Type: S

Test 261

SuperUser Account — Tue, 16 Sep 2008 21:42:59 GMT

Test: Sodium, Serum
Number: 001198
CPT: 84295
Synonyms: Na
Specimen: Serum
Volume: 1 mL
Minimum Volume: 0.5 mL
Container: Red-top tube or gel-barrier tube
Collection: Separate serum from cells within 45 minutes of collection. Label specimen as serum.
Storage Instructions: Maintain specimen at room temperature.
Causes for Rejection: Gross hemolysis; improper labeling
Reference Interval: 135-145 mmol/L
Use: Electrolyte, acid-base balance; water balance; water intoxication; diagnose dehydration.

Hypernatremia occurs in dehydration. For instance, nasogastric protein feeding with insufficient fluids may cause hypernatremia. Hypernatremia without obvious cause may relate to Cushing syndrome, central or nephrogenic diabetes insipidus with insufficient fluids, primary aldosteronism, and other diseases. Severe hypernatremia may be associated with volume contraction, lactic acidosis, azotemia, weight loss, and increased hematocrit as evidence of dehydration. The corrected serum sodium is often high in nonketotic hyperosmolar coma. (A corrected Na⁺ is calculated by increasing Na⁺ by 1.3-1.6 mmol/L for each 100 mg/dL increment in serum or plasma glucose). 100 mg equals 5.56 mmol/L. The corrected serum sodium level calculated in nonketotic hyperosmolar coma: apparent mild hyponatremia with very high glucose may actually mean (corrected) hypernatremia.¹

Hyponatremia occurs with nephrotic syndrome, cachexia, hypoproteinemia, intravenous glucose infusion, in congestive heart failure, and other clinical entities. Serum sodium is a predictor of cardiovascular mortality in patients in severe congestive heart failure.²

Hyponatremia without congestive failure or dehydration may occur with hypothyroidism, the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), renal failure, or renal sodium loss.

The differential diagnosis of hyponatremia includes Addison disease, hypopituitarism, liver disease including cirrhosis, hypertriglyceridemia, and psychogenic polydipsia. Diuretics and other drugs may cause hyponatremia. Sodium decreasing to levels <115 mmol/L can lead to significant neurological dysfunction with cerebral edema and increased intracranial pressure.

The differential diagnosis of hyponatremia includes determination of urine sodium and osmolality and serum urea nitrogen (BUN). BUN is often decreased in SIADH.

Methodology: Ion-selective electrode (ISE); flame photometer
Additional Information: The ratio of serum sodium:osmolality is normally 0.43-0.50; a decreased ratio is found in uremia and other states in which there are increased substances with osmotic activity.

See Urea Nitrogen, Serum [001040] , regarding hyponatremia with sodium <128 mmol/L, hypo-osmolality, low BUN and the syndrome of inappropriate secretion of antidiuretic hormone.

A number of situations result in “pseudohyponatremia.” In these circumstances treatment may be undesirable. With pseudohyponatremia serum sodium is decreased but the serum is not hypotonic (serum osmolality is normal or even increased). This may occur as the result of other molecules replacing water in relation to sodium. The water content is effectively lowered - sodium is “diluted.” In severe hypertriglyceridemia or paraprotein-related marked increase in protein, the concentration of sodium in relation to water is normal but the analytic result is determined as mmol/L of serum. Osmolality in this situation is determined as amount of particles per kg of water and will be normal. It has been shown that analyses by sodium electrode of the direct potentiometric type (requires no dilution) are not artifactually low in patients with hyperlipidemia.³ If large amounts of solute such as glucose or mannitol are present, movement of intracellular water into the extracellular space may produce dilutional hyponatremia. In this case sodium concentration in relation to water is actually low. “Osmolal gap” however exists between measured and calculated serum osmolality. Other substances capable of increasing serum osmolality (eg, ethanol) may also cause increase in the osmolal gap. Yet another cause of pseudohyponatremia is increased serum viscosity due to increased globulin proteins, occurring particularly in Waldenström macroglobulinemia. The sodium analyzer may aspirate too little sample when viscosity is so increased, leading to a factitious low sodium concentration. See discussion of “pseudohyponatremia” by Epstein and Osler.⁴

Hyponatremia may manifest lethal neurological complications (water intoxication with brain edema). Rapid correction of hyponatremia has been described⁵ but has also been implicated as a cause of demyelination.⁶

Hypernatremia may complicate some cases of lactulose-treated portal-systemic encephalopathy.⁷

Drug effects are summarized.⁸

Footnotes:

Daugirdas JT, Kronfol NO, Tzamaloukas AH, et al, “Hyperosmolar Coma: Cellular Dehydration and the Serum Sodium Concentration,” Ann Intern Med, 1989, 110(11):855-7 (review).
Lee WH and Packer M, “Prognostic Importance of Serum Sodium Concentration and its Modification by Converting Enzyme Inhibition in Patients With Severe Chronic Heart Failure,” Circulation, 1986, 73(2):257-67.
Aw TC and Kiechle FL, “Pseudohyponatremia,” Am J Emerg Med, 1985, 3(3):236-9.
Epstein M and Oster JR, “Disorders of Hyponatremia and Hypernatremia,” The Laboratory in Clinical Medicine. Interpretation and Application, 2nd ed, Halsted JA and Halsted CH, eds, Philadelphia, PA: WB Saunders Co, 1981, 289-95.
Votey SR, Peters AL, and Hoffman JR, “Disorders of Water Metabolism: Hyponatremia and Hypernatremia,” Emerg Med Clin North Am, 1989, 7(4):749-69 (review).
Kleinschmidt-DeMasters BK and Norenberg MD, “Rapid Correction of Hyponatremia Causes Demyelination: Relation to Central Pontine Myelinolysis,” Science, 1981, 211(4486):1068-70.
Nelson DC, McGrew WR Jr, and Hoyumpa AM Jr, “Hypernatremia and Lactulose Therapy,” JAMA, 1983, 249(10):1295-8.
Hitz J and Trivin F, “Sodium,” Drug Effects on Laboratory Test Results Analytical Interferences and Pharmacological Effects, Siest G and Galteau MM, eds, Littleton, MA: PSG Publishing Co, Inc, 1988, 391-404

Test 540

SuperUser Account — Tue, 16 Sep 2008 21:48:03 GMT

Test: Sodium, 24 hour Urine
Number: 003178
CPT: 84300
Special Instructions: The request form must state date and time collection started, date and time collection finished, and 24-hour urine volume.
Specimen: Urine (24-hour)
Volume: 10 mL aliquot
Minimum Volume: 1 mL aliquot
Container: Plastic urine container, no preservative
Collection: Instruct the patient to void at 8 AM and discard the specimen. Then collect all urine including the final specimen voided at the end of the 24-hour collection period (ie, 8 AM the next morning). Screw the lid on securely. Container must be labeled with patient´s full name, date and time collection started, and date and time collection finished.
Storage Instructions: Refrigerate
Causes for Rejection: Improper labeling
Reference Interval: 40-220 mmol/24 hours
Use: Work up volume depletion, acute renal failure, acute oliguria, and differential diagnosis of hyponatremia.¹ Division of hyponatremia into hypervolemia or not, edema or not, and urinary Na⁺ less than or greater than 10 mmol/L provides a classification of hyponatremia.² History of diuretics, other drug intake, setting of osmotic diuresis or not, serum/plasma electrolytes and other factors are needed.
Methodology: Ion-selective electrode (ISE); flame photometer
Additional Information: In cases of hyponatremia, urine sodium <10 mmol/L may indicate extrarenal depletion: dehydration (gastrointestinal or sweat loss), congestive heart failure, liver disease or nephrotic syndromes.

Urine sodium >10 mmol/L may indicate diuretics, emesis, intrinsic renal diseases, Addison disease, hypothyroidism, or syndrome of inappropriate antidiuretic hormone (SIADH).² In hypothyroidism and in SIADH, Na⁺ and Cl^- may be >40 mmol/L.³ (Depending on intake, such results also can be found in normal individuals.) In SIADH, urinary sodium is usually >20 mmol/L. Inappropriate secretion of antidiuretic hormone (SIADH) was found in 7% of 250 patients with small cell lung cancer.⁴ Such patients have hyponatremia, often severe, with hypo-osmolar serum, high urinary sodium excretion with urine osmolality greater than that of serum. Acute and subacute diseases of the CNS, TB and other chronic pulmonary diseases may also cause SIADH. SIADH may also be caused by acute intermittent porphyria, LE, occasional malignant neoplasms other than small cell carcinoma of lung, and a number of drugs.⁵

The classification as presented here is overly abbreviated for clinical application. Pitfalls exist (eg, increase of Na⁺ necessary to balance excretion of penicillin).³

Urine Na⁺ >40 mmol/L in oliguria suggests acute tubular necrosis.^3,6 (However, spot urine sodiums without other data have been criticized for their applicability to this diagnosis.)

Low Na⁺ excretion may be found with early obstructive uropathy and with the oliguria of acute glomerulonephritis³ and in some patients with x-ray contrast acute renal failure.

Silver et al recommend measurement of urinary Na⁺ excretion in patients with nephrolithiasis and hypercalciuria.⁷

It is important to know the urinary sodium level in patients with unexplained hyperchloremic metabolic acidosis when the diagnosis of distal renal tubular acidosis is being considered.⁸

Footnotes:

Harrington JT and Cohen JJ, “Measurement of Urinary Electrolytes - Indications and Limitations,” N Engl J Med, 1975, 293(24):1241-3.
Epstein M and Oster JR, “Disorders of Hyponatremia and Hypernatremia,” The Laboratory in Clinical Medicine: Interpretation and Application, 2nd ed, Halsted JA and Halsted CH, eds, Philadelphia, PA: WB Saunders Co, 1981, 289-95.
Sherman RA and Eisinger RP, “The Use (and Misuse) of Urinary Sodium and Chloride Measurements,” JAMA, 1982, 247(22):3121-4.
Hainsworth JD, Workman R, and Greco FA, “Management of the Syndrome of Inappropriate Antidiuretic Hormone Secretion in Small Cell Lung Cancer,” Cancer, 1983, 51(1):161-5.
Streeten DH, Moses AM, and Miller M, “Disorders of the Neurohypophysis,” Harrison´s Principles of Internal Medicine, Braunwald E, Isselbacher KJ, Petersdorf RG, et al, eds, New York, NY: McGraw-Hill Information Services Co, 1987, 1722-32.
Schrier RW, “Acute Renal Failure,” JAMA, 1982, 247(18):2518-22, 2524.
Silver J, Rubinger D, Friedlaender MM, et al, “Sodium-Dependent Idiopathic Hypercalciuria in Renal-Stone Formers,” Lancet, 1983, 2(8348):484-6.
Batlle DC, von Riotte A, and Schlueter W, “Urinary Sodium in the Evaluation of Hyperchloremic Metabolic Acidosis,” N Engl J Med, 1987, 316(3):140-4

Test 777

SuperUser Account — Tue, 16 Sep 2008 21:54:38 GMT

Test: Sedimentation Rate, Westergren
Number: 005215
CPT: 85652
Synonyms: Erythrocyte Sedimentation Rate ; ESR ; Westergren Sedimentation Rate
Specimen: Whole blood
Volume: 5 mL
Minimum Volume: 2 mL
Container: Lavender-top (EDTA) tube
Storage Instructions: Refrigerate
Stability: Refrigerate up to 24 hours
Causes for Rejection: Hemolysis; clotted specimen; underfilled tube; specimen older than 24 hours; improperly labeled specimen; transfer tubes with whole blood
Reference Interval:

Male: 0-50 years: 0-15 mm/hour, 50 years and older: 0-20 mm/hour
Female: 0-50 years: 0-20 mm/hour, 50 years and older: 0-30 mm/hour

