Department of Pathology
and Laboratory Medicine

Akron Children's Hospital
One Perkins Square
Akron, OH 44308
Laboratory
Ph: (330) 543-8573
Fax: (330) 543-3659

LABORATORY TEST REQUISITION


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. Pyruvic Acid, Blood   
2.   
3.   
4.   
5.   
6.   

SPECIMEN INFO
Collection Date & Time:
Collected By:
Test Information for Pyruvic Acid, Blood
CPT Code: 84210

Specimen Type: Whole Blood

Tube Type/Collection Container: The special draw tube contains 2.5 ml of 6% perchloric acid and must be pre-chilled prior to the draw. Tubes should be stored in the refrigerator and transported on ice. For a Unit Collect, nursing staff should call the lab prior to drawing the patient to request that a tube be sent to them.

Cause for rejection: If any other anticoagulant/additive is used. If the tube is not pre-chilled for the draw, or if the tube is not sent to the lab on ice. If more or less than 1 ml of blood is added to the special draw tube.

Availability: Sent to reference lab; Days performed M,W, F

Methodology: Spectrophotometry

Special Instructions: The patient should be fasting for at least 4 hours prior to the draw. Draw enough blood directly into a syringe to add exactly 1 ml of blood to the pre-chilled, perchloric acid collection tube. Once drawn, immediately transfer 1 ml of blood from the syringe to the pre-chilled, perchloric acid collection tube and shake vigorously to mix. (Tube should be filled to the 3.5 ml mark.) Transport the specimen to the lab on ice. If perchloric acid spills before adding the blood specimen, obtain a new, pre-chilled tube. Additional information for lab - Do not spin the specimen. The whole blood specimen should be refrigerated and sent to the reference lab.

TAT: 3-5 days


Additional Info: Reference range: 0.08-0.16 mmol/L NIH Unit: 0.7-1.4 mg/dL

Transport specimens to processing area of the laboratory in an appropriate container. Additional information is available from Cindy Maurer at (330)543-8689.

SHIP TO:
Department of Pathology and Laboratory Medicine
CCL
Akron Children's Hospital
One Perkins Square
Akron, OH 44308


Physician Signature: Date: