Infliximab QN with Reflex to Ab

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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. Infliximab QN with Reflex to Ab
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

INFXR

Test Workstation :

MAYO

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant)tube

Collection Volume:

2.5 mL (minimum 1.5 mL)

Cause for Rejection:

Grossly hemolyzed, grossly icteric or collected in Plasma, whole blood, SST tubes.

Storage:

Frozen

Availability:

Sent to Reference Laboratory

Methodology:

INFX: Selective Reaction Monitoring LC-MS/MS INXAB: Electrochemiluminescent Bridging Immunoassay with Acid Dissociation

Special Instructions:

Draw blood immediately before next scheduled dose (trough specimen). For 12 hours before specimen collection do not take multivitamins or dietary supplements containing biotin (vitamin B7), which is commonly found in hair, skin, and nail supplements and multivitamins.

Lab/Phone:

330-543-8418

TAT:

3-6 days

Additional Info:

Reference range available on patient report.

CPT Code:

80230 82397- if appropriate

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Infliximab QN with Reflex to Ab

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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