LD, Isoenzymes
| 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. LD, Isoenzymes | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
LDISO
Test Workstation :
CLEVE
Specimen Type:
Blood
Tube Type:
Gold top SST (serum separator tube, no anticoagulant)
Alternate Tube Type:
Red Top Serum
Collection Volume:
2.5 mL
Minimum Volume:
1.5 mL
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
LD: Enzymatic, Isoenzymes: Electrophoresis
Special Instructions:
Days Performed: SunSat
Remove serum from cells ASAP
Lab/Phone:
330-543-8418
TAT:
2-3 days
Additional Info:
Reference Range:
Lactate Dehydrogenase:
Age: 0-30 Days; Range: 200-465 U/L
Age: 1-17 Months; Range: 200-450 U/L
Age: 18-24 months; Range: 165-430 U/L
Age: 3-10 Years; Range: 165-430 U/L
Age: 11-16 Years; Range: 127-287 U/L
Age: 17-99 Years; Range: 105-230 U/L
LD1: Range: 14-27%
LD2: Range: 29-42%
LD3: range: 18-30%
LD4: Range:8-15%
LD5: Range: 6-23%
CPT Code:
83615, 83625
Panel Includes:
Lactate Dehydrogenase, LD1, LD2, LD3, LD4, LD5
