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; St. Joseph Mercy Oakland Laboratory REMARKABLE MEDICINE. REMARKABLE CARE. Specimen Collection Manual 08/14 SJMO LABORATORY GENERAL INFORMATION This manual was reviewed and approved by: Sherwin Imlay M.D. Sherwin P. Imlay, M.D. Laboratory Director RETURN TO TEST DIRECTORY RETURN TO HOME PAGE 07/14 SJMO LABORATORY GENERAL INFORMATION TABLE OF CONTENTS Click on the links below to access each section of the manual. Introduction Laboratory Locations Telephone Numbers Inpatient And Outpatient Orders Laboratory Requisitions/Orders Labeling Specimens Patient Identifiers Specimen Rejection Courier Services Test Supply Orders Charting Critical Values STAT Testing Venipuncture and Blood Collection Order Of Draw Visual Aids For Specimen Collection Microbiology Collection Instructions Visual Aids For Microbiology Collection Patient Instructions Laboratory Test Directory RETURN TO TEST DIRECTORY RETURN TO HOME PAGE 07/14 SJMO LABORATORY GENERAL INFORMATION ABOUT OUR LABORATORY: The laboratory of SJMO is accredited by the College of American Pathologists. Staff includes pathologists licensed in both clinical and anatomic pathology, specialists in Blood Bank Hematology, Chemistry and Microbiology, ASCP-registered medical technologists and technicians, certified phlebotomists and other support personnel. The SJMO Laboratory has a comprehensive test directory and participates in an extensive quality management program. LABORATORY LOCATIONS There are several convenient laboratory locations, with flexible hours to meet our patient’s needs. Hours vary by location. Medical Office Building Laboratory 44555 Woodward Avenue, Suite 040 Pontiac, MI 48341 Phone: (248) 858-3258 Fax: (248) - 858 - 3688 Hours: Monday through Friday, 8:30 a.m. to 5 p.m. Outpatient Laboratory (Inside St. Joseph Mercy Oakland) 44405 Woodward Avenue. First Floor Pontiac, MI 48341 Phone: (248) 858-3250 Fax: (248)858-6262 Hours: Monday through Friday, 7 a.m. to 5 p.m., Saturday 7:30 a.m. to 11:30 a.m. Bloomfield Satellite Laboratory 42557 Woodward Ave., Suite 220 Bloomfield Hills, MI 48304 Phone: (248) 335-7834 Fax: (248)-335-7874 Hours: Monday through Friday, 7:45 a.m. to 5:30 p.m. Union Lake Satellite Laboratory 2630 Union Lake Road, Suite 200 Commerce Township, MI 48382 Phone: (248) 366-0612 Fax: (248) 360 - 5226 Hours: Monday through Friday, 8 a.m. to 4:30 p.m. (Closed 12:15 to 1:15 p.m.) RETURN TO TEST DIRECTORY RETURN TO HOME PAGE 07/14 SJMO LABORATORY GENERAL INFORMATION Clarkston Satellite Laboratory 7210 Ortonville Road, Suite 100 Clarkston, MI 48346 Phone: (248) 620-2940 Fax: 248 - 620 – 0468 Hours: Monday through Friday, 7:30 a.m. to 6 p.m. Saturdays 8 a.m. to 1p.m. Lake Orion Satellite Laboratory 1375 S. Lapeer Road, Suite 210 (Located within Mercy Medical Group) Lake Orion, MI 48360 Phone: (248) 814-7310 Fax: 248-814-9978 Hours: Monday through Friday, 8:30 a.m. to 5 p.m. (Closed 1 to 2 p.m.) Waterford Satellite Laboratory 5800 Highland Road Waterford, MI 48327 Phone: (248) 673-7583 Fax: (248) 674-1453 Hours: Monday through Friday 8:30 a.m. to 5 p.m. (Closed 12:15 to 1:15 p.m.) Lexus Satellite Lab 44200 Woodward Ave., Suite 105 Pontiac, MI 48341 Phone: (248) 334-7195 Fax: (248) 332-3747 Hours: Monday through Friday, 8:30 a.m. to 5 p.m. (Closed 1 to 2 p.m.) White Lake Urgent Care 320 Town Center Boulevard (in the Village Lakes Plaza) White Lake, MI 48386 Phone: (248) 758-7800 Fax: (248)698-4281 Hours: Monday through Friday 8 a.m. to 9 p.m. Sat and Sun 8 a.m. to 8 p.m. Lake Orion Urgent Care 1375 S Lapeer Rd, Suite 106 Lake Orion, MI 48360 Phone: (248)693-9040 Fax: (248)693-9007 Hours: Monday through Friday 8 a.m. to 9 p.m. Sat and Sun 8 a.m. to 8 p.m. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE 07/14 SJMO LABORATORY GENERAL INFORMATION Waterford Urgent Care 5210 Highland Rd, Suite 100 Waterford, MI 48327 Phone: (248)673-2474 Fax: (248)618-0355 Hours: Monday through Friday 8 a.m. to 9 p.m. Sat and Sun 8 a.m. to 8 p.m. LABORATORY TELEPHONE NUMBERS AND KEY PERSONNEL PATHOLOGY DEPARTMENT 248-858-3190 Medical Director, Clinical Laboratory Medical Director, Anatomic Pathology Medical Director, Blood Bank Medical Director, Chemistry Medical Director, Hematology Medical Director, Microbiology Dr. Sherwin Imlay Dr. James Furlong Dr. Sherwin Imlay Dr. Brian Edelman Dr. Donald Peven Dr. John Fischer MAIN LABORATORY TELEPHONE MAIN LABORATORY FAX 248-858-3600 248-858-6675 Laboratory Information Systems Laboratory Quality Manager 248-858-3196 248-858-3449 Director of Laboratory Services Client Service Representatives Anatomic Pathology/Cytology Anatomic Pathology/Cytology Supervisor Blood Bank Blood Bank Supervisor Chemistry Chemistry and Hematology Supervisor Coagulation and Urinalysis Mercy Lab and Phlebotomy Supervisors Microbiology Microbiology Supervisor PM Shift Supervisor RETURN TO TEST DIRECTORY 248-858-6179 248-858-6295 248-858-3198 LABORATORY DEPARTMENTS 248-858-6883 248-858-6231 248-858-3272 248-858-6062 248-857-6706 248-858-6980 248-858-6728 248-858-6295 248-858-6256 248-858-6187 248-858-3296 RETURN TO HOME PAGE 07/14 SJMO LABORATORY GENERAL INFORMATION ORDERING LABORATORY TESTS INPATIENT ORDERS Inpatient orders are placed electronically though the hospital information system. OUTPATIENT ORDERS Outpatient orders may be placed electronically or may be marked on a laboratory requisition form. Each request form should include the following: Patient’s name (first and last) Date and time of collection Date of birth Sex Diagnosis code Patient’s address and phone number Source of specimen ( if pathology & microbiology requisition) Date of last menses, pregnancy status, surgical history, previous abnormal paps or biopsies ( if cytology requisition) Requesting physicians(s) phone number(s) Billing information Tests requested Physician /provider signature The following request forms for outreach testing are available: General Laboratory Requisition Form (see Figure 1) Cytopathology / Histology Requisition Form (see Figure 2) RETURN TO TEST DIRECTORY RETURN TO HOME PAGE 07/14 SJMO LABORATORY GENERAL INFORMATION Figure1: Sample General Laboratory Requisition Form RETURN TO TEST DIRECTORY RETURN TO HOME PAGE 07/14 SJMO LABORATORY GENERAL INFORMATION Figure 2: Sample Histology/Cytology Test Requisition Form RETURN TO TEST DIRECTORY RETURN TO HOME PAGE 07/14 SJMO LABORATORY GENERAL INFORMATION LABELING OF SPECIMENS To ensure the proper specimen identification it is essential that each tube or container be legibly labeled with the following information: Patient’s first and last name Patient’s Date of birth Date and time of collection Initials of person collecting specimens Site and type of specimen (For Microbiology specimens, tissue biopsies, excisions, and cytology) Cytology slide specimens require that the site and source be noted on the slide(s) in pencil. INPATIENT SPECIMEN LABELING JOB AID Specimens must be labeled at the bedside immediately after collection All tubes specimens from the patient must be labeled with computer generated label or Patient’s first and last name Date of birth Date and time of collection Initials of person collecting specimens Site and type of specimen (For cultures, tissue biopsies, excisions, and cytology) Ensure information on the label matches the patient's wristband EXACTLY. Place the label on the tube horizontally as shown. Do not wrap the label around the tube Do not flag the label Do not cover any of the tube cap with the label PATIENT IDENTIFIERS Inpatient and Outpatient Properly identify the patient using two patient identifiers. See St Joseph Mercy Oakland Policy – Patient Identifiers. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE 07/14 SJMO LABORATORY GENERAL INFORMATION SPECIMEN REJECTION Occasionally, specimens are delivered to the laboratory without complete patient ID, with incorrect patient identification or without any patient identification. In the event that the specimen(s) are incorrectly submitted the following procedures will be used. Incompletely Labeled Specimens Inpatient: Specimen must be recollected. In rare instances when the specimen cannot be recollected the physician must sign an Inpatient Mislabel Specimen Consent Form for the labeling corrections. Outpatient: The office is contacted and a Mislabel/Unlabeled Specimen Consent Form for the labeling corrections if provided to the physician. Unlabeled Specimens Inpatient: Unlabeled or specimens labeled with wrong patient information must be redrawn. In rare instances when the specimen cannot be recollected the physician must sign off on the labeling corrections. Blood bank specimens will always need to be recollected. Outpatient: The office is contacted and a Mislabel/Unlabeled Specimen Consent Form for the labeling corrections if provided to the physician. The laboratory will contact the physician's office for follow up on the following issues. Test requested - No specimen received Misspelled name, or unable to read Clotted specimen QNS (insufficient specimen) Hemolyzed specimen Incorrect specimen container or collection tube Specimen improperly collected Specimen not transported properly Stability exceeded A specimen received without an order No diagnosis code given. COURIER SERVICE St. Joseph Mercy Oakland Laboratory provides a courier service for routine and stat pick- up service to physician offices and clinics. A lock box can be provided for after hour pick-ups. TEST SUPPLIES Inpatient: Within the hospital, supplies for laboratory testing are obtained through the SJMO Supply Chain. Some specialized supplies may be obtained directly from the Laboratory. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE 07/14 SJMO LABORATORY GENERAL INFORMATION Outpatients: The lab will supply all forms, blood collection tubes and a l l m a t e r i a l s r e l a t e d t o s p e c i m e n c o l l e c t i o n . (See supply order form). Figure 3: Lab Supply Order Form RETURN TO TEST DIRECTORY RETURN TO HOME PAGE 07/14 SJMO LABORATORY GENERAL INFORMATION CHARTING Charts can be delivered to the physician’s office by the courier, fax or electronic interface. Critical values will be called to the licensed caregiver. . See the complete list of SJMO Hospital Critical Values for more detail. Outpatient results are routinely sent to the referring physician. Additional copies will be sent to consulting physician(s) if indicated on the Test Requisition Form. Reports can be delivered to the physician’s office by the courier, put in the physician’s mailbox in the hospital, faxed or printed at the office. CRITICAL VALUES The laboratory values that will be called 24 hours/day, 7 days/week are as follows The following critical results will only be called once every 24 hours: CKMB% and Troponin RETURN TO TEST DIRECTORY RETURN TO HOME PAGE 07/14 SJMO LABORATORY GENERAL INFORMATION TEST – TEST CODE CRITICAL ABNORMAL TEST RESULT Below Above OUTPATIENT EXCEPTION Blood Bank Positive HIV LD HIV Rapid Negative Positive General Chemistry Bilirubin total (>3 months) Bilirubin total (0-3 months) Bilirubin, direct (0 - 3 months) BUN (0-28 day) BUN – (1 mo -150 yr) Calcium, ionized, @ pH 7.4 Calcium, total Carboxy-Hemoglobin (CO-HGB) (0 - 5 yrs) Carboxy-Hemoglobin (CO-HGB) (>5 yrs) Chloride CO2 Inorganic Phosphorus Potassium Sodium Uric Acid Inorganic Phosphorus Enzymes Amylase CK (outpatient physician offices only) CK CKMB Index - % Glucose Glucose, random–peds (0-1 mo) Glucose, random-peds (1 mo–5 yrs) Glucose, random - (> 5 yrs) Glucose (fasting) - pediatrics (0 - 12 months) Glucose (fasting) - adult (> 12 months) RETURN TO TEST DIRECTORY 3.7 mg/dl 7 mg/dl 70 mEq/L 9 mEq/L 1 mg/dl 3 mEq/L 125 mEq/L 15 mg/dl 15 mg/dl 2 mg/dl 50 mg/dl 114 mg/dl 6.3 mg/dl 13 mg/dl 10% 20% 140 mEq/L After office hours call in AM 40 mEq/L After office hours call in AM After office hours call in AM After office hours call in AM 6 mEq/L 155 mEq/L 17.0 mg/dl 1 mg/dl 300U/L 1000U/L 10,000U/L 3% 40 mg/dl 60 mg/dl 60 mg/dl 40 mg/dl 60 mg/dl After office hours call in AM After office hours call in AM 200 mg/dl 450 mg/dl 450 mg/dl 180 mg/dl 450 mg/dl RETURN TO HOME PAGE 07/14 SJMO LABORATORY GUIDE GENERAL INFORMATION TEST – TEST CODE Glucose, (fasting) – DM Glucose, (fasting) – Gestational DM Glucose - 1 Hr, 2 Hr, 2Hr (Diabetes), 3Hr, 4Hr, 5 6Hr Glucose – 2 Hr Post Prandial Therapeutic Drug Monitoring (TDM) Digoxin Lithium Theophylline Toxicology Acetaminophen Carbamazepine CRITICAL ABNORMAL Below TEST RESULT 60 mg/dl 40 mg/dl 60 mg/dl RETURN TO TEST DIRECTORY TEST – TEST CODE 450 mg/dl 450 mg/dl 450 mg/dl 2.4 ng/ml 2 mEq/L 23 mcg/ml 100 mcg/ml 15 mcg/ml Phenytoin (Dilantin) Gentamicin (random, peak) Gentamicin (trough) Phenobarbital Salicylate Tobramycin (random, peak) Tobramycin (trough) Valproic Acid Vancomycin (random, peak, trough) Hematology - Coagulation Hemoglobin, newborn (0 - 7 days) Hemoglobin (> 7 days) - inpatient Hemoglobin (> 7 days) - outpatient Hematocrit, newborn (0 - 7 days) PTT Prothrombin Time INR Platelets, newborn (0 – 1 month) Platelets (> 1 month) WBC, newborn (0 - 1 month) WBC (> 1 month) OUTPATIENT EXCEPTION Above 30 mcg/ml 12 mcg/ml 3 mcg/ml 50 mcg/ml 30 mg/dl 12 mcg/ml 3 mcg/ml 125 mcg/ml 50 mcg/ml 13.1 g/dl 6.1 g/dl 7.1 g/dl 40% 23.9 g/dl 68% 99 sec 5.9 100,001/mm 30,001/mm3 5001/mm3 29.9 x 10/mm3 2.1 x 10/mm3 29.9 x 10/mm3 RETURN TO HOME PAGE SJMO LABORATORY GUIDE GENERAL INFORMATION TEST – TEST CODE Neutrophils Malaria smear Send Outs AFP Screen Caffeine Chlamydia CMV IgM Complete Viral Culture, CSF only Neisseria Gonorrhoeae (GC) Norovirus Pertussis Syphilis Antibody or FTA Varicella IgM Urinalysis Glucose for Pediatrics (AGE<10) CRITICAL ABNORMAL TEST RESULT Below Above OUTPATIENT EXCEPTION 1.1 x 10/mm3 Positive Positive 30 mcg/ml Positive Positive After office hours call in AM Positive After office hours call in AM Positive Positive Positive Positive Positive After office hours call in AM After office hours call in AM After office hours call in AM After office hours call in AM After office hours call in AM Trace After office hours call in AM Microbiology Positive Fungal Culture with Blastomycosis, Histoplasmosis, Coccidiomycosis or Cryptococcosis Positive Blood culture Positive AFB smear*, ** or culture * Positive culture for Mycobacterium tuberculosis ** Positive CSF Gram Stain or Positive CSF cultures Positive Cryptococcal antigen Positive Group B strep antigen (CSF) or culture on infant ≤ 2 weeks of age Positive Legionella culture or antigen Positive Listeria monocytogenes culture (CSF, Blood) Positive Neisseria meningitidis (CSF, Blood only) – must call to Doctor and floor Staphylococcus aureus that is intermediate or resistant to vancomycin (VISA/VRSA) Positive Clostridium difficile toxin Possible bioterrorism agent or emerging infection *After office hours call in AM **If unable to contact a responsible licensed caregiver contact Infection Control and the Oakland County Health Department, TB Control Division RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY GUIDE GENERAL INFORMATION Outreach specimens collected from offsite clients will have a turnaround time of 4 hours from notification. LABORATORY APPROVED STAT LIST Category A: Goal: 91% of all Inpatient STATS completed within 30 minutes. Blood Gases Category B: Goal: 91% of all Inpatient STATS completed within 60 minutes. Acetaminophen Electrolytes Ethanol Ammonia FFN- Fetal Fibrinectin Amylase (serum) Fibrinogen Bilirubin, Total (adult) Glucose, serum or CSF Bilirubin, T&D (neonatal) Gram Stain (CSF) BNP Group B Strep Antigen (CSF) 4N/NICU infants BUN hCG - serum and urine (qualitative) Calcium/ Ca++ BhCG - serum (quantitative) Carbon Monoxide Influenza Ag Testing ER + 4 N CBC w/auto differential HIV Screen Cell count (CSF) Iron CKMB Lactic Acid, CK, Total Lithium Chloride, serum or CSF Lamellar Count Creatinine, serum Lamellar Count Digoxin Magnesium Dilantin® Methemoglobin Dimer Osmolality Drug Screen – serum Partial Thromboplastin Time (PTT) - Ethanol (quantitative) Phosphorus - Acetaminophen (quantitative) Platelet Count - Salicylates (quantitative) Potassium, serum - Tricyclics (qualitative) Protein, CSF Drug Screen – urine Prothrombin Time (PT) - Opiates (qualitative) RSV - Cocaine (qualitative) Salicylates - Benzodiazepine (qualitative) Sodium, serum - PCP (qualitative) Strep Screen - Barbiturates (qualitative) Theophylline - Methadone (qualitative) Troponin I Urinalysis RETURN TO TEST DIRECTORY RETURN TO HOME PAGE Venipuncture and Blood Collection Revised 08/26/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE Table of Contents • • • • • • • • A. Equipment B. Preparation of the patient C. Blood collection D. Special collections E. Collection tube, anticoagulant, specimen amounts F. Patient reactions G. Powerchart ordering and lab sweeps H. Rejection of specimens RETURN TO TEST DIRECTORY RETURN TO HOME PAGE A. EQUIPMENT • Phlebotomy cart or tray with the following items:* Disposable Gloves Alcohol preps Sterile Gauze Syringes Safety needles Butterfly needles Adhesive bandage or tape Vacutainer holders Indelible marking pen Biohazard bags Sharps container Evacuated tubes Luer Adaptors Microtainer containers Lancets Blood transfer device *If a tray is utilized, it may not be brought into the patient’s room. *A cart or tray may not be brought into an isolation room. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE B. PREPARATION • The phlebotomist should use correct hand hygiene per hospital policy. • Review order/labels for all tests that are to be collected to determine the correct tubes and special collections that may be required. • Correctly identify the patient. Refer to the lab policy “Patient Identification and Specimen Labeling Policy”. • In an outpatient setting, patients under 18 years old cannot be drawn unless parental consent form has been signed and consent has been documented by the staff over the phone. Minors with standing orders for blood work may have a parent signed consent form on file enabling them to have the venipuncture without a parent present for each visit. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE B. PREPARATION (cont.) • Verify that the appropriate pretest preparation such as fasting, drug infusions, etc. has occurred. • Explain the procedure to the patient. (If the patient refuses to have their blood drawn, do not proceed. For inpatients inform the nurse and document the delay, if an outpatient inform the ordering physicians office.) • If needed, raise the patient’s bed remembering to return the bed to the original position. • Prepare the equipment. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE C. Blood Collection Selection of venipuncture site and tourniquet application: • Put on gloves. • Apply the tourniquet gently (do not apply the tourniquet too tight as it will compress the artery). • Ask the patient to close their hand. Do not have the patient pump his hand or to make a tight fist. This can cause hemoconcentration and hemolysis. • Locate a vein by site and palpitation. Vein palpitation is performed with the index and second fingers and is more important than being able to see the vein. The three veins most often used are the cephalic, basilica, and median cubital. • Do not leave the tourniquet on longer than one minute. This can cause hemoconcentration and hemolysis. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE C. Blood Collection (cont.) Venipuncture using a vacutainer: • Cleanse the site in a circular motion, starting at inside of the site and working outward in widening concentric circles. • Allow the alcohol to dry for 30 seconds. (If you are collecting an alcohol level, use another method of cleansing.) • Do not touch the site again. • Attach the vacutainer holder to the needle. • The vein should be anchored with the phlebotomists thumb 1-2 inches below the venipuncture site. • Insert the needle, with the bevel up, at an angle between 15 and 30 degrees from the arm. • Collect the tubes in the correct order of draw by gently pushing the tube on the end of the adaptor keeping the needle as stable as possible. (Order of Draw: Blood cultures, Blue, Red, SST, Orange, Green, Purple or pink, Gray, and Yellow.) • Once the blood flow is established, release the tourniquet and have the patient open his hand . RETURN TO TEST DIRECTORY RETURN TO HOME PAGE C. Blood Collection (cont.) • • • • • • • Allow the tubes to fill until the vacuum is exhausted and the blood flow ceases. As each tube is removed it should be inverted several times to ensure mixing. Before taking the needle out of the patient’s arm, remove the last tube being collected. Remove the needle as quickly as possible, activate the safety device, and immediately place sterile gauze over the puncture site. Invert the tubes 8-10 times. Hold pressure on the site until the bleeding stops. If the bleeding continues for greater than 5 minutes or is excessive, the nurse should be notified. In the outpatient areas, if bleeding continues greater than 5 minutes apply cold compresses maintaining pressure on the site. Have the patient elevate the arm above heart. If unable to stop bleeding, notify the ordering physician. Bandage the site. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE C. Blood Collection (cont.) • • • • • Label the specimens. (Refer to the lab policy “Patient Identification and Labeling Policy.”) Labels are placed lengthwise and aligned straight directly below the cap with patients last name at the top. Always label at patient's bedside. Record the patients A# from the wristband (inpatient), date, time of collection, and your initials onto each label. In the outpatient setting, the patient must remain in the chair until labeling is complete. The specimen must have 2 patient identifiers on the tube. (The Laboratory order label, or the patient name and/or date of birth or requisition label with number.) Dispose of supplies: All needles must be disposed of in a sharps container. Gloves, gauze, tape, and tourniquets should be disposed of in the patient’s trash receptacle. Return the bed to original position. Turn off the lights if you turned them on. Thank patient as leaving. Wash your hands. Inpatient specimens should be sent to the lab in a biohazard bag within 20 minutes of collection. Outpatient specimens should be in the lab within 2 hours or centrifuged. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE C. Blood Collection (cont.) Venipuncture using a needle and syringe : • The advantages of using a syringe include: • It is easier to collect blood from tiny/fragile veins with a syringe because the phlebotomist can control the amount of pressure exerted on fragile veins. • The blood appears in the hub of the needles confirming that the needle is in the vein. • The procedure for drawing blood with a syringe is the same as with a Vacutainer (see above) except for: • the syringe plunger must be pulled back on. • A transfer device is used to put the blood in the appropriate tubes (using the same order of draw as above). RETURN TO TEST DIRECTORY RETURN TO HOME PAGE C. Blood Collection (cont.) Venipuncture using a winged infusion set: • The advantages of using winged infusions sets include: • Ease of draw with persons with tiny or poor veins or when drawing from veins in the hand. Butterfly needles are available in 23g and 25g. • When drawing, blood will show in the tubing indicating you are in a vein. • Winged infusion sets can be used with a vacutainer system or syringe. The procedure for drawing blood with a winged infusion set is the same as with a Vacutainer (see above) except for: • A discard tube (non-additive or blue top) should be drawn before a blue top so that the blood collection tubing dead space is accounted for to ensure that the blue top tube is filled for the proper anticoagulant/blood ratio. When using a syringe, a transfer device is attached to put the blood into the appropriate tubes. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE D. Special Collections Timed Collections: • • • • • • There are two basic types of timed collections: A single blood specimen ordered to be drawn at a specific time (glucose, PTT, or drug levels) A test that may require several blood specimens collected over a period of time (glucose tolerance tests, PTT, PT, CBC, Troponins). Collecting Glucose Tolerance Tests: The glucose tolerance test (GTT) is a procedure performed for the diagnosis of diabetes mellitus or hypoglycemia. A glucose level is determined with a glucometer prior to the patient being given a glucose solution to drink. If the glucometer result is greater than 140, the test is discontinued. The patient is given a glucose solution to drink and additional glucose levels are drawn at timed intervals. Timing of the specimen collection is critical, because test results are related to the scheduled times. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE D. Special Collections (CONT.) Diurnal Specimens: • Phlebotomist can be requested to draw specimens for tests at specific times, usually corresponding to the peak diurnal level. Plasma cortisol levels drawn between and 0800 and 1000 will be twice as high as levels drawn at 1600. Therapeutic Drugs: • To ensure patient safety and medication effectiveness, the blood levels of many therapeutic drugs must be closely monitored. Examples of frequently monitored therapeutic drugs are: Digoxin, phenobarbital, lithium, gentamycin, tobramycin, vancomycin, amikacin, and theophylline. Random specimens are occasionally requested; however, the most beneficial levels are those drawn before the next dosage is given (trough level) and shortly after the medication is given (peak level). • Therapeutic drug monitoring collections are coordinated between pharmacy, nursing, and the phlebotomist. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE D. Special Collections (cont.) Timed Coagulation Studies: • All coagulation collection tubes must be filled 90% for accurate results. • PT’s are commonly ordered to monitor oral anticoagulant therapy. Patients are often collected every 4 hours. • PTT’s are commonly used for monitoring heparin and are ordered as timed collections. The time of collection is critical to the pharmacy determining the dosing level of heparin for the patient. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE E. COLLECTION TUBE AND SPECIMEN AMOUNTS • All blood tubes with anticoagulant should be filled to ensure the correct anticoagulant to blood ratio. • Specimen amount, tube type, and any special collection requirements are listed along the bottom of every laboratory order label. The laboratory’s information system updates specimen changes immediately, ensuring the accuracy of the information on all laboratory order labels. • To maximize the efficiency of the automated line the minimum volume of 3ml should be collected for all chemistry tests and a minimum volume of 1.5 ml for all hematology tests run at SJMO. • Blood Bank specimens require a minimum volume of 1ml. • All specimens collected in a microtainer should be filled to the appropriate line. • The following chart outlines the collection tubes (with additive), tube size, min-tube volume and the associated tests. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE E. COLLECTION TUBE AND SPECIMEN AMOUNTS TUBE ADDITIVE TUBE SIZE VOLUME TESTS Mint Green Top Lithium Heparin 4.5 ml 3.0 ml Chemistry Lavender Top K2 EDTA 4.0 ml 1.5 ml Hematology Blue Top Na Citrate 2.7 ml 2.7 ml Coagulation White/clear top None 6.0 ml 3.0 ml Urine Chemistry SST Separator Gel 4.5 ml 3.0 ml Chemistry Orange RST Thrombin 5.0 ml 3.0 mL Troponin Navy Blue Top None 6.0 ml Warde Catalogue Aluminum, zinc, copper , Selenium Navy Blue Top EDTA 7.0 ml Warde Catalogue Lead, Arsenic, Mercury, Heavy Metals Green Na Heparin 10.0 ml Warde Catalogue Cytogenetics, fish, Vit. B1 Yellow ACD 6.0 ml Warde Catalogue Flow cytometry RETURN TO TEST DIRECTORY RETURN TO HOME PAGE F. PATIENT REACTIONS Occasionally a patient may have a reaction that may result in loss of consciousness. Fainting occurs when the blood leaves the extremities and collects in the trunk of the body resulting in a deficiency of the blood supply to the brain. The following symptoms may indicate a reaction: • Extreme paleness • Nausea • Sweating • Coldness of the skin • Dizziness • Numbness-tingling • Loss of consciousness • Perspiration • Convulsions • Weakness RETURN TO TEST DIRECTORY RETURN TO HOME PAGE F. PATIENT REACTIONS (cont.) If a patient should have a reaction the following steps should be followed: Inpatient: • • • • • • Notify the nurse by using the call button. Do not leave the patient unattended. If the patient is in a sitting position, lower the head to the knees, make sure that you hold the patient in the chair. Apply cold compresses to the forehead and the back of the neck. If the reaction is severe, it may be necessary to have the patient lie down and elevate their feet. If the patient is nauseated, instruct the patient to breathe deeply and slowly through their nose, so they do not hyperventilate. If they are vomiting have emesis basin and tissues ready. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE F. PATIENT REACTIONS (cont.) Outpatient: On campus labs: • If the patient does not respond call 222 – Emergency Operator and inform them which lab you are located at. Off campus labs: • If patient does not respond Call 911 • When the patient has revived, offer them a drink of water or juice. • Make sure the patient is fully recovered before you release them. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE G. ORDERING PRIORITIES AND LAB SWEEP TIMES- INPATIENT • STAT: To be used only when the physician requests the test is to be done STAT. The labels are produced immediately on the floors, should be drawn within 20mins, and resulted in 60mins for most tests. • ASAP: Label prints immediately and is drawn when the phlebotomist is rounding the floors. Given priority over routines. • TIMED: Labels print for the time ordered. Should be drawn at the time indicated. Priority is after STATS. • ROUTINE: Use this priority to minimize venipuncture of patient. Labels are printed at specific default times throughout the day. (3am, 6am, 10am, 3pm, 8pm). Blood is drawn throughout the day as phlebotomist is rounding the floors. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE H. REJECTION OF SPECIMENS BY LAB • Specimens may be rejected by laboratory personnel for the following reasons: • Specimens without the two correct patient identifiers will be rejected unless signed off by a physician. (missing date, time and or initials can be corrected by the person drawing the blood by coming to the lab to correct). • Inadequate specimen volume. • Inappropriately stored or transported specimens REFERENCES: • NCCLS: Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture: Approved Standard – Fifth Addition. Volume 23 Number 32. • Kathy Sobanski, MT(ASCP), Core Lab Supervisor • Marian Hutchins, MT(ASCP), Phlebotomy Supervisor RETURN TO TEST DIRECTORY RETURN TO HOME PAGE Specimen Collection Visual Aids REMARKABLE MEDICINE. REMARKABLE CARE. Click on the links below to access these visual aids. Vacutainer Tube Guide Order of Draw Microtainer Tube Guide Safety-Lok Blood Collection Set Blood Transfer Device Processing Urine specimens with the Vacutainer Urine Collection Kit RETURN TO TEST DIRECTORY RETURN TO HOME PAGE RETURN TO TEST DIRECTORY RETURN TO HOME PAGE RETURN TO TEST DIRECTORY RETURN TO HOME PAGE RETURN TO TEST DIRECTORY RETURN TO HOME PAGE RETURN TO TEST DIRECTORY RETURN TO HOME PAGE RETURN TO TEST DIRECTORY RETURN TO HOME PAGE RETURN TO TEST DIRECTORY RETURN TO HOME PAGE ; Microbiology Collection Instructions REMARKABLE MEDICINE. REMARKABLE CARE. SJMO LABORATORY MICRO COLLECTION II. MICROBIOLOGY COLLECTION BY SPECIMEN TYPE Detailed collection instructions for common microbiology specimens. SPECIMEN SOURCE Body Fluids (Abdominal, Ascites, Bile, Joint, Pericardial, Peritoneal, Pleural, Synovial) COLLECTION INSTRUCTIONS 1. Disinfect overlying skin with alcohol and tincture of iodine or CHG. 2. Obtain specimen via percutaneous needle aspiration or surgery. 3. Transport immediately to Lab. 4. Always submit as much fluid as possible; never submit a swab immersed in fluid. SPECIMEN SOURCE Bone Marrow COLLECTION INSTRUCTIONS Before proceeding, obtain a SPS Vacutainer tube from Microbiology. SPS is the anticoagulant of choice for bacterial, fungal or AFB/Mycobacterial agents. 1. Must be collected by a physician using sterile technique. 2. Prepare skin as for a blood culture. 3. Aspirate bone marrow percutaneously using a needle and syringe. SPECIMEN SOURCE COLLECTION INSTRUCTIONS Bordetella Pertussis Detection by PCR Due to the fastidious nature of the organism and the low sensitivity of both culture and DFA, diagnosis by PCR is the current method of choice. Collect a nasopharyngeal (not throat) specimen on a wire Dacron swab: 1. Seat the patient comfortably and tilt the head back. 2. Insert the wire swab thru the nares until resistance is met due to contact with the nasopharynx. 3. Rotate the swab gently and allow the swab to maintain contact with the nasopharynx for 20-30 seconds. 4. Place swab immediately in an approved transport medium. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY MICRO COLLECTION SPECIMEN SOURCE COLLECTION INSTRUCTIONS Bronchoalveolar lavage, Bronchial Brush or Wash or Tracheal aspirate 1. Place aspirate or washing in a sputum trap. 2. Place brush in a sterile container with 1 ml or less of non bacteriostatic saline. SPECIMEN SOURCE COLLECTION INSTRUCTIONS Catheter, I.V. 1. Cleanse the skin around the catheter site with alcohol or alcohol + tincture of iodine. 2. Aseptically remove and clip the 5 cm /2 inch distal tip of the catheter directly into a sterile container. 3. Transport immediately to Laboratory to prevent drying. COMMENTS Acceptable IV catheters for semiquantitative culture (Maki method): Central, CVP, Hickman, Broviac, Peripheral, Arterial, Umbilical, Hyperalimentation, Swan-Ganz. SPECIMEN SOURCE Catheter, Foley COLLECTION INSTRUCTIONS Foley catheters will NOT be accepted since growth represents distal urethral flora. SPECIMEN SOURCE Cellulitis COLLECTION INSTRUCTIONS 1. Cleanse site by wiping with sterile saline or 70% alcohol. 2. Aspirate the area of maximum inflammation (commonly the center rather than leading edge) with a fine needle and syringe. 3. Draw a small amount of sterile saline into the syringe. 4. Remove needle (with a protective device) and replace with sterile cap. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY MICRO COLLECTION SPECIMEN SOURCE Chlamydia Culture COLLECTION INSTRUCTIONS ANY SOURCE IS ACCEPTABLE BUT CHLAMYDIA CULTURES ARE GENERALLY RESERVED FOR THE FOLLOWING SPECIMEN TYPES: BUBOES/LUNG/ SPUTUM/NASOPHARYHX & FOR THE SOLE PURPOSE OF TREATING SEXUAL ABUSE CASES, in which throat, rectal and/or vaginal specimens may be submitted. This information cannot be used as evidence in court since no chain of command is used. 1. Collect with a Dacron culture swab. 2. Place directly into Viral/Chlamydia Transport Medium. SPECIMEN SOURCE Chlamydia trachomatis – Amplified Probe COLLECTION INSTRUCTIONS See Instruction for collection of Neisseria gonorrhoeae Amplified Probe. SPECIMEN SOURCE Cerebrospinal Fluid Physician collected specimen. Collect by Lumbar Puncture. Tube 2 is preferred for culture. SPECIMEN SOURCE Continuous Ambulatory peritoneal Dialysate Fluid (CAPD) Submit fluid 50 ml or more of fluid in sterile container. SPECIMEN SOURCE Decubitus Ulcer COLLECTION INSTRUCTIONS Decubitus culture generally provides questionable microbial information but under circumstances of repeated treatment failure, decubitus culture may be warranted. Specimen(s) of choice: Biopsy > aspirate > swab. 1. Cleanse surface with sterile saline. 2. If a sample biopsy is not available, use a 1 ml syringe with a 23 gauge needle containing 0.2 - 0.4 ml of sterile nonbacteriostatic saline to aspirate the base of the lesion. 3. Transfer material to a sterile tube/container or safely remove the needle & cap and replace with a sterile cap. 4. Transport to Laboratory. 5. If neither a biopsy nor aspirate can be obtained, vigorously swab the base of the lesion. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY MICRO COLLECTION SPECIMEN SOURCE COLLECTION INSTRUCTIONS Dental Culture (Gingival, Periodontal, Periapical, Vincent's stomatitis) 1. Carefully cleanse gingival margin and supragingival tooth surface to remove saliva, debris and plaque. 2. Using a periodontal scaler, carefully remove subgingival lesion material and transfer to anaerobic transport system. 3. Prepare smears collected in the same fashion. SPECIMEN SOURCE COLLECTION INSTRUCTIONS Ear – Inner Tympanocentesis reserved for complicated/recurrent/chronic persistent otitis media. 1. INTACT EAR DRUM: Clean ear canal with soap solution. Collect fluid via syringe aspiration technique. 2. RUPTURED EAR DRUM: Collect fluid on flexible-shaft swab via an auditory-speculum. 3. Place fluid/aspirate in a sterile container. 4. Transport to Laboratory. SPECIMEN SOURCE Ear – Outer COLLECTION INSTRUCTIONS 1. Remove any debris/crust from the ear canal with a moistened swab. 2. Obtain a sample by firmly rotating a swab in the outer canal. COMMENTS For otitis externa, vigorous swabbing is required since surface swabbing may miss streptococcal cellulitis. SPECIMEN SOURCE Eye – Conjunctiva COLLECTION INSTRUCTIONS RETURN TO TEST DIRECTORY Sample both eyes with separate swabs (pre-moistened with sterile saline) by rolling over each conjunctiva. NOTE: Mini-tip swab is available from Microbiology. RETURN TO HOME PAGE SJMO LABORATORY MICRO COLLECTION SPECIMEN SOURCE Eye – Corneal Scrapings COLLECTION INSTRUCTIONS 1. Instill 1-2 drops of local anesthetic. 2. Using a sterile spatula scrape ulcers/lesions and inoculate directly onto media obtained to Laboratory. (NOTE: Media should be at room temperature.) 3. If desired, apply remaining material to 2 clean glass slides for staining. COMMENTS It is generally recommended that swabs for conjunctival culture be taken prior to anesthetic application, whereas corneal scrapings are obtained after. SPECIMEN SOURCE Feces - Clostridium difficile Toxin COLLECTION INSTRUCTIONS Transfer 5 ml of liquid soft stool directly into a clean, dry container. (Soft stool: defined as assuming the shape of its container.) COMMENTS Patients should be passing 5 stools/24hr, the consistency of which should be liquid/soft. Formed stool will not be tested. SPECIMEN SOURCE Feces –Stool Culture/Ova and Parasite Exam/Rotavirus COLLECTION INSTRUCTIONS 1. Pass stool into a clean container. Place a piece of plastic wrap under the toilet seat to aid in collection in adults. 2. For pediatric patients, do not collect from diapers. Turning diaper “inside out” may aid in collection. 3. For test requiring multiple specimens, do not collect multiples on same day. Generally, multiple samples should be spaced at least 1 day apart. COMMENTS Avoid contamination with urine or water from the toilet as this may prevent recovery. For parasite examinations, patient should not have ingested barium bismuth or other antidiarrheal preparations for at least 7 days. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY MICRO COLLECTION SPECIMEN SOURCE Feces - Rectal Swab COLLECTION INSTRUCTIONS 1. Carefully insert a swab ~1 inch beyond the anal sphincter. 2. Gently rotate the swab to sample the anal crypts. COMMENTS Reserved for detecting GC, Shigella, HSV, and anal carriage of S pyogenes OR for patients unable to pass a stool specimen. SPECIMEN SOURCE Gastric Wash/Lavage COLLECTION INSTRUCTIONS Collect in the early morning before eating and while still in bed in order to obtain sputum swallowed during sleep. Please call the Microbiology Laboratory before collecting the Specimen. 1. Introduce a nasogastric tube orally/nasally to the stomach. 2. Perform lavage with 25-50 mLs of chilled sterile distilled water. 3. Recover sample and place in a leak-proof, sterile container. 4. Before removing the NG tube, release suction and clamp. COMMENTS The specimen must be taken to the Laboratory and processed promptly, since mycobacteria die rapidly in gastric washings. Gastric Specimens in general do not yield meaningful culture results except perhaps for septic infants or for older individuals with obstructions high in the intestine. Bacterial colony counts for gastric secretions are of questionable value. Anaerobic bacteria can inhabit normal gastric secretions, and interpretations of culture results may be difficult. The presence of large numbers of bacteria in gastric secretions usually indicates an alkaline pH shift caused by regurgitation of duodenal secretions in patients with intestinal obstructions. SPECIMEN SOURCE Hair (Dermatophytosis) COLLECTION INSTRUCTIONS 1. Using forceps collect at least 10-12 affected hairs with the base of the hair-shaft remaining intact. 2. Place in a clean tube or container. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY MICRO COLLECTION COMMENTS Scalp scales, if present, should be collected along with scrapings of active borders of lesions. Note any antifungal therapy taken recently. SPECIMEN SOURCE Gangrenous Tissue COMMENTS See Wound. Sampling of superficial tissue should be discouraged; tissue biopsy or aspirates are preferred. SPECIMEN SOURCE Genital - Female - Amniotic Fluid COLLECTION INSTRUCTIONS 1. Aspirate via amniocentesis, Cesarean section, or intrauterine catheter. 2. Transfer fluid to sterile container plus Anaerobic Transport tube. COMMENTS Swabbing or aspiration of vaginal membrane is not acceptable due to vaginal contamination. SPECIMEN SOURCE Genital - Female – Bartholin Gland COLLECTION INSTRUCTIONS 1. Disinfect skin with alcohol and tincture of iodine. 2. Aspirate fluid from ducts. SPECIMEN SOURCE Genital - Female – Cervix COLLECTION INSTRUCTIONS 1. Visualize the cervix using a speculum without lubricant. 2. Remove mucus/secretions from the cervix with swab and discard. 3. Firmly yet gently, sample the endocervical canal with a sterile swab. SPECIMEN SOURCE Genital - Female - Cul de sac COLLECTION INSTRUCTIONS 1. Disinfect skin with alcohol and tincture of iodine or CHG. 2. Submit aspirate/fluid in sterile container plus Anaerobic Transport tube. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY MICRO COLLECTION SPECIMEN SOURCE Genital - Female – Endometrium COLLECTION INSTRUCTIONS 1. Collect transcervical aspirate via a telescoping catheter. 2. Transfer to sterile container plus Anaerobic Transport tube. SPECIMEN SOURCE Genital - Female - Products of Conception COLLECTION INSTRUCTIONS 1. Submit a portion of tissue in a sterile container. 2. If obtained by Caesarian section, immediately transfer to an Anaerobic Transport tube, plus sterile container. SPECIMEN SOURCE Genital - Female – Urethra COLLECTION INSTRUCTIONS 1. Remove exudate from the urethral orifice. 2. Collect discharge material on a swab by massaging the urethra against the pubic symphysis through the vagina. COMMENTS If no discharge can be obtained, wash the external urethra with betadine soap and rinse with water. Then, insert an urethrogenital swab 2 - 4 cm into the urethra, rotate while maintaining for 2 seconds. SPECIMEN SOURCE Genital - Female – Vagina COLLECTION INSTRUCTIONS 1. Wipe away any excessive amounts of secretion or discharge. 2. Obtain secretions from the mucosal membrane of the vaginal vault with a sterile swab. 3. If a smear is also requested, obtain it using a second swab. COMMENTS RETURN TO TEST DIRECTORY For intrauterine devices (IUD's), place entire device into a sterile container and submit at room temperature. 1-2 ml of nonbacteriostatic saline may be added for moisture. RETURN TO HOME PAGE SJMO LABORATORY MICRO COLLECTION SPECIMEN SOURCE Genital - Male – Prostate COLLECTION INSTRUCTIONS 1. Cleanse the glans with soap & water. 2. Massage prostate through rectum. 3. Collect fluid on a sterile swab or in a sterile tube. SPECIMEN SOURCE Genital - Male – Urethra COLLECTION INSTRUCTIONS Insert an urethrogenital swab 2-4 cm into the urethral lumen, rotate while maintaining for 2 seconds. NOTE: Mini-tip swab available from Microbiology. SPECIMEN SOURCE Genital Lesion - Male or Female COLLECTION INSTRUCTIONS 1. Using a sterile gauze pad cleanse the lesion with sterile saline and remove its surface. 2. Allow a transudate to accumulate. 3. While pressing the base of the lesion, firmly sample with a sterile swab. SPECIMEN SOURCE Hair (Dermatophytosis) COLLECTION INSTRUCTIONS 1. Using forceps collect at least 10-12 affected hairs with the base of the hair shaft remaining intact. 2. Place in a clean tube or container. COMMENTS Scalp scales, if present, should be collected along with scrapings of active borders of lesions. Note any antifungal therapy taken recently. SPECIMEN SOURCE Lymph Node COLLECTION INSTRUCTIONS 1. Collect aseptically and avoid indigenous microbiota. 2. Do not immerse in saline or other fluid or wrap in gauze. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY MICRO COLLECTION SPECIMEN SOURCE Mouth/ Oral Lesion COLLECTION INSTRUCTIONS 1. Remove oral secretions/debris from the surface of lesion with a swab, and then discard. 2. Using a second swab, vigorously sample the lesion avoiding any areas of normal tissue. SPECIMEN SOURCE Nail – Dermatophytosis COLLECTION INSTRUCTIONS 1. Wipe the nail with 70% alcohol using gauze (not cotton.) 2. Clip away a generous portion of the affected area and collect material/debris from UNDER the nail. 3. Place in a clean container. SPECIMEN SOURCE Nasal COLLECTION INSTRUCTIONS 1. Insert a swab, premoistened with sterile saline, approx. 2 cm into the nares. 2. Rotate the swab against the nasal mucosal. COMMENTS Anterior nose cultures are reserved for detecting staphylococcal and streptococcal carriers, or for nasal lesions. SPECIMEN SOURCE Nasopharynx COLLECTION INSTRUCTIONS 1. Gently insert a Dacron swab into the posterior nasopharynx via the nose. 2. Rotate slowly for 5-20 seconds to absorb secretions; remove, and inoculate media at bedside or place swab in transport medium. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY MICRO COLLECTION SPECIMEN SOURCE Neisseria gonorrhoeae - Amplified Probe COLLECTION INSTRUCTIONS 1. Use unisex swab for urethral cervical collection. 2. For genital specimens, instruct patient not to urinate 1 hour prior to sample. 3. Urethral specimen: Insert swab 2-3 cm into the urethra. Gently rotate the swab ensuring contact with all urethral surfaces for 3-5 seconds. Withdraw swab and break into transport tube. COMMENTS PLEASE NOTE: FOR THE TEST TO BE VALID ONLY THE SWABS PROVIDED IN THE COLLECTION KIT MAY BE USED! Probes for both GC & Chlamydia can be performed from a single swab. This is the method of choice for sexually transmitted cases, but NOT SEXUAL ABUSE CASES. SEXUAL ABUSE CASES MUST BE COLLECTED & TESTED BY THE MICHIGAN STATE POLICE. MICROBIOLOGY RESULTS ARE TO BE USED FOR TREATMENT PURPOSES ONLY. THEY ARE NOT PERMISSIBLE AS EVIDENCE IN COURT! SPECIMEN SOURCE Respiratory (Lower) BAL/BBW Tracheal Aspirate COLLECTION INSTRUCTIONS 1. Place aspirate/wash into a sputum trap. 2. Place brush in a sterile container with saline. SPECIMEN SOURCE Respiratory (Lower) Sputum, Expectorated COLLECTION INSTRUCTIONS 1. Collect Specimen under the DIRECT supervision of a nurse or physician. 2. Have patient rinse/gargle with water. 3. Instruct patient to cough DEEPLY to produce a lower respiratory specimen (not post-nasal fluid) into a sterile container. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY MICRO COLLECTION SPECIMEN SOURCE Respiratory (Lower)Sputum, Induced COLLECTION INSTRUCTIONS 1. Have patient rinse his mouth with water after brushing gums/ tongue to minimize contaminating specimen with food particles, mouthwash, or oral drugs which may inhibit the growth of bacteria. 2. With the aid of a nebulizer, have the patient inhale ~25 mLs of 310% sterile saline. 3. Avoid sputum contamination with nebulizer reservoir water. Saprophytic mycobacteria in tap water may produce false-positive AFB culture or smear results. 4. Collect the induced sputum into a sterile container. SPECIMEN SOURCE Skin – Dermatophytosis COLLECTION INSTRUCTIONS 1. Cleanse the affected area with 70% alcohol. 2. Gently scrape the surface of the skin at the active margin of the lesion. Do not draw blood. 3. Place sample in clean container. SPECIMEN SOURCE Skin Lesion Material COLLECTION INSTRUCTIONS 1. Swabs in transport medium (Amie’s or Stuarts) are acceptable only if biopsy sample or aspirate is not obtainable. 2. For cutaneous ulcer, collect biopsy sample from periphery of lesion, or aspirate material from under margin of lesion. COMMENTS If infection was acquired in Africa, Australia, Mexico, South America, Indonesia, New Guinea or Malaysia, note on request, because Mycobacterium ulcerans may require prolonged incubation for primary isolation. Dry swabs are unacceptable for culture. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY MICRO COLLECTION SPECIMEN SOURCE Throat for Group A Strep COLLECTION INSTRUCTIONS 1. Using a tongue depressor, depress the tongue. 2. Vigorously sample the posterior pharynx, tonsils/pillars and areas of purulence, exudation or ulceration. 3. Microbiology recommends using a dual swab during collection, so that one swab may be used for a "RAPID STREP SCREEN" and the second swab is available for a culture. COMMENTS Order throat culture and note R/O yeast for Candidiasis/Thrush. Notify Microbiology if C. diphtheriae, N. gonorrhoeae, Vincent’s disease or Arcanobacterium are suspected. SPECIMEN SOURCE Tissue COLLECTION INSTRUCTIONS 1. Submit in a sterile container. 2. For small samples, add several drops of non-bacteriostatic, sterile saline to keep moist. Do not immerse in saline or wrap in gauze. 3. DO NOT ALLOW TISSUE TO DRY OUT. COMMENTS Always submit as much tissue as possible. NEVER submit a swab that has simply been rubbed over the surface. Specimens submitted in Formalin or other preservatives are unacceptable for culture. SPECIMEN SOURCE Urine - Indwelling Catheter/Foley COLLECTION INSTRUCTIONS 1. Disinfect the catheter collection port with 70% alcohol. 2. Aseptically, collect 5-10 mLs of urine using a needle/syringe. 3. Transfer to a sterile tube/container/Gray Vacutainer. COMMENTS RETURN TO TEST DIRECTORY Urine samples collected directly from indwelling catheter bags are NOT acceptable. RETURN TO HOME PAGE SJMO LABORATORY MICRO COLLECTION SPECIMEN SOURCE Urine - Midstream (Female) COLLECTION INSTRUCTIONS 1. Thoroughly cleanse the urethral area with soap & water. 2. Rinse with wet gauze pads /towelletes. 3. While holding the labia apart, begin voiding. 4. After several milliliters have passed, collect a midstream portion without stopping the flow of urine. SPECIMEN SOURCE Urine - Midstream (Male) COLLECTION INSTRUCTIONS 1. Cleanse the glans with soap & water. 2. Rinse with wet gauze pads/towelletes. 3. While holding the foreskin retracted, begin voiding. 4. After several milliliters have passed, collect a midstream portion without stopping the flow of urine. SPECIMEN SOURCE Urine – Straight Catheter COLLECTION INSTRUCTIONS 1. Thoroughly cleanse the urethral area with soap & water. 2. Rinse with wet gauze pads. 3. Aseptically, insert a catheter into the bladder. 4. After allowing ~15 mLs to pass, collect urine to be submitted in a sterile container. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY MICRO COLLECTION SPECIMEN SOURCE Wound/Abscess COLLECTION INSTRUCTIONS Closed Wound/Abscess: 1. Remove surface exudate by wiping with sterile saline. 2. Allow surface to dry. 3. Using a needle with Luer-tip syringe, aspirate abscess wall material. 4. Remove needle using a protective device; then recap syringe. 5. Label syringe and place in a sealable, leak-proof-specimen transport bag. 6. Alternatively, the aspirated material may be transferred to a sterile container. Also inoculate Anaerobic transport if anaerobic infection suspected. 7. Deliver PROMPTLY to Microbiology. Open Wound/Abscess: 1. Remove surface exudate by wiping with sterile saline. 2. Allow surface to dry. 3. If possible, aspirate. 4. Alternatively, pass a swab(s) deep into the lesion and firmly sample the lesion's advancing edge. For mycobacterial culture, 2 swabs are preferred. 5. Return swab(s) to transport sleeve. 6. Label appropriately. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY MICRO COLLECTION = REFRIGERATE OR SEND ON ICE ACID FAST CULTURE MICROBIOLOGY SPECIMEN COLLECTION GUIDE ANAEROBIC CULTURE BLOOD CULTURE 10/08 BODY FLUID /TIISUE CULTURE CHLAMYDIA CULTURE CHLAMYDIA TRACHOMATIS /NEISSERIA GONORRHOEAE BY AMPLIFIED PROBE,URINE CLOSTRIDIUM DIFFICILE TOXIN FUNGUS CULTURE GENITAL CULTURE GROUP B STREP SCREEN HERPES CULTURE/PCR OVA AND PARASITE EXAMINATION ROTAVIRUS RETURN TO TEST DIRECTORY PERTUSSIS PCR RSV ANTIGEN CHLAMYDIA TRACHOMATIS & NEISSERIA GONORRHOEAE BY AMPLIFIED PROBE,CERVIX & URETHRA EAR/EYE* CULTURE *Mini-tip swab preferred for eye culture GIARDIA/PARASITE ANTIGEN INFLUENZA ANTIGEN PINWORM SPUTUM/RESPIRATORY CULTURE RETURN TO HOME PAGE SJMO LABORATORY MICRO COLLECTION = REFRIGERATE OR SEND ON ICE STOOL CULTURE MICROBIOLOGY SPECIMEN COLLECTION GUIDE THROAT/RAPID STREP SCREEN URINE CULTURE 10/08 VAGINITIS SCREEN (AFFIRM) RETURN TO TEST DIRECTORY VIRAL CULTURE GRAY TOP URINE VACUTAINER OR STERILE CUP, REFRIGERATED TISSUE/WOUND CULTURE RETURN TO HOME PAGE Microbiology Specimen Collection Visual Aids Click on the links below to access each document. AFB Collection Anaerobic Culture ATTEST Spore Checks Blood Culture Collection Clean-Catch Urine Specimen Collection Eye Culture Collection Fecal Testing Foley Urine Collection GBS Collection Genital Culture Collection Nasopharyngeal Swab Collection Sputum Culture Collection Stool Culture Collection Throat Culture Collection Wound Culture Collection Aptima/GC Chlamydia Probe Viral Culture RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORTORY MICROBIOLOGY VISUAL AIDS St. Joseph Mercy Oakland Laboratory Visual Aid AFB/ACID-FAST STAIN AND CULTURE SPECIMEN REQUIREMENTS SOURCE BLOOD SPS VACUTAINER , 3.3 ML BODY FLUID/CSF BRONCHIAL WASH/BAL 1.0 ML MINIMUM BODY FLUID 3 ML MINIMUM 0.5 ML MINIMUM CSF 10 ML OPTIMAL 5-101 ML PEROPTIMAL DAY/ SAME SOURCE 1 PER DAY/ SAME SOURCE STERILE LEAKPROOF CONTAINER/ LP TUBE LUKEN TUBE/STERILE, LEAK-PROOF CONTAINER GASTRIC STOOL TISSUE URINE STERILE LEAK-PROOF CONTAINER STERILE LEAKPROOF CONTAINER STERILE LEAK-PROOF CONTAINER STERILE LEAK-PROOF CONTAINER 3 ML MINIMUM 1 ML MINIMUM 1 GRAM OF STOOL MINIMUM 10 ML OPTIMAL 10 ML OPTIMAL 1 PER DAY SPECIMENS SHOULD BE COLLECTED AT LEAST 8 HOURS APART. SEE COMMENTS STERILE LEAKPROOF CONTAINER SPUTUM WOUND/ ASPIRATE STERILE LEAKPROOF CONTAINER CONTAINER VOLUME 1 ML MINIMUM 5ML OPTIMAL REPLICA LIMITS 2 PER DAY COMMENTS CLEAN SKIN WITH CHG OR IODINE + ALCOHOL PRIOR TO COLLECTION. COLLECT TWO 3.32 ml YELLOW VACUTAINERS or ONE 10 ml SPS VACUTAINERS FOR EACH CULTURE ORDERED. CSF: TUBE 2 PREFERRED. SUBMIT UNCENTRIFUGED SPECIMEN. REPLACE CAP OF LUKEN TUBE WITH SOLID CAP TO PREVENT LEAKS DURING TRANSPORT NEUTRALIZE pH WITH SODIUM CARBONATE IF TRANSPORT TO SJMO LAB WILL BE >4 HOURS 10 GRAM OF STOOL OPTIMAL 1 PER DAY COLLECT SPECIMEN FROM DEEP COUGH. DO NOT SUBMIT SALIVA. SUBMIT 3 CONSECUTIVE SPECIMENS COLLECTED 8-24 HOURS APART. AT LEAST ONE SPECIMEN MUST BE FIRST MORNING. SPECIFY IF SPECIMEN IS EXPECTORATED, ASPIRATED OR INDUCED. VISIBLE PIECE OF TISSUE NA UTILIZED IN IMMUNOCOMPROMISED PATIENTS AS AN AID IN DIAGNOSING DISSEMINATED INFECTION WITH M. AVIUM COMPLEX 5 ML MINIMUM 40 ML OPTIMAL 1 PER DAY COLLECT 3 CONSECUTIVE FIRST MORNING URINE SPECIMENS. 0.5 ML MINIMUM ASPIRATE OR BIOPSY SAMPLE 1 PER DAY /SAME SOURCE AEROBIC SWAB SPECIMENS WILL BE ACCEPTED BUT YIELD IS MINIMAL CRITERIA FOR REJECTION MISLABELLED SPECIMEN, UNLABELED SPECIMEN, LEAKING SPECIMEN, QUANTITY NOT SUFFICIENT, DELAY IN TRANSPORT, IMPROPER TRANSPORT TEMPERATURE, AND INCORRECT PRESERVATIVE. 24 HOUR POOLED URINE OR SPUTUM COLLECTIONS ARE NOT ACCEPTABLE. STORAGE/ TRANSPORT SJMO: TRANSPORT TO LAB IMMEDIATELY. FOR LOCATIONS OTHER THAN SJMO: REFRIGERATE AFTER COLLECTION & DURING TRANSPORT. TRANSPORT TO LAB WITHIN 24 HOURS IS OPTIMAL LABORATORY PROCEDURE: AFB SPECIMEN REQUIREMENTS RETURN TO TEST DIRECTORY CREATED BY: CAY UPDATED: 10/10/10 RETURN TO HOME PAGE SJMO LABORTORY MICROBIOLOGY VISUAL AIDS St. Joseph Mercy Oakland Laboratory Visual Aid SPECIMENS FOR ANAEROBIC CULTURE Acceptable Specimens: aspirated pus, tissue, body fluids, suprapubic urine TTA and lung aspirates. Tissues fluids and aspirates are always preferred over swab samples. Unacceptable Specimens: throat, NP swabs, sputum, gastric contents, feces, swabs from decubitus ulcers, skin, voided urine, stool, prostatic or seminal fluid and vaginal or cervical swabs. Always submit an aerobic swab with an anaerobic swab. Submit in anaerobic transport container or for fluids and aspirates sterile container. Transport to Laboratory IMMEDIATELY. . LABORATORY PROCEDURE: ANAEROBIC CULTURE RETURN TO TEST DIRECTORY CREATED BY: CAY UPDATED: 02/10/10 RETURN TO HOME PAGE SJMO LABORTORY MICROBIOLOGY VISUAL AIDS quote text box.] RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORTORY MICROBIOLOGY VISUAL AIDS St. Joseph Mercy Oakland Laboratory Visual Aid BLOOD CULTURE COLLECTION DO NOT COVER BAR CODES ON BOTTLES! DO NOT USE EXPIRED BOTTLES! Adult Blood Culture Set Pediatric Bottle SKIN ANTISEPSIS: ●Skin antisepsis is critical. Clean skin with CHG (Chlorhexidene gluconate) swab or scrub. Air-dry for 30 seconds. Collect sample. ●DO NOT use CHG is infants <2 months of age. Alcohol + iodine should be used for skin antisepsis in infants <2 months old. ●For allergy to CHG or iodine, clean site with alcohol 3 times prior to drawing blood culture. ●Avoid drawing from lines. If line draw required, please order as catheter draw and indicate on bottle. To diagnose line sepsis often one set is drawn thru the catheter and the second set is peripheral. NUMBER OF SETS: ●Collect two blood cultures in adult patients. A set consists of an aerobic + an anaerobic bottle. ●For pediatric patients, a single pediatric bottle is usually sufficient. ●Order of more than two sets in a 24-hour period requires Pathology approval. TIMING: ●For orders of BLOOD CULTURE x2, It is not necessary to collect the cultures 10-30 minutes apart. Blood culture x2 may be collected “back-to back” from two different venipuncture sites. ●Always collect blood culture as close to the patient’s fever spike as possible. ●Subacute bacterial endocarditis requires multiple blood cultures spaced at defined intervals. VOLUME OF DRAW: ●Aerobic bottle 5-10 ml acceptable, 8-10 ml optimal ●Anaerobic bottle: 3-7 ml acceptable, 5-7 ml optimal ●Pediatric Bottle: 1-3 ml required ●DO NOT OVERFILL OR UNDERFILL BOTTLES AS THIS MAY AFFECT RECOVERY. SPECIAL COLLECTIONS: ●Recovery of yeast, fungus and AFB require collection of 2 yellow SPS Vacutainers. Obtain from Lab. ●Notify Lab if Brucella is suspected. LABORATORY PROCEDURE: BLOOD CULTURE RETURN TO TEST DIRECTORY CREATED BY: CAY UPDATED: 02/10 RETURN TO HOME PAGE SJMO LABORTORY MICROBIOLOGY VISUAL AIDS St. Joseph Mercy Oakland Laboratory Visual Aid COLLECTION OF A CLEAN-CATCH URINE SPECIMEN 1. Unscrew the cap of the urine specimen cup. Place the cup on the counter. Place the cap on the counter, face up. Do not touch the inside of the cup or cap. 2. Thoroughly cleanse genitalia with towelettes as follows: a. Male: − Wipe the head of the penis in a single motion with the first towelette. Repeat with two other towelettes. If not circumcised, hold the foreskin back before cleansing. − Urinate a small amount in the toilet. − Proceed to the next step. b. Female: − Separate the labia. Wipe the inner labial folds front to back in a single motion with two towelettes. Wipe down through the center of the labial folds with a third towelette. − Keep the labia separated, and urinate a small amount into the toilet. − Proceed to the next step. 3. Place the cup under the stream of urine, and continue to urinate into the cup. 4. Finish voiding into the toilet. 5. Place the cap on the cup. 6. Label the specimen and transport to the laboratory immediately. If a delay in transport is expected the specimen should be refrigerated or placed into a urine preservative tube (see below). LABORATORY PROCEDURE: CCMS URINE COLLECTION RETURN TO TEST DIRECTORY CREATED BY: CAY UPDATED: 02/10/10 RETURN TO HOME PAGE SJMO LABORTORY MICROBIOLOGY VISUAL AIDS St. Joseph Mercy Oakland Laboratory Visual Aid COLLECTION OF AN EYE CULTURE Conjunctival Swab 1. Sample both eyes with separate swabs (premoistened with sterile saline) by rolling over each conjunctiva. 2. Insert swab into collection/transport tube. 3. If desired, use additional swab to collect material for smear. Apply to clean glass slide for staining. Corneal Scrapings 1. Obtain conjunctival swab as described above. 2. Instill 1-2 drop of local anesthetic. 3. Using a sterile spatula scrape ulcers/lesions and inoculate directly onto media. 4. Apply remaining material to 1-2 clean glass slides for staining. It is generally recommended that swabs for conjunctival culture be taken prior to anesthetic application, whereas corneal scrapings are obtained after. LABORATORY PROCEDURE: EYE CULTURE RETURN TO TEST DIRECTORY CREATED BY: CAY UPDATED: 02/10/10 RETURN TO HOME PAGE SJMO LABORTORY MICROBIOLOGY VISUAL AIDS St. Joseph Mercy Oakland Laboratory Visual Aid FECAL TESTING STOOL CULTURE: Detects Salmonella species, Shigella species, Campylobacter and enterohemorrhagic/shiga-toxin producing E. coli. Culture for Vibrio, Yersinia performed with special request. Collect at least 2 samples to rule out bacterial gastroenteritis. OVA AND PARASITE EXAM and PARASITE ANTIGEN: Detects protozoans and parasites found in stool samples. Collect at least two specimens to rule out parasitic infection. Prompt transport is required for fresh stool, especially when protozoan infections suspected. PINWORM COLLECTION: Sticky paddle for Pinworm Collection (Device type May vary) GIARDIA ANTIGEN: Detects presence of Giardia lamblia in stool. LABORATORY CREATED BY: CAY PROCEDURE: FECALkit TESTING UPDATED: 02/10/10 Collect stool using same as for parasites. If both ova and parasite exam and Giardia antigen are ordered, collection of one set of vials is sufficient. If both parasite exam Giardia(Enterobius antigen only one collection kit is needed. Detects infection withand pinworm vermicularis). RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORTORY MICROBIOLOGY VISUAL AIDS St. Joseph Mercy Oakland Laboratory Visual Aid COLLECTION OF A URINE CULTURE FROM AN INDWELLING CATHETER 1. Disinfect the catheter collection port with 70% alcohol. 2. Aseptically, collect 5-10 mLs of urine using a needle/syringe. 3. Transfer urine to a Gray Top (Urine Culture) Vacutainer tube or a sterile cup. 4. Transport to Laboratory. 5. Stability: Gray top Urine Culture Vacutainer: 48 hours at room temperature. Sterile Cup: 2 hours at room temperature, 24 hours if refrigerated. Urine samples collected directly from indwelling catheter bags are NOT acceptable for culture. Foley catheter tips cannot be cultured. X CORRECT INCORRECT LABABORATORY PROCEDURE: FOLEY URINE COLLECTION RETURN TO TEST DIRECTORY CREATED BY: CAY UPDATED: 07/10/10 RETURN TO HOME PAGE X SJMO LABORTORY MICROBIOLOGY VISUAL AIDS St. Joseph Mercy Oakland Laboratory Visual Aid COLLECTION OF A VAGINAL RECTAL SPECIMEN FOR GBS Make sure swab is labeled with name, MRN or date of birth and date and time of collection. GBS swabs should be collected between 35-37 weeks of gestation. LABORATORY PROCEDURE: GBS COLLECTION RETURN TO TEST DIRECTORY CREATED BY: CAY UPDATED: 02/10/10 RETURN TO HOME PAGE SJMO LABORTORY MICROBIOLOGY VISUAL AIDS St. Joseph Mercy Oakland Laboratory Visual Aid GENITAL TESTING GENITAL CULTURE (GCA/GCAD): ●Detects Neisseria gonorrhoeae, yeast in significant numbers, Gardnerella vaginalis, Group B Streptococcus. ●Store at room temperature. DO NOT REFRIGERATE. ●NOTE: Gardnerella vaginalis is best detected by Vaginitis probe (VAG DNA) or gram stain. ●Collect vaginal/rectal swab and order Group B Strep Screen for detection of GBS in pregnant patients. CHLAMYDIA TRACHOMATIS/NEISSERIA GONORRHOEAE PROBE (APTIMA/CHGCRNA): ●Cervix and urethra are acceptable specimens. ●For females use white swab for cleaning; discard. ●For males and females collect specimen with blue swab. ●Use only swab provided with kit. ●Submit blue swab in Aptima Unisex Collection tube. VAGINITIS PROBE DNA): NOTE: Urine can be (AFFIRM/VAG tested, but requires first void specimen and special transport kit. ●Detects Gardnerella vaginalis, Trichomonas vaginalis and Candida species. ●Use only swab provided with kit. ●Preservative stabilizes specimen for 72 hours. HERPES SIMPLEX PCR: ●Submit genital swab or swab of lesion in viral transport medium. Refrigerate until transport. LABORATORY PROCEDURE: GENITAL TESTING RETURN TO TEST DIRECTORY CREATED BY: CAY UPDATED: 008/18/14 RETURN TO HOME PAGE SJMO LABORTORY MICROBIOLOGY VISUAL AIDS St. Joseph Mercy Oakland Laboratory Visual Aid COLLECTION OF A NASOPHARYNGEAL (NP) SPECIMEN The technique described below can be used for Rapid Influenza testing, Rapid RSV, Bordetella pertussis PCR/culture and viral culture for some agents. 1. Immobilize the patient's head. 2. Gently insert nasopharyngeal swab into a nostril until the posterior nares is reached. 3. Leave the swab in place for up to 10 seconds. This procedure may induce coughing and tearing. If resistance is encountered during insertion of the swab, remove it and attempt insertion of the opposite nostril. 4. Remove the swab slowly. 5. Place in transport media. (VIRAL TRANSPORT FOR FLU, RSV, VIRAL CULTURE AND PERTUSSIS PCR.) LABORATORY PROCEDURE: NP SPECIMEN CODE: RSC PERTUSSIS or INFLUAB OR RSV OR VIRAL CULTURE * RETURN TO TEST DIRECTORY CREATED BY: CAY UPDATED: 08/14/14 RETURN TO HOME PAGE SJMO LABORTORY MICROBIOLOGY VISUAL AIDS St. Joseph Mercy Oakland Laboratory Visual Aid COLLECTION OF A SPUTUM SAMPLE 1. Before collecting a sputum specimen, the patient should rinse his mouth with water and remove dentures. Rinsing the mouth lessens the contamination of sputum specimens from oropharyngeal secretions and their associated normal oral flora. 2. Sputum specimens must contain lower respiratory tract secretions. 3. Patients should be instructed to cough as deeply as possible. Appropriately collected induced specimens or aspirations are recommended for adult patients who cannot produce acceptable sputum samples. Consultation with Respiratory Therapy may be required. 4. Collect the sputum specimen generated from a deep, productive cough in a clean, sterile specimen cup. The traps used with suction devices are also acceptable. 5. The specimen should be refrigerated and transported to the laboratory immediately. First morning sputum specimens are the best, especially if a Mycobacteria (AFB) culture has been ordered. Expectorated sputum specimens are unacceptable for Pneumocystis testing. An induced sputum or bronchoscopy specimen should be submitted. LABORATORY PROCEDURE: SPUTUM CULTURE RETURN TO TEST DIRECTORY CREATED BY: CAY UPDATED: 08/08/12 RETURN TO HOME PAGE SJMO LABORTORY MICROBIOLOGY VISUAL AIDS St. Joseph Mercy Oakland Laboratory Visual Aid COLLECTION OF A STOOL CULTURE SAMPLE The ideal specimen for a stool culture is a non-formed, preferably diarrheal, sample. Bacterial enteric pathogens should not be ruled out based on a single negative specimen; therefore multiple specimens should be collected. Two separate specimens, collected on different days, should be obtained. Routine stool culture will not be performed on patients hospitalized for more than 4 days. 1. Collect the stool by placing a piece of plastic under the seat of the toilet or collecting in the sample collector provided. Transfer the specimen to a sterile specimen cup. 2. The specimen should be transported to the laboratory immediately. 3. Specimens should be stored at room temperature prior to transportation to the Laboratory. Routine culture includes culture for Salmonella, Shigella, Enterohemorrhagic E. coli and Campylobacter. If other bacterial enteric pathogens, mycobacteria, parasites or viruses (rotavirus) are suspected, tests for these organisms must be ordered separately. Ova and Parasite Examination and Cryptosporidium/Giardia antigen also require separate order. LABORATORY PROCEDURE: STOOL CULTURE RETURN TO TEST DIRECTORY CREATED BY: CAY UPDATED: 02/10/10 RETURN TO HOME PAGE SJMO LABORTORY MICROBIOLOGY VISUAL AIDS St. Joseph Mercy Oakland Laboratory Visual Aid COLLECTION OF A THROAT SPECIMEN 1. Shine a bright light into the oral cavity of the patient so that the swab can be guided to the posterior pharynx. 2. The patient is instructed to tilt his/her head back and breathe deeply. 3. Depress the tongue with a tongue depressor to help visualize the posterior pharynx. 4. Use a sterile Dacron swab. Extend the swab to the back of the throat between the tonsil pillars and behind the uvula. 5. Have the patient phonate a long ‘aah’ which will lift the uvula and help to prevent gagging. 6. The tonsil areas and posterior pharynx should be firmly rubbed with the swab. 7. Care should be taken not to touch the teeth, cheeks, gums or tongue when inserting or removing the swab to minimize contamination with normal mouth flora. LABORATORY PROCEDURE: THROAT CULTURE RETURN TO TEST DIRECTORY CREATED BY: CAY UPDATED: 02/10/10 RETURN TO HOME PAGE SJMO LABORTORY MICROBIOLOGY VISUAL AIDS St. Joseph Mercy Oakland Laboratory Visual Aid COLLECTION OF A WOUND CULTURE All wound cultures must be clearly labeled with specific designations as to the site and nature of the wound. Example: Abscess from right thumb or drainage from trach site. Simply labeling as “Wound Culture” is not acceptable. THE COLLECTION OF FLUID OR TISSUE IS PREFERABLE TO THE COLLECTION OF SPECIMENS ON SWABS. 1. Open transport swab pack, and peel apart at the point labeled “TO OPEN” until the swab cap is visible. 2. Remove the sterile swabs and collect the specimen. a. The collection of superficial cultures is discouraged. b. Pass the swabs deep into the lesion to firmly sample the lesion’s fresh border. 3. Remove the transport tube of medium from the package. 4. Remove and discard the cap from the tube. Place the swabs into the medium, and push the swab cap firmly onto the tube. 5. Label and send to the Laboratory immediately. 6. Specimens should be stored at room temperature prior to transportation to the Laboratory. 7. Anaerobic cultures are useful for deep wounds and those involving the gastrointestinal or genitourinary tracts. A foul odor and copious pus are indications that an anaerobic culture should be requested. A special anaerobic swab (shown below) is required. Never submit an anaerobic swab alone. Anaerobic infections are usually mixed and require an aerobic plus anaerobic swab. Aerobic Swab LABORATORY PROCEDURE: WOUND RETURN TO TEST DIRECTORY Anaerobic Swab CREATED BY: CAY UPDATED: 02/10/10 RETURN TO HOME PAGE SJMO LABORTORY MICROBIOLOGY VISUAL AIDS RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORTORY MICROBIOLOGY VISUAL AIDS DISEASE/SYMPTOMS VIRUSES RECOMMENDED SPECIMEN Cardiac Myocarditis and Pericarditis Coxsackie B 1-5 Echovirus Pericardial fluid, throat swab Pericardial fluid, throat swab Congenital and Neonatal Infections Rubella Cytomegalovirus Herpes Simplex Virus Enterovirus Varicella-Zoster Virus CSF, throat, urine Urine, throat, blood, tissue, CSF CSF, throat, brain biopsy, vesicle CSF, throat, stool, brain biopsy, autopsy Vesicle, throat Gastrointestinal/Gastroenteritis Adenovirus Astrovirus Norovirus Rotavirus Herpes Simplex Virus Stool Stool Stool Stool Genital swab, vesicle swab, vesicle fluid Malaise Syndrome Cytomegalovirus Epstein-Barr Virus Blood, urine, throat swab Serological testing only Neurologic Aseptic Meningitis and Encephalitis Adenovirus Arbovirus Cytomegalovirus Enterovirus Herpes Simplex Virus LCM Measles Mumps Parechovirus Varicella-Zoster Virus CSF, brain biopsy, blood CSF, brain biopsy, blood Brain biopsy, CSF CSF, throat swab, stool, brain biopsy CSF, brain biopsy, blood Serological testing only CSF, urine CSF, urine CSF, stool CSF, brain biopsy, skin lesions Ocular Conjunctivitis and Keratitis Adenovirus Cytomegalovirus Enterovirus Herpes Simplex Virus Varicella-Zoster Virus Eye swab Eye swab Eye swab Corneal or conjunctival scrapings Eye swab, corneal or conjunctival scrapings Genital Infections RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORTORY MICROBIOLOGY VISUAL AIDS DISEASE/SYMPTOMS VIRUSES RECOMMENDED SPECIMEN Respiratory Tract Infections Adenovirus Enterovirus human Metapneumovirus Influenza A/B Parainfluenza 1/2/3 Rhinovirus RSV SARS NP swab, transtracheal aspirate, throat swab NP swab, throat swab NP, throat swab, bronchial wash, lung tissue NP, throat swab, sputum NP, throat swab NP, throat swab NP swab, aspirate or wash NP, throat swab, bronchial wash, lung tissue Respiratroy Pneumonia Adenovirus Cytomegalovirus Herpes Simplex Virus human Metapneumovirus Influenza A/B Parainfluenza 1/2/3 RSV SARS Varicella-Zoster Virus Throat swab, nasopharyngeal (NP), bronchial wash, tissue Urine, throat swab, lung tissue, blood, bronchial wash Throat swab, bronchial wash, lung tissue, oral lesion, blood NP, throat swab, bronchial wash, lung tissue Throat wash, sputum, lung tissue, NP, bronchial wash Throat swab, sputum, lung tissue, NP, bronchial wash NP, bronchial wash, lung tissue NP, throat swab, bronchial wash, lung tissue Lung tissue, bronchial wash, skin lesions, blood Skin /Cutaneous Enterovirus Herpes Simplex Virus HHV-6 Measles Parvovirus B19 Rubella Varicella-Zoster Virus Vesicle swab, throat swab, stool Vesicle swab Serology/PCR Blood, throat swab Serology/PCR Throat swab, CSF, urine Scrapings from fresh vesicle Exanthems and Enanthems RETURN TO TEST DIRECTORY RETURN TO HOME PAGE RETURN TO TEST DIRECTORY RETURN TO HOME PAGE ; Patient Collection Instructions REMARKABLE MEDICINE. REMARKABLE CARE. SJMO LABORATORY PATIENT INSTRUCTIONS Click on the links below for printable patient collection instructions. Clostridium difficile Toxin A/B or Rotavirus Antigen Collection Fecal Occult Blood Collection Ova and Parasite Collection Pinworm Collection Semen Collection - Fertility Semen Collection - Post Vasectomy Sputum Collection Stool Collection Urine Culture Collection Urine Collection RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY PATIENT INSTRUCTIONS Clostridium difficile Toxin A/B or Rotavirus Antigen Collection Patient Instructions St. Joseph Mercy Oakland 44405 Woodward Pontiac, Michigan 48341 1-248-858-3600 Your physician has ordered a laboratory test which will require you to collect a stool sample. Please follow the instructions below to ensure accurate results Step 1. 2. 3. 4. Instructions Confirm the collection container is labeled correctly with: your (the patient) first and last name, the date and time of collection, and another identifier such as date of birth or medical record number. Incorrectly or incompletely labeled specimens will not be tested. Do not use laxatives, antacids or antidiarrheal medication for at least 1 week before collection of the specimen. First pass urine into the toilet (if you have to). Collect the stool specimen in the container provided or place a large plastic bag/plastic wrap may be placed over the toilet opening (but under the toilet seat) and the stool specimen passed onto the plastic. The stool specimen must not come in contact with water or urine. 5. 6. 7. 8. 9. 