Platelet Clumping Protocol

Orderable EAP code:

LAB101509

Billable EAP Codes:

80001814 x 1

CPT Codes:

85049 x 1

Lab Section:

Core Lab

Turnaround Time:

Routine: 2 Hours
Urgent: 1 Hour

Test Schedule:

24 hours, 7 days a week.

Units:

k/cu mm

Critical Values:

Less than or equal to 10
or
greater than or equal to 1000 k/cu mm.

Specimen Requirements:

BLUE top tube, 3.2% sodium citrate. Tube must be full.

Pediatric Specimen Requirements:

Pediatric BLUE top tube, 3.2% sodium citrate. Tube must be full.

Reference Range:

 Age (years)  PLT Count (k/cu mm)
 0 up to 2  125 to 600
 2 up to 12  150 to 420
 12 up to 150  150 to 400

Comments:

The Platelet Clumping Protocol is used to resolve falsely decreased platelet counts (pseudothrombocytopenia) in patients whose platelets clump in the presence of EDTA. The lab will test the citrate tube and the EDTA tube submitted for the CBC or platelet count ordered concurrently. The lab will examine both tubes for the presence of platelet clumps, and report the platelet count accordingly.

Synonyms:

Platelet Clumper, EDTA Clumper, Pseudothrombocytopenia

Prothrombin Time Mix With Reflex to Lupus Inhibitor

Orderable EAP code:

LAB00612

Billable EAP Codes:

80001108 x 1 (PT 0 Bill)
80001110 x 1 (PT 60 Bill)
80001109 x 1 (PT 0 Mix Bill)
80001111 x 1 (PT 60 Mix Bill)

CPT Codes:

85610 x 1 (PT 0 Bill)
85610 x 1 (PT 60 Bill)
85611 x 1 (PT 0 Mix Bill)
85611 x 1 (PT 60 Mix Bill)

Lab Section:

Core Lab

Turnaround Time:

Routine: 2 Hours
Urgent: 1 Hour

Test Schedule:

Mixes performed 7 days a week in Core lab. Samples received before 1:30 pm are run the same day; after 1:30 pm, samples are processed the next day. Batched 2 times per week. Call 503-494-7383 if STAT.

Units:

seconds

Specimen Requirements:

3 LIGHT BLUE top tube, 3.2% sodium citrate or four (4) 1 mL frozen sodium citrate plasma aliquots. Draw volume is critical due to the liquid anticoagulant. Allow tubes to fill by vacuum. For tubes with a rubber stopper, fill to the line on the label. For tubes with a plastic (hemogard) cap, the fill level is above the top of the label. If drawing with a syringe, do not remove the vacutainer stopper; insert the needle through stopper and allow the tube to fill by vacuum.

Hemostasis & Thrombosis lab sodium citrate specimens must be processed and frozen within 2 hours of specimen collection. OHSU clinics must cab the specimen to the Core Lab, Hatfield Research Center, 9th Floor (room 9D20) if processing is delayed or not possible on site. A phone call is helpful to alert the lab at 503-494-7383. Detailed instructions are included in this manual under Specialized Lab Services, Hemostasis & Thrombosis section.

Pediatric Specimen Requirements:

3 pediatric 1.3 mL LIGHT BLUE top tubes, 3.2% sodium citrate or two 0.5 mL frozen sodium citrate plasma aliquots. For pediatric patients requiring multiple coagulation tests, please call 503-494-7383 regarding draw volumes.

Reference Range:

Normal Pool, 0 min: 11.9 to 16.0 sec.
Normal Pool, 60 min: 11.9 to 16.0 sec.

Lupus anticoagulant testing - see separate test instructions.

Comments:

Avoid warfarin (Coumadin) therapy for 2 weeks and heparin/DOAC/DTI therapy for 2 days prior to test.

The assay is used to distinguish between circulating and coagulation factor deficiency when PT is prolonged. Test is a screening test for the lupus anti-coagulant. Typically, a patient is identified with a prolonged PT without a history of bleeding, or perhaps with a history of thrombosis or miscarriage. Failure to correct a prolonged PT with 1:1 mix suggests a circulating inhibitor. A positive-delete mixing study indicating an inhibitor should be followed by studies to determine whether the inhibitor is a true antibody (i.e. anti-Factor V) or an anti-phospholipid antibody (lupus anticoagulant). Anticoagulant screening may be reflexively performed to exclude drug effects.

