Leukocyte Alkaline Phosphatase

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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. Leukocyte Alkaline Phosphatase
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3.
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SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Specimen Type:

Whole Blood

Tube Type:

Green top (sodium or lithium heparin) tube

Collection Volume:

5.0 mL (minimum 1.0 mL)

Cause for Rejection:

Blood and smears not protected from light, collected in EDTA

Storage:

Ambient

Availability:

Sent to Reference Laboratory

Methodology:

Cytochemical Stain

Special Instructions:

Please order ZMSO with comment LAP to ARUP. ARUP test code 0049000. Collect between 1000 and 1400 Monday through Thursday and send to the lab immediately. Blood and smears must be protected from light. Lab prepare 6 unfixed, well-prepared smears within 24 hours of collection.

Lab/Phone:

330-543-8418

TAT:

1-5 days

Additional Info:

Reference Range: Leukocyte Alkaline Phosphatase:

Female 33-149 (no units)

Male 22-124 (no units)

CPT Code:

85540

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Leukocyte Alkaline Phosphatase

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