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Cold Agglutinin Titer

Centralized Core Laboratory : Chemistry

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. Cold Agglutinin Titer
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

COLDA MAYO

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

10.0 mL (minimum 2.5 mL)

Cause for Rejection:

Refrigerated prior to separation of serum from red cells.

Storage:

Refrigerated

Availability:

Sent to Reference Laboratory

Methodology:

Titration-Red Cell Agglutination at 4 degrees C

Special Instructions:

Do not refrigerate prior to separation of serum from red cells. Use a warm pack to keep specimen at 37 degrees C prior to and after collecting. Allow specimens to clot at 37 degrees C. Lab - Centrifuge at 37 degrees C and separate serum from red cells immediately after blood clots, or within one hour of collection.

TAT:

1 day

Additional Info:

If screen is positive, titer results will be reported.

CPT Code:

86157

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