10. Note: For small children having diarrhea, fasten plastic kitchen wrap to the diaper using childproof safety pins or turn the diaper inside out. After the bowel movement, remove stool from the liner and transfer it into the collection vial. Stool collected in diapers is not acceptable. Carefully unscrew the cap from the plastic collection container. Do not touch the inside of the lid or container with your fingers. Using the applicator stick, fill the container half full. Do not add any foreign materials such as toilet paper or plastic wrap. Collect stool from areas that look bloody, mucoid or watery. Close the screw cap tightly. Seal the container in the zip locked section of the bag and requisition in the pouch section of the bag. Wash your hands with soap and water. Bring the container and lab requisition to the laboratory as soon as possible (within 18 hours). Keep the sample refrigerated/cold until it is brought to the lab. Prolonged delays will affect the test results. 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY PATIENT INSTRUCTIONS Fecal Occult Blood Patient Instructions St. Joseph Mercy Oakland 44405 Woodward Pontiac, Michigan 48341 1-248-858-3600 Your physician has ordered a laboratory test which will require you to collect a stool sample. Please follow the instructions below to ensure accurate results Step 1. 2. 3. 4. 5. 6. 7. 8. Open the collection kit provided by your physic. Place the collection paper inside the toilet. A piece of plastic wrap stretched over the toilet bowl may also be used. Have a bowel movement on the paper or plastic. Remove the green cap with probe from the bottle, Scrape the stool with the probe. Return the probe to the vial. Seal tightly. Complete the information on the label. Write your name, date of birth and collect date. Package and mail immediately. Test must be received within 15 days of collection. 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY PATIENT INSTRUCTIONS Ova and Parasite Examination Patient Instructions WARNING: The preservative in the collection containers are poisonous. Keep out of reach of children. Step Instructions 1 Confirm the collection container is labeled correctly with: your (the patient) first and last name the date and time of collection date of birth. Incorrectly or incompletely labeled specimens will not be tested. 2 Do not use laxatives, antacids or antidiarrheal medication for at least week before collection of the specimen. If these medications were used within the last week, the detection of some parasites may be compromised. 3 Collect the stool specimen in a clean wide-mouthed container (e.g. paper plate or ice cream pail) or a large plastic bag/plastic wrap may be placed over the toilet opening (but under the toilet seat) and the stool specimen passed onto the plastic. The stool specimen must not come in contact with water or urine. Note: For small children having diarrhea, fasten plastic kitchen wrap to the diaper using child proof safety pins. After the bowel movement, remove stool from the liner and transfer it into the collection vials. Alternately the diaper may be put on “inside –out” with the outer plastic next to the child’s skin. Please do this at home. Stool submitted in diapers cannot be accepted for testing. Carefully unscrew the cap from the plastic collection container. Do not touch the inside of the lid or container with your fingers. 4 5 Using the fork/spoon which is attached to the lid of the preservative container, place scoopfuls of stool into the containers especially from areas that look bloody, mucousy or watery. 6 Add stool until the liquid comes to the ‘FILL LINE’ on the container. Do not overfill. Mix thoroughly with the fork/spoon. Do not add any foreign materials such as toilet paper or plastic wrap. . Close the screw cap tightly. If using container with preservative, shake the container several times. . Seal the container in the zip locked section of the bag. Put the Patient History Sheet and lab requisition in the pouch section of the bag. Wash your hands with soap and water. Bring the container, requisition, and Patient History Sheet to any laboratory as soon as possible (within 18 hours). Keep the sample at room temperature until it is brought to the lab. DO NOT refrigerate it. Prolonged delays will affect the test results. 7 8 9 RETURN TO TEST DIRECTORY 07/14 RETURN TO HOME PAGE SJMO LABORATORY PATIENT INSTRUCTIONS Pinworm Collection Patient Instructions St. Joseph Mercy Oakland 44405 Woodward Pontiac, Michigan 48341 1-248-858-3600 Your physician has ordered a laboratory test which will require you to collect a sample for pinworm examination. Please follow the instructions below to ensure accurate results Step Instructions 1. Confirm the collection container is labeled correctly with: your (the patient) first and last name, the date and time of collection, and another identifier such as date of birth or medical record number. Incorrectly or incompletely labeled specimens will not be tested. 2. 3. The ideal time for this procedure is early in the morning before emptying the bowels. Unscrew the cap from the container. Inside the container is a plastic paddle. One side of the paddle is coated with a non-toxic, mildly sticky material. Do not touch the sticky surface with your fingers. Using moderate pressure, press the sticky surface against the skin surrounding the anus. Place the paddle back into the container and tighten the cap. Seal the container in the zip-locked section of the bag and lab requisition in the pouch section of the bag. Wash your hands with soap and water. Bring the container and requisition to the laboratory as soon as possible. Prolonged delays will affect the test results. 4. 5. 6. 7. 8. 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY PATIENT INSTRUCTIONS Semen Sample Patient Instructions Fertility Specimen St. Joseph Mercy Oakland 44405 Woodward Pontiac, Michigan 48341 1-248-858-3600 FERTILITY SPECIMENS: Planning Collect specimen for semen analysis between two days and seven days from the time of most recent ejaculation. Semen specimens are accepted in the Hematology laboratory Monday through Friday from 7:30 AM until 2:30 PM. If you have questions or need directions, please call the Hematology laboratory at 248-858-3249. Specimen must be delivered to the laboratory within one hour of collection, which is most easily accomplished if it is collected at the hospital (in one of the rest rooms). Specimen can be collected at home provided that it can be delivered to the hospital within one hour. Collection Collect the specimen by masturbation using the supplied container to catch the entire specimen. Do not use lubricants or other substances that may contaminate the specimen. Inform lab staff if part of the specimen is not caught. Do not use a condom to collect the specimen; condoms can kill or damage sperm, and it is impossible to get the entire sample out of a condom. Make note of the time that the specimen is collected. That time will need to be indicated on the request form in the lab. Delivery The specimen must be kept at room or body temperature while being transported; if it is cooled (below or 64F) or heated (above or 104F) it will be ruined. The specimen and accompanying paperwork should be delivered directly to the laboratory in the basement of the hospital. (Hematology lab is in the basement. Take the G wing elevators down to LL.) You need not stop at the hospital registration desk. Be sure to give the specimen directly to a technologist to ensure that it is examined while still fresh. Make sure that the entire request form (that you will be given in the lab) is filled in before leaving the laboratory or your sample cannot be processed. Bring your Physician’s order, insurance information, and your driver’s license with you. 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY PATIENT INSTRUCTIONS Semen Sample Post-Vasectomy Testing Patient Instructions St. Joseph Mercy Oakland 44405 Woodward Pontiac, Michigan 48341 1-248-858-3600 BEFORE COLLECTION: • Do not ejaculate (either through sexual intercourse or masturbating) for at least 3 days before collection. COLLECTION: • Collect a sample in the sterile container provided by the laboratory. Do not collect the sample in a condom. Condoms contain a powder that destroys spermatozoa. AFTER COLLECTION: • Sample will ONLY be accepted if: 1) Collected in sterile container provided by laboratory or your doctor. Container must be labeled with patient’s first and last name AND date of birth NOTE: tests will not be done if the specimen is not labeled correctly 2) Delivered to the laboratory within one (1) hour of collection Keep the sample at body temperature (for example, place container in an inside pocket) from the time it is collected until it is delivered to the laboratory DO NOT place specimen in laboratory drop off box, give specimen directly to laboratory staff. 3) Delivered before 2pm Monday-Friday. Samples will not be accepted on weekends or holidays. 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY PATIENT INSTRUCTIONS Sputum Collection Patient Instructions St. Joseph Mercy Oakland 44405 Woodward Pontiac, Michigan 48341 1-248-858-3600 Your physician has ordered a laboratory test which will require you to collect a sputum sample. Please follow the instructions below to ensure accurate results. Step 1. 2. 3. 4. 5. 6. 7. 8. 9. 10 Instructions Confirm the collection container is labeled correctly with: •your (the patient) first and last name, •the date and time of collection, and •another identifier such as date of birth or medical record number. Incorrectly or incompletely labeled specimens will not be tested. The ideal time to collect the sample is early in the morning just after getting out of bed. However, sample may be collected at any time sputum is available to be produced. Gargle and rinse your mouth with water. Sputum collection for Culture and Sensitivity — Do not use mouthwash or brush teeth with toothpaste immediately before collection. Open the container and hold it very close to your mouth. Take as deep a breath as you can and cough, deeply from within the chest. Do not spit saliva into the container. The sample you cough should look thick and be white, yellow or green in color. A minimum of 5 mLs (approx .1 tablespoon) of sample is required. Close the container lid tightly and give sample to your caregiver right away. If you are at home, seal the sample in the zip locked section of the bag and the lab requisition in the pouch section of the bag. Bring the container and lab requisition to the laboratory as soon as possible. If unable to return the sample to the laboratory right away, the sample can be stored in the refrigerator for up to 24 hours. Prolonged delays will affect the test results. If your doctor has ordered multiple sputum cultures, collect only one specimen per day. Bring the sample to the laboratory within 18-24 hours of collection. 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY PATIENT INSTRUCTIONS - Stool Culture Collection Patient Instructions St. Joseph Mercy Oakland 44405 Woodward Pontiac, Michigan 48341 1-248-858-3600 Your physician has ordered a laboratory test which will require you to collect a stool sample. Please follow the instructions below to ensure accurate results Step 1. 2. 3. 4. Instructions Confirm the collection container is labeled correctly with: your (the patient) first and last name, the date and time of collection, and another identifier such as date of birth or medical record number. Incorrectly or incompletely labeled specimens will not be tested. Do not use laxatives, antacids or antidiarrheal medication for at least 1 week before collection of the specimen. First pass urine into the toilet (if you have to.) Collect the stool specimen in the container provided or a large plastic bag/plastic wrap may be placed over the toilet opening (but under the toilet seat) and the stool specimen passed onto the plastic. The stool specimen must not come in contact with water or urine. 5. 6. 7. 8. 9. 10. Note: For small children having diarrhea, fasten plastic kitchen wrap to the diaper using childproof safety pins or turn the diaper inside out. After the bowel movement, remove stool from the liner and transfer it into the collection vial. Stool collected in diapers is not acceptable for testing. Carefully unscrew the cap from the plastic collection container. Do not touch the inside of the lid or container with your fingers. Using the fork/spoon which is attached to the lid of each container, place scoopfuls of stool into the container especially from areas that look bloody, mucoid or watery. Add stool until the liquid comes to the ‘FILL LINE’ on the container. Do not overfill. Mix thoroughly with the fork/spoon. If multiple collections are required to reach the fill line, add some stool to both vials with each collection. Seal the container in the zip locked section of the bag and requisition in the pouch section of the bag. Wash your hands with soap and water. Bring the container and lab requisition to any laboratory as soon as possible (within 18 hours.) Keep the sample at room temperature until it is brought to the lab. Prolonged delays will affect the test results. 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY PATIENT INSTRUCTIONS Urine Culture Collection Patient Instructions St. Joseph Mercy Oakland 44405 Woodward Pontiac, Michigan 48341 1-248-858-3600 Your physician has ordered a laboratory test which will require you to collect a urine sample. Please follow the instructions below to ensure accurate results. Step 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Step 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Female Instructions: Remove the cap from the collection cup. Be careful not to touch the inside of the cup. Wash your hands with soap and water. Separate the folds of skin around the urinary opening. Cleanse the area around the urinary opening with the first towelette. Repeat using the second towelette. Void the first portion of urine into the toilet. As you continue to void, bring the collection cup into the “midstream” to collect the urine specimen. DO NOT touch the inside of the cup with the hands or any other body part. Void the remainder of urine into the toilet. Close the cup touching only the outside of the cap and cup. Label the specimen with your name, date of birth and date and time of collection. Wash your hands with soap and water. Give the specimen to the nurse or medical assistant. If collecting at home, refrigerate the specimen cup after collection and during transport to the Lab. Male Instructions: Remove the cap from the collection cup. Be careful not to touch the inside of the cup. Wash your hands with soap and water. Cleanse the penis using the first towelette beginning at the tip and working toward the base. Repeat with the second towelette. Void the first portion of urine into the toilet. As you continue to void, bring the collection cup into the “midstream” to collect the urine specimen. DO NOT touch the inside of the cup with the hands or any other body part. Void the remainder of urine into the toilet. Close the cup touching only the outside of the cap and cup. Label the specimen with your name, date of birth and date and time of collection. Wash your hands with soap and water Give the specimen to the nurse or medical assistant. If collecting at home, refrigerate the specimen cup after collection and during transport to the Lab. 07/14 Collect the specimen in the blue cup as described above. Fill the tubes contained in the kit if instructed to do so. The nurse or medical assistant may fill these for you. The gray tube is for culture. The yellow tube or tiger tube is for urinalysis. If you are given only a sterile cup without tubes, keep the urine sample cold after collection and during transport to the Lab or Physician’s office. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY PATIENT INSTRUCTIONS RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY ; SJMO Laboratory Test Directory REMARKABLE MEDICINE. REMARKABLE CARE. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY SJMO TEST DIRECTORY HOME PAGE Click below to link to an alphabetical list of tests performed in the SJMO Laboratory: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Tests not performed in the SJMO Laboratory are referred to Warde Medical Laboratory (WML)*. For information on tests not listed in the SJMO directory, please visit the WML website below or contact the SJMO Laboratory at 1-248-858-3600. *The SJMO Laboratory and Warde Medical Laboratory are members of Michigan Consolidated Laboratories (MCL). Tests not available at WML will be submitted to an alternate reference laboratory. WARDE MEDICAL LABORATORY TEST DIRECTORY RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CLICK ON THE TEST NAME IN THE LIST BELOW FOR TEST DETAILS: A ABO Group and RH Type Acetaminophen Acid Fast Culture Alanine Aminotransferase (ALT or SGPT) Albumin Alkaline Phospatase Ammonia Amylase Anaerobic Culture Antibody Elution Procedure Antibody Identification Antibody Screen (Indirect CoombsTest) Antibody Titer Antinuclear Antibody Antithrombin III Arthropod Insect ID ASO/Anti-Streptolysin O Aspartate Aminotransferase B Bacterial Antigen Bactericidal Level Band Counts Basic Metabolic Panel Beta Hydroxybutyrate (Quantitative) Bilirubin, Direct Bilirubin, Total Blood Gases Blood Culture Blood Urea Nitrogen (BUN) BNP B Natriuretic Peptide Body Fluid Culture Body Fluids, Cytology Bone Marrow Bone Marrow Culture Bordetella pertussis PCR Brushing, non-gynecologic cytology C C3 Complement C4 Complement C-Reactive Protein, High Sensitivity C-Reactive Protein Non-cardiac Calcium Carbon dioxide, Total RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY Carcinoembryonic Antigen (CEA) Catheter (IV) Culture Cell Count, Cerebrospinal Fluid (CSF) Cell Count, Miscellaneous Body Fluids Cerebrospinal Fluid (CSF) Culture Cerebrospinal Fluid Non-gynecologic Cytology Chlamydia Culture Chlamydia DFA (Microtrak) Chlamydia trachomatis Amplified Probe Chloride Cholesterol Cholesterol, HDL Cholesterol, LDL Chromosome Analysis Circulating Anticoagulant (Mixing Study) Clostridium difficile toxin, Molecular Complete Blood Count, CBC Comprehensive Metabolic Panel Consultation, Intraoperative Consultation Surgical Pathology Cord Blood Evaluation Cortisol Corynebacterium diphtheriae Culture Creatinine Creatinine Kinase Creatinine Kinase with CK-MB Fraction Crossmatch (Compatibility Testing) Cryptococcal Antigen (CSF/Serum) Cryptosporidium Stain/Antigen Cyst fluid, Non-gynecologic cytology D Digoxin Dimer Direct Antiglobulin Test (Direct Coombs) Direct Smear Only Gram stain E Ear Culture Electrolytes, Blood Eosinophil Smears (Urine Only) Estradiol Ethanol Eye Culture F Factor VIII Assay Factor IX Assay Factor 10A Inhibition RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY Fecal Occult Blood Fecal Reducing Substances Ferritin Fetal Fibronectin Fetal Hemoglobin Test Fibrinogen Fine Needle Aspiration, Deep Tissue Fine Needle Aspiration, Superficial Tissue Flow Cytometry, Lymph Node Folate Follicle Stimulating Hormone Fresh Frozen Plasma Frozen Tissue Section Rapid Screen for Malignancy Fungal Culture (Hair, Skin, Nail) Fungal Culture, Blood Fungal Culture, Other Source G Gamma Glutamyl Transpeptidase Gastric Occult Blood GC Screen (Culture) Genital Culture (Cervix, Vagina, Urethra, Prostate) Genital Culture (Other Source) Gentamicin Giardia Antigen Glucose, Fasting Glucose, Random Glucose, Spinal Fluid (CSF) Glucose Tolerance Test Group B Strep Screen (Genital) Gynecologic Cytology, Thin Prep PAP test Gynecologic Cytology, Thin Prep PAP test with Reflexive HPV H Haptoglobin HCG, Beta Qualitative HCG, Beta Quanitative HCG, Serum HCG, Urine Hemoglobin A1C Hepatitis A Antibody (IgM) Hepatitis B Core Antibody (IgM) Hepatitis B Surface Antibody Hepatitis B Surface Antigen Hepatitis C Antibody Herpes simplex PCR Human Immunodeficiency Virus (HIV), Antibody Screen Human Papillomavirus (HPV) DNA Probe, High Risk RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY I Immunofixation (Serum) Immunofixation (Urine) Immunoglobulins, Quantitative (IgG, IgA, IgM) Influenza A and B antigen Ionized Calcium Iron and Iron Binding Capacity J K Kidney Biopsy KOH Preparation L Lactate Dehydrogenase Lactic Acid Lamellar Body Counts Lead Legionella Culture Legionella Urinary Antigen Leukocyte Reduced Red Blood Cells Lipase Lipid Profile Lipoprotein Low Density, Direct Measurement Lithium Luteinizing Hormone Lyme Antibody M Magnesium Malaria Smear Microalbumin Mononucleosis Screen MRSA Screen Culture Mycoplasma/Ureaplasma Culture N Neisseria gonorrhoeae Amplified Probe Nipple Secretion, Non-gynecologic Cytology O Osmolality, Serum Osmolality, Urine Ova and Parasite Examination P Partial Thromboplastin Time Path CBC Path Eval RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY pH, Body Fluids pH, Feces Phenobarbital Phenytoin (Dilantin) Phospohorus, Blood Phospohorus, Urine Pinworm Preparation Platelet Function Analysis Platelets Plavix Response Test Potassium Prealbumin Progesterone Prolactin Prostate Specific Antigen Protein, Cerebrospinal Fluid Protein C Protein Electrophoresis Protein, Total Protein, Urine 24 hour Prothrombin Time (PT) Q R Rapid Strep Screen Respiratory Culture (Bronchial Wash, BAL) Respiratory Culture Induced Sputum Respiratory Culture, Expectorated Sputum Respiratory Screening Culture (Legionella, etc.) Respiratory Syncytial Virus (RSV) Antigen Reticulocyte Count Rheumatoid Factor Rotavirus Antigen Rubella IgG S Salicylate Sedimentation Rate Semen Analysis Semen Analysis, Post Vasectomy Skin Biopsy, Immunofluorescence Sodium Sodium, Urine Spore Check Sputum, Cytology Stool Culture Surgical Tissue RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY T T3, Free T3, Total T4, Free T4, Total Tegretol Testosterone, Total Throat Culture Thyroid Stimulating Hormone Tissue Culture Tissue Culture, Quantitative Tobramycin Toxoplasma, IgG Transferrin Triglycerides Troponin Tzanck Smear: Viral Studies for Herpes, Pemphigus U Uric Acid, Blood Urinalysis Urine Culture Urine Cytology Urine, Microscopic Urine Reducing Substances V Vaginitis Screen Vancomycin Virus Culture Vitamin B12 Vitamin D W Washing/Lavage Cytology: Bronchial Tracheal or Esophageal Wound Culture X Y Z RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY ; GENERAL LABORATORY TEST DIRECTORY RETURN TO TEST DIRECTORY REMARKABLE MEDICINE. REMARKABLE CARE. RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY ABO GROUP AND RH TYPE TEST NAME: ABO GROUP AND RH TYPE CPT CODE: 86900 & 86901 SPECIMEN REQUIREMENT: Pink top EDTA vacutainer tube COLLECTION REQUIREMENT: INPATIENTS: Name, Medical Record Number (MRN), date, and time of collection, initials of phlebotomist and A#. OUTPATIENTS: 2 patient identifiers, date of collection, initials of phlebotomist. METHOD: Agglutination LAB SECTION PERFORMING TEST: Blood Bank AVAILABILITY: Daily TURNAROUND TIME: 1 day 60 minutes for STATs GENERAL USE OF TEST: To identify a person’s blood type for any reason: compatibility, testing, prenatal workup. STORAGE REQUIREMENTS: Room temperature or at 1-8 C. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY ACETAMINOPHEN TEST NAME: ACETAMINOPHEN ALTERNATE TEST NAME: TYLENOL CPT CODE: 82003 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (lithium heparin) OR 0.5 mL serum from a gold top tube (SST). REFERENCE RANGE: 10-30 ug/mL CRITICAL VALUE: >100 ug/mL METHOD: Immunoassay LAB SECTION PERFORMING TEST: Chemistry COLLECTION REQUIREMENTS: Acetaminophen specimens should not be drawn earlier than 4 hours after ingestion. If the time of ingestion is not known, 2 or more blood samples taken at two or three hour intervals may be used to estimate acetaminophen half-life and assess toxicity. AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of specimens requested STAT will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Drug toxicity, monitoring therapeutic levels. LIMITATIONS: Alcohol and Phenobarbital may interfere by accelerating Acetaminophen toxicity. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2- 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY ALANINE AMINOTRANSFERASE TEST NAME: ALANINE AMINOTRANSFERASE ALTERNATE TEST NAME: ALT, SGPT CPT CODE: 84460 (ALT) SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube (SST). REFERENCE RANGE: Male: 17-63 U/L Female: 9-54 U/L METHOD: Enzymatic LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing. GENERAL USE OF TEST: Liver function SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for at least 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY ALBUMIN TEST NAME: ALBUMIN CPT CODE: 82040 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube (SST) REFERENCE RANGE: 0 – 1 mo: 2.6 – 4.1 g/dL 1 mo -6 mo: 2.8 – 4.6 g/dL 6 mo – 1 yr: 2.8 – 4.8 g/dL 1 yr – 150 yrs: 3.5 – 4.8 g/dL METHOD: Colorimetric LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing. GENERAL USE OF TEST: Nutritional status, blood oncotic pressure. LIMITATIONS: Albumin concentrations vary with posture. Results from an upright posture may be approximately 0.3 g/dL higher than those from a recumbent posture. Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to1 month. Samples will be capped and held for 5 days after testing. SPECIMEN PREPARATION: STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY ALKALINE PHOSPHATASE TEST NAME: ALKALINE PHOSPHATASE ALTERNATE TEST NAME: CPT CODE: 84075 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube (SST) REFERENCE RANGE: AGE 0 MOS to 1 MO 1 MO to 1 YR 1 YR – 3 YRS 3 YRS – 6 YRS 6 YRS – 9 YRS 9YRS – 12 YRS 12 YRS – 15 YRS 15-18 YRS >= 18 years FEMALE 75-316 IU/L 82 - 383 IU/L 104-345 IU/L 93-309 IU/L 69 -325 IU/L 42- 362 IU/L 74-390 IU/L 52-171 IU/L 38-126 IU/L MALE 48-406 IU/L 124 - 341 IU/L 108 - 317IU/L 93 - 309IIU/L 69 - 325 IU/L 51-332 IU/L 50 - 162 IU/L 47 - 119IU/L 38 - 126IU/L METHOD: Enzymatic LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing. GENERAL USE OF TEST: Liver function, bone disease. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2- 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY AMMONIA TEST NAME: AMMONIA CPT CODE: 82140 SPECIMEN REQUIREMENT: AMMONIA: The specimen of choice is sodium or lithium heparinized tubes (green top). Collect by standard venipuncture techniques and keep on ice. Centrifuge specimen immediately. Remove plasma from cells within 15 minutes of collection. Store at 2 - 8C in a tightly stoppered plain transport tube. REFERENCE RANGE: 19-60 ug/DL METHOD: Colorimetric LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of STAT specimens will be reported within 35 minutes of receipt in the laboratory. GENERAL USE OF TEST: Ammonia-hepatic failure, liver necrosis and Reyes Syndrome. LIMITATIONS: Failure to place sample on ice after collection or failure to promptly separate cells and plasma can result in falsely elevated levels of ammonia. SPECIMEN PREPARATION: Centrifuge specimen and remove the plasma from cells within 15 minutes of collection. STORAGE REQUIREMENTS: If not analyzed immediately, a tightly stoppered plasma sample is stable for up to 30 minutes when stored on ice. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY AMYLASE TEST NAME: AMYLASE CPT CODE: 82150 SPECIMEN REQUIREMENT: 0.5 mL serum from a gold top tube (SST) OR 0.5 mL plasma from a green top tube (heparin). REFERENCE RANGE: 0 – 1 MO: 0-18 IU/L 1 MO – 26 WKS: 0-43 IU/L 26 WKS – 1 YR: 0-81 IU/L 1 YR -18 YRS: 0 – 106 IU/L >18 YRS: 28-100 IU/L CRITICAL VALUE: >300 IU/L METHOD: Enzymatic LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of STAT specimens will be reported within 30 minutes of receipt in the laboratory. GENERAL USE OF TEST: Pancreatitis, obstruction in pancreatic duct and macroamylasemia. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen, separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY ANTIBODY ELUTION PROCEDURE TEST NAME: ANTIBODY ELUTION PROCEDURE CPT CODE: 86860 SPECIMEN REQUIREMENT: Pink top EDTA tube COLLECTION REQUIREMENT: EDTA vacutainer tubes INPATIENTS: Name, Medical Record Number (MRN), date, and time of collection, initials of phlebotomist and A#. OUTPATIENTS: 2 patient identifiers, date of collection, initials of phlebotomist. REFERENCE RANGE: Negative CRITICAL VALUE: Patient undergoing a delayed transfusion reaction. METHOD: Acid elution technique LAB SECTION PERFORMING TEST: Blood Bank AVAILABILITY: Daily TURNAROUND TIME: 1 day GENERAL USE OF TEST: Test is performed on patient’s red blood cells when a positive direct antiglobulin test is obtained, shortened red cell survival is suspected and patient has been transfused in the last three months. LIMITATIONS: The amount of antibody bound to the cells, dissociation of antibody during the washing procedure and degree to which immunoglobulin is denatured by low pH during dissociation. STORAGE REQUIREMENTS: Room temperature or at 1 - 8C. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY ANTIBODY IDENTIFICATION TEST NAME: ANTIBODY IDENTIFICATION CPT CODE: 86860 SPECIMEN REQUIREMENT: Pink EDTA vacutainer tube COLLECTION REQUIREMENT: INPATIENTS: Name, Medical Record Number (MRN), date, and time of collection, initials of phlebotomist and A#. OUTPATIENTS: 2 patient identifiers, date of collection, initials of phlebotomist. REFERENCE RANGE: Negative METHOD: Capture or agglutination LAB SECTION PERFORMING TEST: Blood Bank AVAILABILITY: Daily TURNAROUND TIME: 1 day (usually) GENERAL USE OF TEST: To identify an alloantibody in a sensitized patient. LIMITATIONS: This test is performed automatically when a positive antibody screening is obtained. SPECIMEN PREPARATION: None STORAGE REQUIREMENTS: Room temperature or at 1 - 8C. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY ANTIBODY TITER TEST NAME: ANTIBODY TITER CPT CODE: 86886 SPECIMEN REQUIREMENT: Pink EDTA vacutainer tube COLLECTION REQUIREMENT: INPATIENTS: Name, Medical Record Number (MRN), date, and time of collection, initials of phlebotomist and A#. OUTPATIENTS: 2 patient identifiers, date of collection, initials of phlebotomist. CRITICAL VALUE: A rise in antibody titer of more than two tubes over the previous sample suggests that HDN is possible. METHOD: Agglutination using anti-IgG monospecific reagents. LAB SECTION PERFORMING TEST: Blood Bank AVAILABILITY: Daily TURNAROUND TIME: 48 hours GENERAL USE OF TEST: To follow obstetrical patients to determine a change in titer of clinically significant antibodies known to cause HDN. STORAGE REQUIREMENTS: Room temperature or at 1 - 8C. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY ANTINUCLEAR ANTIBODY TEST NAME: ANTINUCLEAR ANTIBODY (Positive screens will be titered) CPT CODE: 86038, 86039 SPECIMEN REQUIREMENT: 0.5 mL serum from a gold top tube (SST) OR red top tube REFERENCE RANGE: Negative (less than 1:160) METHOD: Indirect fluorescent antibody HEP-2 substrate LAB SECTION PERFORMING TEST: Reference Laboratory AVAILABILITY: Screen Sunday-Friday , Titer: Monday-Friday TURNAROUND TIME: Results of screens will be available within 1 day All screens positive will be quantitated on the next scheduled run. GENERAL USE OF TEST: Collagen vascular diseases. LIMITATIONS: Some drugs, such as hydralazine and procainamide, may induce ANA. Grossly hemolyzed icteric or lipemic specimens cannot be used. SPECIMEN PREPARATION: Collect specimen using standard laboratory procedures. Centrifuge specimens; separate serum from cells within 2 hours of collection if possible. Store serum samples at 2-8C. Repeat freezing and thawing may cause deterioration of test specimen. STORAGE REQUIREMENTS: . Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY ANTIBODY SCREEN (Indirect Coombs Test) TEST NAME: ANTIBODY SCREEN (Indirect Coombs Test) CPT CODE: 86850 SPECIMEN REQUIREMENT: Pink EDTA vacutainer tube COLLECTION REQUIREMENT: INPATIENTS: Name, Medical Record Number (MRN), date, and time of collection, initials of phlebotomist and A#. OUTPATIENTS: 2 patient identifiers, date of collection, initials of phlebotomist. REFERENCE RANGE: Negative CRITICAL VALUE: Antibody detection on STAT request. METHOD: Capture or Agglutination LAB SECTION PERFORMING TEST: Blood Bank AVAILABILITY: Daily or STAT TURNAROUND TIME: 24 hours for routines 60 minutes for STATs GENERAL USE OF TEST: To determine if sensitization to red cell antigens has occurred. If screen is positive, antibody identification will be performed. PATIENT PREPARATION: An armband is required on inpatients and outpatients scheduled for transfusion so that positive patient identification can be established. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY ANTITHROMBIN III TEST NAME: ANTITHROMBIN III 85300 CPT CODE: SPECIMEN REQUIREMENT: Plasma from a blue top tube (sodium citrate) METHOD: Chromogenic detection LAB SECTION PERFORMING TEST: Reference Lab AVAILABILITY: Monday-Friday TURNAROUND TIME: 3 Days GENERAL USE OF TEST: Evaluation of antithrombin deficiencies associated with high risk of thromboembolic disorders. STORAGE REQUIREMENTS: See Reference Laboratory Instructions Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY ASO (STREPTOZYME) TEST NAME: ASO (STREPTOZYME) CPT CODE: 86060 SPECIMEN REQUIREMENT: Draw blood in a SST. Spin, separate and send 1.0 mL serum (0.5 mL minimum) refrigerated in a screw-capped plastic vial OR Plasma: EDTA, heparin (lithium) OR Serum: Red-top REFERENCE RANGE: Less than 200 IU/mL METHOD: Nephelometry LAB SECTION PERFORMING TEST: Reference Laboratory AVAILABILITY: Sunday through Friday TURNAROUND TIME: 1 Day GENERAL USE OF TEST: Serodiagnosis of recent streptococcal infections. LIMITATIONS: SPECIMEN PREPARATION: STORAGE REQUIREMENTS: False positives may be associated with liver disease or bacterial contamination of specimens. Streptococcal infections already treated with antibiotics may not produce increased results. Collect specimen using standard lab procedures. Centrifuge specimen; separate serum from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 72 hours. Samples are capped and held for 5 days after testing. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY ASPARTATE AMINOTRANSFERASE (AST or SGOT) TEST NAME: ASPARTATE AMINOTRANSFERASE (AST or SGOT) CPT CODE: 84450 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) or 0.5 mL serum from a gold top tube (SST) REFERENCE RANGE: 0-150 YRS: 15 – 41 IU/L METHOD: Enzymatic LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing. GENERAL USE OF TEST: Cardiac function or liver function. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY BAND COUNTS TEST NAME: BAND COUNTS Alternate TEST NAME: BANDS CPT CODE: SPECIMEN REQUIREMENT: Minimum of 1 ml lavender top tube (EDTA) OR 250 uL lavender microtainer COLLECTION REQUIREMENT: Test is only available for neonates under 3 months of age METHOD: Manual enumeration of percentage of bands per 100 WBCs LAB SECTION PERFORMING TEST: Hematology AVAILABILITY: Daily or STAT TURNAROUND TIME: GENERAL USE OF TEST: STORAGE REQUIREMENTS: Same shift testing Results of specimens requested STAT will be reported within 60 minutes of receipt in the laboratory. May be used to help manage febrile neonates. The validity of the band count has been questioned by many because of the imprecision of band numbers obtained from a 100 cell count and the variability in band identification. Sample must be analyzed within 24 hours of collection. Test may be added on if slide has already been made. Test may be added on if slide has already been made. Contact Lab for availability. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY BASIC METABOLIC PANEL TEST NAME: ALTERNATE TEST NAME: BASIC METABOLIC PANEL (Na, K, Cl, C02, Gluc, Bun, Calcium, Creatinine + GFR) BMP CPT CODE: 80048 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube (SST) REFERENCE RANGE: See individual tests CRITICAL VALUE: See individual tests METHOD: See individual tests LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of specimens requested STAT will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Evaluation of various serum biochemistry constituents. LIMITATIONS: Grossly hemolyzed or lipemic specimens. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY BETA HYDROXYBUTYRATE (QUANTITATIVE) TEST NAME: BETA HYDROXYBUTYRATE (QUANTITATIVE) CPT CODE: 82010 SPECIMEN REQUIREMENT: 1 mL plasma from a green top tube (heparin). REFERENCE RANGE: 0.02 – 0.27 mmol/L METHOD: Enzymatic LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. If ordered STAT, within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: To diagnose Diabetic Ketoacidosis (DKA) and monitor the results of treatment. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen, separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY BILIRUBIN, DIRECT TEST NAME: BILIRUBIN, DIRECT CPT CODE: 82248 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube (SST) REFERENCE RANGE: 0.1 – 0.5 mg/dL CRITICAL VALUE: 0-3 Mos.: >2.0 mg/dL METHOD: Colorimetric LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing. GENERAL USE OF TEST: Liver function test useful in the diagnosis of jaundice due to liver disease, hemolytic anemia. LIMITATIONS: Specimen must be protected from light. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. Protect specimen from light. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY BILIRUBIN, TOTAL TEST NAME: BILIRUBIN, TOTAL CPT CODE: 82247 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin). OR 0.5 mL serum from a gold top tube (SST) REFERENCE RANGE: AGE 0-1 Day 1 Day-2 Days 2 Days-5 Days >5 Days CRITICAL VALUE: RANGE 0-5.1 mg/dl 0-7.2 mg/dl 0-10.3 mg/dl 0.4-2.0 mg/dl >15.0 mg/dl METHOD: Colorimetric LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing. GENERAL USE OF TEST: Liver function test useful in the diagnosis of jaundice due to liver disease, hemolytic anemia. LIMITATIONS: Specimen must be protected from light. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. Protect specimen from light. