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Plasminogen Activator Inhibitor

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. Plasminogen Activator Inhibitor
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

PAI-1 MAYO

Specimen Type:

Blood

Tube Type:

Blue top (sodium citrate) tube

Collection Volume:

2.5 mL (minimum 1.0 mL)

Cause for Rejection:

-

Storage:

Frozen

Availability:

Sent to reference lab

Methodology:

Enzyme-Linked Immunosorbent Assay (ELISA)

Special Instructions:

3.2% sodium citrate is the preferred anticoagulant. 1. Spin down, remove plasma and spin plasma again Freeze specimen immediately at < or = -40C, if possible Note: Double centrifuged specimen is critical for accurate results as platelet contamination may cause spurious results. If collected at an offsite location, send by a STAT Courier to Hospital lab

Lab/Phone:

330-543-8418

TAT:

7-12 days

Additional Info:

Reference range: 3-72 ng/mL

CPT Code:

83520

Synonyms:

-

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