PNH, PI-Linked Antigen, Blood

Centralized Core Laboratory - Mayo Clinic Laboratories : 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. PNH, PI-Linked Antigen, Blood
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

PLINK

Test Workstation :

MAYO

Specimen Type:

Whole Blood

Tube Type:

Yellow Top (ACD)

Alternate Tube Type:

Lavender top (EDTA)

Collection Volume:

2.6 mL

Minimum Volume:

1.0 mL

Cause for Rejection:

Gross Hemolysis

Storage:

Ambient

Availability:

Sent to Reference Lab

Methodology:

Immunophenotyping

Lab/Phone:

330-543-8418

TAT:

1-2 days

CPT Code:

88184-Flow cytometry, RBC x 1 88184-Flow cytometry, WBC x 1 88185-Flow cytometry, additional marker (each), RBC x 1 88185-Flow cytometry, additional m

Panel Includes:

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

Synonyms:

CD55 CD59 FLAER GPILinked Antigen HamCrosby SugarWater 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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PNH, PI-Linked Antigen, Blood

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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