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY BLOOD GASES (pH, pO2, pCO2, HCO3, TCO2, BE) TEST NAME: BLOOD GASES (pH, pO2, pCO2, HCO3, TCO2, BE) CPT CODE: 82803 SPECIMEN REQUIREMENT: REFERENCE RANGE: Whole blood in heparinized syringe obtained by arterial (ABG) or venous (VBG) puncture, cord blood (CBG) obtained by physician. Specimen should be transported immediately in ice slurry. Adult Normal Range Arterial: pH 7.35 – 7.45 pCO2 35 – 45 mmHg pO2 75-110 mmHg HCO3 22 – 26 mmol/L TCO2 22 – 27 mmol/L 0-4 Weeks Arterial: pH pCO2 pO2 Venous: 7.35 – 7.45 35 – 45 mmHg 50-80 mmHg pH pCO2 pO2 HCO3 TCO2 7.32 – 7.42 41 – 51 mmHg 25 – 40 mmHg 24 – 28 mmol/L 25 – 29 mmol/L Cord Blood Arterial pH 7.15 – 7.43 pCO2 31.1 – 74.3 mmHg pO2 3.8 – 33.8 mmHg HCO3 13.3 – 27.5 mmol/L CRITICAL VALUE: Venous 7.24 – 7.49 23.2 – 49.2 mmHg 15.4 – 48.2 mmHg 15.9 – 24.7 mmol/L pH <7.24 or >7.56 pCO2 <19 or >71 mmHg pO2 <54 mmHg 0-4 Weeks pH <7.24 or >7.48 pCO2 <33 or >62 mmHg pO2 <33 or >101 mmHg METHOD: RETURN TO TEST DIRECTORY Ion specific electrodes RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: All specimens handled as STAT. GENERAL USE OF TEST: Determination of acid-base status, respiratory function. LIMITATIONS: Clotted sample, liquid anti-coagulants can cause dilution effect if improper ratio of sample to anti- coagulant when collected, contamination with room air. Specimens must be submitted on ice immediately after being drawn. NOTE: O2 deliver or room air should be noted. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY BLOOD UREA NITROGEN (BUN) TEST NAME: BLOOD UREA NITROGEN(BUN) ALTERNATE TEST NAME: BUN CPT CODE: 84520 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube (SST). REFERENCE RANGE: 0 – 4 wks: 1 – 16 mg/dl 4 wks – 150 yrs: 5 - 25 mg/dl CRITICAL VALUE: 0 – 4 wks: >50 mg/dl 4 wks – 150 yrs: > 115 mg/dl METHOD: Enzyme conductivity LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of specimens requested STAT will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Evaluation of kidney function. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. STORAGE REQUIREMENTS: Refrigerate at 2 – 8C up to 48 hours. Samples will be capped and held for 5 days after testing. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY BNP (B Natriuretic Peptide) TEST NAME: BNP (B Natriuretic Peptide) CPT CODE: 83880 SPECIMEN REQUIREMENT: 1.0 mL from a lavender EDTA tube. (large EDTA tube required) REFERENCE RANGE: <100 pg/mL METHOD: Immunoenzymatic LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of STAT specimens will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Aid in the diagnosis and assessment of severity of congestive heart failure. LIMITATIONS: Concentrations may be elevated in patients: who are experiencing a heart attack who are candidates for renal dialysis who have had renal dialysis This test has been formulated to minimize the effects of antibodies on the assay. However, clinicians should carefully evaluate results from patients suspected of having such antibodies. SPECIMEN PREPARATION: Centrifuge sample and remove plasma within 7 hours of collection. STORAGE REQUIREMENTS: Plasma stored at room temperature or 2 - 8C is stable for 24 hours. Samples are capped and held for 5 days after testing. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY BODY FLUIDS, CYTOLOGY (Pleural fluid, Peritoneal fluid (Ascites fluid) & Pericardial Fluid) TEST NAME: BODY FLUIDS, CYTOLOGY (Pleural fluid, Peritoneal fluid (Ascites fluid) & Pericardial fluid) CPT CODE: 88108 SPECIMEN REQUIREMENT: 10-100 mL fresh body cavity fluid. The practice of salvaging large amounts of fluid is not recommended. If available, a full bottle of fresh unfixed fluid is preferred in addition to the aliquot. COLLECTION REQUIREMENT: Include 5 units of heparin per mL of fluid in a clean, sealed plastic or glass container. Submit fresh without fixative. REFERENCE RANGE: Negative for malignant cells. METHOD: Modified Papanicolaou LAB SECTION PERFORMING TEST: Cytology AVAILABILITY: Monday through Friday (0800 to 1630) TURNAROUND TIME: 24 – 72 hours GENERAL USE OF TEST: To establish the presence of primary or metastatic neoplasm. STORAGE REQUIREMENTS: Refrigerate Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY BONE MARROW TEST NAME: BONE MARROW CPT CODE: 85097 (Aspirate smears) 88305 (Clot) 88305 (Biopsy) 85060 (Peripheral blood smears) SPECIMEN REQUIREMENT: Bone marrow, aspirate and/or biopsy specimen. REFERENCE RANGE: Results interpreted by pathologist. METHOD: Microscopic examination of modified Wright’s Giemsa Stain, paraffin embedded tissue sections. LAB SECTION PERFORMING TEST: Hematology / Anatomic Pathology AVAILABILITY: Weekdays, 0730 to 1200 TURNAROUND TIME: GENERAL USE OF TEST: Bone marrow morphology PATIENT PREPARATION: Physician’s responsibility. Consent form signed. Physician’s office to schedule with Scheduling Department at 83777. Scheduling will send pink form to Hematology. If procedure is to be performed at bedside on floor, call Hematology for scheduling. Physician and technologist meet at bedside If cultures required, inform scheduler so that proper tubes will be collected. 24-32 hours in most cases Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY BRUSHING, NON-GYNECOLOGIC CYTOLOGY (Bronchial slides, Esophageal, Gastric, Small Bowel, Colonic) TEST NAME: BRUSHING, NON-GYNECOLOGIC CYTOLOGY (Bronchial slides, Esophageal, Gastric, Small Bowel, Colonic) ALTERNATE TEST NAME: CPT CODE: 88104, 88112-Thin Prep SPECIMEN REQUIREMENT: After brushing the lesion, Yes if slides are made Place brush tip in container with 30ml Cytolyt. Label slide with patient name. COLLECTION REQUIREMENT: Glass slides, container and 95% ETOH are ob0tained from the laboratory. REFERENCE RANGE: Negative for malignant cells. METHOD: Modified Papanicolaou LAB SECTION PERFORMING TEST: Cytology AVAILABILITY: Monday through Friday (0800 to 1630) TURNAROUND TIME: 24 – 72 hours GENERAL USE OF TEST: To establish the presence of primary or metastatic neoplasm. LIMITATIONS: Specimen is considered non-diagnostic if epithelium lining the site of the brush is not present. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY C3 COMPLEMENT TEST NAME: ALTERNATE TEST NAME: C3 COMPLEMENT C3 CPT CODE: 86160 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube OR 0.5 mL serum from a gold top tube (SST). REFERENCE RANGE: 79 – 152 mg/dL METHOD: Turbidimetric LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing and STAT within 60 minutes GENERAL USE OF TEST: Decrease in autoimmune diseases, serum sickness, acute glomerulonephritis and LE with renal involvement. Increase in acute phase responses, obstructive jaundice and some connective tissue diseases (excluding SLE). LIMITATIONS: Hemolyzed or lipemic specimens should not be used. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum from cells within 2 hours of collection. Store spun and separated serum samples at -15C to 8C. Samples will be held for 5 days after testing. STORAGE REQUIREMENTS: Repeat freezing and thawing may cause deterioration of test specimen. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY ‘ C4 COMPLEMENT TEST NAME: ALTERNATE TEST NAME: C4 COMPLEMENT C4 CPT CODE: 86160 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube OR 0.5 mL serum from a gold top tube (SST). REFERENCE RANGE: 16 - 38 mg/dL METHOD: Turbidimetric LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing + STAT within 60 minutes GENERAL USE OF TEST: To detect individuals with inborn deficiency of this factor or those with immunologic disease in whom hypercatabolism of complement causes reduced levels. These diseases include: Lupus, serum sickness, glomerulonephritis, chronic active hepatitis and others. LIMITATIONS: Hemolyzed or lipemic specimens should not be used. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum from cells within 2 hours of collection. Store spun and separated serum samples at -15C to 8C. Samples will be held for 5 days after testing. STORAGE REQUIREMENTS: Repeat freezing and thawing may cause deterioration of test specimen. Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY C-REACTIVE PROTEIN (High Sensitivity) TEST NAME: C-REACTIVE PROTEIN (High Sensitivity) CPT CODE: 86141 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top heparin tube OR serum from a gold top tube (SST) REFERENCE RANGE: <7.48 mg/L METHOD: Nephelometry LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of STAT specimens will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Used in evaluation of myocardial infarction, stress, trauma, infection, inflammation, surgery and neoplastic proliferation. LIMITATIONS: Hemolyzed or lipemic specimens should not be used. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum from cells within 2 hours of collection. Refrigerate a 2 - 8C up to 72 hours. Samples will be held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY C-REACTIVE PROTEIN (Non-Cardiac) TEST NAME: C-REACTIVE PROTEIN (Non Cardiac) ALTERNATE TEST NAME: CPT CODE: 86140 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top heparin tube OR 0.5 mL serum from a gold top tube (SST) . REFERENCE RANGE: <1.0 mg/dL METHOD: Turbidimetric LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing. GENERAL USE OF TEST: Used in evaluation of stress, trauma, infection, inflammation and surgery. LIMITATIONS: Hemolyzed or lipemic specimens should not be used. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CALCIUM TEST NAME: ALTERNATE TEST NAME: CALCIUM Ca CPT CODE: 82310 SPECIMEN REQUIREMENT: 0.5 mL serum from a gold top tube (SST) OR 0.5 mL plasma from a green top tube (heparin). REFERENCE RANGE: Age 0-1 Wk 1 Wk-1 Mo 1 Mo-3 Mo 3 Mo – 6 Mo 6 Mo – 1 Yr 1Yr – 3 Yrs 3 Yrs – 11 Yrs 11 Yrs- 13 Yrs 13 Yrs – 15 Yrs 15 Yrs – 19 Yrs 19 Yrs-150 Yrs Male 7.6 – 11.3 mg/dL 8.8 – 11.6 mg/dL 8.7 – 11.2 mg/dL 8.5 – 11.3 mg/dL 8.0 – 11.0 mg/dL 8.9 – 9.9 mg/dL 9.0 – 10.1 mg/dL 9.0 – 10.6 mg/dL 9.3 – 10.7 mg/dL 9.0 – 10.7 mg/dL 8.5 – 10.5 mg/dL Female 7.8– 11.2 mg/dL 8.6 – 11.8 mg/dL 8.2 – 11.0 mg/dL 8.0 – 11.4 mg/dL 8.0 – 11.0 mg/dL 8.9 – 9.9 mg/dL 9.0 – 10.1 mg/dL 9.0 – 10.6 mg/dL 9.3 – 10.7 mg/dL 9.0 – 10.7 mg/dL 8.5 – 10.5 mg/dL CRITICAL VALUE: <7.0 or >13.0 mg/dL METHOD: Ion Selective Electrode LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing Results of specimens requested STAT will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Evaluation of calcium metabolism. LIMITATIONS: RETURN TO TEST DIRECTORY Recumbent patients may have 0.2 – 0.3 mg/dL lower levels. Blood from patients on EDTA therapy cannot be used. Blood from patients on Hypaque radiographic contrast agent cannot be used. Blood collected w/stasis may have calcium concentrations 15% higher. RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY SPECIMEN PREPARATION: STORAGE REQUIREMENTS: R Protective gloves manufactured with calcium carbonate powders may cause elevated test results because of contamination of sample handling supplies. Use powder-free gloves; handle supplies with clean hands. Note: Gloves labeled as powder-free may contain some contaminating powder agents on the inside of the gloves. Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. R Revised 07/14. e v i s e d 0 7 / 1 4 . R e v i s e d 0 7 / 1 4 . RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CARBON DIOXIDE, TOTAL TEST NAME: CARBON DIOXIDE, TOTAL ALTERNATE TEST NAME: CO2 CPT CODE: 82374 SPECIMEN REQUIREMENT: 0.5 mL serum from a gold top tube (SST) OR 0.5 mL plasma from a green top tube (heparin). REFERENCE RANGE: 22 – 31 mmol/L CRITICAL VALUE: <10 or >40 mmol/L METHOD: pH rate change LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of specimens requested STAT will be reported within 30 minutes of receipt in the laboratory. GENERAL USE OF TEST: Evaluation of acid-base status. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CARCINOEMBRYONIC ANTIGEN TEST NAME: CARCINOEMBRYONIC ANTIGEN (CEA) ALTERNATE TEST NAME: CEA CPT CODE: 82378 SPECIMEN REQUIREMENT: 1 mL serum from a gold top tube (SST) or red top tube REFERENCE RANGE: Less than 3.0 ng/mL METHOD: Chemiluminescent immunoassay LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing. GENERAL USE OF TEST: Adjunctive aid in management of patients with gastrointestinal carcinoma. LIMITATIONS: SPECIMEN PREPARATION: STORAGE REQUIREMENTS: Not to be used as a screening test for the detection or the presence of cancer. Elevations in circulating levels may be observed in smokers, as well as patients with non-colorectal or pancreatic neoplasms. Patients who have been regularly exposed to animals or immunoglobulin fragments may produce antibodies that interfere with immunoassays. Collect specimen using standard lab procedures. Centrifuge specimen; separate serum from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. Revised 7/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CELL COUNT, CEREBROSPINAL FLUID (RBC, WBC, Total Cell Count & Differential when needed) TEST NAME: CELL COUNT, CEREBROSPINAL FLUID (RBC, WBC, Total Cell Count & Differential when needed) CPT CODE: 89051 SPECIMEN REQUIREMENT: 0.5 mL cerebrospinal fluid collected in sterile screw cap LP tubes, which are labeled #1, #2, #3 and #4. Cell counts will be performed on tube #3 3 REFERENCE RANGE: 0 – 5 cells/mm METHOD: Manual using hemocytometer LAB SECTION PERFORMING TEST: Hematology AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of specimens requested STAT will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Evaluation of cellular exudation into cerebral spinal space. LIMITATIONS: None STORAGE REQUIREMENTS: Cell count must be performed immediately due to rapid cell lysis on standing. Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CELL COUNT, MISC. BODY FLUIDS (RBC, WBC & Differential when needed) TEST NAME: CELL COUNT, MISC. BODY FLUIDS (RBC, WBC & Differential when needed) CPT CODE: 89050 SPECIMEN REQUIREMENT: Thoracentesis, paracentesis or other body fluids collected in a lavender top vacutainer tube (EDTA). METHOD: Manual using hemocytometer LAB SECTION PERFORMING TEST: Hematology AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of specimens requested STAT will be reported within 60-90 minutes of receipt in the laboratory. GENERAL USE OF TEST: Evaluation of pleural, pericardial or abdominal fluid accumulation to determine etiology. LIMITATIONS: Results may be affected if clotted or debris in the sample. STORAGE REQUIREMENTS: Cell count must be performed immediately due to rapid cell lysis on standing. Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CEREBROSPINAL FLUID NON-GYNECOLOGIC CYTOLOGY TEST NAME: CEREBROSPINAL FLUID NON-GYNECOLOGIC CYTOLOGY CPT CODE: 88112 SPECIMEN REQUIREMENT: 1-10 mL second or third tube. COLLECTION REQUIREMENT: Deliver to Cytology Laboratory immediately. After hours CSF, submit fresh. Do not add fixative. REFERENCE RANGE: Negative for malignant cells. METHOD: Modified Papanicolaou LAB SECTION PERFORMING TEST: Cytology AVAILABILITY: Monday through Friday (0800 to 1630) TURNAROUND TIME: One to two working days. GENERAL USE OF TEST: To establish the presence of primary or metastatic neoplasm. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CHLORIDE TEST NAME: ALTERNATE TEST NAME: CHLORIDE Cl CPT CODE: 82435 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube (SST) REFERENCE RANGE: 95 –111 mEq/L <70 OR >140 mEq/L CRITICAL VALUE: METHOD: Ion Selective Electrode LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of specimens requested STAT will be reported within 60 minutes of receipt in the laboratory. Decrease in overhydration, chronic respiratory acidosis and congestive heart failure. Increase in dehydration, renal tubular acidosis and excessive infusion of normal saline. GENERAL USE OF TEST: LIMITATIONS: Grossly hemolyzed specimens should be rejected for analysis. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CHOLESTEROL TEST NAME: CHOLESTEROL CPT CODE: 82465 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube (SST) REFERENCE RANGE: <200 mg/dL METHOD: Enzymatic LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing. GENERAL USE OF TEST: Increase in inherited defect lipoprotein metabolism, endocrine disease, renal disease and decreased liver function impairment. PATIENT PREPARATION: Fasting is preferred. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: The National Cholesterol Education Program has published reference cholesterol values for cardiovascular risk to be: Less than 200 mg/Dl 201 – 239 mg/Dl 240 mg/dL and greater Low risk Borderline risk High risk Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CHOLESTEROL, HDL TEST NAME: CHOLESTEROL, HIGH DENSITY (HDL) CPT CODE: SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL of serum from a gold top tube (SST) REFERENCE RANGE: 40-59 mg/dL METHOD: Detergent/enzymatic LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing. GENERAL USE OF TEST: Suspected coronary heart disease. LIMITATIONS: Fasting is preferred. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CHOLESTEROL, LDL TEST NAME: CHOLESTEROL, LDL (Calculated from total cholesterol, triglyceride and HDL cholesterol) ALTERNATE TEST NAME: LDL CPT CODE: SPECIMEN REQUIREMENT: 1.0 mL serum from a gold top tube (SST) OR plasma from a green top tube (heparin). REFERENCE RANGE: <100 mg/Dl METHOD: Calculation: LDL Cholesterol = T cholesterol – HDLC – Triglyceride/5 LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Monday – Friday TURNAROUND TIME: Daily GENERAL USE OF TEST: Prediction of risk of coronary arterial atherosclerosis. PATIENT PREPARATION: Fasting is preferred. LIMITATIONS: LDL cannot be accurately calculated on samples that have triglyceride levels greater than 400 mg/dL. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CHROMOSOME ANALYSIS TEST NAME: CHROMOSOME ANALYSIS ALTERNATE TEST NAME: Products of Conception or Stillbirth, Genetic Analysis CPT CODE: 88237, 88264 88305 SPECIMEN REQUIREMENT: 3cm products of conception, skin or fascia. 1cm of placenta (including chorionic villi). Patient history required. Sterile container containing sterile saline. Avoid contamination. COLLECTION REQUIREMENT: 3 3 REFERENCE RANGE: See report METHOD: Sent to reference laboratory LAB SECTION PERFORMING TEST: Anatomic Pathology AVAILABILITY: Monday through Friday (0800 to 1600). Notify Anatomic Pathology Lab at 248-858-319. Weekends and holidays send specimen to Laboratory Specimen Processing. Specimen will be examined on the next working day. TURNAROUND TIME: Next Business Day GENERAL USE OF TEST: To cultivate and study the products of conception in habitual aborters. LIMITATIONS: If specimen does not consist of viable products of conception, there may be no cell growth. STORAGE REQUIREMENTS: Refrigerate Do not freeze Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CIRCULATING ANTICOAGULANT (MIXING STUDY) TEST NAME: CIRCULATING ANTICOAGULANT (MIXING STUDY) CPT CODE: Plasma from three full blue top tubes (sodium citrate) SPECIMEN REQUIREMENT: REFERENCE RANGE: Photometric Detection METHOD: LAB SECTION PERFORMING TEST: Coagulation Daily AVAILABILITY: TURNAROUND TIME: 24 hours in most cases GENERAL USE OF TEST: Helpful in discerning between a factor deficiency or a circulating anticoagulant. STORAGE REQUIREMENTS: Plasma must be spun 2 times and removed from cells. O Freeze at -20 C within 4 hours of collection time if testing not immediately performed. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY COMPLETE BLOOD COUNT (CBC) TEST NAME: COMPLETE BLOOD COUNT (CBC) (WBC, RBC, Hgb, Hct, MCV, MCHC, RDW, MPV, PLT, Automated Differential) Manual differential performed when established criteria are met. CPT CODE: 85025 SPECIMEN REQUIREMENT: 3 mL lavender top tube (EDTA). Minimum of 1 mL required OR 250 L lavender microtainer. REFERENCE RANGE: Reference range listed on report. METHOD: Direct current, electrical impedance, light scatter and fluorescence. LAB SECTION PERFORMING TEST: Hematology AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift of collection. STAT: 30 to 60 minutes. GENERAL USE OF TEST: Evaluation of peripheral blood parameters. SPECIMEN REQUIREMENT: Collect specimen using standard lab procedures. Gently invert tube several times immediately after collection. Do not centrifuge. STORAGE REQUIREMENTS: Sample must be analyzed within 24 hours of collection when stored at room temperature or within 48 hours when stored at 2 - 8C. Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY COMPREHENSIVE METABOLIC PANEL TEST NAME: COMPREHENSIVE METABOLIC PANEL (Total Protein, Albumin, A/G Ratio, T. Bilirubin, Ca, Alk Phos, BUN, Creat, AST, Gluc, Na, K, Cl, CO2, Anion GAP, ALT,GFR) CPT CODE: 80053 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin). 0.5 mL serum from a gold top tube (SST) REFERENCE RANGE: See individual tests. METHOD: See individual tests. LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. If ordered STAT: 60 minutes from receipt in laboratory. GENERAL USE OF TEST: Evaluation of various serum biochemistry constituents. SPECIMEN REQUIREMENT: Collect specimen using standard lab procedures. Collect specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CONSULTATION, INTRAOPERATIVE TEST NAME: ALTERNATE TEST NAME: CONSULTATION, INTRAOPERATIVE Pathology Consultation During Surgery CPT CODE: 88329, 88331, 88332, 88333 SPECIMEN REQUIREMENT: Surgical tissue. COLLECTION REQUIREMENT: Fresh tissue. REFERENCE RANGE: Normal tissue. METHOD: Gross examination; consultation. LAB SECTION PERFORMING TEST: Anatomic Pathology AVAILABILITY: Monday through Friday 8:00 AM to 4:00 PM. Notify Pathology Secretary at 248-858-3190. Other hours, notify Pathologist on call at 248-407-1603. TURNAROUND TIME: 15 – 20 minutes. GENERAL USE OF TEST: To evaluate specimen adequacy; determine course of surgery. STORAGE REQUIREMENTS: Immediately deliver to Anatomic Pathology for Pathologist examination. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CONSULTATION, SURGICAL PATHOLOGY TEST NAME: CONSULTATION, SURGICAL PATHOLOGY CPT CODE: 88305 SPECIMEN REQUIREMENT: Hematoxylin and eosin stained slides. When appropriate, special stained slides, unstained slides or paraffin blocks. Outside report and billing information. Requisition requesting consultation. REFERENCE RANGE: Normal tissue METHOD: Light microscopy LAB SECTION PERFORMING TEST: Anatomic Pathology AVAILABILITY: Monday through Friday, 0800 to 1630 TURNAROUND TIME: One to Two business days. GENERAL USE OF TEST: Second opinion regarding diagnoses will be rendered by staff pathologist in consultation with colleagues when appropriate. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CORD BLOOD EVALUATION TEST NAME: CORD BLOOD EVALUATION CPT CODE: 86900 / 86901 / 86880 / 86850 COLLECTION REQUIREMENT: INPATIENTS: Name, Medical Record Number (MRN), date, and time of collection, initials of phlebotomist and A#. REFERENCE RANGE: CRITICAL VALUE: Direct Coombs positive; antibody screen and/or group specific screen positive. METHOD: Agglutination LAB SECTION PERFORMING TEST: Blood Bank AVAILABILITY: Daily or STAT TURNAROUND TIME: GENERAL USE OF TEST: Direct Coombs negative. Expected turnaround time for STATs is 2 hours from time the specimen is received. Routine turnaround time is 8 hours from the time the specimen is received. To determine ABO or Rh incompatibility between mother and newborn. To identify Hemolytic Disease of the Newborn (HDN). If direct antiglobulin test and/or ABO group mismatch exists between mother and newborn, eluates and/or antibody identification techniques will be performed to determine the possible cause of the Hemolytic Disease of the Newborn (HDN). PATIENT PREPARATION: Obtain cord blood samples free of contamination with Wharton’s Jelly. LIMITATIONS: If blood sample is grossly contaminated with Wharton’s Jelly, the test may be invalid. STORAGE REQUIREMENTS: Refrigerate sample(s) at 1° - 8°C. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CORTISOL TEST NAME: CORTISOL CPT CODE: 82533 SPECIMEN REQUIREMENT: 0.5 mL from a green top tube (heparin) OR 0.5 mL serum from a gold top tube (SST). REFERENCE RANGE: Morning: 8.7 – 22.4 g/dL Evening:<10 g/dL 9-24 hour Post Dexamethasone: : <5 g/dL METHOD: Chemiluminescence LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing. GENERAL USE OF TEST: Addison’s Syndrome, Cushing’s Syndrome and adrenal tumor. LIMITATIONS: Diurnal variation Patients who have been regularly exposed to animals or immunoglobulin fragments may produce antibodies that interfere with immunoassays. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for at least 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CREATININE TEST NAME: CREATININE CPT CODE: 82565 SPECIMEN REQUIREMENT: 0.5 mL of plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube (SST) REFERENCE RANGE: 0-4 weeks: 0.5 – 1.2 mg/dL >4 weeks: 0.4 – 1.4 mg/dL CRITICAL VALUE: 0-4 weeks: >2.1 mg/dL >4 weeks: >11.1 mg/dL METHOD: Colorimetric LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of specimens requested STAT will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Kidney function, shock, dehydration SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CREATININE KINASE TEST NAME: CREATININE KINASE ALTERNATE TEST NAME: CK CPT CODE: 82550 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top heparin tube OR 0.5 mL serum from a gold top tube (SST) REFERENCE RANGE: 0.5 mL of plasma from a green top tube (heparin). Female: 41-200 IU/L Male: 52-300 IU/L CRITICAL VALUE: >1,000 IU/L METHOD: Enzymatic LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of specimens requested STAT will be reported within 30 minutes of receipt in the laboratory. GENERAL USE OF TEST: Myocardial infarction; skeletal muscular disease. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 8 – 12 hours or 2 – 3 days at -15C to 8C prior to analysis. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CREATININE KINASE (TOTAL) WITH CK-MB FRACTION TEST NAME: CREATININE KINASE (TOTAL) WITH CK-MB FRACTION CPT CODE: 82553 82550 SPECIMEN REQUIREMENT: 0.5 mL from a green top tube (heparin) OR 1 mL serum from a g o l d top tube (SST). REFERENCE RANGE AND CRITICAL VALUES: Male: CK 52-300 IU/L Critical >1000 IU/L CKMB 0.6-6.3 %CKMB 0.0-3.0% Critical >3.0 Female: CK 41-200 IU/L Critical >1000 IU/L CKMB 0.6-6.3 %CKMB 0.0-3.0% Critical >3.0 METHOD: CK – enzymatic CKMB - chemiluminescent LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of specimens requested STAT will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Myocardial infarction, muscular dystrophy, other muscle disease. LIMITATIONS: CK-MB will be added if CK is >130. For CKMB: Patients who have been regularly exposed to animals or immunoglobulin fragments may produce antibodies that interfere with immunoassays. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY TEST NAME: CREATININE KINASE (TOTAL) WITH CK-MB FRACTION Collect specimen using standard laboratory procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. See storage requirements for creatine kinase (CK) For CK-MB refrigerate at 2-8 C up to 48 hours. Freeze o at -20 C or colder for prolonged storage prior to analysis Samples will be capped and held for 5 days after testing. SPECIMEN PREPARATION: STORAGE REQUIREMENTS: o Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CROSSMATCH (COMPATIBILITY TESTING TEST NAME: CROSSMATCH (COMPATIBILITY TESTING) CPT CODE: 86920 SPECIMEN REQUIREMENT: EDTA vacutainer tube. COLLECTION REQUIREMENT: INPATIENTS: Name, Medical Record Number (MRN), date, and time of collection, initials of phlebotomist and A#. OUTPATIENTS: 2 patient identifiers, date of collection, initials of phlebotomist. REFERENCE RANGE: Compatible unit. METHOD: 1. Computer Crossmatch 2. Capture 3. Agglutination. LAB SECTION PERFORMING TEST: Blood Bank AVAILABILITY: Daily or STAT TURNAROUND TIME: GENERAL USE OF TEST: 60 minutes for STATs (10 minutes if type and screen are already done on sample). Day shift for routines. To determine compatibility of red cell units required for transfusion. Phenotyping of blood units and the patient may need to occur to find compatible units of blood. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CYST FLUID, NON-GYNECOLOGIC CYTOLOGY: BREAST, OVARIAN, RENAL TEST NAME: CYST FLUID, NON-GYNECOLOGIC CYTOLOGY: BREAST, OVARIAN, RENAL CPT CODE: 88112 SPECIMEN REQUIREMENT: Fresh fluid COLLECTION REQUIREMENT: 10 mL of fluid. REFERENCE RANGE: Negative for malignant cells. METHOD: Modified Papanicolaou LAB SECTION PERFORMING TEST: Cytology AVAILABILITY: Monday – Friday, 0800 to 1630 TURNAROUND TIME: 24 – 48 hours GENERAL USE OF TEST: To establish the presence of primary or metastatic neoplasm. STORAGE REQUIREMENTS: Refrigerate Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY DIMER TEST NAME: DIMER CPT CODE: 85379 SPECIMEN REQUIREMENT: Purple top tube (EDTA). REFERENCE RANGE: Reference range listed on report METHOD: Fluorescence immunoassay. LAB SECTION PERFORMING TEST: Hematology AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. STAT specimens will be reported within 30-60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Dimer results < 400 ng/mL DDU are the cutoff level used to rule out deep venous thrombosis(DVT) or Pulmonary embolism(PE) in patients determined to be at low risk for thromboembolic disease STORAGE REQUIREMENTS: Whole blood EDTA good for 24 hours at room temperature 2 - 8C. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY DIGOXIN (LANOXIN) TEST NAME: DIGOXIN (LANOXIN) CPT CODE: 80162 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube (SST). REFERENCE RANGE: 0.5 – 2.0 ng/mL CRITICAL VALUE: >2.5 ng/mL METHOD: Immunoassay LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. STAT specimens will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Diagnosis of digoxin toxicity or insufficient dosage. PATIENT PREPARATION: Specimen should be drawn at least 6 hours after last oral dose. LIMITATIONS: Specimen collected from patient on Dig-A-Bind. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. STORAGE REQUIREMENTS: to Samples will be capped and held for 5 days after testing. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY DIRECT ANTIGLOBULIN (DIRECT COOMBS) TEST TEST NAME: DIRECT ANTIGLOBULIN (Direct Coombs) TEST ALTERNATE TEST NAME: DAT CPT CODE: 86880 SPECIMEN REQUIREMENT: EDTA vacutainer tube COLLECTION REQUIREMENT: INPATIENTS: Name, Medical Record Number (MRN), date, and time of collection, initials of phlebotomist and A#. OUTPATIENTS: 2 patient identifiers, date of collection, initials of phlebotomist. REFERENCE RANGE: Negative CRITICAL VALUE: Positive test detected on cord blood or recently transfused patient. METHOD: Agglutination using anti-IgG and anti-C3bC3d monospecific reagents. LAB SECTION PERFORMING TEST: Blood Bank AVAILABILITY: Daily or STAT TURNAROUND TIME: Routine: 24 hours STAT: 15 minutes For the detection of antibody bound in vivo to the patient’s red cells. An eluate and/or antibody identification techniques may be required to find the source of a positive direct antiglobulin test. GENERAL USE OF TEST: STORAGE REQUIREMENTS: Room temperature or at 1 - 8C. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY ELECTROLYTES, BLOOD (Sodium, Potassium, Chloride & Carbon Dioxide) TEST NAME: ELECTROLYTES, BLOOD (Sodium, Potassium, Chloride & Carbon Dioxide + AGAP) CPT CODE: 80051 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube REFERENCE RANGE: Na: 133 – 145 mEq /L K: 3.5 – 5.3 mEq/L Cl: 95 – 111 mEq/L AGAP 6 – 27 CO2 0- 1 WK: 17- 26 mEq/L 1 WK – 1MO: 17- 27 mEq/L 1MO – 6 MOS: 17 – 29 mEq/L 6 MOS – 1 YR: 18 – 29 mEq/L 1 YR – 150 YRS: 22 – 32 mEq/L CRITICAL VALUE: Na = <124 or >156 mEq/L K = <2.9 or >6.1 mEq/L CO2 = <8 or >41 mEq/L Cl: <70 or >141 mEq/L METHOD: Ion Selective Electrode LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: ● Same shift testing. ● STAT specimens will be resulted within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Electrolyte balance LIMITATIONS: Hemolyzed specimens elevate potassium levels. SPECIMEN PREPARATION: ● Collect specimens using standard lab procedures. ● Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. ● Refrigerate at 2o – 8oC up to 48 hours. . Samples will be capped and held for 5 days after STORAGE REQUIREMENTS: ● testing. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY EOSINOPHIL SMEARS (Urine Only) TEST NAME: EOSINOPHIL SMEARS (Urine Only) CPT CODE: 89190 SPECIMEN REQUIREMENT: Freshly voided urine. REFERENCE RANGE: Positive >1% Negative <1% METHOD: Microscopic examination of cytospin Wright’s stained smears. LAB SECTION PERFORMING TEST: Hematology AVAILABILITY: 24 hours TURNAROUND TIME: 24 hours GENERAL USE OF TEST: Urinary tract infections (UTIs) and AIN (acute interstitial nephritis) are associated with urinary eosinophils. STORAGE REQUIREMENT: Perform on freshly voided urine or store sample at o 2-8 C for testing within 24 hours. Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY ESTRADIOL TEST NAME: ESTRADIOL CPT CODE: 82670 SPECIMEN REQUIREMENT: 0.5 ml plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube (SST). REFERENCE RANGE: Male: 0 – 47 pg/mL Female: Mid-Follicular Phase: 27 – 122 pg/mL Periovulatory: 95 – 433 pg/mL Mid-Luteal Phase: 49 – 291 pg/mL Post-Menopausal: 0 – 40 pg/mL METHOD: Chemiluminescent Immunoassay LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. STAT specimens will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Used to assess gonadal dysfunction including delayed puberty, amenorrhea and menopause. LIMITATIONS: Patients who have been regularly exposed to animals or immunoglobulin fragments may produce antibodies that interfere with immunoassays. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY ETHANOL (Medical Evaluation Only) TEST NAME: ETHANOL (Medical Evaluation Only) CPT CODE: 82055 SPECIMEN REQUIREMENT: 0.5 mL plasma from a gray top tube (sodium fluoride/potassium oxalate) OR 0.5 mL serum from a gold top tube (SST). REFERENCE RANGE: None detected. CRITICAL VALUE: NA METHOD: Enzymatic LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily, STAT TURNAROUND TIME: Same shift testing. STAT specimens will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Quantitative measurement of ethanol. PATIENT PREPARATION: Venipuncture: Do not use alcohol prep or any other volatile disinfectants to cleanse draw site. SPECIMEN PREPARATION: Deliver tightly stopped tube to laboratory. Centrifuge specimens; remove serum/plasma from cells within 2 hours of collection. Assay immediately after opening the sample tube. STORAGE REQUIREMENTS: Samples will be capped and held for 5 days after testing. Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY FACTOR VIII ASSAY TEST NAME: FACTOR VIII ASSAY CPT CODE: SPECIMEN REQUIREMENT: Plasma from a full blue top tube (sodium citrate). COLLECTION REQUIREMENT: METHOD: LAB SECTION PERFORMING TEST: Chromogenic detection Reference Laboratory Monday-Saturday AVAILABILITY: TURNAROUND TIME: 5-& Days Aids in detection of factor deficiencies. GENERAL USE OF TEST: PATIENT PREPARATION: o Plasma should be removed from cells and frozen at -20 C within 4 hours of collection time. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY FACTOR IX ASSAY TEST NAME: FACTOR IX ASSAY CPT CODE: SPECIMEN REQUIREMENT: Plasma from a full blue top tube (sodium citrate). COLLECTION REQUIREMENT: METHOD: LAB SECTION PERFORMING TEST: Chromogenic detection Reference Laboratory AVAILABILITY: TURNAROUND TIME: < 24 hours Aids in detection of factor deficiencies. GENERAL USE OF TEST: PATIENT PREPARATION: See Reference Laboratory Instructions Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY FACTOR 10 A INHIBITION FACTOR 10 A INHIBITION TEST NAME: CPT CODE: SPECIMEN REQUIREMENT: Plasma from a full blue top tube (sodium citrate). COLLECTION REQUIREMENT: METHOD: LAB SECTION PERFORMING TEST: Chromogenic Detection Coagulation Daily AVAILABILITY: TURNAROUND TIME: GENERAL USE OF TEST: PATIENT PREPARATION: < 24 hours Provides quantitative determination of unfractionated and low molecular weight heparins. Plasma should be removed from cells and frozen at 20oC within 4 hours of collection time if testing is not immediately performed. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY FECAL REDUCING SUBSTANCES TEST NAME: FECAL REDUCING SUBSTANCES CPT CODE: 81099 SPECIMEN REQUIREMENT: ● Random fresh stool in a plastic screw top container. ● Transport to the laboratory immediately after collection. REFERENCE RANGE: Negative. METHOD: Benedict’s copper reduction reaction. LAB SECTION PERFORMING TEST: Urinalysis AVAILABILITY: 24 hours TURNAROUND TIME: 24 hours. GENERAL USE OF TEST: Increased amounts of reducing substance in fecal material is indicative of malabsorption syndromes and is often performed on infants who have failure to thrive syndrome. STORAGE REQUIREMENTS: Must be frozen within 2 hours of collection. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY FERRITIN TEST NAME: FERRITIN CPT CODE: 82728 SPECIMEN REQUIREMENT: 0.5 mL from a green top tube (heparin) OR 0.5 mL serum from a gold top tube (SST) REFERENCE RANGE: Male: 23.9 – 336.2 ng/mL Female: 11.0 – 306.8 ng/mL METHOD: Chemiluminescence LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing. GENERAL USE OF TEST: Depletion of iron stores (anemia). Also aids in diagnosis of diseases affecting iron metabolism (hemochromatosis). LIMITATIONS: Patients who have been regularly exposed to animals or immunoglobulin fragments may produce antibodies that interfere with immunoassays. