Epinephrine Platelet Aggregation

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. Epinephrine Platelet Aggregation
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

EPNPH SPCOG

Specimen Type:

Blood

Tube Type:

Lt Blue top (sodium citrate) tube

Collection Volume:

10.0 mL (minimum 5.0 mL)

Cause for Rejection:

Specimen hemolyzed, clotted, or grossly lipemic; specimen from patients who have taken drugs that inhibit platelet function, Plt <50,000

Storage:

Ambient

Availability:

Must be scheduled in advance

Methodology:

Biodata Platelet Aggregation Profile Model PAP-4/Platelet Rich Plasma

Special Instructions:

Call Centralized Core Lab (330-543-8416) in advance to schedule test. Testing is drawn at Akron campus only. Special handling is required. Specimen must arrive in laboratory by 1000. Special handling is required. Patient fasting 10 hours prior to collection. Refrain from smoking and caffeine day of test.

Lab/Phone:

330-543-8416

TAT:

72 hours

Additional Info:

Reference range: Normal Study

CPT Code:

85576

Synonyms:

Aggregometer Test; Platelet Function Studies

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Laboratory Services

Epinephrine Platelet Aggregation

Centralized Core Laboratory : Hematology

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