AFP, Amniotic Fluid

Centralized Core Laboratory : Special Chemistry

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. AFP, Amniotic Fluid
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

MOMSO / MAYO

Specimen Type:

Amniotic fluid

Tube Type:

Fluid container

Collection Volume:

1.0 mL (minimum 0.5 mL)

Cause for Rejection:

Gestational age < 13 weeks or > 24 weeks

Storage:

Refrigerated

Availability:

Mon-Fri

Methodology:

AFP-Immunoenzymatic Assay; Acetylcholinesterase-Polyacrylamide Electrophoresis

Special Instructions:

Order Mayo Miscellaneous Sendout (Epic LAB3065) for AFP, Amniotic Fluid. See www.mayomedicallaboratories.com/test catalog for required form: "Second Trimester Maternal Screening Alpha-Fetoprotein (AFP)/QUAD Screen Patient Information". -- If alpha-fetoprotein (AFP) is positive, then acetylcholinesterase (AChE) will be performed at an additional charge.

TAT:

2-4 days

Additional Info:

Reference range: < or =2.0 multiples of median (MoM) ----- The following information is required: a. Date ultrasound performed b. Estimated due date by ultrasound c. Collection date d. Gestational age must be between 13 and 24 weeks; 16 to 18 weeks preferred

CPT Code:

82106 (AFP); 82013-Acetylcholinesterase (if appropriate)

Synonyms:

Alpha-Fetoprotein, Amniotic Fluid