Pyruvate Kinase
| 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. Pyruvate Kinase | |
| 2. | |
| 3. | |
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| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
PYKIN
Test Workstation :
MAYO
Specimen Type:
Whole Blood
Tube Type:
Yellow top (ACD-B) tube: Whole Blood
Alternate Tube Type:
Lavender top (EDTA)
Collection Volume:
6.0 mL (minimum 1.0 mL)
Cause for Rejection:
Gross hemolysis
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Kinetic Spectrophotometry (KS)
Special Instructions:
Do not freeze. Do not transfer blood to other containers.
Lab/Phone:
330-543-8418
TAT:
1-4 days
Additional Info:
Reference range: > or =12 months of age: 5.5-12.4 U/g Hb
Reference values have not been established for patients who are less than12 months of age.
CPT Code:
84220
