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

Phenylalanine and Tyrosine Blood Spot

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. Phenylalanine and Tyrosine Blood Spot  
2.  
3.  
4.  
5.  
6.  

SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
PTBS/SHIMZ
Specimen Type:
Blood
Tube Type:
Blood Spot Card only
Collection Volume:
Filter paper must be saturated
Cause for Rejection:
Blood Spot card where filter paper is not saturated with blood. DO NOT USE STATE SCREEN CARD
Storage:
Ambient
Methodology:
Liquid Chromatorgraphy-Tandem Mass Spectrometry (LC-MSMS)
Special Instructions:
Please have patient fast a minimum of 4 hours prior to collection. do not allow capillary tube or patient heel to touch the collection card. Allow sample to air dry for 3 hours before sending to laboratory. Filter paper on Blood Spot card must be saturated with blood.
Lab/Phone:
330-543-0223
TAT:
3 days
Additional Info:
Reference range: Phenylalanine 69-182 uMol/L; Tyrosine <30 days: 42-49 uMol/L; > or = 1 month to 16 years: 29-86 uMol/L; > or = 16 years: 21-87 uMol/L
CPT Code:
84030, 84510

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