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Akron Children's > For Healthcare Professionals > Lab Tests : Akron | Mahoning Valley

Factor XI Activity Assay

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 XI Activity Assay  
2.  
3.  
4.  
5.  
6.  

SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
F11A
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Lt. Blue top (sodium citrate) tube
Collection Volume:
2.7 mL (minimum 1.8mL) - properly filled tube. Must use appropriate sodium citrate tube based on volume of blood drawn(1.8mL or 2.7mL)
Cause for Rejection:
Grossly hemolyzed, grossly lipemic, grossly icteric. Patient must not be receiving Coumadin or heparin therapy.
Storage:
Spin and freeze immediately. Frozen plasma.
Availability:
Sent to reference lab
Methodology:
Optical Clot-Based
Special Instructions:
Draw one lt. blue top tube per test. For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).
Lab/Phone:
330-543-8418
TAT:
1-3 days
Additional Info:
Reference range available on patient report
CPT Code:
85270
Synonyms:
Coagulation Factor XI Activity Assay, Plasma, Factor XI Activity Assay

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