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate serum at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY FETAL FIBRONECTIN TEST NAME: FETAL FIBRONECTIN CPT CODE: 82731 SPECIMEN REQUIREMENT: Specimen collected from the posterior fornix of the vagina using the Adeza Biomedical Specimen Collection Kit. REFERENCE RANGE: N/A METHOD: Lateral flow, solid phase immunosorbent assay. LAB SECTION PERFORMING TEST: Hematology/Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift of collection or 60 minutes if STAT. GENERAL USE OF TEST: Detection of fetal fibronectin as an aid in assessing the risk of pre-term delivery. SPECIMEN COLLECTION: After collection, submerge the tip of the applicator swab in the tube of buffer, break the shaft even with the top of the tube, cap and push down tightly to secure the top. LIMITATIONS: Grossly bloody samples will be rejected. Results of this test should be used in conjunction with information from the clinical evaluation and other diagnostic procedures. STORAGE REQUIREMENTS: If not tested within 8 hours, refrigerate at 2 - 8C within 3 days of collection. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY FETAL HEMOGLOBIN TEST (Kleihauer-Betke Acid Elution) TEST NAME: FETAL HEMOGLOBIN TEST (Kleihauer-Betke Acid Elution) CPT CODE: 85460 SPECIMEN REQUIREMENT: EDTA vacutainer tube COLLECTION REQUIREMENT: Two unique patient identifiers, date of specimen collection and initials of individual collecting the blood sample on tube label. REFERENCE RANGE: 0.0 – 0.5% METHOD: Based on resistance of fetal hemoglobin to elution by citrate buffer. LAB SECTION PERFORMING TEST: Hematology AVAILABILITY: Daily TURNAROUND TIME: 24 hours GENERAL USE OF TEST: Identification and enumeration of fetal cells in the maternal circulation. To determine the correct dosage of Rh immune globulin to be administered. LIMITATIONS: The blood sample must be less than 24 hours old at the time of testing. STORAGE REQUIREMENTS: Store at 2 - 8C if not performed immediately. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY FIBRINOGEN TEST NAME: FIBRINOGEN CPT CODE: 85384 SPECIMEN REQUIREMENT: Plasma from one full blue top tube (sodium citrate) REFERENCE RANGE: Reference range listed on report. METHOD: Photometric detection LAB SECTION PERFORMING TEST: Hematology/Coagulation AVAILABILITY: Daily TURNAROUND TIME: 30 - 60 minutes GENERAL USE OF TEST: Fibrinogen is an acute phase reactant as well as the focal point in the coagulation process. Consumption of fibrinogen is a major and clinically threatening aspect of disseminated intravascular coagulation. LIMITATIONS: Hemolysis. Icteric or lipemic specimens SPECIMEN PREPARATION: Mix immediately after drawing. Incomplete filling of vacutainer tube. STORAGE REQUIREMENTS: Plasma is stable for 4 hours at room temperature or at 2 8C. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY FINE NEEDLE ASPIRATION, DEEP TISSUE (Lung, Kidney, Pancreas, Liver, Etc.) TEST NAME: FINE NEEDLE ASPIRATION, DEEP TISSUE (Lung, Kidney, Pancreas, Liver, Etc.) CPT CODE: 88173 – Interpretation and report 88172 – Immediate study to determine specimen adequacy SPECIMEN REQUIREMENT: Needle aspirate, entire specimen. COLLECTION REQUIREMENT: Place small amount of aspirated specimen on end of glass slide(s). Use a second glass slide to smear material and immediately fix in 95% alcohol. Send up six (6) slides (optimum). Place remaining material in Cytolyt. When a STAT evaluation of specimen adequacy is required; notify the laboratory in advance of specimen collection. REFERENCE RANGE: Negative for malignant cells. METHOD: Modified Papanicolaou LAB SECTION PERFORMING TEST: Cytology AVAILABILITY: Monday through Friday (0800 to 1630). TURNAROUND TIME: One to two working days. GENERAL USE OF TEST: To establish the presence of primary or metastatic neoplasm. LIMITATIONS: Inadequate specimens. STORAGE REQUIREMENTS: Deliver immediately to Cytology Laboratory. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY FINE NEEDLE ASPIRATION, SUPERFICIAL TISSUE (Breast, Thyroid, Prostate, Etc.) TEST NAME: FINE NEEDLE ASPIRATION, SUPERFICIAL TISSUE (Breast, Thyroid, Prostate, Etc.) CPT CODE: 88173 – Interpretation and report SPECIMEN REQUIREMENT: Needle aspirate, entire specimen. COLLECTION REQUIREMENT: Place small amount of aspirated specimen on end of glass slide(s). Use a second glass slide to smear material and immediately fix in 95% alcohol. Send up six (6) slides (optimum). Place remaining material in Cytolyt. When a STAT evaluation of specimen adequacy is required; notify the laboratory in advance of specimen collection. REFERENCE RANGE: Negative for malignant cells. METHOD: Modified Papanicolaou LAB SECTION PERFORMING TEST: Cytology AVAILABILITY: Monday through Friday (0800 to 1630). STAT evaluations must be scheduled including EBUS. Endo does not schedule Stat FNA. TURNAROUND TIME: One to two working days. GENERAL USE OF TEST: To establish the presence of primary or metastatic neoplasm. STORAGE REQUIREMENTS: Deliver immediately to Cytology Laboratory. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY FLOW CYTOMETRY, LYMPH NODE TEST NAME: FLOW CYTOMETRY, LYMPH NODE CPT CODE: Varies according to tests performed. SPECIMEN REQUIREMENT: Lymph node cut into fragments. COLLECTION REQUIREMENT: Sterile tube pre-filled with RPMI media (obtain from Anatomic Pathology at 562-7418). REFERENCE RANGE: Written report METHOD: Flow Cytometry LAB SECTION PERFORMING TEST: Sent to Reference Laboratory. For additional information, call Anatomic Pathology at 562-7418. AVAILABILITY: Monday through Friday (0800 to 1630). Not STAT. TURNAROUND TIME: Approximately one week GENERAL USE OF TEST: Diagnosis of lymphoma. Applicable in cases of chronic lympho-proliferative disorders and malignant lymphomas. LIMITATIONS: Adequacy of sample. STORAGE REQUIREMENTS: Deliver immediately to Cytology Laboratory. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY FOLATE TEST NAME: FOLATE CPT CODE: 82746 SPECIMEN REQUIREMENT: 1 mL plasma from a green top tube (heparin) OR 1 mL serum from a gold top tube (SST) REFERENCE RANGE: Greater than 5.9 ng/Ml METHOD: Chemiluminescent immunoassay. LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing. GENERAL USE OF TEST: Folate is an essential vitamin vital to cell growth and DNA synthesis. Folate deficiency can lead to megaloblastic anemia followed by severe neurological problems. PATIENT PREPARATION: Fasting preferred. LIMITATIONS: Patient’s true folate status may be masked by whole blood transfusions. Patients who have been regularly exposed to animals or immunoglobulin fragments may produce antibodies that interfere with immunoassays. INTERFERENCE: Hemolysis SPECIMEN PREPARATION: Centrifuge and separate serum/plasma from cells immediately after collection. STORAGE REQUIREMENTS: Refrigerate at 2 - 8C up to 8 hours. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY FOLLICLE STIMULATING HORMONE TEST NAME: FOLLICLE STIMULATING HORMONE CPT CODE: 83001 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube (SST). REFERENCE RANGE: FSH (mIU/mL) Adult Male: 1.27– 19.26 mIU/mL Adult Female: Follicular 3.85 – 8.78 mIU/mL Luteal 1.79 – 5.12 mIU/mL Mid-Cycle Peak 4.54 – 22.51 mIU/mL Post-Menopausal 16.74 – 113.59 mIU/mL METHOD: Chemiluminescent Immunoassay. LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing GENERAL USE OF TEST: Assessment of pituitary function and to distinguish between primary and secondary gonadal failure. LIMITATIONS: SPECIMEN PREPARATION: STORAGE REQUIREMENTS: FSH values vary widely during the different phases of the normal female menstrual cycle. Patients who have been regularly exposed to animals or immunoglobulin fragments may produce antibodies that interfere with immunoassays. Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY FRESH FROZEN PLASMA (FFP) FRESH FROZEN PLASMA (FFP) CPT CODE: EST NAME: SPECIMEN REQUIREMENT: Pink EDTA vacutainer tube if blood type is not on file. METHOD: Thawing is performed using a 37C waterbath. LAB SECTION PERFORMING TEST: Blood Bank AVAILABILITY: STAT on all 3 shifts TURNAROUND TIME: 45 minutes GENERAL USE OF TEST: For the treatment of coagulation deficiencies or to replace depleted coagulation factors. PATIENT PREPARATION: Refer to Transfusion Guidelines. LIMITATIONS: Fresh frozen plasma is administered as ABO compatible without regard to Rh type. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY FROZEN TISSUE SECTION: RAPID SCREEN FOR MALIGNANCY TEST NAME: FROZEN TISSUE SECTION: RAPID SCREEN FOR MALIGNANCY CPT CODE: 88331, 88332 performed.) SPECIMEN REQUIREMENT: Fresh tissue (excluding bone and calcified tissue). COLLECTION REQUIREMENT: Operative diagnosis and source must be provided. If an infectious disease is suspected, a warning must be stated on the requisition and specimen label. (CPT codes vary based upon testing REFERENCE RANGE: Results interpreted by consulting Pathologist. METHOD: Cryotomy, Microscopy LAB SECTION PERFORMING TEST: Histology AVAILABILITY: Monday through Friday; 0800 to 1630 Other times, notify Pathologist on call. TURNAROUND TIME: Approximately 20 minutes. GENERAL USE OF TEST: Provisional histologic diagnosis and aid to surgical therapy. LIMITATIONS: Occasional false negative result. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY GAMMA GLUTAMYL TRANSPEPTIDASE TEST NAME: GAMMA GLUTAMYL TRANSPEPTIDASE ALTERNATE TEST NAME: CPT CODE: SPECIMEN REQUIREMENT: REFERENCE RANGE: METHOD: GGT 82977 0.5 mL plasma from a green top tube (heparin) OR serum from a gold top tube (SST AGE 0 WKS to 1 WK 1WK to 1 MO 1 MOS to 3 MOS 3 MOS to 6 MOS 6 MOS to 12 MOS >12 MOS FEMALE 18-148 IU/L 16-140 IU/L 16-140 IU/L 13-123 IU/L 8-59 IU/L 7-50 IU/L MALE 25-168 IU/L 23-174 IU/L 16-147 IU/L 5-93 IU/L 8-38 IU/L 7-50 IU/L Enzymatic LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing. GENERAL USE OF TEST: Liver function SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen, separate serum/plasma from cells within 2 hours of collection. STORAGE REQUIREMENTS: Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY GENTAMICIN TEST NAME: GENTAMICIN CPT CODE: 80170 Random Peak Trough SPECIMEN REQUIREMENT: 0.5 mL serum from a gold top tube (SST) OR 0.5 mL from a green top tube (heparin). REFERENCE RANGE: Gentamicin: 0.5 – 10.0 Gentamicin Peak: 5.0-10.0 g/mL Gentamicin Trough: 0.5 – 1.5 g/mL CRITICAL VALUE: Gentamicin: 12.1 g/mL Gentamicin Peak: 12.1 g/mL Gentamicin Trough: 3.1 g/mL METHOD: Immunoassay LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of specimens requested STAT will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: To monitor antibiotic therapy and to test for insufficient or toxic serum levels of gentamicin. PATIENT PREPARATION: SPECIMEN PREPARATION: STORAGE REQUIREMENTS: Trough: Specimen is drawn 30 minutes to immediately prior to next dose. Peak: Drawn 30 minutes after the infusion is complete for “traditional dosing” regime. Drawn 60 minutes after infusion is complete when following the “once daily dosing” regime. Collect specimen using standard laboratory procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2C up to 48 hours. Samples will be capped and held for 5 days after testing. Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY GLUCOSE, FASTING TEST NAME: GLUCOSE, FASTING CPT CODE: 82947 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR a gray top tube (potassium oxalate/sodium fluoride) OR serum from a gold top tube (SST) REFERENCE RANGE: 0-4 wks: 45 – 99 mg/dL >4wks: 65-99 mg/dL CRITICAL VALUE: 0-4 wks: <39 or >200 mg/dL >4wks: <58 or >450 mg/dL METHOD: Glucose oxidase <50 or >400 mg/dL LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing Results of specimens requested STAT will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Evaluation of carbohydrate metabolism. PATIENT PREPARATION: Fasting, if indicated. SPECIMEN PREPARATION: Collect specimen using standard laboratory procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY GLUCOSE, RANDOM TEST NAME: GLUCOSE, RANDOM CPT CODE: 82947 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR a gray top tube (potassium oxalate/sodium fluoride) OR serum from a gold top tube (SST) REFERENCE RANGE: 0-4 wks: 45 – 99 mg/dL >4wks: 65-00 mg/dL CRITICAL VALUE: 0-5 wks: <39 or >201 mg/dL >4wks: <59 or >451 mg/dL METHOD: <50 or >400 mg/dL Glucose oxidase LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing Results of specimens requested STAT will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Carbohydrate metabolism disorders. SPECIMEN PREPARATION: Collect specimen using standard laboratory procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY GLUCOSE, SPINAL FLUID TEST NAME: GLUCOSE, SPINAL FLUID CPT CODE: 82945 SPECIMEN REQUIREMENT: 0.5 mL spinal fluid in a sterile plastic CSF screw cap tube (#1). REFERENCE RANGE: 40 – 70 mg/dL METHOD: Glucose oxidase with glucose electrode. LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of specimens requested STAT will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Diagnosis of central nervous system disorders. LIMITATIONS: Grossly bloody specimen; bacterial contamination. SPECIMEN PREPARATION: If specimen is cloudy or bloody, centrifuge and remove the supernatant within 30 minutes of collection. STORAGE REQUIREMENTS: Refrigerate at 2 - 8C for up to 5 days Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY GLUCOSE TOLERANCE, BLOOD TEST NAME: GLUCOSE TOLERANCE, BLOOD CPT CODE: 82947, 82950 Standard Oral 82951, 82952 (Standard Gestational 82950 Gestational Screen SPECIMEN REQUIREMENT: 0.5 mL serum from a gold top tube (ST) OR plasma from a green top tube (heparin), OR a gray top tube (potassium oxalate/sodium fluoride). NOTE: Use same tube type consistently throughout test. REFERENCE RANGE: Standard 2 Hour Tolerance: Fasting: 65 – 99 mg/dL 120 mines: 75 – 139 mg/dL Glucose 1 Hour OB Screen: 75 – 135 mg/dL Standard 3 Hour Gestational: Fasting: 65 – 99 mg/dL 1 Hour: 70 – 179 mg/dL 2 Hours: 70 – 154 mg/dL 3 Hours: 70 – 139 mg/dL CRITICAL VALUE: <60 or >450 mg/dL METHOD: Glucose oxidase LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: TURNAROUND TIME: Results will be reported upon completion of tolerance test. GENERAL USE OF TEST: Endocrine disorders, carbohydrate metabolism. PATIENT PREPARATION: Fasting; no smoking. Administer Dexicola after baseline test is performed. Patient can drink water. Collect specimen using standard laboratory procedures. SPECIMEN PREPARATION: STORAGE REQUIREMENTS: Monday through Friday. Centrifuge specimen; separate serum from cells within 2 Refrigerate at15C to C up to 48 hours. .Samples will be capped and held for 5 days after testing Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY GYNECOLOGIC CYTOLOGY, THIN PREP® PAP TEST™ (2 Pages) TEST NAME: GYNECOLOGIC CYTOLOGY, THIN PREP® PAP TEST™ CPT CODE: Varies based on testing performed. COLLECTION REQUIREMENT: This test requires a Thin Prep® Pap Test™ Collection Kit which is supplied by the Anatomic Pathology Laboratory at 248-858-6883 SPECIMEN REQUIREMENT: After visualization of the cervix is accomplished, collect the sample. Brush / Spatula Collection: Obtain an adequate sampling from the ectocervix using a plastic spatula. Rinse the spatula into the Preserv Cyt® solution vial by swirling the spatula vigorously in the vial 10 times. Discard the spatula. Insert the brush into the cervix until only the bottom most fibers are exposed. Slowly rotate or turn in one direction. Do not over rotate. Rinse the brush in the Preserv Cyt® solution by rotating the device in the solution 10 times while pushing against the vial wall. Swirl the brush vigorously to further release material. Discard the brush. REFERENCE RANGE: Bethesda Reporting. METHOD: Modified Papanicolaou, manual screening. LAB SECTION PERFORMING TEST: Cytology AVAILABILITY: Monday through Friday, 08:00 – 16:3 0.5 mL TURNAROUND TIME: Approximately one week. GENERAL USE OF TEST: Screening of unsuspected or confirmation of suspected atypia, pre-malignant or malignant changes. Follow up of patients with known and/or treated premalignant or malignant lesions. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY Evaluation of inflammatory/infections or benign proliferative conditions. PATIENT PREPARATION: Patient to avoid douches 38-72 hours prior to exam. Obtain specimen prior to bimanual exam. Use an unlubricated speculum (saline or warm water may be used). Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY GYNECOLOGIC CYTOLOGY, THIN PREP PAP WITH REFLEXIVE HPV TEST NAME: GYNECOLOGIC CYTOLOGY, THIN PREP PAP WITH REFLEXIVE HPV CPT CODE: Varies based on testing performed. SPECIMEN REQUIREMENT: Refer to Gynecologic Cytology, Thin Prep® PAP Test™ Specimen Collection for collection guidelines. Remarks: Must be ordered in conjunction with Thin Prep® PAP Test™. Thin Prep PAP test results with a diagnosis of ASCUS will be sent for High Risk HPV testing by Digene method unless the box on the requisition indicating HPV testing is not desired has been checked. Vial must be kept at 4° to 37°C. Stability: Three weeks ambient temperature, three weeks refrigerated. Do not freeze. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY HAPTOGLOBIN, BLOOD TEST NAME: HAPTOGLOBIN, BLOOD CPT CODE: 83010 SPECIMEN REQUIREMENT: 0.5 ml from a green top OR 0.5 mL serum from a gold top tube (SST). REFERENCE RANGE: Adults: 36 – 195 mg/dL METHOD: Turbidimetric LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Monday through Friday. TURNAROUND TIME: Daily GENERAL USE OF TEST: Intravascular hemolysis. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum from cells within 2 hours of collection. Store spun and separated serum samples at -15°C to °8C. Samples will be held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY HCG, BETA (QUALITATIVE SERUM) TEST NAME: HCG, BETA (QUALITATIVE SERUM) CPT CODE: 84703 SPECIMEN REQUIREMENT: 0.5 mL serum from a red top tube REFERENCE RANGE: Assay reported as positive or negative. METHOD: Chromatographic immunoassay. LAB SECTION PERFORMING TEST: Hematology AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. STAT specimens will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Detection of pregnancy LIMITATIONS: None. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY HCG, BETA (QUANTITATAIVE) TEST NAME: HCG, BETA (QUANTITATIVE) CPT CODE: 84702 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube (SST) REFERENCE RANGE: Non-pregnant females: Less than 5.0 mIU/mL. METHOD: Chemiluminescent immunoassay. LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. If ordered STAT, within 60 minutes of receipt in the laboratory. Hydatidiform mole. Choriocarcinoma. Ectopic pregnancy. Threatened or missed abortion. GENERAL USE OF TEST: LIMITATIONS: Patients who have been regularly exposed to animals or immunoglobulin fragments may produce antibodies that interfere with immunoassays. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY HCG, SERUM TEST NAME: HCG, SERUM CPT CODE: Red top tube only ( no additives) SPECIMEN REQUIREMENT: COLLECTION REQUIREMENT: METHOD: Chromogenic immunoassay LAB SECTION PERFORMING TEST: Hematology AVAILABILITY: Daily TURNAROUND TIME: Same shift of Collection If ordered STAT, within 60 minutes of receipt in the Laboratory. GENERAL USE OF TEST: Detection of pregnancy STORAGE REQUIREMENTS: Room temperature if tested immediately Store at 2-8o C for up to 48 hours Samples greater than 48 hours old are unacceptable Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY HCG, URINE TEST NAME: HCG, URINE CPT CODE: 84703 SPECIMEN REQUIREMENT: 1 mL of urine. REFERENCE RANGE: Assay reported as Positive or Negative METHOD: Chromatographic immunoassay. LAB SECTION PERFORMING TEST: Hematology AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift of collection. If ordered STAT, within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Detection of pregnancy. SPECIMEN PREPARATION: Submit urine in a clean, dry container. STORAGE REQUIREMENTS: Room temperature if testing immediately. Store at 2-8 C for up to 48 hours. Bring to room temperature before testing. Specimens greater than 48 hours old will be unacceptable. o Revised: 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY HEMOGLOBIN A1C TEST NAME: HEMOGLOBIN A1C CPT CODE: 83036 SPECIMEN REQUIREMENT: 0.5 mL whole blood (EDTA) from a lavender top tube. REFERENCE RANGE: 4.0 – 6.0% METHOD: Ion exchange HPLC. LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Monday-Saturday. GENERAL USE OF TEST: Monitor diabetic patient. LIMITATIONS: Hemoglobin variants may interfere. STORAGE REQUIREMENTS: Whole blood samples are stable for 5 days at 2 - 8C. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY HEPATITIS A ANTIBODY (IgM) TEST NAME: HEPATITIS A ANTIBODY (IgM) CPT CODE: 86709 SPECIMEN REQUIREMENT: 0.5 mL serum from a gold top tube (SST) OR 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL plasma from a purple top tube (EDTA.) REFERENCE RANGE: Negative METHOD: Chemiluminescent immunoassay. LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Monday – Friday TURNAROUND TIME: Daily Monday-Friday. GENERAL USE OF TEST: Acute Hepatitis A is associated with Hepatitis A IgM antibodies. LIMITATIONS: Test cannot determine patient’s immune status to Hepatitis A. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum from cells within 2 hours of collection. Refrigerate at 2° - 8°C up to 7 days. Samples will be capped and held for 7 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY HEPATITIS B CORE ANTIBODY (IgM) TEST NAME: HEPATITIS B CORE ANTIBODY (IgM) CPT CODE: 86705 SPECIMEN REQUIREMENT: 0.5 mL serum from a gold top tube (SST) OR 0.5 mL plasma from a green top tube (lithium heparin) OR 0.5 mL plasma from a purple top tube (EDTA.) REFERENCE RANGE: Negative METHOD: Chemiluminescent immunoassay. LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Monday – Friday TURNAROUND TIME: Daily. Monday-Friday. GENERAL USE OF TEST: Acute Hepatitis B is associated with Hepatitis B core IgM antibodies. LIMITATIONS: Test cannot determine patient’s immune status to Hepatitis B. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum from cells within 2 hours of collection. Refrigerate at 2° - 8°C up to 1 week. Samples will be capped and held for 7 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY HEPATITIS B SURFACE ANTIBODY, QUALITATIVE AND QUANTITATIVE TEST NAME: HEPATITIS B SURFACE ANTIBODY QUALITATIVE AND QUANTITATIVE CPT CODE: 86706 SPECIMEN REQUIREMENT: 0.5 mL serum from a gold top tube (SST) OR 0.5 mL plasma from a green top tube (lithium heparin) OR 0.5 mL plasma from a purple top tube (EDTA.) REFERENCE RANGE: Qualitative: Unvaccinated: Negative Or Vaccinated: Positive Quantitative: Unvaccinated 10mIU/ml or Vaccinated >10 mIU/L. METHOD: Chemiluminescent immunoassay. LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily Monday – Friday TURNAROUND TIME: Daily GENERAL USE OF TEST: SPECIMEN PREPARATION: STORAGE REQUIREMENTS: Presence of Hepatitis B antibody indicates resolved infection and/or lasting immunity. Presence of antibody also used to monitor post vaccination immunity. Collect specimen using standard lab procedures. Centrifuge specimen; separate serum from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Freeze at or below C for prolonged storage prior to analysis. Samples will be capped and held for 5 days after testing. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY HEPATITIS B SURFACE ANTIGEN TEST NAME: HEPATITIS B SURFACE ANTIGEN CPT CODE: 87341 SPECIMEN REQUIREMENT: 0.5 mL serum from a gold top tube (SST) OR 0.5 mL plasma from a green top tube (lithium heparin) OR 0.5 mL plasma from a purple top tube (EDTA.) REFERENCE RANGE: Negative METHOD: Enzyme Immunoassay LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Monday – Friday Can be ordered STAT for expedited newborn/ maternal testing, testing of source patient following a needlestick injury or testing of new/traveling dialysis patient. Daily STAT results will be reported the same shift. TURNAROUND TIME: GENERAL USE OF TEST: Detection of surface antigen to Hepatitis B. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY HEPATITIS C ANTIBODY TEST NAME: HEPATITIS C ANTIBODY CPT CODE: 86803 SPECIMEN REQUIREMENT: 0.5 mL serum from a gold top tube (SST) OR 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL plasma from a purple top tube (EDTA.) REFERENCE RANGE: Negative METHOD: Chemiluminescent immunoassay. LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Monday – Friday TURNAROUND TIME: Daily Monday-Friday. GENERAL USE OF TEST: Signals acute, resolving or chronic infection. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 7 days. Freeze at or below C for prolonged storage prior to analysis. Samples will be capped and held for 5 days after testing. PATIENT PREPARATION: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY HUMAN IMMUNODEFICIENCY VIRUS (HIV 1, 2) ANTIBODY SCREEN TEST NAME: HUMAN Immunodeficiency VIRUS (HIV 1, 2) ANTIBODY SCREEN (BLOOD AND BODY FLUID/NEEDLESTICK EXPOSURE OR NEWBORN/MATERNAL TESTING ONLY) CPT CODE: G0432 SPECIMEN REQUIREMENT: 0.5 ml plasma from a green top OR 0.5 ml serum from a red top REFERENCE RANGE: Negative METHOD: Immunoassay LAB SECTION PERFORMING TEST: Chemistry Daily AVAILABILITY: TURNAROUND TIME: Can be ordered STAT for expedited newborn/ maternal testing or testing of source patient and/or hospital employee following a needlestick injury. Labor & Delivery and Needlestick profile 1 hour All other patients – 24 hours-48 hours GENERAL USE OF TEST: Detection of antibody to HIV-1, 2. LIMITATIONS: All positive results will be sent to a reference laboratory for confirmatory testing. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. STORAGE REQUIREMENTS: Store at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY HUMAN PAPILLOMAVIRUS (HPV) DNA PROBE, HIGH RISK TEST NAME: HUMAN PAPILLOMAVIRUS (HPV) DNA PROBE, HIGH RISK CPT CODE: 87621 SPECIMEN REQUIREMENT: Cervical specimen submitted in Preserv Cyt Solution (Thin Prep Pap Test System)OR Cervical specimen or Cervical Biopsy in Digene Transport COLLECTION REQUIREMENT After visualization of the cervix is accomplished, collect the sample. Brush / Spatula Collection: Obtain an adequate sampling from the ectocervix using a plastic spatula. Rinse the spatula into the Preserv Cyt Solution vial by swirling the spatula vigorously in the vial 10 times. Discard the spatula. Insert the brush into the cervix until only the bottom most fibers are exposed. Slowly rotate or turn in one direction. DO NOT OVER ROTATE. Rinse the brush in the Preserv Cyt Solution by rotating the device in the solution 10 times while pushing against the vial wall. Swirl the brush vigorously to further release material. Discard the brush. Tighten the cap so that the torque line on the cap passes the torque line on the vial. REFERENCE RANGE: Negative METHOD: Hybrid Capture 2 Procedure LAB SECTION PERFORMING TEST: Reference Laboratory AVAILABILITY: Daily, Monday-Friday TURNAROUND TIME: 7 days GENERAL USE OF TEST: Screening for HPV high-risk infection. LIMITATIONS: STORAGE REQUIREMENTS: Not intended to be substituted for regular cervical cytology screening. Does not differentiate between the various high-risk HPV types. Room temperature 14 days. Refrigerated 3 weeks. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY IMMUNOFIXATION (SERUM) TEST NAME: IMMUNOFIXATION (SERUM) CPT CODE: (86334) SPECIMEN REQUIREMENT: 1 mL serum from a gold top tube (SST) REFERENCE RANGE: See Interpretive Report METHOD: Immunoprecipitation LAB SECTION PERFORMING TEST: Reference Laboratory AVAILABILITY: Monday – Friday TURNAROUND TIME: 1 - 3 days GENERAL USE OF TEST: . SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum from cells within 2 hours of collection. Refrigerate spun and separated specimens at 2 - 8C for up to 5 days. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY IONIZED CALCIUM TEST NAME: IONIZED CALCIUM CPT CODE: 82330 SPECIMEN REQUIREMENT: 3 mL green top tube. Or 7mL yellow top tube (SST) Do not remove the tube stopper. Place on ice. Do not centrifuge. REFERENCE RANGE: 1.17 – 1.33 mmol/L CRITICAL VALUE: <0.80 or >10.0 mmol/L METHOD: ISE LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of STAT specimens will be reported within 30 minutes of receipt in the laboratory. GENERAL USE OF TEST: Measure of physiologically active calcium fraction. SPECIMEN PREPARATION: Collect specimen using standard laboratory procedures. STORAGE REQUIREMENTS: Stable on ice for 3 hours OR 18 hours serum if spun and never uncapped. O7/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY IMMUNOFIXATION (URINE) TEST NAME: IMMUNOFIXATION (URINE) CPT CODE: (86335) SPECIMEN REQUIREMENT: REFERENCE RANGE: See interpretive report. METHOD: Immunoprecipitation LAB SECTION PERFORMING TEST: Reference Labortory AVAILABILITY: Monday - Friday TURNAROUND TIME: GENERAL USE OF TEST: LIMITATIONS: STORAGE REQUIREMENTS: 5 mL of urine from a 24-hour urine specimen, collected on ice, containing no preservatives in a plastic container obtained from the laboratory. Random urine may also be used. 1 - 3 days Gammopathy – Abnormal immunoglobulins – Bence Jones Proteinuria. No preservatives. Refrigerate specimen during collection. Refrigerate at 2 - 8C up to a week. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY IMMUNOGLOBULINS, QUANTITATIVE (IgG, IgA, IgM) TEST NAME: IMMUNOGLOBULINS, QUANTITATIVE (IgG, IgA, IgM) CPT CODE: 82784 x3 SPECIMEN REQUIREMENT: 0.5 mL serum from a gold top tube (SST). See Interpretive Report for Details REFERENCE RANGE: METHOD: Turbidimetric LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Daily, 60 minutes for STAT requests GENERAL USE OF TEST: Evaluation of humoral immunity. SPECIMEN PREPARATION: Collect specimen using standard laboratory procedures. Centrifuge specimen; separate serum from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 72 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY IRON AND IRON BINDING CAPACITY TEST NAME: IRON AND IRON BINDING CAPACITY CPT CODE: 83540 SPECIMEN REQUIREMENT: 1 mL serum from a gold top tube (SST) OR 1 mL plasma from a green top tube (heparin). REFERENCE RANGE: IRON (Total): Male: ………….45 – 182 g/dL Female: ……….28 – 170 g/dL IRON % Saturation:…………..25 – 50% TRANSFERRIN: Male:……..180 – 329 mg/dL Female:….192 – 382 mg/dL TIBC: 261-478 METHOD: Colorimetric LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Routine, same shift testing. Results of specimens for total iron studies requested STAT will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Evaluation of iron metabolism. PATIENT PREPARATION: Fasting is recommended. LIMITATIONS: Contraindicated during iron therapy. SPECIMEN PREPARATION: Collect specimen using standard laboratory procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY . KIDNEY BIOPSY TEST NAME: KIDNEY BIOPSY CPT CODE: As appropriate for testing performed. SPECIMEN REQUIREMENT: Tissue Call Histology Lab before collecting specimen. Patient history required. The ordering physician will need to submit a kidney biopsy requisition for the reference laboratory with the specimen. These are available through Anatomic Pathology. REFERENCE RANGE: Results interpreted by consulting Pathologist. METHOD: Sent out to reference laboratory. LAB SECTION PERFORMING TEST: Anatomic Pathology AVAILABILITY: TURNAROUND TIME: Approximately one week. GENERAL USE OF TEST: Histologic diagnosis. STORAGE REQUIREMENTS: Must immediately be examined in the Pathology Department in sterile saline. Monday through Friday; 0800 to 163 0.5 mL Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY LACTATE DEHYDROGENASE TEST NAME: LACTATE DEHYDROGENASE ALTERNATE TEST NAME: LDH CPT CODE: 83615 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube (SST) REFERENCE RANGE: AGE 0 MOS to 1 MO 1 MO to 3 MOS 3 MOS to 6 MOS 6 MOS to 12 MOS 12 MOS to 3 YRS 3 YRS to 6 YRS 6 YRS to 9YRS 9 YRS to 15 YRS 15 YRS to 19 YRS >= 19 years FEMALE 187-600 IU/L 152-353 IU/L 158-353 IU/L 152-327 IU/L 164-286 IU/L 155-280 IU/L 141-237 IU/L 129-231 IU/L 117-213 IU/L 98-192 IU/L MALE 178-629 IU/L 158-373 IU/L 135-376 IU/L 129-367 IU/L 164-286 IU/L 155-280 IU/L 141-237 IU/L 129-231 IU/L 117-213 IU/L 98-192IU/L METHOD: Enzymatic LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing. GENERAL USE OF TEST: Cardiac and liver disorder, hematologic disorders, certain tumors. LIMITATIONS: Hemolyzed samples should not be used; hemolysis will cause falsely elevated results. SPECIMEN PREPARATION: Collect specimen using standard laboratory procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Samples will be capped and held for 5 days after testing. Do not freeze or refrigerate prior to analysis. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY LACTIC ACID TEST NAME: LACTIC ACID CPT CODE: 83605 SPECIMEN REQUIREMENT: 1 mL plasma from a green top tube (heparin). If possible, collect specimen without applying a tourniquet. Specimen must be placed on ice immediately after collection. REFERENCE RANGE: CRITICAL VALUE: 0.5 – 2.2 MEQ/L >4.1 MEQ/L METHOD: Electrode LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. STAT specimens in 60 minutes. GENERAL USE OF TEST: Detection of tissue hypoxia, diabetes mellitus, malignancies, glycogen storage disease, ethanol, methanol or salicylate ingestion and metabolic acidosis. PATIENT PREPARATION: The patient should avoid any exercise of the arm or hand before or during collection of specimen. SPECIMEN PREPARATION: Collect specimen using standard laboratory procedures. Centrifuge specimen; remove plasma from cells within 15 minutes of collection. STORAGE REQUIREMENTS: Specimen can be stored for 4 hours on ice (unspun) or up to 5 days if refrigerated. Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY LAMELLAR BODY COUNTS TEST NAME: LAMELLAR BODY COUNTS CPT CODE: Amniotic Fluid SPECIMEN REQUIREMENT: COLLECTION REQUIREMENT: METHOD: Should be performed 1 hour after collection. Samples containing blood, meconium or mucus will not be processed. Platelet channel of automated hematology cell counter LAB SECTION PERFORMING TEST: Hematology AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift of collection STAT: 30-60 minutes GENERAL USE OF TEST: May be used as a rapid screen to predict fetal lung maturity. Immature or indeterminate results should be followed by more specific test performed as send outs. STORAGE REQUIREMENTS: Stable for 1 hour after collection, can be frozen if necessary. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY LEAD TEST NAME: LEAD CPT CODE: 83655 (Venous lead level) (Capillary lead level) SPECIMEN REQUIREMENT: REFERENCE RANGE AND CRITICAL VALUES/FOLLOWUP: 0.2 mL to 1.0 mL in dark blue top (EDTA) tube OR lavender top OR brown top tube. If sample drawn is capillary, indicate on tube. Blood lead in children according to CDC Classification (May 13, 2013) Blood Lead Comment < 5 µg/dL Not lead-poisoned 5-9.9 µg/dL Rescreen within 6 months. Provide lead education and prevention strategies 10-14 µg/dL Rescreen within 3 months. Provide lead education and preventions strategies. 15-19 µg/dL Rescreen again in 1-3 months. Provide lead education and prevention strategies. 20-44 µg/dL Provide lead education and prevention strategies. Provide environment investigation and control current lead hazards. 45-69 µg/dL Provide lead education and prevention strategies and refer for chelation therapy. >70 µg/dL Provide lead education and prevention strategies plus hospitalized child for chelation therapy immediately. A medical emergency. *Elevated levels of blood lead should be confirmed with a second specimen before remedial action is instituted. Elevated capillary blood specimens should be repeated using a venous specimen due to possible contamination. Adults: Blood Lead Comment Less than 1 0.5 mL0 No action required ug/dL 1 0.5 mL0-24.9 ug/dL Identify and minimize exposure 25.0-49.9 ug/dL Remove from exposure if symptomatic 5 0.5 mL0-79.9 ug/dL Remove from lead exposure. Immediate medical evaluation required. >= 8 0.5 mL0 ug/dL Chelation may be indicated if symptomatic. Seek consultation. METHOD: Atomic Absorption Spectrophotometry LAB SECTION PERFORMING TEST: Reference Laboratory AVAILABILITY: Daily-Sunday-Friday TURNAROUND TIME: 1-2 days RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY GENERAL USE OF TEST: Determine lead levels. LIMITATIONS: Contact Reference Laboratory. SPECIMEN PREPARATION: STORAGE REQUIREMENTS: Store at 2 - 8C until testing is performed for up to 1 month. Freezing is not recommended... Collect sample using standard venipuncture or capillary puncture procedures. Completed samples will be retained for 7 days after assay. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY LEUKOCYTE REDUCED RED BLOOD CELLS TEST NAME: LEUKOCYTE REDUCED RED BLOOD CELLS CPT CODE: SPECIMEN REQUIREMENT: Pink EDTA vacutainer tube is required for a crossmatch. COLLECTION REQUIREMENT: METHOD: Two unique patient identifiers on tube label date of specimen collection and initials of individual collecting the blood sample. The patient must be positively identified using a Securline blood band. Capture or Agglutination LAB SECTION PERFORMING TEST: Blood Bank AVAILABILITY: STAT on all 3 shifts. TURNAROUND TIME: 45 minutes to 1 hour. GENERAL USE OF TEST: PATIENT PREPARATION: Indicated for any patient who requires a packed red cell product. Indicated for treatment of symptomatic anemia in patients who require only an increase of oxygen carrying capacity and red blood cells mass. Refer to Transfusion Guidelines. