SPECIMEN REQUIREMENTS. Specimen Specimen Volume (min) Specimen Type Specimen Container Transport Environment

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Stella Perry
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Carboxyhemoglobin Order Name: CARBOXYHGB Test Number: 2001600 Revision Date: 09/24/2014 LOINC Code: 20563-3 Carboxyhemoglobin Hemoximeter Preferred 2 ml (1.

1 Carboxyhemoglobin Order Name: CARBOXYHGB Test Number: Revision Date: 09/24/2014 LOINC Code: Carboxyhemoglobin Hemoximeter Preferred 2 ml (1.0) Whole Blood Lithium Heparin (Dark Green Top / No-Gel) Alternate 1 2 ml (1.0) Whole Blood Sodium Heparin (Green Top / No-Gel) Ambient / Ambient / Stability for Carboxyhemoglobin specimens only: 5 days Room Temperature, 5 Days. (If collecting with Venous or Artierial Blood Gases, please follow those specimen requirements.) Daily 1 day Useful for verifying carboxyhemoglobin levels in cases of suspected exposure to carbon monoxide. CPT Code(s) 82375

2 Celiac Disease Antibody Panel Order Name: CELIAC PNL Test Number: Revision Date: 09/11/2014 LOINC CODE Tissue Transglutaminase IgA (IgA anti-ttg) Enzyme Immunoassay Gliadin Deamidated Antibody, IgA Enzyme Immunoassay Gliadin Deamidated Antibody, IgG Enzyme Immunoassay Immunoglobulin, IgA Quantitative Nephelometry Preferred 1 ml (0.5 ml) Serum Clot Activator SST (Red/Gray or Tiger Top) Specimen stability: Ambient 8 hours, more than 8 hours. Notes Mon, Wed, Fri 2-5 Days RML now recommends utilizing the celiac panel rather than the celiac analyzer because of the major improvements in the sensitivity and specificity of the IgA and IgG anti-gliadin assays. The celiac panel will now include quantitative IgA, the utilization of the synthetic gliadin-related deamidated peptides and human tissue transglutaminase (ttg). The utilization of the human tissue transglutaminase (ttg) and the synthetic gliadin-related deamidated peptide antigens in the EIA assay format for the detection of IgA anti-ttg, IgA anti-gliadin and IgG anti-gliadin have proven to be very sensitive and highly specific for celiac disease. IgA deficiency is times greater in patients with CD and therefore it would be important to reflex to IgG anti-ttg if the patient is IgA deficient and negative for IgG anti-gliadin. In patients with normal levels of IgA, any of the above serologic assays are suitable for following compliance to diet. A diet compliant patient will experience loss of the IgA anti-ttg, IgA anti-gliadin and/or IgG anti-gliadin after approximately 6 months. CPT Code(s) 83516x3; 82784

3 Celiac Disease Panel - Pediatric Order Name: PED CELIAC Test Number: Revision Date: 09/11/2014 LOINC CODE Tissue Transglutaminase IgA (IgA anti-ttg) Enzyme Immunoassay Gliadin Deamidated Antibody, IgA Enzyme Immunoassay Immunoglobulin, IgA Quantitative Nephelometry Preferred 1 ml (0.5 ml) Serum Clot Activator SST (Red/Gray or Tiger Top) Specimen stability: Ambient 8 hours, more than 8 hours. Notes Mon, Wed, Fri 2-5 Days Evaluation of Celiac Disease in pediatric patients less than 3 years of age. In toddlers, IgG anti-ttg is not reliable, and referral for a small bowel biopsy is recommended for those with serum IgA deficiency. Recent literature has reported that Celiac disease (CD) is a more common disorder in the United States than previously recognized. CPT Code(s) 83516x2; 82784

4 Cyanide Whole Blood Order Name: CYANIDE Test Number: Revision Date: 09/09/2014 Cyanide Whole Blood Colorimetric Preferred 10mL (6mL) Whole Blood Sodium Heparin (Green Top / No-Gel) Room Temperature Alternate 1 10mL (6mL) Whole Blood EDTA (Lavender Top) Room Temperature 10 ml Whole blood collected in sodium heparin (green-top) No-Gel tube. Specimen Stability: Room temperature: 14 Days, : 14 Days, Frozen: 30 Days Mon,Wed,Fri 2-3 Days CPT Code(s) Lab Section Reference Lab

