Complete Blood Count with Differential (CBC WITH DIFF)
| PATIENT INFO |
| Patient Name: |
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| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
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| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
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| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Complete Blood Count with Differential (CBC WITH DIFF) | |
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| SPECIMEN INFO |
| Collection Date & Time: |
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| Hospital: |
Test ID :
CBC
Test Workstation :
AHEM1
Specimen Type:
Blood
Tube Type:
Purple top (EDTA) tube: Whole Blood
Collection Volume:
2.0 mL EDTA (minimum 0.3 mL)
Cause for Rejection:
Specimens hemolyzed, clotted, diluted with IV fluid, or collected in heparin; tubes improperly filled; specimens at RT > 8 hrs or 4C > 24 hrs
Storage:
Refrigerated
Availability:
Daily, 24 hours; STAT
Methodology:
Impedance measurement with Optical Flow light scatter and fluorescent measurements and microscopic evaluation of a Wright's stained blood film
Special Instructions:
Indicate clearly if the specimen has been drawn from an arterial line or from a line that has been rinsed with heparin.
Lab/Phone:
330-543-8416
TAT:
8 hours
Additional Info:
Reference ranges available on patient report
CPT Code:
-
Panel Includes:
Synonyms:
CBC; Hemogram & Smear Review; CBC with diff