Methodology: Clot-based on prolongation of PT assay.

Synonyms:

PT 1:1 Mix, PTM, 50:50, 1:1 Mix, PT Mix

Culture, Blood Bacti and Yeast

Orderable EAP code:

LAB00180

Billable EAP Codes:

80003526 x 1
80001884 x 1 (if subcultured)

CPT Codes:

87040 x 1
87077 x 1 (if subcultured)

Lab Section:

Core Lab

Turnaround Time:

Preliminary results available at time 0 with bottle file, 24, 48, 72, and 96 hours; final results available in 5 days.

Test Schedule:

24 hours, 7 days a week.

Specimen Requirements:

STAT to lab.

Optimal blood volume is the single most important factor contributing to sensitive detection of bloodstream infections.

Click on the link Blood Culture Collection (Opens in a new window) for further details.

Pediatric Specimen Requirements:

See above.

Comments:

Routine aerobic blood culture includes yeast. For culture bottles that turn positive growth, initial gram stain and rapid Molecular Blood Culture Identification (BCID) are performed by Core Laboratory 24/7. (See complete list of reflex BCID targets (Opens in a new window)). Positive results will reflex to the Blood Culture for confirmation of isolate identification and in vitro susceptibility testing.

Synonyms:

Blood AFB Culture
Blood Bacterial Culture
Blood Culture
Blood Fungal Culture
Blood Yeast Culture
Bone Marrow AFB Culture
Bone Marrow Culture
Bone Marrow Fungal Culture

Specific Gravity, Urine

Orderable EAP code:

LAB100302

Billable EAP Codes:

80001685 x 1

CPT Codes:

81003 x 1

Lab Section:

Core Lab

Turnaround Time:

Routine: 2 Hours
Urgent: 1 Hour

Test Schedule:

24 hours, 7 days a week.

Specimen Requirements:

2 mL urine in a urine cup

Pediatric Specimen Requirements:

1 mL urine in a urine cup

Reference Range:

1.005 to 1.030

Comments:

Specific gravity will be reported to the nearest thousandth (0.001).

Synonyms:

Urine S.G, Refractometer

Hemoglobin, Plasma Free

Orderable EAP code:

LAB102505

Billable EAP Codes:

80083051 x 1

CPT Codes:

83051 x 1

Lab Section:

Core Lab

Turnaround Time:

Routine: 2 Hours
Urgent: 1 Hour

Test Schedule:

24 hours, 7 days a week.

Units:

mg/dL

Specimen Requirements:

4 mL blood in a GREEN top, lithium heparin tube.

Pediatric Specimen Requirements:

1 mL blood in a GREEN top, lithium heparin tube.

Reference Range:

Less than 10 mg/dL

Comments:

Frozen samples are unacceptable.

EDTA and citrated plasma are unacceptable.

Specimen stabilty after separated from cells: ambient 2 hours, refrigerated 1 week.

Synonyms:

Plasma free Hemoglobin

Lipase, Body Fluid

Orderable EAP code:

LAB101667

Billable EAP Codes:

80001758 x 1

CPT Codes:

83690 x 1

Lab Section:

Core Lab

Turnaround Time:

Routine: 2 Hours
Urgent: 1 Hour

Test Schedule:

24 hours, 7 days a week.

Units:

U/L

Related Links:

Specimen Requirements:

2 mL body fluid in a body fluid container

Pediatric Specimen Requirements:

0.5 mL in a 4 mL RED top tube or urine sample cup

Reference Range:

None available

Reticulocyte Profile

Orderable EAP code:

LAB101507

Billable EAP Codes:

80004066 x 1

CPT Codes:

85046 x 1

Lab Section:

Core Lab

Includes:

Reticulocyte count; Reticulocyte count; Immature Retic Fraction (IRF); Reticulocyte Hemoglobin (RET-He)

Turnaround Time:

Routine: 2 Hours
Urgent: 1 Hour

Test Schedule:

24 hours, 7 days a week.