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY LIPASE TEST NAME: LIPASE CPT CODE: 83690 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube (SST) REFERENCE RANGE: 22 – 51 IU/L METHOD: Enzymatic LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. STAT specimens in 60 minutes. GENERAL USE OF TEST: Acute pancreatitis; obstruction of pancreatic duct. SPECIMEN PREPARATION: Collect specimen using standard laboratory procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY LIPID PROFILE TEST NAME: LIPID PROFILE (HDL, Cholesterol, Triglycerides, LDL and Chol/HDL Ratio + CHD RISK) CPT CODE: 80061 SPECIMEN REQUIREMENT: 2 plasma from a green top tube (heparin) OR serum from a gold top tube (SST) REFERENCE RANGE: See individual tests. METHOD: See individual tests. LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Daily and STAT within 60 minutes GENERAL USE OF TEST: See individual tests. PATIENT PREPARATION: Fasting is preferred. SPECIMEN REQUIREMENT: Collect specimen using standard lab procedures. Collect specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY LIPOPROTEIN LOW DENSITY DIRECT MEASUREMENT TEST NAME: LIPOPROTEIN LOW DENSITY DIRECT MEASURMENT CPT CODE: 83721 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL of serum from a gold top tube (SST) . REFERENCE RANGE: <100 mg/dL METHOD: Detergent/colorimetric LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing. GENERAL USE OF TEST: Used for the evaluation of coronary heart disease. LIMITATIONS: Fasting is preferred. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 5 days. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY LITHIUM TEST NAME: LITHIUM CPT CODE: 80178 SPECIMEN REQUIREMENT: 0.5 mL serum from a gold top tube (SST) OR 0.5 mL serum from a red top tube (plain) COLLECTION REQUIREMENT: Recommended time for collection is 8-12 hours post dose. REFERENCE RANGE: 0.6 – 1.2 mEq/L CRITICAL VALUE: >2.0 mEq/L METHOD: Colorimetric LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of specimens requested STAT will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Therapeutic monitoring of lithium. SPECIMEN PREPARATION: Collect specimen using standard laboratory procedures. Centrifuge specimen; separate serum from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 1 week. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY LUTEINIZING HORMONE TEST NAME: LUTEINIZING HORMONE CPT CODE: 83002 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube (SST). REFERENCE RANGE: Adult Male: 1.24 – 12.86 mIU/mL Adult Female: Follicular: 2.12 – 1 0.89 mIU/mL Ovulatory:19.18 - 103.03 mIU/mL Luteal: 1.2 – 12.86 mIU/mL Postmenopausal: 1 0.5 mL87 – 58.64 mIU/mL METHOD: Chemiluminescent Immunoassay. LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing. GENERAL USE OF TEST: Regulation of menstrual cycle. Maintenance of pregnancy. Assessment of hypothalamic function and pituitary function. To distinguish between primary or secondary gonadal failure. LIMITATIONS: Patients who have been regularly exposed to animals or immunoglobulin fragments may produce antibodies that interfere with immunoassays. SPECIMEN PREPARATION: Collect specimen using standard laboratory procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY LYME ANTIBODY TEST NAME: LYME ANTIBODY (IgG, IgM) CPT CODE: 86618 SPECIMEN REQUIREMENT: 0.5 mL serum from a gold top tube (SST). REFERENCE RANGE: No antibody detected. METHOD: Chemiluminescent Immunoassay LAB SECTION PERFORMING TEST: Reference Laboratory AVAILABILITY: Monday, Wednesday and Friday. TURNAROUND TIME: 2 Days GENERAL USE OF TEST: For use in the detection of Lyme Disease caused by the tickborne spirochete Borrelia burgdorferi. LIMITATIONS: Early stages of infections may not produce detectable levels of antibody. SPECIMEN PREPARATION: Collect specimen using standard laboratory procedures. Centrifuge specimen; separate serum from cells within 2 hours of collection Refrigerate at 2 - 8C up to 5 days. Samples will be capped and held for 7 days after testing. STORAGE REQUIREMENTS: Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY MAGNESIUM TEST NAME: MAGNESIUM CPT CODE: 83735 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR serum from a gold top tube (SST) REFERENCE RANGE: 1.8 – 2.5 mg/dL CRITICAL VALUE: <1.0 mg/dL or >5.0 mg/dL METHOD: Colorimetric LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of specimens requested STAT will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Evaluation of metabolic disorders. LIMITATIONS: None SPECIMEN PREPARATION: Collect specimen using standard laboratory procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY MALARIA SMEAR TEST NAME: MALARIA SMEAR CPT CODE: 87207 SPECIMEN REQUIREMENT: 3 mL whole blood (EDTA) in a lavender top vacutainer REFERENCE RANGE: No parasite observed. METHOD: Examination of thin and thick smears. LAB SECTION PERFORMING TEST: Hematology and Microbiology AVAILABILITY: TURNAROUND TIME: GENERAL USE OF TEST: Suspected malarial disease. Microscopic examination of thick and thin blood smears for blood borne parasites. A single negative result does not rule out the presence of Malaria organisms. Multiple samples over a 36-hour period are recommended. Antimalarial chemotherapy; improper timing of collection. LIMITATIONS: Daily Average 1-2 days. SPECIMEN PREPARATION: Venipuncture or capillary collection should take place just prior to or at onset of chills. STORAGE REQUIREMENTS: Smears must be made within 1 hour of collection. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY MICROALBUMIN TEST NAME: MICROALBUMIN CPT CODE: 82043 SPECIMEN REQUIREMENT: Random urine or 24-hour urine collected with no preservative in a plastic container obtained from the laboratory. REFERENCE RANGE: Random: 0 – 30 mg/L 24-hour Urine: 0 – 30 mg/24 HOUR VOLUME METHOD: 24 Hour: Turbidimetric Random: Turbidimetric + Jaffe Rate LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Same shift for random. Day shift only for 24 hours TURNAROUND TIME: Same shift for random. Day shift only for 24 hours GENERAL USE OF TEST: Aids in the diagnosis of kidney and intestinal disease. STORAGE REQUIREMENTS: Refrigerate at 2 - 8C up to 72 hours. Samples will be capped and held for 5 days after testing. Do not freeze samples. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY MONONUCLEOSIS, SCREEN TEST NAME: MONONUCLEOSIS, SCREEN CPT CODE: 86308 SPECIMEN REQUIREMENT: 0.5 mL serum from a gold top tube (SST) OR plasma from a lavender top tube (EDTA). REFERENCE RANGE: Negative METHOD: Immunochromatographic dipstick technology LAB SECTION PERFORMING TEST: Hematology AVAILABILITY: Daily or STAT TURNAROUND TIME: Results of routine specimens collected by 9:00 PM will be reported by 7:00 AM. Results of specimens requested STAT will be reported within 30 minutes of receipt in the laboratory. GENERAL USE OF TEST: The detection of heterophile antibodies related to infectious mononucleosis. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 1 week. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY NIPPLE SECRETION, NON-GYNECOLOGIC CYTOLOGY TEST NAME: NIPPLE SECRETION (NIPPLE DISCHARGE) NON-GYNECOLOGIC CYTOLOGY CPT CODE: 88160 SPECIMEN REQUIREMENT: Nipple secretion; glass slides, container with 95% ethyl alcohol are available from the Cytology Laboratory. COLLECTION REQUIREMENT: Gently squeeze the subareolar area and nipple with thumb and forefinger. When secretion occurs, allow a pea-sized drop to accumulate on the apex of the nipple. Move slide across the nipple, smearing the secretion(s) across the slide and fix immediately in 95% ETOH. Label slide with the patient’s name. REFERENCE RANGE: Negative for malignant cells. METHOD: Modified Papanicolaou LAB SECTION PERFORMING TEST: Cytology AVAILABILITY: Monday through Friday; 0800 to 163 0.5 mL TURNAROUND TIME: One to two working days. GENERAL USE OF TEST: To establish the presence of primary or metastatic neoplasm. STORAGE REQUIREMENTS: Refrigerate Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY OSMOLALITY, SERUM TEST NAME: OSMOLALITY, SERUM CPT CODE: 83930 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube OR 0.5 mL serum from a gold top tube (SST). REFERENCE RANGE: 275 – 295 mOsm/Kg METHOD: Freezing point depression. LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT. TURNAROUND TIME: Same shift testing. Results of specimens requested STAT will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Dehydration, electrolyte balance. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum from cells within 2 hours of collection. Refrigerate at 2° - 8°C up to 1 week. Samples will be capped and held for at least 48 hours after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY OSMOLALITY, URINE TEST NAME: OSMOLALITY, URINE CPT CODE: 83935 SPECIMEN REQUIREMENT: 0.5 mL random urine REFERENCE RANGE: Female: 390 – 1090 mOsm/Kg Male: 300 – 1090 mOsm/Kg METHOD: Freezing point depression. LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of specimens requested STAT will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Dehydration, concentrating ability of the kidney. SPECIMEN PREPARATION: Keep specimens refrigerated until analysis. STORAGE REQUIREMENTS: Refrigerate at 2 - 8 up to a week. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY PARTIAL THROMBOPLASTIN TIME TEST NAME: ALTERNATE TEST NAME: ACTIVATED PARTIAL THROMBOPLASTIN TIME PTT CPT CODE: 85730 SPECIMEN REQUIREMENT: Plasma from a full blue top tube (sodium citrate). REFERENCE RANGE: Reference range listed on report. CRITICAL VALUE: >100 secs. METHOD: Photometric detection LAB SECTION PERFORMING TEST: Hematology/Coagulation AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. STAT = 30 – 60 min. GENERAL USE OF TEST: Measurement of intrinsic coagulation system. LIMITATIONS: Heparin therapy should be noted on requisition. Clotted specimen, inadequate filling of tube, specimen greater than 4 hours old (or 2 hours old if patient received heparin), improper labeling, hemolyzed, icteric or lipemic specimens, specimen drawn above an IV. Mix well immediately after drawing. Centrifuge at within four hours of collection. Store unopened tube at room temperature or 2 - 8C for up to 4 hours (or 2 hours if patient on heparin)prior to analysis. SPECIMEN PREPARATION: STORAGE REQUIREMENTS: Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY PATH CBC TEST NAME: PATH CBC CPT CODE: SPECIMEN REQUIREMENT: 3mL lavender top tube (EDTA) Minimum of 1 mL required or 250 ul lavender microtainer COLLECTION REQUIREMENT: METHOD: Pathologist reviews prepared slide and enters comment in computer. LAB SECTION PERFORMING TEST: Hematology AVAILABILITY: Daily TURNAROUND TIME: GENERAL USE OF TEST: STORAGE REQUIREMENTS: 24 hours, not performed on Sundays. A physician may request a pathologist to review a blood smear slide for various abnormalities. 24 hours of collection at room temperature. Test may be added if a slide has been already prepared – call x3249 to check availability. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY PATH EVAL(COMPREHENSIVE REPORT) TEST NAME: PATH EVAL (COMPREHENSIVE REPORT)\ CPT CODE: SPECIMEN REQUIREMENT: 3mL lavender top tube (EDTA) Minimum of 1 mL required or 250 ul lavender microtainer COLLECTION REQUIREMENT: Order must include diagnosis/reason for requesting comprehensive report or a completed history sheet filled out on all outpatients. Fax to 248-858-3078. METHOD: Direct current, electrical impedance. Light scatter and fluorescence. Pathologist reviews all results. LAB SECTION PERFORMING TEST: Hematology AVAILABILITY: CBC and Reticulocyte parameters are available STAT or daily. TURNAROUND TIME: 24 hours, not performed on Sundays GENERAL USE OF TEST: The physician may request a comprehensive pathology review in certain patient cases. The pathologist performs a review of the complete history and medical records and dictates a completed report. Test parameters performed include CBC, Differential and Reticulocyte count including a final evaluation report performed by the pathologist. STORAGE REQUIREMETNS: Sample must be analyzed within 24 hours of collection at room temperature. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY pH, BODY FLUIDS TEST NAME: pH, BODY FLUIDS CPT CODE: 82800 SPECIMEN REQUIREMENT: Body fluid submitted in a green top tube (heparin) OR a red top tube (Plain) OR a gold top tube OR other clean or sterile leak-proof container REFERENCE RANGE: Should be interpreted in regard to fluid type submitted. METHOD: Ion Selective Electrode BG or dipstick LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing Results of specimens requested STAT will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Determine pH of clinical specimen. STORAGE REQUIREMENTS: Refrigerate at 2 - 8C for up to a week. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY pH, FECES TEST NAME: pH, FECES CPT CODE: 84999 SPECIMEN REQUIREMENT: REFERENCE RANGE: pH 5.0 – 6.0 METHOD: Clinitek Advantus or Multistix manual dipstick LAB SECTION PERFORMING TEST: Urinalysis AVAILABILITY: Daily TURNAROUND TIME: 24 hours GENERAL USE OF TEST: Low pH of stool (acidic) is seen in lactose intolerance or where there is rapid intestinal transit time as in diarrhea. PATIENT PREPARATION: No barium procedures, laxatives or antiamebic drugs for one week prior to specimen collection. STORAGE REQUIREMENTS: Freeze within 2 hours of collection if testing is not performed immediately. Stool must be < 2 hours old Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY PHENOBARBITAL TEST NAME: PHENOBARBITAL CPT CODE: 80184 SPECIMEN REQUIREMENT: REFERENCE RANGE: 15 – 40 μg/Ml CRITICAL VALUE: >50 μg/mL METHOD: Immunoassay/Turbidimetric LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. STATs will be resulted within 60 minutes of receipt in the laboratory. 0.5 mL plasma from a green top tube (heparin) OR serum from a gold top tube (SST). GENERAL USE OF TEST: Monitor phenobarbital levels to ensure appropriate therapy. PATIENT PREPARATION: Trough: One hour prior to next dose. SPECIMEN PREPARATION: Collect specimen using standard laboratory procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for at least 48 hours after testing. STORAGE REQUIREMENTS: Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY PHENYTOIN (DILANTIN) TEST NAME: PHENYTOIN (DILANTIN) CPT CODE: 80185 SPECIMEN REQUIREMENT: REFERENCE RANGE: 10 – 20 μg/mL CRITICAL VALUE: 340 μg/mL METHOD: Turbidimetric Inhibition Immunoassay LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing; reported the same day. STATs will be resulted within 60 minutes of receipt in the laboratory. 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube (SST). GENERAL USE OF TEST: Monitor phenytoin levels to ensure appropriate therapy. PATIENT PREPARATION: Trough: One hour prior to next dose. SPECIMEN PREPARATION: Collect specimen using standard laboratory procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for at least 48 hours after testing. STORAGE REQUIREMENTS: Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY PHOSPHORUS, BLOOD TEST NAME: PHOSPHORUS, BLOOD CPT CODE: 84100 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube (SST) REFERENCE RANGE: CRITICAL VALUE: AGE 0 MOS to 1 MO 1 MO to 3 MOS 3 MOS to 12 MOS 12 MOS to 2 YRS 2 YRS to 13 YRS 13 YRS to 16 YRS 16 YRS TO 18 YRS >= 18 years FEMALE 3.1 -7.7 mg/dL 3.1 -7.2 mg/dL 3.1 – 6.8 mg/dL 3.1 – 6.3 mg/dL 3.1 – 5.9 mg/dL 3.1 - 5.5mg/dL 3.1 – 4.8 mg/dL 2.4. - 4.7mg/dL MALE 2.8 -7.0 mg/dL 3.1 -6.6 mg/dL 3.1 – 6.6 mg/dL 3.1 – 6.2 mg/dL 3.1 – 5.9 mg/dL 3.1 - 5.3mg/dL 3.1 – 5.1 mg/dL 2.4. - 4.7mg/dL <0.9mg/dL METHOD: Colorimetric LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing. GENERAL USE OF TEST: Measurement of phosphorus is used in the diagnosis and treatment of parathyroid gland and kidney diseases, and Vitamin D imbalance. SPECIMEN PREPARATION: Collect specimen using standard laboratory procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY PHOSPHORUS, URINE TEST NAME: PHOSPHORUS, URINE CPT CODE: 84105 SPECIMEN REQUIREMENT: Random urine or 24-hour urine collected with no preservative in a plastic container obtained from the laboratory. REFERENCE RANGE: 0.4 mL – 1.3 G/24 hrs METHOD: Colorimetric LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same Day testing. GENERAL USE OF TEST: Measurement of phosphorus is used in the diagnosis and treatment of parathyroid gland and kidney diseases, and Vitamin D imbalance. SPECIMEN PREPARATION: No preservatives necessary. Refrigerate specimen during collection and until analysis. STORAGE REQUIREMENTS: Refrigerate at 2 - 8C up to 3 days. Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY TEST NAME: PLATELET FUNCTION ANALYSIS PLATELET FUNCTION ANALYSIS CPT CODE: Sodium citrate whole blood SPECIMEN REQUIREMENT: COLLECTION REQUIREMENT: METHOD: Sample must be collected on campus. Call x83249 for kit. After collection, sample must be walked to the lab (DO NOT transport in the Pneumatic tube system) Test cannot be performed if platelet count is <50,000 or hematocrit <25. Test cartridge system on PFA-100 instrument LAB SECTION PERFORMING TEST: Coagulation AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing GENERAL USE OF TEST: Aids in detection of platelet dysfunction. STORAGE REQUIREMENTS: Test must be performed after at least 30 minute but no more than 4 hours after collection time. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY PLATELETS TEST NAME: PLATELETS CPT CODE: P9035 or P9037 SPECIMEN REQUIREMENT: Pink EDTA or plain red top vacutainer tube if blood type is not on file. COLLECTION REQUIREMENT: METHOD: Leukoreduced plateletpheresis or irradiated products used. LAB SECTION PERFORMING TEST: Blood Bank AVAILABILITY: STAT on all three shifts. TURNAROUND TIME: 30 minutes GENERAL USE OF TEST: To correct platelet deficiencies if clinical indicated. PATIENT PREPARATION: Refer to Transfusion Guidelines. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY PLAVIX RESPONSE TEST TEST NAME: PLAVIX RESPONSE TEST CPT CODE: 85576 X2 SPECIMEN REQUIREMENT: Call 83249 to obtain kit. COLLECTION REQUIREMENTS: Sample must be collected on campus. Call x83249 for collection kit. After collection, samples must be walked to the Laboratory. DO NOT transport by pneumatic tube system. Whole blood may be collected from venous or arterial sites using a 21-gauge or larger needle first drawn in a in 3.2% regular blue top tube, then two Greiner tubes filled to the black diamonds. Blood samples should be obtained from an extremity free of IV fluids. Collect a discard tube first (at least 2 mL). Gently invert the sample tubes 5 times to ensure complete mixing. REFERENCE RANGE: Research suggests that there is variability in response to clopidogrel (Plavix). P2Y12 Reaction Units (PRU) reference range =194-418 Lower PRU levels implymore anti-platelet effect. METHOD: Turbimetric based optical system that measures platelet induced aggregation. LAB SECTION PERFORMING TEST: Hematology AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of STAT specimens will be reported within 30 minutes of receipt in the lab. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY GENERAL USE OF TEST: To measure the level of patient P2Y12 receptor blockade. LIMITATIONS: Patients with inherited platelet disorders, such as von Willebrand Factor Deficiency, Glanzmann Thrombasthenia and Bernard-Soulier Syndrome, have not been studied with this assay. SPECIMEN PREPARATION: Specimens must be assayed within 4 hours of collection. Specimens that are not assayed within 4 hours will be rejected. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY POTASSIUM TEST NAME: POTASSIUM CPT CODE: 84132 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR serum from gold top tube (SST) REFERENCE RANGE: 3.5 – 5.3 mEq/L CRITICAL VALUE: <2.9 mEq/L or >6.0 mEq/L METHOD: Ion Selective Electrode LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of specimens requested STAT will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Electrolyte balance LIMITATIONS: Hemolysis falsely increases potassium. PATIENT PREPARATION: SPECIMEN PREPARATION: STORAGE REQUIREMENTS: The patient should avoid any exercise of the arm or hand before or during collection because opening and closing the fist increases concentrations by 10 to 20%. Do not draw from an arm receiving IV. Collect specimen using standard laboratory procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY PREALBUMIN TEST NAME: PREALBUMIN CPT CODE: 84134 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube (SST). REFERENCE RANGE: 18 – 38 mg/dL METHOD: Turbidimetric LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing. GENERAL USE OF TEST: Aids in the assessment of the patient’s nutritional status. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 72 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY PROGESTERONE TEST NAME: PROGESTERONE CPT CODE: 84144 0.5mL serum from a red top tube. SPECIMEN REQUIREMENT: REFERENCE RANGE: Serum can be stored for up to 12 hours on the gel of the SST tube. Male: 0.14 – 2.06 ng/ml Female: Mid -Follicular: 0.31 – 1.52 ng/mL Mid-Luteal 5.16 – 18,56 ng/ml Postmenopausal: <0.08 – 0.78 ng/mL First Trimester: 4.73 – 50.74 ng/mL Second Trimester: 19.41- 45.30 ng/mL METHOD: Chemiluminescence LAB SECTION PERFORMING TEST: Reference Laboratory AVAILABILITY: Daily, Monday-Friday TURNAROUND TIME: 1-2 Days GENERAL USE OF TEST: Progesterone is a steroid hormone that plays an important role in the preparation for and maintenance of pregnancy, and is a reliable method to detect ovulation. LIMITATIONS: Patients who have been regularly exposed to animals or immunoglobulin fragments may produce antibodies that interfere with immunoassays. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum from cells IMMEDIATELY Refrigerate serum at 2 - 8C up to 3 days.. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY PROLACTIN EST NAME: PROLACTIN CPT CODE: 84146 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube (SST). SPECIMEN REQUIREMENT: REFERENCE RANGE: NONE METHOD: Chemiluminescent immunoassay LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing GENERAL USE OF TEST: Pituitary function test useful in the detection of prolactin secreting pituitary tumors with or without galactorrhea and in the assessment of pituitary dysfunction. Pituitary adenoma, amenorrhea, galactorrhea and infertility. LIMITATIONS: Patients who have been regularly exposed to animals or immunoglobulin fragments may produce antibodies that interfere with immunoassays. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY PROSTATE SPECIFIC ANTIGEN TEST NAME: PROSTATE SPECIFIC ANTIGEN CPT CODE: 84153 SPECIMEN REQUIREMENT: 0.5 mL serum from a gold top tube (SST) OR 0.5 mL serum from a red top tube (plain). REFERENCE RANGE: Less than 4.0 ng/mL METHOD: Chemiluminescent immunoassay LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing GENERAL USE OF TEST: An adjunctive test used as an aid in the management of prostate cancer patients. LIMITATIONS: SPECIMEN PREPARATION: STORAGE REQUIREMENTS: Serum PSA measurement is not an absolute test for malignancy. The PSA value should be used in conjunction with information available from clinical evaluation and other diagnostic procedures. Specimens obtained from patients undergoing prostate manipulation procedures may give erroneous results. Patients who have been regularly exposed to animals or immunoglobulin fragments may produce antibodies that interfere with immunoassays. Collect specimen using standard lab procedures. Centrifuge specimen; separate serum from cells within 3 hours of collection. Refrigerate serum at 2 - 8C up to 24 hours. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY PROTEIN, CEREBROSPINAL FLUID TEST NAME: PROTEIN, CEREBROSPINAL FLUID CPT CODE: 84157 SPECIMEN REQUIREMENT: 0.5 mL cerebrospinal fluid collected in a sterile plastic CSF screw cap tube (#1). REFERENCE RANGE: 15 – 45 mg/Dl METHOD: Colorimetric LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing Results of specimens requested STAT will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Diagnosis of cerebrospinal fluid pathological processes. LIMITATIONS: Presence of hemoglobin may elevate levels. SPECIMEN PREPARATION: If specimen is cloudy or bloody, centrifuge and remove the supernatant within 4 hours of collection. STORAGE REQUIREMENTS: Refrigerate serum at 2 - 8C up to a week. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY PROTEIN C TEST NAME: PROTEIN C CPT CODE: SPECIMEN REQUIREMENT: Plasma from a full blue top tube (sodium citrate) COLLECTION REQUIREMENT: METHOD: Chromogenic detection LAB SECTION PERFORMING TEST: Reference Laboratory AVAILABILITY: Monday-Friday TURNAROUND TIME: GENERAL USE OF TEST: STORAGE REQUIREMENTS: 3 Days Deficiency of the Vitamin K dependent Protein C is associated with recurrent venous thrombosis. o Plasma should be removed from cells and frozen at -20 C within 4 hours of collection. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY PROTEIN ELECTROPHORESIS (SERUM) TEST NAME: PROTEIN ELECTROPHORESIS (SERUM) (Albumin, Alpha 1, Alpha 2, Beta and Gamma fractions, Serum Total Protein) CPT CODE: 84165 84155 SPECIMEN REQUIREMENT: 1.0 mL serum from a gold top tube (SST). REFERENCE RANGE: Albumin 3.7-4.9 g/dL 52.9-66.9% Alpha-1 Globulin 0.2- 0.4 g/dL 3.3-5.8% Alpha-2 Globulin 0.5- 0.9 g/dL 7.5-13.4% Beta Globulin 0.6-1.0 g/dL 8.5-13.7% Gamma Globulin 0.6-1.4 g/dL 8.8-19.2% Total serum protein 6.4-8.2 g/dL METHOD: Electrophoresis LAB SECTION PERFORMING TEST: Reference Laboratory AVAILABILITY: Monday – Friday TURNAROUND TIME: One Day GENERAL USE OF TEST: SPECIMEN PREPARATION: STORAGE REQUIREMENTS: Collect specimen using standard lab procedures. Centrifuge specimen; Refrigerate serum at 2 - 8C up to 10 days or store frozen up to 1 month. . Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY PROTEIN, TOTAL TEST NAME: PROTEIN, TOTAL CPT CODE: 80002 SPECIMEN REQUIREMENT: 0.5 mL serum from a gold top tube (SST) OR 0.5 mL plasma from a green top tube (heparin). REFERENCE RANGE: AGE 0MOS – 1 MO 1M0 – 6 MOS MALE 4.1 – 6.3 g/dL 4.7 – 6.7 g/dL FEMALE 4.2 – 6.2 g/dL 4.4 – 6.6 g/dL 6MOS- 12 MOS 12MOS – 18 YRS >= 18 YRS 5.5 – 7.0 g/dL 5.7 – 7.9 g/dL 6.1 -7.9 g/dL 5.6 – 7.9 g/dL 5.7 – 7.9 g/dL 6.1 -7.9 g/dL METHOD: Colorimetric LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing. GENERAL USE OF TEST: Detection of hypo and hyperproteinemia. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY PROTEIN, URINE 24-HOUR TEST NAME: PROTEIN, URINE 24-HOUR CPT CODE: 84156 SPECIMEN REQUIREMENT: Random urine or a 24-hour urine collected with no preservatives in a plastic container obtained from the laboratory. REFERENCE RANGE: 50 – 100 mg/24 hours METHOD: Colorimetric LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing for urine protein. 24 hour urine protein performed on day shift Performed STAT (60 minutes) for Labor and Delivery. GENERAL USE OF TEST: Detection of clinically significant proteinuria. LIMITATIONS: No preservatives necessary. Collect timed specimens on ice or refrigerate specimen during collection. Urine samples should not be collected after intense physical exertion, or acute fluid load or deprivation. Collect specimens prior to administration of contrast media. SPECIMEN PREPARATION: Centrifuge specimen before analysis to remove particulate matter. STORAGE REQUIREMENTS: Refrigerate at 2 - 8C up to 3 days. Do not freeze. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY PROTHROMBIN TIME TEST NAME: PROTHROMBIN TIME CPT CODE: 85610 SPECIMEN REQUIREMENT: Plasma from a full blue top tube (sodium citrate). REFERENCE RANGE: Reference range listed on report. CRITICAL VALUE: INR > 6.0 METHOD: Photometric Detection LAB SECTION PERFORMING TEST: Hematology/Coagulation AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. STAT: 30 – 60 minutes GENERAL USE OF TEST: Evaluation of extrinsic coagulation system and Vitamin K dependent factors. LIMITATIONS: Clotted specimen. Improper labeling. Specimen greater than 24 hours old. Incomplete filling of vacutainer. Hemolyzed, icteric or lipemic specimen. Anticoagulant therapy should be noted on requisition. SPECIMEN PREPARATION: Mix immediately after drawing. STORAGE REQUIREMENTS: Store unopened tube at room temperature or 2-8 C. for up to 24 hours prior to analysis. o Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY RETICULOCYTE COUNT TEST NAME: ALTERNATE TEST NAME: RETICULOCYTE COUNT Retics CPT CODE: 85045 SPECIMEN REQUIREMENT: 3 mL whole blood (EDTA) from lavender top tube OR 250 uL from a lavender microtainer. REFERENCE RANGE: 0-2 Wks Old:: 2.5 – 6.5% >2 Wks Old: 0.4 – 2.0% METHOD: 1. Supervital dye stains reticulocytes which are then measured by light scatter, direct measurements and opacity characteristics on analyzer. 2. Manually stained smear using new methylene blue LAB SECTION PERFORMING TEST: Hematology AVAILABILITY: Daily TURNAROUND TIME: 24 hours GENERAL USE OF TEST: Evaluation of the rate of red cell production in the bone marrow. LIMITATIONS: Recently transfused patients. Clotted specimen. Specimens for reticulocyte counts are stable at room temperature or 2 - 8C for 24 hours after collection. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY RHEUMATOID FACTOR (RA) TEST NAME: RHEUMATOID FACTOR (RA) CPT CODE: 86431 SPECIMEN REQUIREMENT: 0.5 mL serum from a gold top tube (SST). REFERENCE RANGE: Less than 14U/mL METHOD: Turbidimetric LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Monday through Friday TURNAROUND TIME: Results of specimens collected by 7:00 AM will be reported by 3:00 PM. GENERAL USE OF TEST: Detection of rheumatoid arthritis. SPECIAL PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen and separate serum from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 1 week. Samples will be capped and held for at least 48 hours after testing. Do not freeze samples. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY RUBELLA (IgG) TEST NAME: RUBELLA (IgG) CPT CODE: 86762 SPECIMEN REQUIREMENT: 0.5 mL serum from a gold top tube (SST). REFERENCE RANGE: Immune METHOD: Chemiluminescent immunoassay LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing. GENERAL USE OF TEST: For the quantitative measurement of IgG antibodies to rubella virus in serum and to aid in the determination of immune status. LIMITATIONS: Patients who have been regularly exposed to animals or immunoglobulin fragments may produce antibodies that interfere with immunoassays. SPECIAL PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen and separate serum from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY SALICYLATE TEST NAME: SALICYLATE CPT CODE: 80196 SPECIMEN REQUIREMENT: 0.5 mL serum from a gold top tube (SST) OR 0.5 mL plasma from a green top tube (heparin). REFERENCE RANGE: 0-19 mg/dL CRITICAL VALUE: >30 mg/dL METHOD: Enzymatic LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of specimens requested STAT will be reported within 60 minutes of receipt in the laboratory. Monitor therapeutic drug level. Salicylate toxicity and poisoning. Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. GENERAL USE OF TEST: SPECIMEN PREPARATION: STORAGE REQUIREMENTS: Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY SEDIMENTATION RATE TEST NAME: SEDIMENTATION RATE ALTERNATE TEST NAME: ESR CPT CODE: 85651 SPECIMEN REQUIREMENT: 4.0 mL whole blood in a purple top tube(EDTA) REFERENCE RANGE: Male: 0-10 mm/hour Female: 0-20 mm/hour METHOD: Modified Westergren using light transmittance LAB SECTION PERFORMING TEST: Hematology AVAILABILITY: Daily TURNAROUND TIME: Same Shift Testing GENERAL USE OF TEST: Non-specific activity of disease processes. SPECIMEN PREPARATION: Gently invert tube six times immediately after collection. STORAGE REQUIREMENTS: Blood kept at room temperature must be analyzed within 24 hours of collection. Store at room temperature or 2 - 8C. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY SEMEN ANALYSIS TEST NAME: SEMEN ANALYSIS CPT CODE: 89320 SPECIMEN REQUIREMENT: Single, total ejaculate submitted within 30-60 minutes in clean glass container. 4 oz. plastic screw top container, second choice. REFERENCE RANGE: Reference range listed on report METHOD: Manual count using hemocytometer and morphology determination. LAB SECTION PERFORMING TEST: Hematology AVAILABILITY: M-F 7:30 A/M. – 2:30 P.M. No weekends or holidays. TURNAROUND TIME: Up to 3 business days. GENERAL USE OF TEST: Quantitative and qualitative examination of seminal fluid in the diagnosis of male infertility. PATIENT PREPARATION: SPECIMEN PREPARATION: Patient should abstain from sexual activity for the three days prior to specimen collection. Patient should receive our instruction sheet. Specimen is deposited directly into container. Exact time of collection must be noted on container or requisition. Specimen must be kept at body temperature while being transported to the laboratory. STORAGE REQUIREMENTS: Specimen must be received in the lab within one hour of collection. Keep sample warm; do not refrigerate. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY SEMEN ANALYSIS POST VASECTOMY TEST NAME: SEMEN ANALYSIS POST VASECTOMY CPT CODE: 89300 SPECIMEN REQUIREMENT: Single, total ejaculate submitted in clean glass or plastic screw top container. Submission within 4 hours is preferred. REFERENCE RANGE: Sperm absent METHOD: Microscopic examination LAB SECTION PERFORMING TEST: Hematology AVAILABILITY: Before 5:00 P.M. Monday – Friday. No weekends or Holidays. May be delivered to outpatient labs. TURNAROUND TIME: 3 business days. GENERAL USE OF TEST: Determine presence or absence of sperm after vasectomy procedure. PATIENT PREPARATION: Patient should abstain from sexual activity for the three days prior to specimen collection. SPECIMEN PREPARATION: Specimen is deposited directly into container. Time of collection must be noted on container or requisition. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY SKIN BIOPSY IMMUNOFLUORESCENCE TEST NAME: SKIN BIOPSY IMMUNOFLUORESCENCE CPT CODE: SPECIMEN REQUIREMENT: Tissue biopsy: specimen must be received in the laboratory within 24 hours. Notify Anatomic Pathology before collecting specimen. COLLECTION REQUIREMENT: Pre-filled container of transport media obtain from Histology Lab, (Michelle’s Fixative) 248-858-6883. REFERENCE RANGE: See report METHOD: Sent to reference lab LAB SECTION PERFORMING TEST: Anatomic Pathology AVAILABILITY: Monday through Friday, 0800 to 1630 TURNAROUND TIME: Approximately 1 week GENERAL USE OF TEST: Used to demonstrate in vivo fixation of antibody in autoimmune diseases. STORAGE REQUIREMENTS: Refrigerate Revised 07/14. TEST NAME: RETURN TO TEST DIRECTORY CPT CODE: SPECIMEN REQUIREMENT: SURGICAL TISSUE ROUTINE TISSUE PATHOLOGY RETURN TO HOME PAGE Determined by specimen type and dia Fresh tissue SJMO LABORATORY TEST DIRECTORY SODIUM TEST NAME: SODIUM CPT CODE: 84295 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube (SST) REFERENCE RANGE: 133 – 145 mEq/L CRITICAL VALUE: <124 OR >160 mEq/L METHOD: Ion Selective Electrode LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of specimens requested STAT will be reported within 60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Electrolyte balance. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY SODIUM, URINE TEST NAME: SODIUM, URINE CPT CODE: 84300 SPECIMEN REQUIREMENT: Random urine or 24-hour urine collected with no preservative in a plastic container obtained from the laboratory. REFERENCE RANGE: 40 - 220 mEq/24 hours METHOD: Ion Selective Electrode LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing. Day shift only for 24-hour urine sodium GENERAL USE OF TEST: Renal function. SPECIMEN PREPARATION: No preservations necessary. Refrigerate during collection. Refrigerate at 2 - 8C up to 3 days. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY SPUTUM, CYTOLOGY TEST NAME: SPUTUM, CYTOLOGY CPT CODE: 88161 or 88112 if thin prep made SPECIMEN REQUIREMENT: 2 mL of deep cough sputum. Three to five consecutive early morning deep cough specimens are necessary. COLLECTION REQUIREMENT: Fix with equal volume. Received fresh. REFERENCE RANGE: Negative for malignant cells. METHOD: Modified Papanicolaou LAB SECTION PERFORMING TEST: Cytology AVAILABILITY: Monday – Friday; 0800 to 163 0.5 mL TURNAROUND TIME: One to two working days. GENERAL USE OF TEST: To establish the presence of primary or metastatic neoplasm. PATIENT PREPARATION: Upon arising, the patient rinses mouth and coughs forcefully and vigorously to expectorate a deep cough specimen into a plastic container. LIMITATIONS: If dust-pigmented laden macrophages are not identified, specimen will be reported as unsatisfactory. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY SURGICAL TISSUE TEST NAME: SURGICAL TISSUE ROUTINE TISSUE PATHOLOGY CPT CODE: Determined by specimen type and diagnosis. SPECIMEN REQUIREMENT: Fresh tissue COLLECTION REQUIREMENT: 10% Neutral buffered formalin. Operative diagnosis required. REFERENCE RANGE: Results interpreted by consulting Pathologist. METHOD: Paraffin embedded tissue sections. Microscopy LAB SECTION PERFORMING TEST: Histology AVAILABILITY: Monday through Friday, 0800 to 1630 TURNAROUND TIME: 24 – 48 hours GENERAL USE OF TEST: Histologic diagnosis Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY T3, FREE TEST NAME: T3, FREE CPT CODE: 84480 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube. REFERENCE RANGE: 2.5 – 3.9 pg/mL METHOD: Chemiluminescent immunoassay LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing GENERAL USE OF TEST: Evaluate thyroid function. LIMITATIONS: Patients who have been regularly exposed to animals or immunoglobulin fragments may produce antibodies that interfere with immunoassays. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. STORAGE REQUIREMENTS: Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY T3, TOTAL TEST NAME: T3, TOTAL CPT CODE: 84480 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube. REFERENCE RANGE: 0.5 mL9 – 1.8 ng/mL METHOD: Chemiluminescent immunoassay LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing GENERAL USE OF TEST: Evaluate thyroid function. LIMITATIONS: Patients who have been regularly exposed to animals or immunoglobulin fragments may produce antibodies that interfere with immunoassays. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. STORAGE REQUIREMENTS: Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY T4, FREE TEST NAME: T4, FREE CPT CODE: 84439 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube. REFERENCE RANGE: 0.5 – 1.64 ng/dl METHOD: Chemiluminescent immunoassay LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing GENERAL USE OF TEST: Evaluate thyroid function. LIMITATIONS: Patients who have been regularly exposed to animals or immunoglobulin fragments may produce antibodies that interfere with immunoassays. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. STORAGE REQUIREMENTS: Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY T4, TOTAL TEST NAME: T4, TOTAL CPT CODE: 84436 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube. REFERENCE RANGE: 6.1– 12.2 ug/mL METHOD: Chemiluminescent immunoassay LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing GENERAL USE OF TEST: Evaluate thyroid function. LIMITATIONS: Patients who have been regularly exposed to animals or immunoglobulin fragments may produce antibodies that interfere with immunoassays. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. STORAGE REQUIREMENTS: Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY TEGRETOL (CARBAMAZEPINE) TEST NAME: TEGRETOL (CARBAMAZEPINE) CPT CODE: 81056 SPECIMEN REQUIREMENT: REFERENCE RANGE: 4 - 12 g/mL CRITICAL VALUE: >15 g/mL METHOD: Immunoassay LAB SECTION PERFORMING TEST: Chemistry COLLECTION REQUIREMENTS: Trough: Immediately prior to next oral dose. Peak: Draw 3 hours after oral dose. 0.5 mL serum from a plain red top tube OR 0.5 mL serum from a gold top tube OR 0.5 mL plasma from a green top tube (heparin). AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing Results of STAT specimens will be reported within 30-60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Monitor therapeutic drug levels. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum from cells within 2 hours of collection. STORAGE REQUIREMENTS: Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY TESTOSTERONE, TOTAL TEST NAME: TESTOSTERONE, TOTAL CPT CODE: 84403 SPECIMEN REQUIREMENT: 0.5 mL serum from a gold top tube (SST) OR 0.5 mL plasma from a green top tube (heparin). REFERENCE RANGE: Male (age >18 yrs.): Female (age >21 yrs): METHOD: Chemiluminescent immunoassay LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing GENERAL USE OF TEST: 175 - 781 ng/dL 10 - 75 ng/dL In males: used to investigate sexual dysfunction. In females: investigate infertility, amenorrhea and hirsuitism. LIMITATIONS: Patients who have been regularly exposed to animals or immunoglobulin fragments may produce antibodies that interfere with immunoassays. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. STORAGE REQUIREMENTS: Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY THYROID STIMULATING HORMONE TEST NAME: THYROID STIMULATING HORMONE (Ultrasensitive TSH) CPT CODE: 84443 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR serum from yellow tube (SST) REFERENCE RANGE: 0.34 – 5.60 IU/mL METHOD: Chemiluminescent immunoassay LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing GENERAL USE OF TEST: Differential diagnosis of primary hypothyroidism from secondary hypothyroidism. LIMITATIONS: Patients who have been regularly exposed to animals or immunoglobulin fragments may produce antibodies that interfere with immunoassays. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. STORAGE REQUIREMENTS: Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY TOBRAMYCIN (NEBCIN) TEST NAME: TOBRAMYCIN (NEBCIN) CPT CODE: 80200 : Random : Trough : Peak SPECIMEN REQUIREMENT: 0.5 mL serum from a 7 mL gold top tube (SST) OR plasma from a green top tube (heparin). REFERENCE RANGE: Tobramycin 0.0 – 10.0 g/mL Tobramycin Trough 0.0 – 1.9g/mL Tobramycin Peak 5.0- 10.0 g/mL CRITICAL VALUE: Tobramycin 12.1 g/mL Tobramycin Trough 3.1 g/mL Tobramycin Peak 12.1 g/mL METHOD: Immunoassay LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. GENERAL USE OF TEST: To monitor antibiotic therapy; test for insufficient or toxic levels of tobramycin. PATIENT PREPARATION: Trough: 30 minutes to immediately prior to next dose. Peak: 30 minutes after infusion is complete. Collect specimen using standard lab procedures. SPECIMEN PREPARATION: Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. STORAGE REQUIREMENTS: Refrigerate at 2 - 8C up to 48 hours prior to analysis. If analysis is delayed more than 48 hours, freeze samples at 15C to -20C. Samples will be capped and held for 4 days after testing. Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY TOXOPLASMA (IgG) TEST NAME: TOXOPLASMA (IgG) CPT CODE: 86777 SPECIMEN REQUIREMENT: 0.5 mL serum from in a gold top tube (SST). REFERENCE RANGE: See Reference Laboratory Report METHOD: Immunofluorescence LAB SECTION PERFORMING TEST: Reference Laboratory AVAILABILITY: Monday-Friday TURNAROUND TIME: 1-2 Days GENERAL USE OF TEST: For use in the detection of antibodies to the protozoan parasite Toxoplasma gondii. LIMITATIONS: Sera collected very early in the acute stages of the disease may have antibody too low to detect. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum from cells within 2 hours of collection. STORAGE REQUIREMENTS: Refrigerate at 2 - 8C up to 48 hours. If longer storage is needed, freeze at C for up to 2 months. Samples will be capped and held for 5 days after testing. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY TRANSFERRIN TEST NAME: TRANSFERRIN CPT CODE: 84466 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR serum from a gold tube (SST) REFERENCE RANGE: 180 – 329 mg/dL (male) 192 – 382 mg/dL (female) METHOD: Turbidimetric LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing. GENERAL USE OF TEST: Aids in diagnosis of malnutrition, acute inflammation, and infection, assessment of renal function and red blood cell disorders. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. STORAGE REQUIREMENTS: If not assayed within 8 hours of collection, store at 2 8C for 48 hours. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY TRIGLYCERIDES TEST NAME: TRIGLYCERIDES CPT CODE: 84478 SPECIMEN REQUIREMENT: 0.5 mL plasma from a green top tube (heparin) OR serum from a gold top tube (SST) REFERENCE RANGE: 40 - 149 mg/dL METHOD: Enzymatic LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing GENERAL USE OF TEST: Hyper or hypo lipidemia. PATIENT PREPARATION: Fasting is preferred. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum from cells within 2 hours of collection. STORAGE REQUIREMENTS: Refrigerate at 2 - 8C up to 48 hours. Samples will be capped and held for 5 days after testing. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY TROPONIN TEST NAME: TROPONIN CPT CODE: 84484 SPECIMEN REQUIREMENT: 0.5 mL plasma from an orange top tube OR 0.5 mL serum from a gold top tube (SST)for outpatients only REFERENCE RANGE: Reference Interval: < 0.5 mL03 ng/mL (Interpretation: Negative – repeat testing in four to six hours if clinically indicated.) CRTICAL VALUE: > 0.5 mL40 ng/mL METHOD: Chemiluminescent immunoassay LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. STAT specimens will be reported within 30-60 minutes of receipt in the laboratory. GENERAL USE OF TEST: Cardiac specific marker, which is released after AMI or ischemic damage. LIMITATIONS: Patients who have been regularly exposed to animals or immunoglobulin fragments may produce antibodies that interfere with immunoassays. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate plasma from cells within 2 hours of collection. STORAGE REQUIREMENTS: Revised 07/14. RETURN TO TEST DIRECTORY Specimens may be stored for up to 24 hours at 2 - 8C. Samples will be capped and held for 5 days after testing. RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY TZANCK SMEAR: VIRAL STUDIES FOR HERPES, PEMPHIGUS TEST NAME: TZANCK SMEAR CPT CODE: 88160 SPECIMEN REQUIREMENT: Direct scrapes of lesion at margins of the vesicle. COLLECTION REQUIREMENT: Firmly scrape the margins of the lesion with moist end of tongue depressor. Spread cellular material evenly on glass slide(s) and immediately immerse in 95% ETOH. Label slide(s) with patient’s name. Collection materials may be obtained from Laboratory. 83600 REFERENCE RANGE: No viral inclusion bodies identified. METHOD: Modified Papanicolaou LAB SECTION PERFORMING TEST: Cytology AVAILABILITY: Monday – Friday; 800 to 1630 TURNAROUND TIME: One to two working days. GENERAL USE OF TEST: To establish the presence of viral disease; herpes virus infection or pemphigus. PATIENT PREPARATION: Superficial skin lesions should be moistened before scraping to remove loose, degenerated cellular debris and serum crust. Apply wet compresses over lesion for ½ hour. STORAGE REQUIREMENTS: Refrigerate Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY URIC ACID, BLOOD TEST NAME: URIC ACID, BLOOD CPT CODE: 84550 SPECIMEN REQUIREMENT: 0.5 m plasma from a green top tube (heparin) OR 0.5 mL serum from a gold top tube (SST) REFERENCE RANGE: AGE 000 MOS to 1 MO 1 MO to 3 MOS 3 MOS to 12 MOS 12 MOS to 9 YRS 3 YRS to 6 YRS 9 YRS to 11 YRS 11 YRS to 13 YRS 15 YRS to 19 YRS >= 19 years MALE 1.2 – 4.9 mg/dL 1.3 – 5.8 mg/dL 1.3 – 6.7 mg/dL 1.7 – 5.0 mg/dL 2.3 – 5.4 mg/dL 2.7 – 6.8mg/dL 2.4 – 7.9 mg/dL 4.0- 8.7 mg/dL 4.8 – 8.7 mg/dL FEMALE 1.3 – 6.2 mg/dL 1.3 – 5.8 mg/dL 1.3 – 6.7 mg/dL 1.7 – 5.0 mg/dL 3.0 – 4.7 mg/dL 3.0 - 5.8mg/dL 3.0 – 5.8 mg/dL 3.0 – 5.9 mg/dL 2.6 – 8.0 mg/dL METHOD: Colorimetric LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing. GENERAL USE OF TEST: Diagnosis of gout and other metabolic disorders. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum/plasma from cells within 2 hours of collection. STORAGE REQUIREMENTS: Refrigerate at 2 – 8C up to 48 hours. Samples will be capped and held for 5 days after testing. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY URINALYSIS TEST NAME: URINALYSIS (pH, Color, Appearance, Specific Gravity, Protein, Leukocytes, Glucose, Ketone, Nitrite, Urobilinogen, Bilirubin, Hemoglobin and Microscopic if required) CPT CODE: 81003 SPECIMEN REQUIREMENT: 10 mL from a first morning clean catch midstream, catheterized specimen or random specimen REFERENCE RANGE: Reference ranges listed on report. METHOD: Chemical reaction using a dipstick on automated instrument LAB SECTION PERFORMING TEST: Urinalysis AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of STAT specimens will be reported within 30 minutes of receipt in the laboratory. GENERAL USE OF TEST: Evaluate kidney function, endocrine or metabolic disorders. SPECIMEN PREPARATION: Submit random, clean catch midstream urine random urine or a catheterized sample in a labeled, sealed container. Aliquot urine to a yellow top tube. STORAGE REQUIREMENTS: Refrigerate up to 24 hours before analysis. Specimens left at room temperature for more than 2 hours are unacceptable. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY URINE CYTOLOGY TEST NAME: URINE CYTOLOGY CPT CODE: 88112 SPECIMEN REQUIREMENT: Second morning specimen, voided or catheterized. 50mL of urine, not less than. Received fresh with NO fixative COLLECTION REQUIREMENT: Pour all urine into conical tube and replace cap. REFERENCE RANGE: Negative for malignant cells. METHOD: Modified Papanicolaou LAB SECTION PERFORMING TEST: Cytology AVAILABILITY: Monday through Friday – 0800 to 1630 TURNAROUND TIME: One to two working days. GENERAL USE OF TEST: To establish the presence of primary or metastatic neoplasm. PATIENT PREPARATION: After first morning void, patient may be hydrated with one glass of water every 30 minutes for three hours. Instructions to the patient are included in the patient education section of this guide. LIMITATIONS: First morning or 24-hour urine samples are unsatisfactory. Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY URINE, MICROSCOPIC TEST NAME: URINE, MICROSCOPIC CPT CODE: 88108 SPECIMEN REQUIREMENT: 10 m L f r o m a random, first morning clean catch mid - stream or catheterized specimen. METHOD: Automated digital microscopic examination of urine sediment or manual microscopy LAB SECTION PERFORMING TEST: Urinalysis AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing. Results of STAT specimens will be reported within 30 minutes of receipt in the laboratory. GENERAL USE OF TEST: Detection of increased and/or abnormal formed elements. LIMITATIONS: This test is included in a routine urinalysis when abnormal dipstick readings are present. SPECIMEN PREPARATION: Submit a random, clean catch mid-stream urine sample or a catheterized sample in a labeled sealed container. Aliquot to a yellow tube. STORAGE REQUIREMENTS: Refrigerate up to 24 hours before analysis. Specimens left at room temperature more than 2 hours are unacceptable for assay. Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY URINE REDUCING SUBSTANCES TEST NAME: URINE REDUCING SUBSTANCES CODE: 81099 SPECIMEN REQUIREMENT: 10 mL from fresh random urine. REFERENCE RANGE: Negative METHOD: Benedict’s copper reduction reaction. LAB SECTION PERFORMING TEST: Urinalysis AVAILABILITY: Daily or STAT Only performed on children < 1 month old TURNAROUND TIME: Same shift testing. Results of STAT specimens will be reported within 30 minutes of receipt in the laboratory. GENERAL USE OF TEST: The presence of reducing substances in urine can be an indication of certain metabolic disorders. LIMITATIONS: The test is routinely performed on all pediatric patients up to 1 month of age. STORAGE REQUIREMENTS: Refrigerate for 24 hours if sample cannot be tested immediately. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY VANCOMYCIN (VANCOCIN HC1) TEST NAME: VANCOMYCIN (VANCOCIN HC1) CPT CODE: 80202 Random Trough Peak SPECIMEN REQUIREMENT: 0.5 mL serum from a gold top tube (SST). REFERENCE RANGE: Vancomycin 5- 40 g/mL Vancomycin Trough 5 - 20g/mL Vancomycin Peak 30 - 40g/mL CRITICAL VALUE: Vancomycin 51g/mL Vancomycin Trough 51g/mL Vancomycin Peak 51g/mL METHOD: Immunoassay LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily or STAT TURNAROUND TIME: Same shift testing GENERAL USE OF TEST: Monitor therapeutic drug levels. PATIENT PREPARATION: Trough: 30 minutes to immediately prior to next dose. Peak: Draw 2 hours after infusion complete. SPECIMEN PREPARATION: Collect specimen using standard lab procedures. Centrifuge specimen; separate serum from cells within 2 hours of collection. STORAGE REQUIREMENTS: Refrigerate at 2 - 8C up to 48 hours. to C for prolonged storage prior to analysis. Samples will be capped and held for 5 days after testing. Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY VITAMIN B12 TEST NAME: VITAMIN B12 CPT CODE: 82607 SPECIMEN REQUIREMENT: 1 mL plasma from a green top tube (heparin) OR 1 mL serum from a gold top tube (SST) REFERENCE RANGE: 180-914 pg/mL METHOD: Chemiluminescent immunoassay LAB SECTION PERFORMING TEST: Chemistry AVAILABILITY: Daily TURNAROUND TIME: Same shift testing GENERAL USE OF TEST: Megalobastic anemia, dietary deficiency. PATIENT PREPARATION: Fasting is preferred. LIMITATIONS: Patients who have been regularly exposed to animals or immunoglobulin fragments may produce antibodies that interfere with immunoassays. SPECIMEN PREPARATION: Centrifuge and separate serum or plasma from cells immediately after collection. STORAGE REQUIREMENTS: Store at 2 - 8C for up to 24 hours. Samples will be held for at least 5 days after testing. Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY VITAMIN D TEST NAME: VITAMIN D CPT CODE: 82306 SPECIMEN REQUIREMENT: 1 mL plasma from a green Lithium Heparin OR 1 mL serum from a gold top tube (SST) REFERENCE RANGE: >29 ng/mL METHOD: Chemiluminescent immunoassay LAB SECTION PERFORMING TEST: Send Outs/Chemistry AVAILABILITY: Weekdays TURNAROUND TIME: Same day if received before 5:00 pm. GENERAL USE OF TEST: Vitamin D is important for general bone health. Vitamin D deficiency (less than 10 ng/mL) is characterized by muscle weakness, bone pain and fragility fractures. PATIENT PREPARATION: None LIMITATIONS: The effect of heterophilic antibodies on this assay’s performance has not been evaluated. SPECIMEN PREPARATION: Centrifuge and separate serum from cells immediately after collection. STORAGE REQUIREMENTS: Store at 2 - 8C for up to 24 hours. Samples will be held for at least 5 days after testing. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY WASHING / LAVAGE CYTOLOGY: BRONCHIAL, TRACHEAL OR ESOPHAGEAL TEST NAME: WASHING / LAVAGE CYTOLOGY: BRONCHIAL, TRACHEAL OR ESOPHAGEAL CPT CODE: 88112 - Washing 88104 - Smears 88305 – Cell Block SPECIMEN REQUIREMENT: Washing obtained by physician during endoscopy. lavage, washings, bronchial-received fresh, no fixative REFERENCE RANGE: Negative for malignant cells. METHOD: Modified Papanicolaou LAB SECTION PERFORMING TEST: Cytology AVAILABILITY: Monday through Friday, 0800 to 1600 TURNAROUND TIME: 24 to 72 hours GENERAL USE OF TEST: To establish the presence of primary or metastatic neoplasm. LIMITATIONS: Washings are considered non-diagnostic if epithelium lining the site of the wash is not present. STORAGE REQUIREMENTS: Refrigerate Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY MICROBIOLOGY TEST DIRECTORY RETURN TO TEST DIRECTORY RETURN TO HOME PAGE REMARKABLE MEDICINE. REMARKABLE CARE. SJMO LABORATORY TEST DIRECTORY ACID FAST CULTURE WITH STAIN TEST NAME ACID FAST CULTURE WITH STAIN Sputum 3- . Urine Gastric 40 ml Blood in SPS* or Mycolytic F Feces 1 gram Bronchial washings, Bronchoalveolar lavage, Tissue, Pleural fluid, other body fluids, wounds, biopsy SPECIMEN REQUIRED/ MINIMUM VOLUME First morning specimen required for gastric, urine. REJECTION CRITERIA 24 hour or pooled sputum or urine is not acceptable for culture. For sputum, 3 specimens are recommended. The specimens should be collected 8 24 hours apart; at least one of 3 specimens must be a first morning collection. Low volume sputum, urine. Feces in non-immunocompromised patient. Multiple samples less than 8 hours apart. Saliva and swabs will not be tested. TRANSPORT TIME/TEMP COLLECTION/TRANSPORT CONTAINER < 1 hour, Room temperature. Refrigerate for longer storage/transport times. Sterile Container STABILITY 24 hours, Refrigerated. Specimens transported from off-site locations will be accepted up to 72 hours. REPLICA LIMITS 1/day/same site PERFORMED Sunday-Saturday METHODOLOGY Fluorescent Stain and Culture TEST TURN AROUND TIME Smear within 24 hours. Culture: 6-8 weeks. CLINICAL USE AND INTERPRETATION Used to diagnose tuberculosis and other mycobacterial infections. AFB smear without culture will be used to monitor therapy in smear- positive patients. COMMENTS Organisms accumulate in the bladder and lungs overnight, so first morning specimen provides the best yield. Specimens collected at other times are dilute and are not RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY optimal but will be accepted. SPS** tube for Acid-fast culture of blood can be obtained from Microbiology. Urine specimens of <40 ml are not acceptable unless a larger volume is not obtainable. Call Microbiology the day before collection of a gastric specimen. Antimicrobial susceptibility automatically performed on M. tuberculosis isolates by Michigan Department of community Health. Microbiology must be notified if sensitivity is required on Mycobacterium species other than M. tuberculosis. AFB susceptibility is a send out test. CHG =*Chlorhexidene gluconate SPS = sodium polyanethiol sulfonate Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY ANAEROBIC CULTURE TEST NAME ANAEROBIC CULTURE SPECIMEN REQUIRED/ MINIMUM VOLUME Acceptable specimens include aspirated pus, tissue, body fluids, suprapubic urine, transtracheal aspirate (TTA) and lung aspirates. Tissues fluids and aspirates are always preferred over swab samples. REJECTION CRITERIA Aerobic culture swabs. Specimens which have been refrigerated. Throat, NP swabs, sputum, gastric contents, feces, swabs from decubitus ulcers, skin, voided urine, stool, prostatic or seminal fluid, I.U.D., vaginal or cervical swabs are unacceptable for anaerobic culture. TRANSPORT TIME/TEMP 1 hour, Room temperature. DO NOT REFRIGERATE. COLLECTION TRANSPORT CONTAINER Anaerobic Swab STABILITY Stable for 24 hours at room temperature. REPLICA LIMITS 1/day/same site PERFORMED Sunday-Saturday METHODOLOGY Culture TEST TURN AROUND TIME 4-6 Days CLINICAL USE AND INTERPRETATION Used to diagnose anaerobic infection in appropriate specimens. COMMENTS CAUTION: Glass tube is fragile. Use bubble wrap/cushioned packaging for transport in pneumatic tube. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY ARTHOPOD INSECT ID (ARTHID) TEST NAME ARTHOPOD/ INSECT ID (ARTHID) SPECIMEN REQUIRED/ MINIMUM VOLUME Submit arthropod/insect in tightly capped container. Submit patient history. For tick, submit location (state, county) of tick bite. REJECTION CRITERIA Insects/arthropods other than those associated with human infection. Spiders are not identified. TRANSPORT TIME/TEMP Room temperature, 1 day. COLLECTION TRANSPORT CONTAINER Clean or Sterile Container STABILITY Room temperature 1-3 days REPLICA LIMITS NA PERFORMED Monday-Friday, Saturday & Sunday for inpatients only. METHODOLOGY Direct Examination TEST TURN AROUND TIME 1-7 days CLINICAL USE AND INTERPRETATION Used for identification of common human ectoparasites. COMMENTS Some ticks, insects and arthropods will be referred. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY BACTERIAL ANTIGEN GROUP B STREP TEST NAME BACTERIAL ANTIGEN GROUP B STREP SPECIMEN REQUIRED/ MINIMUM VOLUME Cerebrospinal fluid (CSF), 0.5 mL. Tube 2 preferred REJECTION CRITERIA Urine and serum are not accepted for testing. Test must be ordered in conjunction with CSF culture. TRANSPORT TIME/TEMP Room temperature 1 hour COLLECTION/TRANSPORT CONTAINER LP tube 2. STABILITY 24 hours refrigerated REPLICA LIMITS 1/day PERFORMED Sunday-Saturday METHODOLOGY Latex Agglutination TEST TURN AROUND TIME 24 hours CLINICAL USE AND INTERPRETATION Use as an aid in diagnosis of meningitis due to Streptococcus agalactiae, especially in patients previously treated with antibiotics. It will also be used in patients with laboratory data and clinical history suggestive of meningitis when gram stain is negative. COMMENTS Urine for antigen not accepted because of low sensitivity and predictive value. Requests for CSF bacterial antigen for other organisms must be sent to a reference laboratory. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY BACTERICIDAL LEVEL TEST NAME BACTERICIDAL LEVEL SPECIMEN REQUIRED/ MINIMUM VOLUME Serum Peak 1.0 ml Serum Trough 1.0 ml CONTACT MICROBIOLOGY PRIOR TO AND AFTER COLLECTION. MUST BE COLLECTED BETWEEN 0600 and 1800 hours. Test requires collection of peak and trough sera. TROUGH: Trough specimen should be collected immediately before (1-30 minutes) antibiotic dose. PEAK: Peak specimen should be collected 30-60 minutes after completion of the antibiotic dose. (Recommend end of 30 minute IV infusion, or 15 minutes after a 60 minute IV infusion or 60 minutes after IM dose.) Indicate antibiotics being administered, dosing schedule and bacterium to be tested. REJECTION CRITERIA Specimens collected at times other than those described or those with prolonged transport times will be rejected. TRANSPORT TIME/TEMP Transport < 1 hour, room temperature. NOTE: Deliver specimen to Microbiology. COLLECTION/TRANSPORT CONTAINER Red Top Vacutainer x 2 (1 peak, 1 trough) STABILITY Indicate antibiotics being administered, dosing schedule and bacterium to be tested. REPLICA LIMITS 1/day PERFORMED Variable, performed at reference laboratory. METHODOLOGY Serum dilution TEST TURN AROUND TIME Variable CLINICAL USE AND INTERPRETATION Used as an aid in treatment of infections. COMMENTS This test is sent to a Reference Laboratory. NOTE: Peak and trough sera usually collected after third or fourth dose of antibiotic. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY BLOOD CULTURE TEST NAME BLOOD CULTURE SPECIMEN REQUIRED/ MINIMUM VOLUME COLLECTION: SKIN ANTISEPSIS IS CRITICAL! Two sets should be collected from two separate venipunctures to detect suspected bacteremia/fungemia. Draw prior to initiating antibiotic therapy if possible. Contact Microbiology if Brucella or other special pathogens suspected. Submit aerobic and anaerobic bottle on adults or peds bottle on pediatric patients. Recommend collection of Myco Lytic F for detection of yeast mold in blood culture. See Fungus Blood Culture. Collect Myco-Lytic F for detection of acid-fast bacilli in blood. Order Acid-Fast Culture, Blood. REJECTION CRITERIA Submission in bottles other than those compatible with Bactec System. Delay in transport to Laboratory >48 hours. STABILITY 48 hours, Room Temperature. REPLICA LIMITS LIMIT: 2/day unless diagnosis is Subacute Bacterial Endocarditis. Order for >2 sets/day in other diagnoses requires Pathology approval. PERFORMED Sunday-Saturday METHODOLOGY Bactec Continuous Monitoring System/CO2 Detection TEST TURN AROUND TIME 5 days negatives, 1-5 days for positives. Positive blood culture is a critical value. CLINICAL USE AND INTERPRETATION For diagnosis of sepsis due to bacteria, yeasts. COMMENTS Contact Laboratory if Brucella suspect; extended incubation required. Most true positives are detected within 48 hours. DELAY IN TRANSPORT WILL INCREASE TIME TO DETECTION IN POSITIVE CULTURES. SEE HOSPITAL BLOOD CULTURE POLICY FOR COMPLETE DETAILS. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY BODY FLUID CULTURE/BODY FLUID CULTURE WITH GRAM STAIN BODY FLUID CULTURE BODY FLUID CULTURE WITH GRAM STAIN SPECIMEN REQUIRED/ MINIMUM VOLUME Sterile, leakproof container (Abdominal, Ascites, Bile, Joint, Pericardial, Peritoneal, Pleural, Synovial) REJECTION CRITERIA Specimens on swabs will not be accepted. TRANSPORT TIME/TEMP 1 hour, Room temperature COLLECTION/TRANSPORT CONTAINER Sterile Container Red top Vacutainer will be accepted. STABILITY 4 Hours, Room Temperature. 24 hours, Refrigerated. REPLICA LIMITS 1/day/same source. PERFORMED Sunday-Saturday METHODOLOGY Gram stain (if ordered) Culture TEST TURN AROUND TIME 1-3 Days CLINICAL USE AND INTERPRETATION Used as an aid to diagnosis of infection in various body fluids. COMMENTS When volume permits, fluid inoculated in blood culture bottles will be submitted as a supplement to the specimen in the sterile container. Order Anaerobic Culture, Fungus Culture, Acid fast Culture or Viral Culture separately if these pathogens suspect. Revised 07/14 RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY BONE MARROW CULTURE TEST NAME BONE MARROW CULTURE (ORDER AS BODY FLUID CULTURE) SPECIMEN REQUIRED/ MINIMUM VOLUME 1-3 ml bone marrow in SPS (preferred) REJECTION CRITERIA Other Anticoagulants, such as citrate, oxalate, EDTA, are not suitable because of their toxicity for some bacteria. TRANSPORT TIME/TEMP 30 minutes, Room temperature. COLLECTION/TRANSPORT CONTAINER SPS-Vacutainer Tube STABILITY 24 hours, Room temperature. REPLICA LIMITS None PERFORMED Sunday-Saturday METHODOLOGY Gram stain (if ordered) Culture TEST TURN AROUND TIME 3 days CLINICAL USE AND INTERPRETATION Used for diagnosis of infection due to several organisms. COMMENTS Small yellow-top vacutainer tubes containing sodium polyaniethol sulfonate (SPS) are designed for a maximum 3.0 ml draw. SPS required for Acid fast and Fungus. Heparin will be used for routine culture only. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY Bordetella pertussis DETECTION BY PCR TEST NAME Bordetella pertussis DETECTION BY PCR SPECIMEN REQUIRED/ MINIMUM VOLUME Nasopharyngeal swab in M4-RT Transport medium. Transport media can be obtained from Microbiology - 86256. REJECTION CRITERIA 24 hours, Room temperature. TRANSPORT TIME/TEMP 1/day/same source LLECTION/TRANSPORT CONTAINER M4-RT Transport STABILITY Room temperature 3 days, Refrigerated 2 weeks. REPLICA LIMITS 1/day PERFORMED Monday – Friday METHODOLOGY Polymerase Chain Reaction (PCR) TEST TURN AROUND TIME 1-3 days CLINICAL USE AND INTERPRETATION Used for diagnosis of whooping cough/ Bordetella pertussis. COMMENTS Agents causing a Whooping Cough Syndrome include: B pertussis, parapertussis, B. bronchiseptica and Adenovirus. If PCR for pertussis negative, respiratory culture and viral culture will detect the other agents, which will cause whooping cough syndrome. Specimen sent in charcoal transport media will be submitted to Michigan Department of Community Health for testing. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CATHETER, I.V. CULTURE TEST NAME CATHETER, I.V. CULTURE SPECIMEN REQUIRED/ MINIMUM VOLUME 2 inch segment of catheter tip REJECTION CRITERIA Catheter in non-sterile container. Catheter with attached tubing. Catheter submitted without 2 sets of blood cultures will be rejected. TRANSPORT TIME/TEMP 1 hour, Room temperature. COLLECTION/TRANSPORT CONTAINER Sterile Container STABILITY 4 hours, Room temperature. REPLICA LIMITS None PERFORMED Sunday-Saturday METHODOLOGY Semi-quantitative Maki technique TEST TURN AROUND TIME 2-3 days CLINICAL USE AND INTERPRETATION Used in conjunction with blood cultures for detection of line-related sepsis. COMMENTS Acceptable IV catheters: Central, CVP, Hickman, Boric, Peripheral, Arterial, Umbilical, Hyperal, and Swan Ganz. Blood cultures X2 MUST be collected within 24 hours of catheter tip culture. Catheter tip culture will be rejected if blood cultures are not collected. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CEREBROSPINAL FLUID TEST NAME CEREBROSPINAL FLUID SPECIMEN REQUIRED/ MINIMUM VOLUME CSF, 0.5 mL2 - 0.5 mL REJECTION CRITERIA CSF submitted on ice, QNS for culture TRANSPORT TIME/TEMP < 1 hour, Room temperature for bacterial agents. For viral agents, send on ice. COLLECTION/TRANSPORT CONTAINER Tube 2, preferred STABILITY 2 hours, Room temperature for bacterial. GRAM STAIN IS PERFORMED ON ALL CSF FOR CULTURE. 72 hours viral, Refrigerated. REPLICA LIMITS 1/day PERFORMED Sunday-Saturday METHODOLOGY Culture with Gram Stain TEST TURN AROUND TIME 1-3 days CLINICAL USE AND INTERPRETATION Used for diagnosis of bacterial meningitis. COMMENTS Viral culture/Viral agent PCR must be ordered separately. DO NOT SUBMIT ON ICE OR REFRIGERATE Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CHLAMYDIA CULTURE TEST NAME CHLAMYDIA CULTURE SPECIMEN REQUIRED/ MINIMUM VOLUME Acceptable specimens include cervix, urethra, eye, nasopharyngeal aspirate, throat, and rectal swab or bronchoalveolar lavage. REJECTION CRITERIA Specimens submitted in transport media other than M4-RT. TRANSPORT TIME/TEMP 1/day/same source COLLECTION/TRANSPORT CONTAINER Chlamydia/Viral Transport (M4-RT) STABILITY 24 hours, Refrigerated REPLICA LIMITS 1/day/same source PERFORMED Sunday-Friday METHODOLOGY Tissue culture for Chlamydia TEST TURN AROUND TIME Variable CLINICAL USE AND INTERPRETATION Used for diagnosis of respiratory infections, ocular infections and genital tract infections due to Chlamydia species. COMMENTS CSF or Semen are not acceptable specimens. Do NOT use CALGISWABS Detects Chlamydia trachomatis and Chlamydia pneumoniae. Serology/PCR optimal for detection of Chlamydia psittaci. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CHLAMYDIA DFA (MICRO-TRAK) TEST NAME CHLAMYDIA DFA (MICRO-TRAK) SPECIMEN REQUIRED/ MINIMUM VOLUME Ocular swab inoculated to Microtrak slide. REJECTION CRITERIA Specimens submitted in transport media. Unfixed smears. TRANSPORT TIME/TEMP Room Temperature COLLECTION/TRANSPORT CONTAINER Chlamydia Micro Trak STABILITY 3 days, Room temperature. REPLICA LIMITS 1/day/same source PERFORMED Sunday-Friday METHODOLOGY Direct Fluorescent Antibody TEST TURN AROUND TIME 1-3 days CLINICAL USE AND INTERPRETATION Used for diagnosis of ocular infections due to Chlamydia species. COMMENTS Sent to Reference Laboratory. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CHLAMYDIA PROBE TEST NAME CHLAMYDIA PROBE SPECIMEN REQUIRED/ MINIMUM VOLUME Cervix or urethral specimen on Aptima unisex swab. REJECTION CRITERIA Specimens submitted with white swab only, specimens submitted with two swabs ( white plus blue), specimens submitted with no swabs and specimens submitted with swabs other than those supplied with the kit will be rejected. For urine first void specimen is required. Clean catch mid-stream specimens are not acceptable. Ocular specimens are not acceptable. TRANSPORT TIME/TEMP 1/day/same source COLLECTIONRANSPORT CONTAINER STABILITY 30 days, unisex swab 60 days in urine transport REPLICA LIMITS 1/day/same source PERFORMED Sunday-Friday METHODOLOGY Transcription Mediated Amplification TEST TURN AROUND TIME 1-3 days CLINICAL USE AND INTERPRETATION Used for diagnosis of genital tract infections due to Chlamydia trachomatis. COMMENTS For ocular specimens, order Chlamydia Culture or Chlamydia DFA. Test is performed at a Reference Laboratory. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CLOSTRIDIUM DIFFICILE TOXIN, MOLECULAR TEST NAME CLOSTRIDIUM DIFFICILE TOXIN, MOLECULAR SPECIMEN REQUIRED/ MINIMUM VOLUME Soft or liquid stool required. REJECTION CRITERIA TRANSPORT TIME/TEMP (Soft/liquid stool is defined as stool sample assuming the shape of its container.) Formed stool will be rejected. Stool in preservative will be rejected. Stool with delay in transport to lab > 1 hour if not cold during transport. 1 hour, Room temperature. 24 hours, Refrigerated. Sterile Container. Transfer of liquid/soft stool directly into container. COLLECTION/TRANSPORT CONTAINER STABILITY REPLICA LIMITS 1 hour, Room temperature 24 hours, Refrigerated Testing repeated after 7 days if negative. Testing repeated after 10 days if positive. Routine Test, Sunday-Saturday Twice daily weekdays(Approx.10 AM and 6 PM) TEST SCHEDULE Once per day on weekends and holidays (Approx. 3PM) .Additional test runs may be performed if there is a critical need; contact Microbiology. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY Illumigene C. difficile Toxin assay. Isothermal nucleic acid amplification test uses LAMP methodology. METHODOLOGY Sensitivity* 95.2% Specificity* 95.3% * From package insert TEST TURN AROUND TIME 24 hours CLINICAL USE AND INTERPRETATION Used as in aid to diagnosis of pseudomembranous colitis and C difficile infection NOTE: ADHERENCE TO TRANSPORT CONDITIONS IS CRITCAL. C. difficile assays should not be ordered as a test of cure. COMMENTS Infants and cystic fibrosis patients have high colonization rates, positive results should be interpreted with caution. The test does not distinguish between viable and non-viable organisms. Revised 07/14. RETURN TO TEST DIRECTORY . RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY Corynebacterium diphtheriae CULTURE TEST NAME Corynebacterium diphtheriae CULTURE SPECIMEN REQUIRED/ MINIMUM VOLUME Throat swab, naspharyngeal and or skin swab REJECTION CRITERIA Specimen other than aerobic culture swab TRANSPORT TIME/TEMP 2-12hours, Room temperature COLLECTION/TRANSPORT CONTAINER Aerobic Swab Use Minitip wire for NP. STABILITY 24 hours, Refrigerated REPLICA LIMITS 1/day/same source PERFORMED Sunday-Saturday METHODOLOGY Culture TEST TURN AROUND TIME 1-5 days CLINICAL USE AND INTERPRETATION Use to detect diphtheria COMMENTS Isolates of possible C diphtheriae must be submitted to Michigan Department of Community Health for ID and determination of toxin production. Order as Respiratory Screen culture; indicate C. diphtheriae. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CRYPTOCOCCAL ANTIGEN – CSF/ SERUM TEST NAME SPECIMEN REQUIRED/ MINIMUM VOLUME CRYPTOCOCCAL ANTIGEN – CSF/ SERUM 0.5 mL serum or cerebrospinal fluid REJECTION CRITERIA Plasma cannot be tested. TRANSPORT TIME/TEMP 1 hour, Room temperature COLLECTION TRANSPORT COTAINER Lumbar Puncture tube (CSF) STABILITY 24 hours, refrigerated REPLICA LIMITS 1/day/same source PERFORMED Sunday-Saturday METHODOLOGY Latex Agglutination TEST TURN AROUND TIME 24 hours CLINICAL USE AND INTERPRETATION Used for diagnosis of Cryptococcal neoformans infections. Normal: Negative. Positive specimen is reported as a titer. COMMENTS Titer will be used to monitor therapy. Decrease in titer correlates with clinical improvement. Red Top Vacutainer (Serum) Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY CRYPTOSPORIDIUM STAIN TEST NAME CRYPTOSPORIDIUM STAIN CRYPTODPORIDIUM ANTIGEN PARASITE ANTIGEN SPECIMEN REQUIRED/ MINIMUM VOLUME Stool in sterile container. Stool in Formalin/PVA preservative kit. Follow instructions for collection of fecal specimen for ova and parasite exam. Approximately of stool. REJECTION CRITERIA Specimens obtained with barium, bismuth, mineral oil or magnesium is not acceptable. Patient must wait 7-10 days to clear these compounds. TRANSPORT TIME/TEMP <60 minutes unpreserved. <1 day if preserved COLLECTION/TRANSPORT CONTAINER Formalin/PVA Vials or Sterile Container STABILITY 1 hour, unpreserved. 7 days preserved. REPLICA LIMITS 1/day PERFORMED Monday-Friday METHODOLOGY Acid Fast Stain TEST TURN AROUND TIME 1-3 Days CLINICAL USE AND INTERPRETATION Used for diagnosis of Cryptosporidium parvum infections. COMMENTS Diagnosis can also be made by detection of Cryptosporidium antigen. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY DIRECT SMEAR/GRAM STAIN ONLY TEST NAME GRAM STAIN ONLY SPECIMEN REQUIRED/ MINIMUM VOLUME Variable REJECTION CRITERIA Separate order must be placed for gram stain (in addition to culture order) for all sites other than CSF, respiratory culture and wounds. TRANSPORT TIME/TEMP See culture instructions by anatomic site. COLLECTION /TRANSPORT CONTAINER Sterile Container STABILITY NA REPLICA LIMITS NA PERFORMED Sunday-Saturday METHODOLOGY Gram Stain TEST TURN AROUND TIME <60 minutes for STAT orders. 