Centralized Core Laboratory - Mayo Clinic Laboratories :
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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
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SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
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
Cold Agglutinin Titer
Test ID/Workstation :
COLDA
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
10.0 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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