Phenylalanine and Tyrosine Plasma

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 Plasma
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

PTP/SHIMZ

Specimen Type:

Blood

Tube Type:

Green top tube- Lithium heparin is preferred. Sodium heparin is acceptable. NO GEL Tubes

Collection Volume:

1.0 mL (minimum 0.4 mL)

Storage:

Frozen

Methodology:

Liquid Chromatorgraphy-Tandem Mass Spectrometry (LC-MSMS)

Special Instructions:

Please have patient fast a minimum of 4 hours prior to collection. Specimens must be centrifuged and separated within 2 hours of collection. Collect Sunday - Thursday Only

Lab/Phone:

330-543-0223

TAT:

3-5 days

Additional Info:

Reference range: Phenylalanine Premature: 98-213 uMol/L; 0 to 31 days: 38-137 uMol/L; 1 to 24 months: 31-75 uMol/L; 2-18 years: 26-91 uMol/L; > or = 19 years: 35-85 uMol/L; Tyrosine Premature: 147-420 uMol/L; 0 to 31 days:55-147 uMol/L; 1 to 24 months: 22-108 uMol/L; 2-18 years: 24-115 uMol/L; > or = 19 years: 34-112 uMol/L

CPT Code:

84030, 84510