Order Name: ANTI-FCER Anti-FceR (CU Index) … medical laboratory 1923 south utica avenue tulsa, oklahoma 74104-6502 order name:

REGIONAL MEDICAL LABORATORY1923 SOUTH UTICA AVENUE

TULSA, OKLAHOMA 74104-6502

Order Name: ANTI-FCER Anti-FceR (CU Index) Antibody Test Number: 5587500

TEST COMPONENTS REV DATE:5/31/2007Test Name: Methodology:

Anti-FceR (CU Index) Antibody CU Index

SPECIMEN REQIREMENTSSpecimen Specimen Type Specimen Container Transport Volume(min) Environment

Preferred 2 mL (1mL) Serum Clot Activator SST (Red/Gray or Tiger Top) Room Temperature Specimen:Special Patients taking calcineurin inhibitors should stop their medication for 72hrs prior to collection. Instructions:

GENERAL INFORMATION Testing Schedule: Mon-Fri Expected TAT: 2-3 Days

Clinical Use: To aid in the evaluation of Chronic Urticaria (CU). Patients with a chronic form of urticaria who are positive (>10) with the CU Index (Functional Anti-FceR test) have an autoimmune basis for their disease. A positive

result does not indicate which autoantibody (anti-IgE, anti-FceRI or anti-FceRII) is present. Cpt Code(s): 86343; 83088; 86021

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Order Name: CA125 CA 125 Assay Test Number: 2015625


CA 125 Assay CIA


Preferred 1 mL (0.5) Serum Clot Activator SST (Red/Gray or Tiger Top) See Instructions Specimen:Special Specimen stability: Ambient 8 hours. Refrigerated 24 hours. Freeze if > 24 hours. If testing is delayed >24 Instructions: hours, freeze serum.

GENERAL INFORMATION Testing Schedule: Mon - Fri Expected TAT: 1-3 days Clinical Use: Useful in the follow-up management of patients undergoing cancer therapy, especially for ovarian carcinoma. Cpt Code(s): 86304




Order Name: CMV EARLY CMV Antigenemia Test Number: 5523475


CMV antigenemia IFA


Preferred 4.5 mL Whole Blood EDTA (Lavender Top) Room Temperature Specimen:Special Clean venipuncture site thoroughly. Collect seperate full EDTA tube and do not share specimen with other Instructions: testing. Send to RML Main Lab Mirobiology department ASAP, Testing must begin within 18 hours of

collection.

GENERAL INFORMATION Testing Schedule: Mon, Wed, Fri Expected TAT: 3 Days

Clinical Use: This test detects reactivations of previous infections in immunocompromised patients. The CMV antigen is present in the neutorphils if rectivation antigenemia is present.Notes: Not designed for assessing new infections. If new infections are suspected suggest viral culture(s) or CMV G/M AB.

Cpt Code(s): 87271




Order Name: C TELOPEP Collagen Type I C-Telopeptide(CTx) Test Number: 5572555


Collagen Type I C-Telopeptide(CTx) CIA


Preferred 1 mL (0.5) Serum Clot Activator (Red Top, No-Gel) Frozen Specimen:Special Fasting is required! Non-Fasting specimens are unacceptable. Fasting morning collection 8-10 am. (Diurnal Instructions: variations cause elevated levels at night). Allow blood to clot (10-15 minutes) at room temperature. Centrifuge

and separate the serum from the cells and place into plastic aliquot tube. Label aliquot tube as Serum and Freeze as soon as possible.

GENERAL INFORMATION Testing Schedule: Tue, Thr, Sat. Expected TAT: 2-4 Days

Clinical Use: CTx is useful to asses bone resorption in patients with metabolic bone disease. The test is also useful in monitoring therapy to slow or halt osteoporotic bone loss. Notes: Specimen Stability: Room temperature= 16hr; Refrigerated= 3day; Frozen= 3mo. Cpt Code(s): 82397




Order Name: C CRYPTOSP Cryptosporidium Prep Exam Test Number: 6001600


Cryptosporidium Prep Exam DFA


Preferred Fecal/Stool Parapak Refrigerated Specimen:Special Place stool in formalin container found with ova and parasite kits. This is usually performed ordered in Instructions: conjunction with an ova and parasite exam.

