Centralized Core Laboratory - Mayo Clinic Laboratories :
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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 :
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
Carbohydrate Deficient Transferrin
Test ID/Workstation :
CARDT
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 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
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