Diphtheria Toxoid IgG Ab
| 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. Diphtheria Toxoid IgG Ab | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
DIPTX
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red top ( no anticoagulant)
Collection Volume:
1.5 mL (minimum 1.0 mL)
Cause for Rejection:
Gross hemolysis, Gross lipemia, Gross icterus, Heat inactivated specimen
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Enzyme-Linked Immunosorbent Assay (ELISA)
Lab/Phone:
330-543-8418
TAT:
1-4 days
Additional Info:
The minimum level of protective antibody in the normal population is between 0.01 and 0.1 IU/mL. The majority of vaccinated individuals should demonstrate protective levels of antibody >0.01 IU/mL. A diphtheria toxoid booster should be considered for patients with antidiphtheria toxoid IgG values between 0.01 and less than 0.1 IU/mL.
CPT Code:
86317
