BCR/ABL1, p210, Quant, Monitor

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. BCR/ABL1, p210, Quant, Monitor
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

BCRAB/MAYO

Specimen Type:

Whole Blood or Bone Marrow

Tube Type:

Purple Top (EDTA)

Collection Volume:

10 ml EDTA Whole Blood or 3 ml EDTA Bone Marrow

Cause for Rejection:

Grossly Hemolyzed

Storage:

Refrigerated

Availability:

Sent to reference laboratory

Methodology:

Quantitative, reverse transcription PCR (Cepheid Gene Expert)

Special Instructions:

Only collect specimens Monday through Thursday. Specimen must arrive at Mayo within 72 hours. Test performed at Mayo Monday through Friday only.

Lab/Phone:

330-543-8418

TAT:

3-6 days

CPT Code:

81206

Synonyms:

Acute lymphoblastic leukemia (ALL), Acute myeloid leukemia (AML), B lymphoblastic leukemia (B-ALL), T lymphoblastic leukemia (T-ALL), BCR-ABL1, BCR ABL, BCR/ABL, Chronic myelogenous leukemia (CML), Philadelphia chromosome, Ph bone marrow/blood t(9;22), Tyrosine kinase inhibitor (TKI) therapy monitoring, PCR