GENERAL INFORMATION Testing Schedule: Daily Expected TAT: 2 Days Clinical Use: Detects Cryptosporidium sp. infections Cpt Code(s): 87272




Factor 10a (Xa) Inhibition, Low Molecular Weight Order Name: LMWHEPARIN Heparin (LMWH) Test Number: 1506175

TEST COMPONENTS REV DATE:5/8/2007Test Name: Methodology:Factor 10a (Xa) Inhibition, Low Molecular Weight Heparin Chrom (LMWH)


Preferred 2.7 mL Whole Blood Sodium Citrate 3.2% (Blue Top) Ambient whole blood Specimen: or frozen aliquotsAlternate 2.7 mL Double Spun Sterile, Capped Plastic Tube Ambient whole blood Specimen: Plasma or frozen aliquots

Special Please indicate anticoagulant therapy. Should collect at 4 hours post subcutaneous injection. Tube must be Instructions: filled to the proper level, no hemolysis. Improperly filled tubes can give erroneous results. Whole blood must be transported to lab within 1 hour of collection. If sending citrated plasma aliquots, they must be double spun then aliquot 1. 5 ml plasma from each tube into individual plastic aliquot tubes and freeze. Do not pool aliquots together!

GENERAL INFORMATION Testing Schedule: Mon - Fri Expected TAT: 1 Day

Clinical Use: The assesment of the anti-Xa effect of heparin by this method gives a high sensitivity in detecting Low Molecular Weight Heparin levels. Cpt Code(s): 85520




Order Name: UNFRAC HEP Factor 10a (Xa) Inhibition, Unfractionated Heparin. Test Number: 1507100


Factor 10a (Xa) Inhibition, Unfractionated Heparin. Chrom


Preferred 2.7 mL Whole Blood Sodium Citrate 3.2% (Blue Top) Ambient whole blood Specimen: or frozen aliquotsAlternate 2.7 mL Double Spun Sterile, Capped Plastic Tube Ambient whole blood Specimen: Plasma or frozen aliquots

Special Please indicate anticoagulant therapy. Tubes must be filled to the proper level, no hemolysis. Improperly Instructions: filled tubes can give erroneous results. Whole blood must be transported to lab within 2 hours of collection. If sending citrated plasma aliquots, they must be double spun then aliquot 1. 5 ml plasma from each tube into individual plastic aliquot tubes and freeze. Do not pool aliquots together!

GENERAL INFORMATION Testing Schedule: Mon - Fri Expected TAT: 1 Day

Clinical Use: The assesment of the anti-Xa effect of heparin by this method gives a high sensitivity in detecting Unfractionated Heparin levels. Cpt Code(s): 85520




Order Name: GIARD FEC Giardia lamblia, DFA fecal Test Number: 6002325


Giardia lamblia, DFA fecal DFA


Preferred Fecal/Stool Parapak Room Temperature Specimen:Special Stool specimen needs to be in formalin. Place stool in PARA-PAK formalin container found with ova and parasite Instructions: kits.

GENERAL INFORMATION Testing Schedule: Daily Expected TAT: 2 Days Clinical Use: Detects Giardia lamblia in stool Cpt Code(s): 87328




Order Name: GLUC 1 HR Glucose Tolerance (1 Hour Only) Glucola Test Number: 2012650


Glucose Tolerance (1 Hour Only) Glucola Hexokinase


Preferred 1 mL (0.5) Plasma Sodium fluoride (gray top) Refrigerated Specimen:Alternate 1 mL (0.5) Plasma Lithium Heparin PST (Light Green Top) Refrigerated Specimen:

1 mL (0.5) Serum Clot Activator SST (Red/Gray or Tiger Top) Refrigerated Special Fasting is not necessary. Preferably performed at 28 weeks gestation. Give 50 gms of glucola. For non pregnant Instructions: give 75 gms of glucola. Draw 1 hour after glucola load. Lithium heparin and clot tube must be spun within 2

hours for the integrity of the specimen. Specimen stability: Ambient 8 hours. Refrigerated 7 days.

