Activated Clotting Time

Centralized Core Laboratory - : Hematology

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. Activated Clotting Time
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

ACT

Test Workstation :

MNCOG

Specimen Type:

Fresh Whole Peripheral Blood - Venous or arterial collection

Tube Type:

None

Collection Volume:

0.05 mL whole blood

Cause for Rejection:

Specimens diluted with IV fluid or contaminated with heparin, specimens contaminated with tissue thromboplastin, specimens collected using anticoagulants such as EDTA, citrate, oxalate, or heparin, specimens contaminated with alcohol cleansing solution or with visible clots or debris accumulation, will be rejected.

Storage:

none

Availability:

Daily, 24 hours

Methodology:

Electronic Optical Detection Clotting Assay, cartridge-based

Special Instructions:

Testing is done on unanticoagulated blood at the bedside. Specimen can only be drawn at the Akron campus Whole blood specimen only.

Lab/Phone:

330-543-8416

TAT:

30 minutes

Additional Info:

Reference range: 110-182 secs.

CPT Code:

85347

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Activated Clotting Time

Centralized Core Laboratory - : Hematology

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