Lymphocyte Proliferation, Mitogens

Centralized Core Laboratory - : 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. Lymphocyte Proliferation, Mitogens
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

LYMIT

Test Workstation :

CINCI

Specimen Type:

Whole Blood

Tube Type:

Green top (Sodium Heparin) tube

Collection Volume:

Call Laboratory Sendouts ext. 34853 for collection volume.

Cause for Rejection:

Specimen rejected: Frozen, clotted, hemolyzed or centrifuged specimens. Specimens collected in anticoagulants other than Sodium Heparin.

Storage:

Ambient

Availability:

Sent to Reference Laboratory

Methodology:

Tritiated thymidine incorporation

Special Instructions:

Call Laboratory Sendouts ext. 34853 between 8:0015:00 for collection volume. Draw Monday Thursday between 10:0013:00. Send specimen in original tube. Do not aliquot. For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).

Lab/Phone:

330-543-4853

TAT:

7 days

CPT Code:

86353 X 3

Synonyms:

Mitogen Stimulation, Mitogen Proliferation, PHA, Con A, ConA, PWM

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Lymphocyte Proliferation, Mitogens

Centralized Core Laboratory - : Send Out

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