GENERAL INFORMATION Testing Schedule: Daily Expected TAT: 1-2 days

Clinical Use: This is the screening test for gestational diabetes. It should only be performed on pregnant females. The reference ranges and interpretive data contain the established reference ranges, interpretive data, and criteria

for confirming diagnosis of gestational diabetes. The glucola dosing is 50g. Cpt Code(s): 82950




Order Name: GLUC 2 HR Glucose Tolerance (2 Hour Only) Glucola Test Number: 2002250


Glucose Tolerance (2 Hour Only) Glucola Hexokinase


Preferred 1 mL (0.5) Plasma Sodium Floride (Gray) Refrigerated Specimen:Alternate 1 mL (0.5) Plasma Lithium Heparin PST (Light Green Top) Refrigerated Specimen:

1 mL (0.5) Serum Clot Activator SST (Red/Gray or Tiger Top) Refrigerated Special According to the American Diabetes Association, Collect specimen 2 hours after the patient ingests 75g of Instructions: Glucola. Lithium heparin and clot tube must be spun within 2 hours for the integrity of the specimen. If doctor

instructs the patient to ingest a Normal Meal, then order GLUC 2HRPC Glucose Tolerance (2 Hour Only) Post Prandial. Specimen stability: Ambient 8 hours. Refrigerated 7 days.

GENERAL INFORMATION Testing Schedule: Mon - Fri Expected TAT: 1-2 days

Clinical Use: Criteria for Diagnosis of Diabetes from the American Diabetes Association recommends Random plasma glucose >200 mg/dl with symptoms (polyuria, polydypsia, and unexplained weight loss) repeated to confirm on subsequent day, or Fasting plasma glucose >126 mg/dl repeated to confirm, or 2-hr plasma glucose >200 mg/dl post 75g glucose challenge repeated to confirm.

Notes: Glucose measurements are used in the diagnosis and treatment of carbohydrate metabolism disorders including diabetes mellitus, neonatal hypoglycemia and idiopathic hypoglycemia and pancreatic islet cell carcinoma. Cpt Code(s): 82950




Order Name: GLUC 2HRPC Glucose Tolerance (2 Hour Only) Post Prandial Test Number: 2002200


Glucose Tolerance (2 Hour Only) Post Prandial Hexokinase


Preferred 1 mL (0.5) Plasma Sodium Floride (Gray) Refrigerated Specimen:Alternate 1 mL (0.5) Plasma Lithium Heparin PST (Light Green Top) Refrigerated Specimen:

1 mL (0.5) Serum Clot Activator SST (Red/Gray or Tiger Top) Refrigerated Special This test should only be used if the patient has been instructed by their physician to have glucose testing 2 Instructions: hours after patient has ingested a normal meal. If doctor instructs the patient to ingest Glucola, then order

GLUC 2 HR Glucose 2 Hour Only. Lithium heparin and clot tube must be spun within 2 hours for the integrity of the specimen. Specimen stability: Ambient 8 hours. Refrigerated 7 days.

GENERAL INFORMATION Testing Schedule: Daily Expected TAT: 1-2 days

Clinical Use: Criteria for Diagnosis of Diabetes from the American Diabetes Association recommends Random plasma glucose >200 mg/dl with symptoms (polyuria, polydypsia, and unexplained weight loss) repeated to confirm on subsequent day, or Fasting plasma glucose >126 mg/dl repeated to confirm, or 2-hr plasma glucose >200 mg/dl post 75g glucose challenge repeated to confirm.

