Centralized Core Laboratory - Mayo Clinic Laboratories :
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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. ADAMTS13 Activity and Inhibitor Profile
2.
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6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
ADM13
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Light Blue (Sodium citrate) tube
Collection Volume:
5.0 mL
Storage:
Strict Frozen
Availability:
Sent to Reference Laboratory
Methodology:
ADMFX/61211: Fluorescent Resonance Energy Transfer (FRET)
ADMIS/61213, ADMBU/61214: Mixing Studies
Special Instructions:
If collected at an offsite location, send by a STAT Courier to Hospital lab.
Lab/Phone:
330-543-8418
TAT:
24 hours to 3 days
Additional Info:
Testing begins with ADAMTS13 activity assay. If the ADAMTS13 activity is <30%, an inhibitor screen will be performed to look for specific ADAMTS13 inhibition. If specific inhibition is apparent, the titer of the inhibitor will be determined.
CPT Code:
85397 and (85335x2 if appropriate)
Panel Includes:
CPT code 85397 (activity assay)
CPT code 85335 (Inhibitor Screen assay, if appropriate)
CPT code 85335 (Bethesda titer, if appropriate)
ADAMTS13 Activity and Inhibitor Profile
Test ID/Workstation :
ADM13
Specimen Type:
Blood
Tube Type:
Light Blue (Sodium citrate) tube
Collection Volume:
5.0 mL
Storage:
Strict Frozen
Availability:
Sent to Reference Laboratory
Methodology:
ADMFX/61211: Fluorescent Resonance Energy Transfer (FRET)
ADMIS/61213, ADMBU/61214: Mixing Studies
Special Instructions:
If collected at an offsite location, send by a STAT Courier to Hospital lab.
Lab/Phone:
330-543-8418
TAT:
24 hours to 3 days
Additional Info:
Testing begins with ADAMTS13 activity assay. If the ADAMTS13 activity is <30%, an inhibitor screen will be performed to look for specific ADAMTS13 inhibition. If specific inhibition is apparent, the titer of the inhibitor will be determined.
CPT Code:
85397 and (85335x2 if appropriate)
Panel Includes:
CPT code 85397 (activity assay)
CPT code 85335 (Inhibitor Screen assay, if appropriate)
CPT code 85335 (Bethesda titer, if appropriate)
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