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Alpha-Galactosidase, Leukocytes

Centralized Core Laboratory : 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. Alpha-Galactosidase, Leukocytes
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

AGALL MAYO

Specimen Type:

Blood

Tube Type:

Yellow top (ACD) tube: Whole Blood

Collection Volume:

6.0 mL(minimum 5.0 mL)

Cause for Rejection:

Frozen specimen

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Fluorometric

Special Instructions:

Deliver specimen to laboratory promptly. For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly)

Lab/Phone:

330-543-8418

TAT:

8-15 days

Additional Info:

Reference range: Available on patient report

CPT Code:

82657

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