Chromosome Analysis, Bone Marrow, Neoplastic Disorder
| 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. Chromosome Analysis, Bone Marrow, Neoplastic Disorder | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
KBMZ
Test Workstation :
KARYO
Specimen Type:
3 mL whole bone marrow collected in sodium heparin (green top) tube.
Minimum Volume:
Specimen minimum volume is 1 mL.
Cause for Rejection:
Clotted, nonsterile, or frozen specimen.
Storage:
Transport blood at room temperature. Upon arrival in laboratory, store at room temperature for no more than 24 hours. If specimen is to be stored longer than 24 hours, it should be refrigerated for up to 7 days.
Availability:
Mon-Fri (0700-1600) Sat (0900-1300)
Methodology:
Cell culture, harvest and chromosome analysis with G-banding.
Special Instructions:
Include pertinent medical findings on the requisition with suspected diagnosis and/or indication(s) for the testing. Include copy of Pathology report.
Lab/Phone:
330-543-8483
TAT:
7-21 days, patient with age less than or equal to 7 days and/or in NICU will be expedited.
CPT Code:
88237, 88262, 88280, 88291
Synonyms:
Karyotype, Bone Marrow Karyotype, Bone Marrow Cytogenetics, Chromosome Analysis
