Disaccharidase Analysis

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. Disaccharidase Analysis
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

DISAC MAYO

Specimen Type:

Tissue

Tube Type:

Clean screw top plastic vial

Collection Volume:

5 mg tissue

Storage:

Frozen

Methodology:

Spectrophotometry

Special Instructions:

Freeze immediately after collection and ship frozen.

Note:Specimen should not be placed on gauze, filter paper, nor should any saline, support or embedding material be added.

Lab/Phone:

330-543-8418

TAT:

3-11 days

Additional Info:

Reference range: Lactase:Range 24.5 +/- 8.0

Abnormal <15

Units = uM/min/gram protein

Sucrase: Range 54.4 +/- 25.4

Abnormal <25.0

Units = uM/min/gram protein

Maltase: Range 160.8 +/- 62.8

Abnormal <100.0

Units = uM/min/gram protein

Palatinase: Range 11.1 +/- 6.5

Abnormal <5.0

Units = uM/min/gram protein

CPT Code:

82657X4

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Disaccharidase Analysis

Centralized Core Laboratory : Chemistry

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