Osmotic Fragility, RBC

Centralized Core Laboratory : Hematology

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.
3.
4.
5.
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SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

OSFRE 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:

Hemolysis

Storage:

Refrigerated

Availability:

Sent to Reference Laboratory

Methodology:

Osmotic Lysis

Special Instructions:

Draw a control specimen at the same time from a normal, unrelated, non-smoking 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