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Akron Children's > For Healthcare Professionals > Lab Tests : Akron | Mahoning Valley

Adenovirus, Qualitative PCR

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. Adenovirus, Qualitative PCR  
2.  
3.  
4.  
5.  
6.  

SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
LAB3001
Specimen Type:
Blood (plasma)
Swab
Lesion
Conjunctiva
Bronchoalveolar lavage (BAL)
Wash
Tracheal Aspirate
Body Fluid
Urine
Synovial Fluid
Cerebrospinal Fluid (CSF)
Stool
Collection Volume:

Blood (plasma): 2 mL collected in a Purple Top- EDTA Tube (0.5 mL minimum)

Swab, Lesion, or Conjunctiva: 1 Flocked Swab in 3.0 mL of M4 Viral Transport Medium

BAL, Wash, or Tracheal Aspirate: 2.0 mL collected in a Sterile Container (1.2 mL minimum)

Body Fluid, Urine, or Synovial Fluid: 2.0 mL collected in a Sterile Container (0.2 mL minimum)

Cerebrospinal Fluid: 1.0 mL collected in a CSF Tube/Container (0.2 mL minimum)

Stool: 250mg (pea sized amount) of soft stool or 0.5 mL liquid stool in Sterile Container (125 mg soft stool or 0.2 mL liquid stool minimum)

Cause for Rejection:

Quantity Not Sufficient
Specimen Not Received
Specimen Mislabeled
Specimen Not Labeled
Broken/Spilled in Transport
Hemolyzed
Specimen Clotted
Unacceptable Type or Source Submitted
Wrong Container
Improperly Preserved/Processed
Sample Stored at Incorrect Temperature
Improper Swab
Multiple Swabs per Vial of M4 VTM
Swab Not Present in M4 VTM vial
Swab Not Placed in M4 VTM Vial (Dry Swab)
Sample Exceeds Holding Time

Storage:
Refrigerated
Availability:
Mon-Fri (7:30-16:00)
Methodology:
Real-Time Polymerase Chain Reaction
Special Instructions:
Upon arrival in laboratory, promptly centrifuge blood specimen tube and send 1.0 mL of the plasma to the Molecular laboratory. Refrigerate.
Lab/Phone:
330-543-8722
TAT:
1-3 days
CPT Code:
87798
Synonyms:
Adenovirus DNA
ADNQL

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