LD, Isoenzymes

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. LD, Isoenzymes
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

LDISO CLEVE

Specimen Type:

Blood

Tube Type:

Gold top SST (serum separator tube, no anticoagulant)

Collection Volume:

2.5 mL (minimum 1.5 mL)

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

LD: Enzymatic, Isoenzymes: Electrophoresis

Special Instructions:

Days Performed: Sun-Sat Remove serum from cells ASAP

Lab/Phone:

330-543-8418

TAT:

2-3 days

Additional Info:

Reference Range: Lactate Dehydrogenase:

Age: 0-30 Days; Range: 200-465 U/L

Age: 1-17 Months; Range: 200-450 U/L

Age: 18-24 months; Range: 165-430 U/L

Age: 2-10 Years; Range: 165-430 U/L

Age: 11-16 Years; Range: 127-287 U/L

Age: 16-99 Years; Range: 105-230 U/L

LD1: Range: 14-27%

LD2: Range: 29-42%

LD3: range: 16-22%

LD4: Range:8-15%

LD5: Range: 6-23%

CPT Code:

83615, 83625

Panel Includes:

Lactate Dehydrogenase, LD1, LD2, LD3, LD4, LD5

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LD, Isoenzymes

Centralized Core Laboratory : Chemistry

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