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.

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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Epinephrine Platelet Aggregation

Centralized Core Laboratory : Hematology

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