DHR Flow Cytometric Test, Blood

Centralized Core Laboratory : Hematology

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. DHR Flow Cytometric Test, Blood
2.
3.
4.
5.
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SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

DHR MAYO

Specimen Type:

Whole Blood

Tube Type:

Green top ( sodium heparin) tube

Collection Volume:

5.0 mL

Storage:

Ambient

Availability:

Mon-Thu specimen in lab by 1400

Methodology:

Flow Cytometry

Special Instructions:

Please send 5.0 mL whole blood specimen and a 5.0 mL whole blood sodium heparin control specimen from an unrelated, healthy donor.

Lab/Phone:

330-543-8377

TAT:

3 days

Additional Info:

It is recommended that specimens arrive within 24 hours of draw. Samples arriving on the weekend may be cancelled. Draw and package specimen as close to shipping time as possible. Ship specimen overnight in an Ambient Mailer- Critical Specimens Only (Supply T668). ---Draw MON-THU only. Do not aliquot. DRAW CONTROL TUBE. Sample must be in Akron Campus lab by 1400 same day to sendout.

CPT Code:

86352x2

Synonyms:

Chronic Granulomatous Disease, Neutrophil Oxidative Burst, Nitroblue Tetrazolium Assay, Chemiluminescence, Dihydrorhodamine, Neutrophil Function, Rac2 deficiency