Protein C Activity
| 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. Protein C Activity | |
| 2. | |
| 3. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
PRTC3
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Blue top (sodium citrate) tube
Collection Volume:
2.7 mL (minimum 1.8mL) - properly filled tube. Must use appropriate sodium citrate tube based on volume of blood drawn(1.8mL or 2.7mL)
Cause for Rejection:
Gross hemolysis, Gross lipemia, Grossly icteric
Storage:
Frozen
Availability:
Sent to reference lab
Methodology:
Chromogenic
Special Instructions:
Days Performed: Mon Fri
Please send 1 mL frozen citrated plasma.
If collected at an offsite location, send by a STAT Courier to Hospital lab
Lab/Phone:
330-543-8418
TAT:
1-3 days
Additional Info:
- Reference range:
- Adults: 70%-150%
- Normal, full-term newborn infants or healthy premature infants may have decreased levels of protein C activity (15%-50%), which may not reach adult levels until later in childhood or early adolescence.*
CPT Code:
85303
