PNH, PI-Linked Antigen, Blood

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. PNH, PI-Linked Antigen, Blood
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

PLINK/MAYO

Specimen Type:

Whole Blood

Tube Type:

Yellow Top (ACD)

Collection Volume:

2.6 mL

Cause for Rejection:

Gross Hemolysis

Storage:

Ambient

Availability:

Sent to Reference Lab

Methodology:

Immunophenotyping

Lab/Phone:

330-543-8377

TAT:

1-2 days

Panel Includes:

PNH RBC-Partial Ag Loss PNH RBC-Complete Ag Loss PNH Granulocytes PNH Monocystes Interpretation

Synonyms:

CD55 CD59 FLAER GPI-Linked Antigen Ham-Crosby Sugar-Water Test, Blood Hemolytic Anemia Paroxysmal Nocturnal Hemoglobinuria (PNH) PI Linked Antigen Sucrose Analysis Sucrose Fragility Sucrose Hemolysis Sugar Water PNH Screen Sugar Water Test, Ham Crosby, Blood

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