Phenylalanine and Tyrosine Blood Spot

Laboratory : Metabolic Lab

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. Phenylalanine and Tyrosine Blood Spot
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SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

PTBS/SHIMZ

Specimen Type:

Blood

Tube Type:

Blood Spot Card only

Collection Volume:

Filter paper must be saturated

Cause for Rejection:

Blood Spot card where filter paper is not saturated with blood. DO NOT USE STATE SCREEN CARD

Storage:

Ambient

Methodology:

Liquid Chromatorgraphy-Tandem Mass Spectrometry (LC-MSMS)

Special Instructions:

Please have patient fast a minimum of 4 hours prior to collection. do not allow capillary tube or patient heel to touch the collection card. Allow sample to air dry for 3 hours before sending to laboratory. Filter paper on Blood Spot card must be saturated with blood.

Lab/Phone:

330-543-0223

TAT:

3 days

Additional Info:

Reference range: Phenylalanine 69-182 uMol/L; Tyrosine <30 days: 42-49 uMol/L; > or = 1 month to 16 years: 29-86 uMol/L; > or = 16 years: 21-87 uMol/L

CPT Code:

84030, 84510