Porphobilinogen, Quantitative Urine
| 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. | |
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| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
PBGQT
Test Workstation :
CLEVE
Specimen Type:
Urine
Tube Type:
Urine container
Collection Volume:
24 hour urine or 8 mL random urine
Minimum Volume:
3.5 mL random collection
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 wellmixed 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.
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Reference Range:
Porphobilinogen: 24 hour collection 0.0-11.0 umol/d;
Random collection 0.0-8.8 umol/L
CPT Code:
84110
