FK506

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. FK506
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

FK5CC

Test Workstation :

E8011

Specimen Type:

Blood

Tube Type:

Purple top (EDTA) tube: Whole Blood, Store samples protected from light.

Collection Volume:

2.0 mL (minimum half the tube)

Minimum Volume:

1 mL 2 EDTA Microtainer tubes (If only 1 microtainer is collected repeat analysis will be unable to be performed.)

Preferred Volume:

2 mL

Cause for Rejection:

Centrifuged, clotted.

Storage:

Shipping- Send Refrigerated; Storage- Room Temp: 5 days; Refrigerated: 7 days; Frozen: 30 days

Availability:

7 days/week Dayshift

Methodology:

Roche-ECLIA sandwich principle

Special Instructions:

Specimens in lab by 12:00. Results by 16:00. Available STAT with the approval of the Medical Director. Patients should be on a specified dose of Tacrolimus for at least 48 hours prior to sample collection. Trough levels should be collected just prior to the next dose.

Lab/Phone:

330-543-8418

TAT:

4 hours

Additional Info:

Reference range:

5.0-20.0 ng/mL

Critical: >25.0 ng/mL

CPT Code:

80197

Synonyms:

Tacrolimus

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FK506

Centralized Core Laboratory - : Chemistry

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