24 hours for other samples. CLINICAL USE AND INTERPRETATION Used as an aid in diagnosing infection. COMMENTS All CSF gram stains are read as STATS. Sensitivity of gram stain is approximately 10,000 CFU***/ml of fluid or per gram of tissue. ***CFU =Colony Forming Units Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY EAR CULTURE (INNER AND OUTER EAR) EAR CULTURE OR EAR CULTURE WITH GRAM STAIN TEST NAME EAR CULTURE (INNER AND OUTER EAR) EAR CULTURE OR EAR CULTURE WITH GRAM STAIN SPECIMEN REQUIRED/ MINIMUM VOLUME Sterile tube OR Aerobic Swab Include anaerobic transport for aspirate and biopsy. REJECTION CRITERIA Delay in transport to Laboratory. Submission in viral transport media. TRANSPORT TIME/TEMP 1-4 hours, Room temperature COLLECTION/TRANSPORT COTAINER Aerobic Swab STABILITY 12 hours, Room temperature REPLICA LIMITS 1/day/same source PERFORMED Sunday-Saturday METHODOLOGY Culture or Gram stain with Culture. Sensitivity performed on pathogens isolated. TEST TURN AROUND TIME 1-3 days CLINICAL USE AND INTERPRETATION Used for diagnosis of otitis externa and otitis media. Normal skin flora: Coagulase negative staphylococcus, diphtheroids. Common pathogens: Pseudomonas aeruginosa, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis. COMMENTS If aspirate or biopsy, use anaerobic transport system and transport. Throat or nasopharyngeal cultures are not predictive of agents responsible for otitis media. For otitis externa, vigorous swabbing is required since surface swabbing will miss streptococcal cellulites. Place additional order for anaerobic culture (AC) if required. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY EYE – CONJUNCTIVA CULTURE EYE CULTURE EYE CULTURE WITH GRAM STAIN TEST NAME EYE – CONJUNCTIVA CULTURE EYE CULTURE EYE CULTURE WITH GRAM STAIN SPECIMEN REQUIRED/ MINIMUM VOLUME Conjunctiva or corneal scrapings REJECTION CRITERIA Swab other than aerobic swab TRANSPORT TIME/TEMP Swabs: 12 hours, Room temperature. Plates: 30 minutes, Room temperature. COLLECTION/TRANSPORT CONTAINER Aerobic swab (Mini-tip preferred) STABILITY 24 hours, Room temperature REPLICA LIMITS None PERFORMED Sunday-Saturday METHODOLOGY Gram stain (if ordered) Culture TEST TURN AROUND TIME 1-3 days CLINICAL USE AND INTERPRETATION Conjunctiva must be sampled to determine indigenous microflora. It is generally recommended that swabs for culture be taken prior to anesthetic application, whereas corneal scrapings should be obtained after anesthetic application. COMMENTS Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY FECAL OCCULT BLOOD FECAL OCCULT BLOOD DIAGNOSTIC FECAL OCCULT BLOOD IMMUNOLOGIC TEST NAME FECAL OCCULT BLOOD FECAL OCCULT BLOOD DIAGNOSTIC FECAL OCCULT BLOOD IMMUNOLOGIC SPECIMEN REQUIRED/ MINIMUM VOLUME Stool smear on card or inoculated into collection tube REJECTION CRITERIA Stool in preservative Immunologic sample received more than 15 days after collection TRANSPORT TIME/TEMP 48-72 hours, Room Temperature COLLECTION/TRANSPORT CONTAINER FECAL OCCULT BLOOD FECAL OCCULT BLOOD SCREENING/DIAGNOSTIC STABILITY 7 days, Room temperature REPLICA LIMITS 1/day PERFORMED Sunday-Saturday METHODOLOGY Guaic or immunologic TEST TURN AROUND TIME 1-3 days CLINICAL USE AND INTERPRETATION Fecal occult blood and fecal occult blood screening can be used to detect occult bleeding in both the upper and lower GI tract. These tests are prone to false positive test from medications and diet if not carefully controlled. COMMENTS The fecal occult blood immunologic detects only occult bleeds in the colon and is used to detect bleeding which will be related to colon cancer. This test is specific for human hemoglobin and is not affected by the patient’s diet. For outpatients label with name, date of birth and date of collection. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY TEST/ TEST CODE FUNGAL CULTURE HAIR SKIN OR NAIL HAIR SKIN, NAIL WITH KOH PREP SPECIMEN REQUIRED/ MINIMUM VOLUME Approximately 10 hairs Skin: enough scrapings to cover the head of a thumbtack Nail: 3-4 pieces of nail REJECTION CRITERIA Quantity not sufficient; swabs TRANSPORT TIME/TEMP 24 hours, Room temperature COLLECTION/TRANSPORT CONTAINER Sterile Container STABILITY 24 hours, Room temperature REPLICA LIMITS 1/day/same source PERFORMED Sunday-Saturday METHODOLOGY KOH direct examination (if ordered) Fungal culture TEST TURN AROUND TIME 1-4 weeks CLINICAL USE AND INTERPRETATION Used for diagnosis of infections with dermatophytes and other fungi causing human skin infections. COMMENTS Scales, if present, should be collected along with scrapings of active borders of lesions. Note any antifungal therapy taken recently. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY TEST/ TEST CODE FUNGAL CULTURE SPECIMEN OTHER THAN HAIR, SKIN, OR NAIL SPCIMEN OTHER THAN HAIR, SKIN, NAIL WITH KOH PREP SPECIMEN REQUIRED/ MINIMUM VOLUME Body Fluids, CSF, Eye, Abscess/drainage, Sputum, Tissue, Bone Marrow Urine REJECTION CRITERIA Quantity not sufficient; swabs TRANSPORT TIME/TEMP 24 hours, Room temperature COLLECTION/TRANSPORT CONTAINER Sterile Container STABILITY 24 hours, Room temperature REPLICA LIMITS 1/day/same source PERFORMED Sunday-Saturday METHODOLOGY Fungal Culture KOH direct examination (if ordered) Fungal culture TEST TURN AROUND TIME 1-4 weeks CLINICAL USE AND INTERPRETATION Used for diagnosis of fungal infections in a variety of specimen sources. COMMENTS Molds identified on routine bacterial culture are reflexed to Mycology for identification. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY FUNGAL CULTURE, BLOOD TEST NAME FUNGAL CULTURE, BLOOD SPECIMEN REQUIRED/ MINIMUM VOLUME 2 yellow SPS tubes, 3 ml draw, Total 2 ml required REJECTION CRITERIA Quantity not sufficient; swabs TRANSPORT TIME/TEMP 24 hours, Room temperature COLLECTION/TRANSPORT CONTAINER Yellow SPS Vacutainer (Obtain from Microbiology Laboratory) STABILITY 24 hours, Room temperature REPLICA LIMITS 2/day/same source CLINICAL USE AND INTERPRETATION Used for diagnosis of fungal infection of the blood stream. COMMENTS Bacterial isolates may also be recovered. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY GASTRIC OCCULT BLOOD TEST NAME GASTRIC OCCULT BLOOD SPECIMEN REQUIRED/ MINIMUM VOLUME Gastric aspirate or emesis REJECTION CRITERIA 15 minutes, Room temperature TRANSPORT TIME/TEMP 24 hours, Refrigerate COLLECTION/TRANSPORT CONTAINER Sterile Container STABLITY 24 hours REPLICA LIMITS 1/day PERFORMED Sunday-Saturday METHODOLOGY Gastrocult/Guaic TEST TURN AROUND TIME 1-2 days CLINICAL USE AND INTERPRETATION Used for diagnosis of occult bleeding in the stomach. COMMENTS Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY GC SCREEN TEST NAME GC SCREEN SPECIMEN REQUIRED/ MINIMUM VOLUME Cervical, urethral, ocular or throat specimen submitted in aerobic culture swab REJECTION CRITERIA Delay in transport or refrigerated specimen TRANSPORT TIME/TEMP 12-18 hours, Room temperature COLLECTION/TRANSPORT CONTAINER Aerobic swab (Use Mini-tip for male urethral) STABILITY 18 hours, Room temperature REPLICA LIMITS 1/day/same source PERFORMED Sunday-Saturday METHODOLOGY Culture TEST TURN AROUND TIME 1-3 Days CLINICAL USE AND INTERPRETATION Used to screen for gonococcal infections. COMMENTS DO NOT REFRIGERATE. Amplified Probe recommended for urine, cervix, and urethra. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY GENITAL CULTURE / VAGINA, CERVIX, URETHRA, PROSTATE GENITAL CULTURE GENITAL CULTURE WITH GRAM STAIN TEST NAME GENITAL CULTURE / VAGINA, CERVIX, URETHRA, PROSTATE SPECIMEN REQUIRED/ MINIMUM VOLUME Vaginal, cervical, urethral or prostate specimen REJECTION CRITERIA Refrigerated sample; specimen other than aerobic swab TRANSPORT TIME/TEMP 12 hours, Room temperature COLLECTION/TRANSPORT CONTAINER Aerobic Swab STABILITY 12 hours in aerobic swab REPLICA LIMITS 1/day/same source PERFORMED Sunday-Saturday METHODOLOGY Gram stain (if ordered) GENITAL CULTURE GENITAL CULTURE WITH GRAM STAIN Culture TEST TURN AROUND TIME 1- 3 days CLINICAL USE AND INTERPRETATION Used as an aid in diagnosis of vaginitis, cervicitis, urethritis and prostatitis. COMMENTS Includes evaluation for Neisseria gonorrhoeae, Group B beta streptococcus, Candida albicans and Gardnerella vaginitis. Amplified probe for gonorrhea and Chlamydia is recommended for cervix and urethra in lieu of culture. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY GENITALCULTURE - FEMALE - BARTHOLIN, CUL-DE-SAC, ENDOMETRIUM, OVARIES, FALLOPIAN TUBE, PLACENTA, IUD GENITAL CULTURE GENITAL CUTURE WITH GRAM STAIN TEST NAME GENITAL CULTURE - FEMALE - BARTHOLIN, CUL-DE-SAC, ENDOMETRIUM, OVARIES, FALLOPIAN TUBE, PLACENTA,UD GENITAL CULTURE GENITAL CUTURE WITH GRAM STAIN SPECIMEN REQUIRED/ MINIMUM VOLUME Swab or aspirate in sterile container. Tissues and fluids are superior to swab specimens. REJECTION CRITERIA Refrigerated specimen TRANSPORT TIME/TEMP 2 hours, Room temperature COLLECTION/TRANSPORT CONTAINER Sterile container or Aerobic swab STABILITY 2 hours, Room temperature REPLICA LIMITS 1/day/same source PERFORMED Sunday-Saturday METHODOLOGY Gram Stain (if ordered) Culture TEST TURN AROUND TIME 1-5 days CLINICAL USE AND INTERPRETATION Used as an aid in diagnosis. COMMENTS Lochia should not be processed. Viral, fungal, Mycoplasma and Ureaplasma must be ordered separately and will require additional samples. ANAEROBIC CULTURE: Order anaerobic culture in addition to genital culture if anaerobes suspect. Please Note: Bartholin gland, fallopian tube, IUD, ovary, placenta via C-section, and endometrial aspiration are the only acceptable genital specimens for anaerobes. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY GIARDIA LAMBLIA ANTIGEN / CRYPTOSPORIDIUM PARVUM ANTIGEN (PARASITE ANTIGEN) TEST NAME GIARDIA LAMBLIA ANTIGEN / CRYPTOSPORIDIUM PARVUM ANTIGEN (PARASITE ANTIGEN) SPECIMEN REQUIRED/ MINIMUM VOLUME Stool in sterile container REJECTION CRITERIA Follow collection guidelines for Ova and Parasite exam. Fresh specimen in sterile cup accepted if delivered to Lab within 1 hour of collection. TRANSPORT TIME/TEMP Fresh specimen accepted if delivered to Lab within 1 hour of collection for liquid stool or two hours if soft or formed. Formalin PVA specimens also acceptable, Room temperature Fresh 30 minutes – 1 hour. COLLECTION/TRANSPORT CONTAINER Stool in Formalin vial + PVA vial Formalin PVA vials STABILITY 7 days, room temperature REPLICA LIMITS 1/day PERFORMED Sunday-Saturday METHODOLOGY EIA TEST TURN AROUND TIME 1-2 days CLINICAL USE AND INTERPRETATION Use for detection of two common protozoan infections associated with diarrhea: Giardia lamblia and Cryptosporidium parvum. Recommend at least two specimens to rule out infection. COMMENTS Specimens saved for 7 days. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY GROUP B BETA STREP SCREEN GROUP B BETA STREP SCREEN WITH SENSITIVITY TEST NAME GROUP B BETA STREP SCREEN GROUP B BETA STREP SCREEN WITH SENSITIVITY SPECIMEN REQUIRED/ MINIMUM VOLUME Rectal vaginal swab collected at 35-37 weeks REJECTION CRITERIA Specimens submitted in viral transport media TRANSPORT TIME/TEMP 12 hours, Room temperature COLLECTION/TRANSPORT CONTAINER Aerobic Swab STABILITY 4 days, Room temperature REPLICA LIMITS 1/day PERFORMED Sunday-Saturday METHODOLOGY Culture TEST TURN AROUND TIME 1-3 Days CLINICAL USE AND INTERPRETATION Used to detect colonization with Group B strep in pregnant patients. COMMENTS Vaginal or cervical swab are not sufficient to detect carrier status. Group B strep (Streptococcus agalactiae) is susceptible to penicillin and ampicillin. Antimicrobial susceptibility testing is performed only upon request in patients with Penicillin allergy. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY Herpes simplex DETECTION by PCR (Replaces Herpes Culture) TEST NAME Herpes Simplex DETECTION by PCR (Replaces Herpes Culture) SPECIMEN REQUIRED/ MINIMUM VOLUME CSF, cervical, vaginal urethral specimen, skin lesion, ocular sample in M4-RT REJECTION CRITERIA Specimens submitted in transport media other than M4-RT TRANSPORT TIME/TEMP 1 hour, Refrigerated COLLECTION/TRANSPORT CONTAINER M4-RT Transport Medium STABILITY 3 days, Refrigerated REPLICA LIMITS 1/day/same source PERFORMED Monday-Friday METHODOLOGY Polymerase Chain Reaction TEST TURN AROUND TIME 1-3 days CLINICAL USE AND INTERPRETATION Used to diagnose Herpes Simplex I and II infections in a variety of sources. COMMENTS This test is performed at a reference laboratory. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY INFLUENZA ANTIGEN (INFLUENZA A + B) TEST NAME INFLUENZA ANTIGEN (INFLUENZA A + B) SPECIMEN REQUIRED/ MINIMUM VOLUME Nasopharyngeal swab in M4- RT vial transport medium or saline Nasopharyngeal aspirate Nasopharyngeal washing REJECTION CRITERIA Specimen submitted in viral transport medium other than M4-RT Specimen submitted without ice/room temperature Specimen other than nasopharynx TRANSPORT TIME/TEMP <1 hour, cold COLLECTION/TRANSPORT CONTAINER Chlamydia/Viral Transport Media (M4-Rt). Use Mini-Tip Swab only. STABILITY 24 hours, Refrigerated REPLICA LIMITS 1/day PERFORMED Sunday-Saturday Performed as STAT for ER, LD Triage and Pediatrics patients METHODOLOGY Membrane EIA TEST TURN AROUND TIME 1 hour -24 hours CLINICAL USE AND INTERPRETATION Used to diagnose infection due to Influenza A and B viruses. COMMENTS Nasopharyngeal washes are the most sensitive specimens. Rapid influenza test will not detect Novel Influenza virus infections such as those due to H1N1. Testing for Novel influenza virus available thru MDCH^ or reference laboratory. Specimens saved for 7 days in case additional testing is required. ^MDCH =Michigan Department of Community Health Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY KOH PREPARATION KOH PREPARATION TEST NAME SPECIMEN REQUIRED/ MINIMUM VOLUME Skin scrapings, hair, nail, respiratory fluid, or genital specimen. REJECTION CRITERIA Specimen QNS for testing. Some specimen sites submitted on swabs. TRANSPORT TIME/TEMP 2 hours, Room temperature COLLECTION/TRANSPORT CONTAINER Sterile Container STABILITY 24 hours, Room temperature REPLICA LIMITS 1/day/same site PERFORMED Sunday-Saturday METHODOLOGY Direct Examination TEST TURN AROUND TIME 24 Hours CLINICAL USE AND INTERPRETATION Used for detection of fungus in keratinized samples. COMMENTS Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY LEGIONELLA URINARY ANTIGEN LEGIONELLA URINARY ANTIGEN TEST NAME SPECIMEN REQUIRED/ MINIMUM VOLUME Urine, First morning REJECTION CRITERIA Specimen other than urine TRANSPORT TIME/TEMP 2 hours, Room temperature COLLECTION/TRANSPORT CONTAINER Sterile Container STABILITY 24 hours, Refrigerated REPLICA LIMITS 1/day PERFORMED Sunday-Saturday METHODOLOGY Membrane EIA TEST TURN AROUND TIME 24 hours CLINICAL USE AND INTERPRETATION Used to detect soluble urinary antigen in patients infected with Legionella pneumophila serogroup one. A positive result indicates infection with this organism. COMMENTS This test detects only L. pneumophila serogroup 1. Legionella culture of respiratory samples and Legionella PCR or serology should be ordered if the urinary antigen test is negative and clinical history is suggestive of legionellosis Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY LEGIONELLA CULTURE TEST NAME LEGIONELLA CULTURE SPECIMEN REQUIRED/ MINIMUM VOLUME Acceptable specimens: Lung biopsies, pleural fluid, bronchial washings, bronchial brushings, induced sputum and postmortem tissues. Culture of expectorated/aspirated sputum is discouraged because yield is negligible. REJECTION CRITERIA Specimens other than those listed TRANSPORT TIME/TEMP 1 hour, Room Temperature COLLECTION/TRANSPORT CONTAINER Sterile Container STABILITY 24 hours, Refrigerated REPLICA LIMITS 1/day/same source PERFORMED Sunday-Saturday METHODOLOGY Culture TEST TURN AROUND TIME 7-14 days CLINICAL USE AND INTERPRETATIN Used to detect Legionella species in a variety of respiratory specimens. COMMENTS Order Legionella urine antigen for rapid diagnosis of L. pneumophila serogroup 1. This organism is difficult to culture. Consider Legionella PCR or serology for diagnosis. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY MALARIA SMEAR TEST NAME MALARIA SMEAR SPECIMEN REQUIRED/ MINIMUM VOLUME Blood, Minimum 2.0 ml collected when patient has fever spikes REJECTION CRITERIA Serum or anticoagulant other than EDTA. TRANSPORT TIME/TEMP 6 hours, Room temperature COLLECTION/TRANSPORT CONTAINER Lavender (EDTA) Vacutainer STABILITY 24 hours, Refrigerated. REPLICA LIMITS 1/day PERFORMED Sunday-Saturday METHODOLOGY Thin and Thick film examination TEST TURN AROUND TIME 1 -2 days CLINICAL USE AND INTERPRETATION Used to detect infection with Plasmodium species. This test will also be used to detect other blood parasites including: Trypanosomes, Leishmania, Microfilaria, Babesia, and Ehrlichia. COMMENTS Slides should be made and stained within 1 hour of collection for best visualization of Shuffner’s dots. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY MRSA SCREEN TEST NAME MRSA SCREEN SPECIMEN REQUIRED/ MINIMUM VOLUME Nasal swab, skin, groin, urine sputum REJECTION CRITERIA Rayon swab; swab submitted in transport media other than Armies or Stuarts TRANSPORT TIME/TEMP 1-12 hours, Room temperature COLLECTION/TRANSPORT CONTAINER Aerobic Swab STABILITY 24 hours Room Temperature REPLICA LIMITS 1/day/same source PERFORMED Sunday-Saturday METHODOLOGY Culture screen TEST TURN AROUND TIME 1-2 Days CLINICAL USE AND INTERPRETATION Used to detect patients colonized with MRSA. COMMENTS Susceptibility is not reported for screening cultures. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY MYCOPLASMA/ UREAPLASMA CULTURE TEST/ TESTCODE MYCOPLASMA/ UREAPLASMA CULTURE SPECIMEN REQUIRED/ MINIMUM VOLUME GENITAL MYCOPLASMA/UREAPLASMA: cervical or urethral swab; RESPIRATORY SECRETIONS. Contact Laboratory for additional specimen sources. REJECTION CRITERIA Specimens other than those listed above Specimens submitted in transport media other than UTM%. TRANSPORT TIME/TEMP COLLECTION/TRANSPORT CONTAINER STABILITY Refrigerate/keep cold UTM or Sterile container < 1 Day. Refrigerate after collection. REPLICA LIMITS 1/day/ same source PERFORMED Sunday-Friday METHODOLOGY Culture TEST TURN AROUND TIME 1-7 days CLINICAL USE AND INTERPRETATION Used as in aid in diagnosis of non-specific cervicitis/urethritis. COMMENTS UTM=Universal Transport Medium Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY Neisseria gonorrhoeae PROBE TEST NAME Neisseria gonorrhoeae PROBE SPECIMEN REQUIRED/ MINIMUM VOLUME Cervix or urethral specimen on Aptima unisex swab. REJECTION CRITERIA Specimens submitted with white swab only, specimens submitted with two swabs (white plus blue), specimens submitted with no swabs and specimens submitted with swabs other than those supplied with the kit will be rejected. For urine, first void specimen is required. Clean catch mid-stream specimens are not acceptable. Ocular specimens are not acceptable. TRANSPORT TIME/TEMP 1/day/same source COLLECTION/TRANSPORT CONTAINER STABILITY 30 days, unisex swab 60 days in urine transport REPLICA LIMITS 1/day/same source PERFORMED Sunday-Friday METHODOLOGY Transcription mediated amplification TEST TURN AROUND TIME 1-3 days COLLECTION/TRANSPORT CONTAINER Used for diagnosis of genital tract infections due to Chlamydia trachomatis. CLINICAL USE AN INTERPRETATION For ocular specimens, order eye culture for detection of N. gonorrhoeae. COMMENTS Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY OVA AND PARASITE EXAM TEST NAME OVA AND PARASITE EXAM SPECIMEN REQUIRED/ MINIMUM VOLUME Stool, walnut sized piece if fresh. Ova and parasite collection vials, both filled to line on vial Parasite/worm for Identification Duodenal aspirate Urine, Sputum REJECTION CRITERIA Stool and Duodenal Aspirates, unpreserved received >-30 minutes after collection Specimens with barium, bismuth or other anti-diarrheal medications. Presence of other compounds which will obscure parasites on microscopic exam TRANSPORT TIME/TEMP Unpreserved: 30-60 minutes, Room temperature Preserved: 12 hours, Room temperature COLLECTION/TRANSPORT CONTAINER Formalin and PVA vials. Fill to line. Do not overfill. Multiple collections will be used to fill vial if necessary. Note date and time of collection on each vial. STABILITY Unpreserved stool: 30-60 minutes, Room temperature. Preserved stool: 7 days Urine, sputum: 1 day, Refrigerated REPLICA LIMITS 1/day/same source PERFORMED Sunday-Saturday METHODOLOGY Microscopic Examination TEST TURN AROUND TIME 1-3 days CLINICAL USE AND INTERPRETATION COMMENTS Giardia cryptosporidium performed as reflex test if no history provided. (Fall 2014) Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY PINWORM EXAMINATION TEST NAME PINWORM EXAMINATION SPECIMEN REQUIRED/ MINIMUM VOLUME Sticky paddle or scotch tape sample of area around anus. Collect specimen during the night or first thing in the morning prior to bathing or using the toilet. REJECTION CRITERIA Specimens collected at times other than those recommended. Note: Transparent tape must be used. Magic or other nontransparent tape is unacceptable. If using scotch tape technique contact Microbiology for instructions. TRANSPORT TIME/TEMP 1 day, Room temperature COLLECTION/TRANSPORT CONTAINER Pinworm Paddle. Contact Laboratory for instructions for scotch tape technique. STABILITY 3 days, Room temperature REPLICA LIMITS 1/day PERFORMED Monday-Friday METHODOLOGY Direct Examination of scotch tape preparation or Pinworm paddle TEST TURN AROUND TIME 1-2 Days CLINICAL USE AND INTERPRETATION Used to diagnose infection with the pinworm (Enterobius vermicularis.) COMMENTS Pinworm cannot be reliably detected in stools samples. Ova and parasite exam should not be ordered to rule out this parasite. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY RAPID STREP SCREEN TEST NAME RAPID STREP SCREEN SPECIMEN REQUIRED/ MINIMUM VOLUME Throat swab REJECTION CRITERIA Specimen other than aerobic culture sab TRANSPORT TIME/TEMP 2-24 hours, Room temperature COLLECTION/TRANSPORT CONTAINER Aerobic Swab STABILITY 24 hours, Room Temperature REPLICA LIMITS 1/day/same source PERFORMED Sunday-Saturday METHODOLOGY Membrane Enzyme Immunoassay TEST TURN AROUND TIME 1 hour - 1 day CLINICAL USE AND INTERPRETATION Used for diagnosis of pharyngitis due to Group A beta streptococcus (Streptococcus pharyngitis) COMMENTS Sensitivity is approximately 90%. American Academy of Pediatrics recommends throat culture for pediatric patients negative in rapid strep A antigen screens. Culture backup will be performed on negative rapid strep screens. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY RESPIRATORY CULTURE WITH GRAM STAIN BRONCHOALVEOLAR LAVAGE, BRONCIAL BRUSH OR WASH OR TRACHEAL ASPIRATE TEST NAME RESPIRATORY CULTURE WITH GRAM STAIN BRONCHOALVEOLAR LAVAGE, BRONCIAL BRUSH OR WASH OR TRACHEAL ASPIRATE SPECIMEN REQUIRED/ MINIMUM VOLUME > 1ml sample REJECTION CRITERIA Delay in transport to Laboratory; leaking specimens TRANSPORT TIME/TEMP 2 hours, Room temperature COLLECTION/TRANSPORT CONTAINER *If mycobacterial cultures requested, at least required. See Acid Fast Culture. Sterile Container Lukens tube acceptable. Hand carry to lab if tubing attached. Lukens samples with pneumatic tube transport cap (no tubing) can be sent through the pneumatic tube system. STABILITY 2 Hours, Room temperature 24 hours, Refrigerated REPLICA LIMITS None PERFORMED Sunday-Saturday METHODOLOGY Gram Stain with Culture TEST TURN AROUND TIME 1-3 days CLINICAL USE AND INTERPRETATION Use for diagnosis of lower respiratory tract infections. COMMENTS Fungal, AFB and viral cultures require additional orders and will require additional samples. Specimens will be assessed for quality by gram stain. H. capsulatum and B. dermatitidis survive for only short periods of time once a specimen is obtained. Streptococcus pneumoniae, Haemophilus pneumoniae and Neisseria meningitidis will not survive in refrigerated samples. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY RESPIRATORY CULTURE WITH GRAM STAIN \ SPUTUM, EXPECTORATED TEST NAME RESPIRATORY CULTURE WITH GRAM STAIN \ SPUTUM, EXPECTORATED SPECIMEN REQUIRED/ MINIMUM VOLUME Sputum, >1 ml REJECTION CRITERIA Sputum with excessive oropharyngeal contamination by gram stain. Repeat specimen and order will be requested. TRANSPORT TIME/TEMP 2 hours, Room temperature (preferred) 24 hours, Refrigerated COLLECTION/TRANSPORT CONTAINER Sterile Container STABILITY 24 hours, Refrigerated REPLICA LIMITS 1/day/same source PERFORMED Sunday-Saturday METHODOLOGY Gram stain with Culture TEST TURN AROUND TIME 1-3 days CLINICAL USE AND INTERPRETATION Used for diagnosis of pneumonia bronchitis and other lower respiratory tract infections due to bacterial agents. COMMENTS Fungal, acid fast and viral culture require additional orders and specimen. Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis may not survive in refrigerated samples. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY RESPIRATORY CULTURE WITH GRAM STAIN SPUTUM, INDUCED TEST NAME RESPIRATORY CULTURE WITH GRAM STAIN SPUTUM, INDUCED SPECIMEN REQUIRED/ MINIMUM VOLUME Sterile Container > REJECTION CRITERIA Delay in transport to Laboratory TRANSPORT TIME/TEMP 2 hours, Room temperature COLLECTION/TRANSPORT CONTAINER Sterile Container STABILITY 24 hours, Refrigerated REPLICA LIMITS 1/day/ same source PERFORMED Sunday-Saturday METHODOLOGY Gram stain and Culture TEST TURN AROUND TIME 1-3 days CLINICAL USE AND INTERPRETATION Use for detection of lower respiratory tract specimens. Used in patients who cannot produce specimen by coughing. Specimen of choice for detection of Pneumocystis. COMMENTS H. capsulatum and B. dermatitidis survive for only short periods of time once a specimen is obtained. Streptococcus pneumoniae, Haemophilus pneumoniae and Neisseria meningitidis may not survive in refrigerated samples. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY RESPIRATORY SCREEN TEST NAME RESPIRATORY SCREEN SPECIMEN REQUIRED/ MINIMUM VOLUME Nasal specimen for MRSA Nasopharyngeal specimen for Group A strep, Neisseria meningitidis or Bordetella pertussis Throat swab for Corynebacterium diphtheriae, Neisseria gonorrhoeae or Yeast Specify organism in test order. REJECTION CRITERIA Specimens other than those described above Delay in transport to Laboratory TRANSPORT TIME/TEMP 12 hours, Room temperature COLLECTION/TRANPORT CONTAINER Aerobic swab for MRSA Group A strep, C. diphtheriae, yeast and GC Collect nasopharyngeal swab for Neisseria meningitidis See Bordetella pertussis Culture/PCR for specimen collection requirements. STABILITY 1/day/same source REPLICA LIMITS Anterior nose cultures are reserved for detecting staphylococcal and streptococcal carriers or for nasal lesions. PERFORMED Sunday-Saturday METHODOLOGY Culture TEST TURN AROUND TIME 1-3 days CLINICAL USE AND INTERPRETATION Use to detect colonization of MRSA, Group A Strep and Neisseria meningitidis in patients or contacts. Used for detection of C. diphtheriae or B. pertussis in symptomatic patients. Testing for both organisms is referred to MDCH or Reference Laboratory. COMMENTS Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY ROTAVIRUS ANTIGEN TEST NAME ROTAVIRUS ANTIGEN SPECIMEN REQUIRED/ MINIMUM VOLUME Stool, pea-walnut sized piece REJECTION CRITERIA Stool in preservative Delay in transport Unrefrigerated sample TRANSPORT TIME/TEMP Sterile Container COLLECTION/TRANSPORT CONTAINER 1-24 hours, Refrigerate or on ice STABILITY 24 hours, Refrigerated REPLICA LIMITS 1/day PERFORMED Sunday-Saturday METHODOLOGY Membrane EIA TEST TURN AROUND TIME 1 day CLINICAL USE AND INTERPRETATION Used to detect gastroenteritis due to Rotavirus. COMMENTS Most infections occur in the winter months and in children. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY RSV ANTIGEN TEST NAME RSV ANTIGEN SPECIMEN REQUIRED/ MINIMUM VOLUME Nasopharyngeal swab in M4 RT, Nasopharyngeal aspirate or Nasopharyngeal wash REJECTION CRITERIA Specimens submitted in transport media other than those approved Patients >5 years of age TRANSPORT TIME/TEMP 1-2 hours, Refrigerated or on ice COLLECTION/TRANSPORT CONTAINER M4-RT transport medium or Saline STABILITY 24 hours, Refrigerated REPLICA LIMITS 1/day/same source PERFORMED Sunday-Saturday Performed as a STAT procedure for ER and in-house pediatric patients METHODOLOGY Membrane EIA for antigen detection TEST TURN AROUND TIME 1 hour - 1 day CLINICAL USE AND INTERPRETATION Used as an aid in respiratory tract infection due to Respiratory Synclinal virus in children <= 5 years old. COMMENTS Methodology is approved for detection of RSV in young children. Alternate methodology such as culture or DFA is recommended or detection of RSV in older children and adults. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY SPORE CHECK /STERILITY CULTURE TEST NAME SPORE CHECK /STERILITY CULTURE SPECIMEN REQUIRED/ MINIMUM VOLUME Attest Spore Ampoule, Spore strip or other spore indicator system REJECTION CRITERIA Attest or Spore strip submitted without control sample TRANSPORT TIME/TEMP 1 - 2 days, Room temperature COLLECTION/TRANSPORT CONTAINER Attest Spore Ampoule or Spore Strips STABILITY 1 - 2 days, Room temperature REPLICA LIMITS NA PERFORMED Sunday-Saturday METHODOLOGY Culture TEST TURN AROUND TIME 2 days CLINICAL USE AND INTERPRETATION Used to verify proper functioning of autoclave. COMMENTS If control vial/ test is positive, sterility has not been achieved. Recall/ re-sterilization should be performed and the spore test repeated. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY STOOL CULTURE TEST NAME STOOL CULTURE SPECIMEN REQUIRED/ MINIMUM VOLUME Stool pea-walnut sized piece, unpreserved. Stool to fill line in preservative vial. REJECTION CRITERIA Stool, unpreserved > 4 hours after collection Rectal swab Stool, preserved > 48 hour delay to lab Stool in fixative such as Formalin TRANSPORT TIME/TEMP COLLECTION/TRANSPORT CONTAINER STABILITY 1-2 Hours, Room temperature, unpreserved Sterile Container or Enteric Plus Transport 48 hours, Room temperature in preservative 1 - 2hours, Room temperature unpreserved 24 Hours, Refrigerated REPLICA LIMITS 1/day/same source PERFORMED Sunday-Saturday METHODOLOGY Culture TEST TURN AROUND TIME 2-3 days CLINICAL USE AND INTERPRETATION Used as an aid in diagnosis of bacterial gastroenteritis. COMMENTS Stool culture will be rejected for patients hospitalized for > 3 days. Clostridium difficile is most commonly responsible for diarrhea in these patients. Rectal swab reserved for detecting GC, Shigella, HSV, and anal carriage of S. pyogenes OR for patients unable to pass a stool specimen. Detects Salmonella, Shigella, Campylobacter and Enterohemorrhagic E. Coli. Notify Microbiology if Yersinia, Vibrio or other pathogens suspected. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY THROAT FOR GROUP A STREP TEST NAME THROAT FOR GROUP A STREP SPECIMEN REQUIRED/ MINIMUM VOLUME Throat swab REJECTION CRITERIA Specimen other than aerobic culture swab; dry swab TRANSPORT TIME/TEMP 2 - 24 hours, Room temperature COLLECTION/TRANSPORT CONTAINER Aerobic Swab STABILITY 24 hours, Room temperature REPLICA LIMITS 1/day/same source PERFORMED Sunday-Saturday METHODOLOGY Culture TEST TURN AROUND TIME 1-2 days CLINICAL USE AND INTERPRETATION Use to detect bacterial pharyngitis due to Group A beta streptococci. COMMENTS Sensitivity of culture for Group A Strep: Good Specimen = 90% Poor Specimen = 30% Throat cultures are contraindicated for patients with an inflamed epiglottis. Note: Throat Specimens are routinely processed for the recovery of beta-hemolytic streptococci only. Antimicrobial susceptibility tests are not performed on bacterial isolates from throat cultures unless specifically requested due to penicillin allergy. If organisms other than beta-hemolytic streptococci are suspected, the laboratory must be notified. Notify Microbiology if special agents of pharyngitis are suspected: Yeast, Arcanobacterium haemolyticum, Corynebacterium diphtheriae, Vincent’s angina. If ordering Rapid strep screen plus throat culture, submission of a dual swab is optimal. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY TISSUE CULTURE TISSUE CULTURE TISSUE CULTURE WITH GRAM STAIN TEST NAME TISSUE CULTURE TISSUE CULTURE TISSUE CULTURE WITH GRAM STAIN SPECIMEN REQUIRED/ MINIMUM VOLUME Piece of tissue REJECTION CRITERIA Delay in transport >2 hours Specimens submitted on swabs Specimens submitted in preservatives such as Formalin or alcohol. TRANSPORT TIME/TEMP 2-4 hours, Room temperature for bacterial and mycobacterial agents. For viral agents, refrigerate 72 hours. COLLECTION/TRANSPORT CONTAINER Sterile Container STABILITY 2 - 4 hours, Room temperature REPLICA LIMITS 1/day/same source PERFORMED Sunday-Saturday METHODOLOGY Gram Stain (if ordered) Culture TEST TURN AROUND TIME 3 days CLINICAL USE AND INTERPRETATION Used as an aid in diagnosis of infection in a variety of tissues and organs. COMMENTS Always submit as much tissue as possible. NEVER submit a swab that has simply been rubbed over the surface. Specimens submitted in formalin are unacceptable for culture. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY TISSUE CULTURE QUANTITATIVE TEST NAME TISSUE CULTURE QUANTITATIVE SPECIMEN REQUIRED/ MINIMUM VOLUME Piece of tissue, 0.5 mL2 gm minimum, 0.5 mL5 grams or greater preferred REJECTION CRITERIA Delay in transport to Laboratory > 1 Hour TRANSPORT TIME/TEMP 1 hour, Room Temperature. CONTACT MICROBIOLOGY PRIOR TO SUBMISSION. COLLECTION/TRANSPORT CONTAINER Sterile Container. DO NOT ADD FIXATIVES OR PRESERVATIVES. STABILITY 1-2 hours, Room temperature Specimen in preservatives 4 hours, Refrigerated REPLICA LIMITS 1/day/same source PERFORMED Sunday-Saturday METHODOLOGY Culture TEST TURN AROUND TIME 3 days CLINICAL USE AND INTERPRETATION Used as in aid in diagnosis of infection, especially with skin grafts and burn sites. COMMENTS Always submit as much tissue as possible. NEVER submit a swab that has simply been rubbed over the surface. Specimens submitted in formalin are unacceptable for culture. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY URINE CULTURE TEST NAME URINE CULTURE SPECIMEN REQUIRED/ MINIMUM VOLUME Clean-catch, indwelling catheter, pediatric urine collection, straight catheter, suprapubic or cystoscopic. Indicate method of collection. REJECTION CRITERIA Unpreserved urine at room temperature > 2 hours Refrigerated, Unpreserved urine> 2 hours Urine in gray top preservative >48 hours Urine previously processed for urinalysis TRANSPORT TIME/TEMP Unpreserved: 2 hours, Room temperature Preserved (gray top): 48 hours COLLECTION/TRANSPORT CONTAINER STABILITY BD Vacutainer Collection Gray top for Culture OR Sterile container Unpreserved: 2 hours, Room temperature Unpreserved: 24 hours, Refrigerated Gray top Preserved: 48 hours, Room temperature REPLICA LIMITS 1/day/same source/same method of collection PERFORMED Sunday-Saturday METHODOLOGY Culture with colony count TEST TURN AROUND TIME 1-3 days. CLINICAL USE AND INTERPRETATION Used as an aid in diagnosis of urinary tract infections. COMMENTS Urine taken directly from a Foley catheter bag is not acceptable. Collect suprapubic urine and submit order for urine culture plus anaerobic culture when anaerobic UTI is suspected. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY VAGINITIS SCREEN TEST NAME VAGINITIS SCREEN SPECIMEN REQUIRED/ MINIMUM VOLUME Vaginal swab or secretions collected on Affirm swab REJECTION CRITERIA Specimens other than vaginal specimens Specimens submitted with swabs other than the AFFIIRM swab TRANSPORT TIME/TEMP 1 - 7 hours, Room Temperature COLLECTION/TRANSPORT CONTAINER Affirm Collection Kit STABILITY 72 hours, Room temperature when preservative is added 1 hour, Room temperature for unpreserved specimens REPLICA LIMITS 1/day PERFORMED Sunday-Saturday Specimens from ER & LD Triage performed as STATS METHODOLOGY AFFIRM Molecular Probe TEST TURN AROUND TIME 1 hour- 1 day CLINICAL USE AND INTERPRETATION Used as an aid in diagnosis of vaginitis due to Trichomonas vaginalis, Gardnerella vaginalis and Candida species. COMMENTS Specimen collection kits available for Microbiology/Laboratory. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY Revised 07/14. VIRAL CULTURE TEST NAME VIRAL CULTURE SPECIMEN REQUIRED/ MINIMUM VOLUME Throat, nasopharyngeal swab, nasopharyngeal aspirate or wash, bronchial washings, Broncho alveolar lavage, CSF, body fluids, Urine, Stool, Tissues, Swabs, Blood REJECTION CRITERIA Specimens other than those sited; improper transport medium; dry swabs TRANSPORT TIME/TEMP 1 - 4 Hours, Refrigerated COLLECTION/TRANSPORT CONTAINER M4-RT Transport Media STABILITY Variable, most 1 day, Refrigerated REPLICA LIMITS 1/day/same source PERFORMED Sunday-Friday METHODOLOGY Rapid shell vial or viral culture, DFA, PCR, variable with virus TEST TURN AROUND TIME 1-7 days CLINICAL USE AND INTERPRETATION Used for diagnosis of a variety of viral infections. COMMENTS See Visual Aids portion of manual for specimen selection for viral diagnosis. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY WOUND CULTURE TEST NAME WOUND CULTURE SPECIMEN REQUIRED/ MINIMUM VOLUME Cellulitis, oral abscess, open or closed abscess, decubitus ulcer GRAM STAIN IS PERFORMED ON ALL WOUND/ABSCESS SPECIMENS. REJECTION CRITERIA Capped Luer-tip Syringe OR Sterile Tube OR Swab Transport OR Anaerobic Swab TRANSPORT TIME/TEMP 2 hours, Room temperature COLLECTION/TRANSPORT CONTAINER Aerobic swab STABILITY 12-18 Hours, Room Temperature REPLICA LIMITS None PERFORMED Sunday-Saturday METHODOLOGY Gram Stain with Culture TEST TURN AROUND TIME 1- 5 days CLINICAL USE AND INTERPRETATION Used for diagnosis of wound and abscess infections. COMMENTS Cellulitis: Yield of potential pathogens is only 25-35 % (when aspirates, blood cultures and skin biopsies have been obtained.) A decubitus swab provides little clinical information and its collection should be discouraged; tissue biopsy or needle aspirates are the specimens of choice. Periodontal lesions should be processed only by reference laboratories equipped to provide specialized techniques for the detection and enumeration of specific agents. Sampling of superficial tissue for bacterial is discouraged; tissue Biopsy or needle aspirates are specimens of choice. Anaerobic culture requires separate order and anaerobic transport swab. Revised 07/14. RETURN TO TEST DIRECTORY RETURN TO HOME PAGE SJMO LABORATORY TEST DIRECTORY RETURN TO TEST DIRECTORY RETURN TO HOME PAGE
