Carbohydrate Deficient Transferrin
| 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. Carbohydrate Deficient Transferrin | |
| 2. | |
| 3. | |
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| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
CARDT
Test Workstation :
MAYO
Specimen Type:
blood
Tube Type:
Red Top
Alternate Tube Type:
SST
Collection Volume:
0.5 mL
Storage:
Frozen
Availability:
Sent to Reference Laboratory
Methodology:
Affinity Chromatography-Mass Spectrometry (MS)
Special Instructions:
Required Question when ordering:
Reason for Referral:
1 Developmentally delayed
2 Congenital disorders of glycosylation
3 Followup of known patient with CDG
TAT:
5-10 days
Additional Info:
This test is for congenital disorders of glycosylation.
NOTE: Test requires informed consent for Genetic Testing.
CPT Code:
82373
Panel Includes:
Mono-oligosaccharide/di-oligosaccharide transferrin ratio
a-oligosaccharide /di-oligosaccharide transferrin ratio
tri-sialo/di-oligosaccharide transferrin ratio
apolipoprotein CIII-1/apolipoproteinCIII-1/apolipoprotein CIII-2 ratio
apolipoprotein CIII-0/apolipoprotein CIII-2 ratio
