Cold Agglutinin Titer
| PATIENT INFO |
| Patient Name: |
| Medical Record #: |
| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
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| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
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| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Cold Agglutinin Titer | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
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Test ID :
COLDA
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
10.0 mL
Minimum Volume:
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
