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Anti-Glomerular Basement Membrane IgG

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. Anti-Glomerular Basement Membrane IgG
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

GBMG MAYO

Specimen Type:

Blood

Tube Type:

Gold top (serum separator tube) tube

Collection Volume:

1.5 mL (minimum 1.0 mL)

Cause for Rejection:

Storage:

Refrigerated

Availability:

Sent to Reference Laboratory

Methodology:

Multiplex Flow Immunoassay

Special Instructions:

Detects the presence of circulating glomerular basement membrane-specific antibodies in Goodpasture's Syndrome.

Lab/Phone:

330-543-8418

TAT:

1-3 days

Additional Info:

Reference range:

<1.0 U (negative)

> or = 1.0 U (positive)

CPT Code:

83520

Synonyms:

Anti-GBM Glomerular Basement Membrane Ab

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