Centromere Ab

- : 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. Centromere Ab
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

CENTR

Test Workstation :

CLEVE

Specimen Type:

Blood

Tube Type:

Gold top SST (serum separator tube, no anticoagulant)

Collection Volume:

2.5 mL (minimum 0.5 mL)

Cause for Rejection:

Hemolysis, hyperlipemia or microbial growth

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Indirect Immunofluorescence (IFA)

Special Instructions:

Useful in diagnosis of Crest Syndrome (Scleroderma)

Lab/Phone:

330-543-8418

TAT:

1-3 days

Additional Info:

Reference range: Negative

CPT Code:

86256

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Centromere Ab

- : Immunology

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