Notes: Glucose measurements are used in the diagnosis and treatment of carbohydrate metabolism disorders including diabetes mellitus, neonatal hypoglycemia and idiopathic hypoglycemia and pancreatic islet cell carcinoma. Cpt Code(s): 82947




Glucose Tolerance (3 Hour) Gestational Diabetes Order Name: GTT PREG Panel Test Number: 2023550


Gestational Fasting Glucose Hexokinase Gestational 1hr Glucose Hexokinase Gestational 2hr Glucose Hexokinase Gestational 3hr Glucose Hexokinase



2 mL (0.5) Serum Clot Activator SST (Red/Gray or Tiger Top) Refrigerated Special Must schedule collection Monday thru Friday from 8am to 12pm. Overnight fasting required. Nothing by mouth Instructions: except water during testing.

Collect a full Sodium fluoride (gray top) tube to for each time interval. 2mL (0. 5) of Plasma is required for each glucose interval. Collect and label a baseline gray top tube for the Fasting Glucose. Then give the patient 100 mg Glucola. Collectand label a gray top for 1 hour, 2 hours and 3 hour interals after the ingestion of the Glucola. Performed only on pregnant women. If not pregnant, order GLUC 2 HR. Specimen stability: Ambient 8 hours. Refrigerated 7 days.


Clinical Use: Used in diagnosing gestational diabetes, and to predict perinatal morbidity, risk of fetal abnormality and perinatal mortality. Notes: For more information on this test, access our "Specialized Tests" section. Cpt Code(s): 82951; 82952x2




Order Name: GTT 3 HR Glucose Tolerance (3 Hour) w/o Urine Test Number: 2006700


Glucose Fasting Hexokinase Glucose 0.5 Hour Tolerance Hexokinase Glucose 1 Hour Tolerance Hexokinase Glucose 2 Hour Tolerance Hexokinase Glucose 3 Hour Tolerance Hexokinase



1 mL (0.5) Serum Clot Activator SST (Red/Gray or Tiger Top) Refrigerated Special Fasting overnight and during test. Patient may have water. Draw fasting specimen. Adults: Give 75 gm of Instructions: glucola. Children: Adjusted amount of glucola to be calculated by lab. Call (918) 744-2500. Specimen stability:

Ambient 8 hours. Refrigerated 7 days.


Clinical Use: There are no established guidelines, reference ranges or criteria, for the evaluation of a three hour specimen following a three hour glucose challenge.Notes: This test should no longer be used to diagnose diabetes. The current ADA criteria for diagnosis of diabetes will be listed in the interpretive data on this test.

Cpt Code(s): 82951; 82952x2




Order Name: HEP B PCR Hepatitis B Virus DNA UltraQuant Test Number: 5592525


Hepatitis B Virus DNA UltraQuant PCR


Preferred 2 mL (1) Plasma EDTA (Lavender Top) Frozen Specimen:Alternate 2 mL (1) Serum Clot Activator SST (Red/Gray or Tiger Top) Frozen Specimen:

Special Centrifuge specimen and separate plasma from cells, then transfer plasma to capped sterile, plastic, aliquot Instructions: tubes. Freeze plasma within 2 hours of collection!

GENERAL INFORMATION Testing Schedule: Tues - Sat Expected TAT: 3-6 Days

Clinical Use: Quantitates Hepatitis B Virus DNA down to 0. 01 pg/mL for establishment of a baseline and to monitor viral load. The most important test for determining the efficacy of antiviral treatment is quantitative HBV DNA monitoring. HBV DNA testing is useful in detecting potential disease transmission from prospective donors and for post-transplantation monitoring. Although HBeAg is considered an indirect monitor of viral replication, high viral replication may occur without circulating HBeAg, due to mutations of the virus preventing the production ofHBeAg.

