Porphobilinogen, Quantitative Urine

Centralized Core Laboratory : Chemistry

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. Porphobilinogen, Quantitative Urine
2.
3.
4.
5.
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SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

PBGQT CLEVE

Specimen Type:

Urine

Tube Type:

Urine container

Collection Volume:

24 hour urine or 8 mL (min. 3.5 mL) random collection

Cause for Rejection:

Storage:

Frozen

Availability:

Sent to reference lab. Days Performed: Mon-Fri

Methodology:

Ion Exchange Chromatography/Spectrometry (IECS)

Special Instructions:

8.0 mL urine (minimum 3.5 mL) aliquot from well-mixed 24 hour or random urine in a clean container without preservative. Instruct patient on 24 hour urine collection. To begin the urine collection, have the patient void. DISCARD THIS URINE SPECIMEN. This is best done with the first morning specimen. Note the time and record on the requisition. From then on collect all the urine that is voided and place in container. If more than one container is needed, please mark the first as #1 of 2 and retain on the floor until the collection is complete. The final void should be made 24 hours after the first void described earlier. The specimen should be included with the collection. Refrigerate during collection. Protect from light.

Lab/Phone:

330-543-8418

TAT:

2-5 days

Additional Info:

Reference Range: Creatinine Reference range is available on patient report. --- Reference Range: Porphobilinogen: 24 hour collection 0.0-11.0 umol/d; Random collection 0.0-8.8 umol/L

CPT Code:

84110

Synonyms: