Centralized Core Laboratory - Mayo Clinic Laboratories :
Send Out
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 Antigen
2.
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5.
6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
PRCAG
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
Storage:
Frozen
Availability:
Sent to reference lab
Methodology:
Enzyme-Linked Immunosorbent Assay (ELISA)
Special Instructions:
Days Performed: Mon Fri
Centrifuge, remove plasma, centrifuge again.
Please send 1 mL frozen plasma.
If collected at an offsite location, send by a STAT Courier to Hospital lab
Lab/Phone:
330-543-8418
TAT:
3-7 days
Additional Info:
Reference Range:
Adults: 72-160%
Normal, full-term newborn infants or healthy premature infants may have decreased levels of protein C antigen (15%-50%), which may not reach adult levels until later in childhood or early adolescence
CPT Code:
85302
Protein C Antigen
Test ID/Workstation :
PRCAG
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
Storage:
Frozen
Availability:
Sent to reference lab
Methodology:
Enzyme-Linked Immunosorbent Assay (ELISA)
Special Instructions:
Days Performed: Mon Fri
Centrifuge, remove plasma, centrifuge again.
Please send 1 mL frozen plasma.
If collected at an offsite location, send by a STAT Courier to Hospital lab
Lab/Phone:
330-543-8418
TAT:
3-7 days
Additional Info:
Reference Range:
Adults: 72-160%
Normal, full-term newborn infants or healthy premature infants may have decreased levels of protein C antigen (15%-50%), which may not reach adult levels until later in childhood or early adolescence
CPT Code:
85302
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