5 Cytomegalovirus (CMV) DNA, Quantitative Cytomegalovirus (CMV) DNA, Quantitative Order Name: CMV QT PCR Test Number: Revision Date: 09/17/2014 Polymerase Chain Reaction Preferred 1mL (0.5mL) Plasma EDTA (Lavender Top) Alternate 1 1mL (0.5mL) Whole Blood EDTA (Lavender Top) Alternate 2 1mL (0.5mL) Fluid Sterile Screwtop Container For EDTA plasma, specimen should be centrifuged and plasma removed from cells within 2-4hrs of collection. Alternate specimen types: Serum, Random urine, CSF or Amniotic fluid - Aliquot and keep refrigerated. Specimen Stability: Room temperature= 48 Hours; = 8 Days; Frozen= 1 Month. Note*(Keep EDTA Whole Blood, Do Not Freeze!) Mon, Tue, Thr 1-3 Days CPT Code(s) 87497

6 Enterovirus DNA PCR Enterovirus DNA PCR Order Name: CSF ENTPCR Test Number: Revision Date: 09/09/2014 Polymerase Chain Reaction Preferred 0.7 ml (0.3 ml) CSF (Cerebrospinal Fluid) Sterile Screwtop Container Frozen Alternate ml (0.3 ml) Plasma EDTA (Lavender Top) Frozen Alternate 2 See See See Frozen Stability: Room temperature: 48 Hours, : 7 Days, Frozen: 30 Days. Preferred Specimen: 0.7mL(0.3mL) CSF. Alternate Specimens: Plasma (ACD, EDTA); Serum, Throat or Rectal swab in M4 or V-C-M medium OR 1 gm Stool (minimum 0.3 ml). Best to freeze all specimens soon after collection for ultimate stability. Avoid repeated freezing and thawing of specimens. Notes Mon-Sun 2-3 Days Unacceptable Conditions: Nonfrozen samples, samples exposed to repeated freeze/thaw cycles, nonsterile or leaking containers, heparinized samples, and hemolyzed samples. CPT Code(s) Lab Section Reference Lab

7 Fecal Fat Qualitative Order Name: FAT QL FEC Test Number: Revision Date: 09/09/2014 LOINC Code: Fecal Fat Qualitative Nile Blue Preferred 1 ml (0.5) Fecal/Stool Sterile Orange Screwtop Container Specimen stability: Ambient 8 hours. 3 days, Frozen 7 days. Mon - Fri 1-3 days Useful for the evaluation of persons with intestinal malabsorption and investigation of suspected laxative abuse. CPT Code(s) 82705

8 Gliadin Deamidated Antibody, IgA Gliadin Deamidated Antibody, IgA Order Name: GLIAD IGA Test Number: Revision Date: 09/11/2014 LOINC Code: Enzyme Immunoassay Preferred 1.0 ml (0.5 ml) Serum Clot Activator SST (Red/Gray or Tiger Top) Specimen stability: Ambient 8 hours, more than 8 hours. Mon, Wed, Fri 2-5 Days Assist in diagnosis of celiac disease; however, interpret results with caution due to the propensity of assay false positives. Useful to monitor diet compliance in celiac patients. CPT Code(s) 83516

9 Gliadin Deamidated Antibody, IgG Gliadin Deamidated Antibody, IgG Order Name: GLIAD IGG Test Number: Revision Date: 09/11/2014 LOINC Code: Enzyme Immunoassay Preferred 1.0 ml (0.5 ml) Serum Clot Activator SST (Red/Gray or Tiger Top) Specimen stability: Ambient 8 hours, more than 8 hours. Mon, Wed, Fri 2-5 Days Assist in diagnosis of celiac disease; however, interpret results with caution due to the propensity of assay false positives. Useful to monitor diet compliance in celiac patients. CPT Code(s) 83516

10 hcg Quantitative: Tumor Marker hcg Quantitative: Tumor Marker Order Name: HCG TM Test Number: Revision Date: 09/19/2014 LOINC Code: Chemiluminescence Assays Preferred 2 ml (1 ml) Serum Clot Activator SST (Red/Gray or Tiger Top) Specimen must be in original tube. No pour-off tubes. Specimen stability: Ambient 8 hours. 48 hours. Freeze if not tested within 48 hours. Daily 1-3 days Increased levels in men or in nonpregnant women suggest neoplasia. hcg is also useful in the evaluation of men with gynecomastia and boys with isosexual precocious puberty to diagnose testicular malignancies. CPT Code(s) 84702

11 Hepatitis C Genotype Hepatitis C Genotype Order Name: HCV GENO Test Number: Revision Date: 09/09/2014 Polymerase Chain Reaction Preferred 6 ml (2.5 ml) Plasma EDTA (Lavender Top) Frozen 6mL EDTA Plasma - Separated into Two mL EDTA Plasma Frozen Aliquots. Centrifuge specimen and separate plasma from cells, then transfer 3mL plasma into two sterile, plastic, aliquot tubes. (Minimum volume two 2mL aliquots). Freeze plasma within 2 hours of collection! Notes Set up Thurdsay, Reports following Friday 9 Days HCV viral genotype is used to predict the likelihood of therapeutic response and determine duration of treatment. Patient must have a viral load of > 500 IU/mL for Genotype to be determined. CPT Code(s) 87902

12 Immunoglobulin, IgA Quantitative Order Name: IGA Test Number: Revision Date: 09/11/2014 LOINC Code: Immunoglobulin, IgA Quantitative Nephelometry Preferred 1 ml (0.5 ml) Serum Clot Activator SST (Red/Gray or Tiger Top) Specimen stability: Ambient 8 hours, more than 8 hours. Mon - Fri 3 Days Useful for detection of monoclonal gammopathies and immune deficiencies. CPT Code(s) 82784

13 Lead, Blood (Whole Blood) Lead, Blood (Whole Blood) Order Name: LEAD Test Number: Revision Date: 09/15/2014 Electro Chemical Preferred 3mL (0.5mL) Whole Blood EDTA (Royal Blue Top/Trace Element Free) Alternate 1 0.5mL (0.2mL) Whole Blood EDTA (Lavender) Microtainer/Bullet Ambient / Ambient / The best specimen for lead testing on children is EDTA whole blood. Whole blood should be collected in Royal Blue-top (EDTA) evacuated tubes with negligible trace element levels. Capillary collection should be 0.5mL in Lavender Capillary Tube, gently invert capped microtainer several times to avoid clotting. Specimen Stability: Room temperature 5 days, 14 days, Frozen 60 days. Specimens can be transported either or Ambient temperature. Collection : Use powder-less gloves. For capillary collection, wash hands thoroughly with soap and dry with clean, low-lint towel. Once washed, fingers must not come into contact with any surface. Clean skin (finger or other area for venipuncture) with lead free alcohol swab prior to puncture. Avoid worksite collection: Tests performed on a specimen submitted in a non-trace element tube or non acid washed/non metal free container may not accurately reflect the patient's level. If a non-trace element tube/container is received, it will be accepted for testing. However, elevated results shall be reported with a message that a re-submission with a trace element tube/container is recommended. Mon-Fri 3 Days The State will require that the patient have an EDTA whole blood specimen collected so that accurate numerical results are obtained. Notes Note: The BD MicroGuard Pink-Top is no longer being provided for testing, use the standard Lavender Capillary Tube for capillary collections. CPT Code(s) 83655

14 Magnesium, Random Urine Order Name: MAG R U Test Number: Revision Date: 09/18/2014 LOINC CODE Magnesium, Random Urine Atomic Absorption Spectrophotometry Creatinine, Random Urine Enzymatic - Colorimetric Preferred 10 ml (0.5 ml) Urine, Random Sterile Screwtop Container Please submit 10 ml of a well-mixed random collection. Adjust ph to <3.0 with 6N HCl prior to aliquoting for testing. Refrigerate during and after collection. Stability: Room temperature: 4 days; : 7 days; Frozen: 90 days. Tue - Sat 2-3 Days CPT Code(s) 82570, Lab Section Reference Lab

15 Mantle Cell Lymphoma, IGH/CCND1, t(11;14) by FISH Order Name: MANTLE FSH Test Number: Revision Date: 09/12/2014 Mantle Cell Lymphoma, IGH/CCND1, t(11;14) by FISH Fluorescence in Situ Hybridization Preferred 5 ml (1 ml) Bone Marrow Sodium Heparin (Green Top / No-Gel) Alternate 1 5 ml (3 ml) Whole Blood Sodium Heparin (Green Top / No-Gel) Room Temperature Room Temperature Send specimen ASAP, Keep at room temperature! ( DO NOT FREEZE). Frozen samples will be rejected. Notes CPT Code(s) Lab Section Mon-Fri 3-5 Days Useful to detect classical translocation in Mantle cell lymphoma. For more information on this test, access our "Specialized Tests" section , TCx1 Reference Lab

16 Peripheral Blood Smear (PBS) Analyzer Order Name: ANEMIA AN Test Number: Revision Date: 10/02/2014 LOINC CODE Anemia Analyzer Smear Microscopy Complete Blood Count (CBC) with Automated Differential Immature Platelet Fraction Flow cytometry Reticulocyte (Retic) Count Preferred See See EDTA (lavender top) and Clot Activator SST (Red/Gray or Tiger Top) Collect Both: One 5mL(3mL) EDTA (Lavender) and One 10 ml Clot Activator SST (Red/Grey or Tiger). For best results: Room temperature specimens should be tested within 12hrs, otherwise send. specimens can be tested up to 24hrs. Specimens received after 24hrs will not receive a 5 part differential. Specimens received greater than 48hrs old will be canceled. Notes CPT Code(s) Daily 1 Day This algorithm is used in the evaluation of newly encountered anemia. A CBC and reticulocyte count begin a cascade with the appropriate chemistry tests added as needed. The peripheral blood smear, the results of the biochemical tests and the patient clinical history is reviewed by a pathologist who issues an interpretive report. For more information on this Analyzer, access our "Specialized Tests" section of this guide for a complete listing of tests and CPT codes. See the Test Notes Section of this test.

17 Peripheral Blood Smear (PBS) Comprehensive Consult Order Name: PBS RML Test Number: Revision Date: 10/02/2014 Complete Blood Count (CBC) with Automated Differential LOINC CODE WBC Differential Count, Manual Microscopy Reticulocyte (Retic) Count Immature Platelet Fraction Flow cytometry Peripherial Blood Smear Eval Preferred 5 ml (1 ml) Whole Blood EDTA (Lavender Top) Alternate 1 2 Slides (1 Slide) Peripheral Blood Smears Glass Slides with Holder Room Temperature Alternate 2 1 ml (0.5 ml) Whole Blood EDTA (Lavender) Microtainer/Bullet For best results: Room temperature specimens should be tested within 12hrs, otherwise send. specimens can be tested up to 24hrs. Specimens received after 24hrs will not receive a 5 part differential. Specimens received greater than 48hrs old will be canceled. Notes Daily 1-2 Days Provide patient history as available. Testing includes CBC, IPF, Manual Differential, Retic Count and pathologist interpretation. If this testing is performed at your laboratory please send these results with the smears and the lavender tube. If the question is anemia, consider ordering an Anemia Analyzer with the algorythmic reflex ordering of the appropriate chemistry tests. CPT Code(s) 85027, 85045, 85007, 80502, 85055

18 Tissue Transglutaminase IgA (IgA anti-ttg) Tissue Transglutaminase IgA (IgA anti-ttg) Order Name: TISTRANGL Test Number: Revision Date: 09/11/2014 LOINC Code: Enzyme Immunoassay Preferred 1 ml (0.5 ml) Serum Clot Activator SST (Red/Gray or Tiger Top) Specimen stability: Ambient 8 hours, more than 8 hours. Mon, Wed, Fri 2-5 Days An important marker in the diagnosis of Celiac disease and monitoring diet compliance. CPT Code(s) 83516

19 Varicella Zoster Antibody IgM Varicella Zoster Antibody IgM Order Name: VAR M ZOS Test Number: Revision Date: 10/06/2014 LOINC Code: Indirect Fluorescent Antibody Preferred 1 ml (0.5) Serum Clot Activator SST (Red/Gray or Tiger Top) Mon, Wed, Fri 3 Days CPT Code(s) 86787

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