Cpt Code(s): 87517




Order Name: HCV IMMUNO Hepatitis C Antibody, Confirmatory Test, RIBA Test Number: 5501400


Hepatitis C Antibody, Confirmatory Test, RIBA RIBA/SIA


Preferred Specimen: 1 mL (0.1) Serum Clot Activator SST (Red/Gray or Tiger Top) Refrigerated Alternate Specimen: 1 mL (0.1) Plasma EDTA (Lavender Top) Refrigerated

Special STABILITY: Room temperature= 1 Week; Refrigerated= 2 Weeks; Frozen= 1 Month. Instructions:

GENERAL INFORMATION Testing Schedule: Tues - Sat Expected TAT: 2-3 Days Cpt Code(s): 86804X5




Order Name: LYME EIA Lyme Antibody (Polyvalent) Test Number: 5570800


Lyme Antibody (Polyvalent) EIA


Preferred 1 mL Serum Clot Activator SST (Red/Gray or Tiger Top) Refrigerated Specimen:

GENERAL INFORMATION Testing Schedule: Seasonal and Volume Dependant Expected TAT: 5 -7 Days

Clinical Use: All positives or borderline results are confirmed with western blot. Serology may not be positive until 2-4 weeks after onset of erythema migrans. Cpt Code(s): 86618




Order Name: MYAS GRAV1 Myasthenia Gravis Panel 1 Test Number: 5551325


Acetylcholine Receptor Binding Antibody RIA Striated Muscle Antibody IFA


Preferred 2 (0.4) mL Serum Clot Activator SST (Red/Gray or Tiger Top) Refrigerated Specimen:

GENERAL INFORMATION Testing Schedule: Mon - Sat Expected TAT: 4-5 Days

Clinical Use: Myasthenia Gravis is a neurological disorder characterized by a decrease in acetylcholine receptors. Patients exhibit skeletal muscle weakness and fatigability. Cpt Code(s): 86255; 83519




Order Name: PEP AN Protein Electrophoresis Analyzer, Serum Test Number: 5004425


Protein Electrophoresis Analyzer, Serum EP


Preferred 3 mL (1) Serum Clot Activator SST (Red/Gray or Tiger Top) Room Temperature Specimen:

GENERAL INFORMATION Testing Schedule: Mon - Sat Expected TAT: 1-3 Days

Clinical Use: Initial testing: Protein Electrophoresis; Total Protein; Serum Free Light Chains (Kappa/Lambda); Pathologist InterpretationNotes: For more information on this Analyzer, access our "Specialized Tests" section of this guide for a complete listing of tests and CPT codes.

Cpt Code(s): See the Test Notes Section of this test.




Order Name: PEPU AN Protein Electrophoresis Analyzer, Urine Test Number: 5004450


Protein Electrophoresis Analyzer, Urine EP


Preferred 10mL Urine, Random Sterile Urine container Refrigerated Specimen:Alternate 10mL Urine, 24-hour 24 hour Urine Container Refrigerated Specimen:

Special Urine random or 24 hour collection no preservatives 24 hour urine - no preservatives. Instructions:

GENERAL INFORMATION Testing Schedule: Mon - Sat Expected TAT: 1-3 Days Clinical Use: Initial testing: Protein Electrophoresis; Total Protein; Pathologist Interpretation.

Notes: For more information on this Analyzer, access our "Specialized Tests" section of this guide for a complete listing of tests and CPT codes. Cpt Code(s): See the Test Notes Section of this test.




