Factor VIII Assay

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. Factor VIII Assay
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

FVIII

Test Workstation :

ACOAG

Specimen Type:

Blood

Tube Type:

Blue top (sodium citrate) tube

Collection Volume:

2.7 mL (minimum 1.8 mL) Must use appropriate sodium citrate tube based on volume of blood drawn (1.8 mL or 2.7 mL tube)

Cause for Rejection:

Samples hemolyzed, clotted, diluted with IV fluid; contam with heparin; improperly filled; received > 4 hours after drawn

Storage:

Ambient- Whole Blood

Availability:

Daily (0700-1500)

Methodology:

Photometric/Turbidometric

Special Instructions:

Indicate the time replacement therapy was administered, amount & type of therapy given, whether the specimen was drawn pretreatment or posttreatment and the time drawn. Indicate if a specimen has been drawn from an arterial line or from a line that has been rinsed with heparin. If collected at an offsite location, send Whole blood by a STAT Courier to Akron Childrens Lab. Must be received within 4 hours

Lab/Phone:

330-543-8416

TAT:

4 hours

Additional Info:

Reference range: 50-170%

CPT Code:

85240

Synonyms:

Antihemophiliac Factor (AHF)

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Factor VIII Assay

Centralized Core Laboratory - : Hematology

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