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Cardiolipin ABS

Infectious Disease Laboratories : Immunology

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. Cardiolipin ABS
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

CARDI MAYO

Specimen Type:

Serum

Tube Type:

Gold top SST (Serum Separator) tube

Collection Volume:

1.5 mL(minimum 1.0 mL)

Storage:

Refrigerated

Availability:

Sent to Reference Laboratory

Methodology:

Enzyme Linked Immunosorbent Assay (ELISA)

Lab/Phone:

330-543-8418

TAT:

1-2 days

Additional Info:

Reference range:

IgG Cardiolipin Ab:

Negative: <10

Borderline: 10.0-14.9

Weakly Positive: 15.0-39.9

Positive: 40.0-79.9

Strongly Positive: > or = 80.0

CPT Code:

86147 (X2)

Panel Includes:

IgG Cardiolipin Ab IgM Cardiolipin Ab

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