Osmotic Fragility, RBC
| 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. Osmotic Fragility, RBC | |
| 2. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
OSFRE
Test Workstation :
MAYO
Specimen Type:
Whole blood
Tube Type:
Purple top (EDTA)
Collection Volume:
Patient: 4.0 mL (minimum 2.0 mL)
Normal control: 4.0 mL (minimum 2.0 mL)
Cause for Rejection:
Gross Hemolysis or Clotted
Storage:
Refrigerated
Availability:
Sent to Reference Laboratory
Methodology:
Osmotic Lysis
Special Instructions:
Draw a control specimen at the same time from a normal, unrelated, nonsmoking individual. Clearly write "normal control" on label.
Specimens must arrive within 72 hours of draw.
Patient Collection Instructions: Immediately refrigerate specimen after draw. Refrigerate at 0 to 4 degrees C. Do not freeze. Freezing causes sample lysis, and tests will not be performed on hemolyzed specimens.
Send specimen in original tube. Do not aliquot. Rubber band patient specimen and control vial together. Control must accompany the patient sample at all times to ensure the reliability of testing results. Be sure specimen and control are stored and transported together at refrigerate temperature, carefully following proper handling and shipping instructions. Additional Information: Patient's age and sex are required.
Control Collection Instructions:
Draw a control specimen from a normal (healthy), unrelated, nonsmoking person at the same time as the patient. Label clearly on outermost label normal control. Immediately refrigerate specimen after draw. Refrigerate at 0 to 4 degrees C. Do not freeze. Freezing causes sample lysis, and tests will not be performed on hemolyzed specimens.
For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).
Lab/Phone:
330-543-8418
TAT:
2-5 days
Additional Info:
See patient report for Reference Values
CPT Code:
85557