Order Name: RPR RPR (Rapid Plasma Reagin) Test Number: 5500600


RPR (Rapid Plasma Reagin) CF


Preferred 1 mL Serum Clot Activator SST (Red/Gray or Tiger Top) Specimen:Special Must be submitted in original container Instructions:

GENERAL INFORMATION Testing Schedule: Mon - Fri Expected TAT: 3 Days

Clinical Use: A non-treponemal test which screens for syphilis. A positive is always confirmed by a treponemal tests (e. g. FTA). Cpt Code(s): 86592




Order Name: TICK PANEL Tickborne Disease Panel Test Number: 5571750


Ehrlichia chaffeensis Antibody, IgM, IgG IFA Rocky Mountain Spotted Fever (RMSF) IFA Tularemia Antibody LA


Preferred 3 mL Serum Clot Activator SST (Red/Gray or Tiger Top) See Instructions Specimen:Special Allow 15-30 minutes for specimen to clot. Keep serum refrigerated until processed. However due to the Instructions: shortened stability for the Tularemia Antibody, it is preferred if a 1mL aliquot of serum is placed into a plastic

pour off tube and frozen for this test. Please see Tularemia Antibody test for details. Tularemia Specimen Stability: Room temperature= Unacceptable; Refrigerated= 48 Hours; Frozen= 7 Days.

GENERAL INFORMATION Testing Schedule: Assay Dependant Expected TAT: 3-5 Days

Clinical Use: E. chaffeensis - A tick-borne disease common to the OK/ARK/MO/KS area. Peak titers will occur at 6 weeks after onset. Only 22% will be positive after 1 week, 68% after 2 weeks and 100% after 4 weeks.

Rocky Mountain Spotted Fever - To assist in the diagnosis of RMSF. Patients may not seroconvert until 10 days after onset of illness. Tularemia Antibody - Diagnosis of exposure to Francisella tularensis.

Cpt Code(s): See Individual components




Order Name: TICK/LYME Tickborne Disease Panel (with Lyme Antibody) Test Number: 5571775


Ehrlichia chaffeensis Antibody, IgM, IgG IFA Rocky Mountain Spotted Fever (RMSF) IFA Tularemia Antibody LA Lyme Antibody (Polyvalent) EIA


Preferred 4 mL Serum Clot Activator SST (Red/Gray or Tiger Top) See Instructions Specimen:Special Allow 15-30 minutes for specimen to clot. Keep serum refrigerated until processed. However due to the Instructions: shortened stability for the Tularemia Antibody, it is preferred if a 1mL aliquot of serum is placed into a plastic

pour off tube and frozen for this test. Please see Tularemia Antibody test for details. Tularemia Specimen Stability: Room temperature= Unacceptable; Refrigerated= 48 Hours; Frozen= 7 Days.

GENERAL INFORMATION Testing Schedule: Assay Dependant Expected TAT: 3-5 Days

Clinical Use: E. chaffeensis - A tick-borne disease common to the OK/ARK/MO/KS area. Peak titers will occur at 6 weeks after onset. Only 22% will be positive after 1 week, 68% after 2 weeks and 100% after 4 weeks. Rocky Mountain Spotted Fever - To assist in the diagnosis of RMSF. Patients may not seroconvert until 10

days after onset of illness. Tularemia Antibody - Diagnosis of exposure to Francisella tularensis. Lyme Antibody - All positives or borderline results are confirmed with western blot. Serology may not be positive until 2-4 weeks after onset of erythema migrans.

Cpt Code(s): See Individual Components




Order Name: TULAREM AB Tularemia Antibody Test Number: 5570900


Tularemia Antibody LA


Preferred 1 mL (0.5) Serum Clot Activator SST (Red/Gray or Tiger Top) Frozen Specimen:Special Allow 15-30 minutes for specimen to clot. Centrifuge and aliquot 1mL serum into plastic pour off tube and Instructions: freeze.

Specimen Stability: Room temperature= Unacceptable; Refrigerated= 48 Hours; Frozen= 7 Days.

GENERAL INFORMATION Testing Schedule: Mon - Fri Expected TAT: 3 Days Clinical Use: Diagnosis of exposure to Francisella tularensis. Cpt Code(s): 86668


Documents

Order Name: ANTI-FCER Anti-FceR (CU Index) … medical laboratory 1923 south utica avenue tulsa, oklahoma 74104-6502 order name: