Prothrombin Time
| 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. Prothrombin Time | |
| 2. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
PT
Test Workstation :
ACOAG
Specimen Type:
Blood
Tube Type:
Blue top (sodium citrate) tube
Collection Volume:
2.7 mL (minimum 1.8 mL)
Must use appropriate sodium citrate tube based on volume of blood drawn (1.8 mL or 2.7 mL tube)
Cause for Rejection:
Sample hemolyzed, clotted, diluted with IV fluid; contaminated with heparin; improperly filled; received >4 hours after drawn
Storage:
Ambient
Availability:
Daily, 24 hours; STAT
Methodology:
Photometric/turbidometric
Special Instructions:
Indicate clearly if a specimen has been drawn from an arterial line or from a line that has been rinsed with heparin. This information is absolutely essential to the CCL personnel for the proper handling of the specimen and the reporting of results. Please indicate if the patient is currently receiving anticoagulant therapy. If collected at an offsite location, send Whole Blood by a STAT Courier to Akron Children's lab. Must be received within 4 hours
Lab/Phone:
330-543-8416
TAT:
4 hours
Additional Info:
Reference range: 8.5-14.0 secs; INR: 0.7-1.3
Recommended Therapeutic Range for Oral Anticoagulant Therapy: Prophylaxis of venous thrombosis, Treatment of venous thrombosis, Treatment of pulmonary embolism, Prevention of systemic embolism, and Tissue heart valves - INR 2.0-3.0, Myocardial infarction (to prevent systemic embolism), Valvular heart disease, Atrial fibrillation, Mechanical prosthetic valves - INR 2.0-3.0
CPT Code:
85610
Synonyms:
PROTIME; PT; Protime with INR, PT/INR
