White Blood Cell Count

Centralized Core Laboratory : Hematology

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. White Blood Cell Count
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

WBC AHEM1

Specimen Type:

Blood

Tube Type:

Purple top (EDTA) tube: Whole Blood

Collection Volume:

2.0 mL (minimum 0.3 mL)

Cause for Rejection:

Specimen hemolyzed, clotted, diluted with IV fluid, or collected in heparin, specimen at room temperature >8hours or refrigerated specimens >24 hours.

Storage:

Refrigerated

Availability:

Daily, 24 hours; STAT

Methodology:

Impedance measurement with Optical Flow light scatter and fluorescent measurements and microscopic evaluation of a Wright's stained blood film

Special Instructions:

Indicate clearly if a specimen has been drawn from an arterial line or from a line that has been rinsed with heparin.

Lab/Phone:

330-543-8416

TAT:

8 hours

Additional Info:

Reference range is available on patient report

CPT Code:

85048

Synonyms:

White Count; Total WBC; Leukocyte Count

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White Blood Cell Count

Centralized Core Laboratory : Hematology

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