Interpretation:

Reticulocyte Hemoglobin Equivalent (RET-He):The measurement of reticulocyte hemoglobin content is a direct assessment of the incorporation of iron into erythrocyte hemoglobin and thus a direct estimate of the functional availability of iron into the red blood cell. Low values indicate inadequate iron supply relative to demand. Referenced from: Brugnara, C., Schiller, B., Moran, J. (2006). Reticulocyte hemoglobin equivalent (Ret He) and assessment of iron-deficient states, Clinical Laboratory Hematology, 18:303-308.

Specimen Requirements:

3.0 mL blood in a LAVENDER top tube, collected within 24 hours of testing.

Pediatric Specimen Requirements:

0.5 mL in a 0.5 mL LAVENDER top tube, collected within 24 hours of testing.

Reference Range:

 Reticulocyte count %  0.5 to 1.5%
 Reticulocyte count
 10 to 90 K/cu mm
 Immature Retic Fraction (IRF) %  3.0 to 12.0 %
 Reticulocyte Hemoglobin (RET-He) pg  29.0 to 38.0 pg

Synonyms:

RET-He
Reticulocyte Hemoglobin

Calcium, Ionized

Orderable EAP code:

LAB00077

Billable EAP Codes:

80001703 x 1

CPT Codes:

82330 x 1

Lab Section:

Core Lab

Includes:

Measured & pH-corrected ionized calcium

Turnaround Time:

Routine: 30 Minutes
Urgent: 15 Minutes
Extreme Emergency: 15 Minutes

Test Schedule:

24 hours, 7 days a week.

Units:

mmol/L

Critical Values:

Measured ICA:
Less than or equal to 0.75 mmol/L
Greater than or equal to 1.62 mmol/L

Specimen Requirements:

1 mL blood in a heparinized syringe OR one full GREEN top (sodium or lithium heparin) tube.

Pediatric Specimen Requirements:

0.3 mL blood in a heparinized syringe OR 0.6 mL blood in a pediatric GREEN top (sodium or lithium heparin) tube.

Reference Range:

Measured Ion Calcium: 1.14 to 1.32 mmol/L
Corrected to pH 7.4: 1.14 to 1.28 mmol/L

Comments:

Measured ionized calcium is reported at the actual pH of the sample. Corrected ionized calcium is reported at a pH of 7.4.

Stability: Whole blood up to 4 hours at room temperature.

Synonyms:

Ca
ICA
Ionized Calcium

MTB/Rifampin Resistance by PCR, Respiratory Only

Orderable EAP code:

LAB102617

Billable EAP Codes:

80001585 x 1
80002612 x 1 (if Rifampin resistance resulted)

CPT Codes:

87556 x 1
87798 x 1 (if Rifampin resistance resulted)

Lab Section:

Core Lab

Turnaround Time:

Routine: 4 Hours
Urgent: 2 Hours

Test Schedule:

24 hours, 7 days a week.

Critical Values:

All positive MTB results will be phoned per the Critical Value Policy.

Specimen Requirements:

  • Raw sputum only. Induced or expectorated sputum is acceptable.
  • Should receive 2 sputum samples at least 8 hours apart.
  • Minimum sample requirement - 1 ml
  • BAL samples unacceptable.

Reference Range:

Negative

Comments:

Performance of the Xpert MTB/RIFAssay has not been evaluated with samples from patients less than 18 years of age.

Synonyms:

MTB, TB, Mycobacterium

Immature Platelet Fraction

Orderable EAP code:

LAB101508

Billable EAP Codes:

80004059 x 1

CPT Codes:

85055 x 1

Lab Section:

Core Lab

Turnaround Time:

Routine: 2 Hours
Urgent: 1 Hour

Test Schedule:

24 hours, 7 days a week.

Units:

%

Interpretation:

The Immature Platelet Fraction (IPF) is an index of thrombopoiesis and can help to determine the mechanism of thrombocytopenia. An increased IPF in the presence of thrombocytopenia is indicative of a platelet destruction or consumption condition. Values at or below this range in combination with thrombocytopenia are indicative of decreased marrow production.

Specimen Requirements:

3.0 mL blood in a LAVENDER top vacutainer, collected within 24 Hrs of testing.

Pediatric Specimen Requirements:

0.5 mL in a 0.5 mL LAVENDER top tube, collected within 24 Hrs of testing.

Reference Range:

1.0 to 7.5%

Synonyms:

IPF, Reticulated Platelet

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