IgG Synthesis and Index
| 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. IgG Synthesis and Index | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
SFIN
Test Workstation :
MAYO
Specimen Type:
Blood & CSF
Tube Type:
Serum-Red Top and CSF-Sterile Vial
Collection Volume:
5.0 mL (minimum 2.5 mL) serum and 1.0 mL CSF (minimum 0.5 mL)
Cause for Rejection:
Not labeling specimen with correct source such as serum or spinal fluid.
Grossly Lipemic Serum
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Nephelometry and Photometric
Special Instructions:
Serum and spinal fluid are required. Specimens must be obtained within 1 week of each other.
Serum must be poured off in two separate vials, each containing at least 0.5 mL.
Lab/Phone:
330-543-8418
TAT:
2-5 days Performed Monday through Friday
Additional Info:
Reference ranges are available on patient report
CPT Code:
82040,82042,82784
Panel Includes:
IgG Index, CSF
IgG, Serum
Albumin, Serum
IgG, CSF
Albumin, CSF
IgG/Albumin, Serum
IgG/Albumin, CSF
Synthesis Rate, CSF
Synonyms:
Cerebrospinal Fluid (CSF) IgG Index
CSF (Cerebrospinal Fluid) Specific Protein IgG (immunoglobulinG), Albumin
CSF Index
CSF, Specific Protein IgG, Albumin
IgG (Immunoglobulin G) Index
IgG (Immunoglobulin G) Spinal Fluid
IgG (Immunoglobulin G) Synthesis Rate
IgG Index
IgG Synthesis Rate
Synthesis Rate IgG
