Carbohydrate Deficient Transferrin

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. Carbohydrate Deficient Transferrin
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

CARDT / MAYO

Specimen Type:

blood

Tube Type:

Red Top

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- Follow-up 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