Circulating Anticoagulant Inhibitor

Centralized Core Laboratory - Cleveland Clinic Laboratories : Send Out

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. Circulating Anticoagulant Inhibitor
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

CAI

Test Workstation :

CLEVE

Specimen Type:

Blood

Tube Type:

Blue top (sodium citrate) tube

Collection Volume:

2.8 mL

Minimum Volume:

1.8 mL

Storage:

Strict Frozen

Availability:

Sent to reference lab

Methodology:

Clotting Assay

Special Instructions:

Discontinue coumadin therapy for 14 days and heparin therapy for 2 days prior to collection. If collected at an offsite location, send by a STAT Courier to Hospital lab

OC Power Word:

Indicate Factor VIII or IX

Lab/Phone:

330-543-8418

TAT:

1-3 days

Additional Info:

Reference range: < or = 0.4 Inhib Unit

CPT Code:

85335

Synonyms:

Bethesda Inhibitor

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Circulating Anticoagulant Inhibitor

Centralized Core Laboratory - Cleveland Clinic Laboratories : Send Out

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