Platelet Aggregation Profile
| 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. Platelet Aggregation Profile | |
| 2. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
PLTAG
Test Workstation :
SPCOG
Specimen Type:
Blood
Tube Type:
Blue top (sodium citrate) tube & purple top (EDTA) tube
Collection Volume:
25.0 mL Blue top( sodium citrate) & 2.0 mL purple top (EDTA) tube
Cause for Rejection:
Specimen hemolyzed, clotted or grossly lipemic; platelet count <50,000; specimen from patients who have taken drugs that inhibit platelet function; test not scheduled in advance.
Storage:
Ambient
Availability:
Test must be scheduled in advance
Methodology:
Biodata Platelet Aggregation Profiler Model PAP-4 Platelet Rich Plasma
Special Instructions:
NOTE: Call Centralized Core Lab (3305438416) in advance to schedule. Testing is drawn at Akron campus only. Special handling is required.
Lab/Phone:
330-543-8416
TAT:
72 hours
Additional Info:
Reference range is available under individual tests
CPT Code:
85576
Synonyms:
Platelet Function Studies; Aggregometer test
