Platelet Antibody

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. Platelet Antibody
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

PLTAB NORC

Specimen Type:

Blood

Tube Type:

7.0 mL Red top (no anticoagulant)tube and 7.0 mL Purple top (EDTA)tube

Collection Volume:

7.0 mL EDTA & 7.0 mL Red top (Do not centrifuge)

Cause for Rejection:

SST (serum separator) tubes will be rejected.

Storage:

Ambient

Availability:

Sent to reference lab

Methodology:

Platelet Antibody Screen, Platelet Associated IgG, HPA-1a (PLA1) Typing

Special Instructions:

Must have collector (employee # and date & time) written on specimen tubes. Red Cross paperwork must be completed. Notify Red Cross. For specimens collected at Mahoning Valley: Must have collector (employee # and date & time) written on specimen tubes. Red Cross paperwork must be completed and can be obtained from Akron Campus hematology department. Store at room temperature for same day delivery; refrigerate if sent the next day.

Lab/Phone:

330-543-8418

TAT:

5 days

Additional Info:

Reference range is available on patient report

CPT Code:

86022