labeled tubes, then frozen
Store samples at 80 until they can be shipped
2)Complete Medical Neurogenetics, LLC request form.
Include test required, sample date and date of birth.
3)Label tubes with patient name and ID number, leaving the tube number viewable.
4)Place samples inside a specimen transport bag and the Medical Neurogenetics, LLC request form inside the pouch of the transport bag.
5)Ship samples frozen on dry ice.
One set of tubes is required per patient.
Total CSF volume required is 4.5 milliliters
1.Each collection kit contains 5 micro centrifuge tubes.
2.Tube #3 contains antioxidants necessary to perform this test.
Lab/Phone:
330-543-8418
TAT:
10-18 days
CPT Code:
82542
Synonyms:
Pyridoxamine, NC05