Use: Evaluate the nonspecific activity of infections, inflammatory states, autoimmune disorders, and plasma cell dyscrasias
Limitations: Optimum results are from blood less than 2 hours old.
Methodology: Westergren
Additional Information: Elevations in fibrinogen, alpha- and beta-globulins (acute phase reactants), and immunoglobulins increase the sedimentation rate of red cells through plasma. The test is important in the diagnosis of temporal arteritis, as well as its management.¹
Footnotes:

Wong RL, Korn JH. ?Temporal Arteritis Without an Elevated Erythrocyte Sedimentation Rate. Case Report and Review of the Literature,? Am J Med, 1986; 80(5):959-964.

References:

Gambino SR, Dire JJ, et al, ?The Westergren Sedimentation Rate Using K₃ EDTA,? Am J Clin pathol, 1965; 43:173.

Test 1030

SuperUser Account — Tue, 16 Sep 2008 22:03:19 GMT

Test: Soluble Liver Antigen (SLA) IgG Antibody
Number: 007441
CPT: 83516
Synonyms: SLA, IgG Antibody
Specimen: Serum
Volume: 0.1 mL
Minimum Volume: 0.05 mL (Note: This volume does not allow for repeat testing.)
Container: Red-top tube or gel-barrier tube
Collection: If a red-top tube is used, transfer separated serum to a plastic transport tube.
Storage Instructions: Refrigerate
Causes for Rejection: Nonserum specimen received; specimen in azide or other preservative; microbially-contaminated specimen; heat-treated specimen; gross lipemia or hemolysis
Reference Interval:

Negative: 0.0-20.0 units
Equivocal: 20.1-24.9 units
Positive: >24.9 units

Use: Aid in the diagnosis of autoimmune hepatitis (AIH)^1,2,3,4
Limitations: A negative SLA IgG does not rule out autoimmune hepatitis.
Methodology: Enzyme immunoassay (EIA)
Additional Information: Autoimmune hepatitis (AIH) is a chronic, progressive, heterogeneous inflammatory liver disease of unknown etiology.⁴ Diagnosis is often difficult since there is no single diagnostic test for AIH and presenting symptoms can be quite varied. Diagnosis includes evaluation of clinical laboratory and histological findings as well as the exclusion of other causes of chronic hepatitis. Diagnosis is particularly difficult with patients classified with cryptogenic hepatitis, described as having an undefined chronic hepatitis without antibodies to viral or the conventional profile of autoimmune markers. Early diagnosis of AIH and immunosuppressive treatment are essential to help prevent severe liver damage.

AIH patients are generally divided into two groups based on the presence of specific autoantibodies.^2,4 AIH type 1 (also referred to as classic, active chronic, lupoid, plasma cell, or autoimmune chronic active hepatitis) is the more common type of AIH. AIH-1 is characterized by antinuclear, antismooth muscle (directed against both antiactin and nonactin components), and perinuclear and antineutrophil cytoplasmic antibodies. Liver/kidney microsome antibodies and antiliver cytosol antigen (LC-1) characterize AIH type 2.

Autoantibodies against soluble liver antigen (anti-SLA) show a high specificity (approximately 99%) for AIH.^1,2 However, they are detectable in only 10% to 30% of patients with AIH.³ SLA is a 50 kilodalton cytosolic protein that is thought to be involved in the selenocysteine pathway.^2,4 Anti-SLA and the independently described anti-LP are identical.³ The findings of anti-SLA has been associated with an increased prevalence of the HLA-DR3 genotype and a decreased prevalence of the HLA-DR4 genotype.^2,3 Anti-SLA positive patients have a higher rate of relapse after corticosteroid than seronegative patients.³ Recent studies have suggested that patients with anti-SLA/LP have a more severe course of autoimmune hepatitis, although the exact function and role of this autoantibody remain unclear.³

Footnotes:

Ballot E, Homberg JC, and Johanet C, “Antibodies to Soluble Liver Antigen: An Additional Marker in Type 1 Autoimmune Hepatitis,” J Hepatol, 2000, 33(2):208-15.
Czaja AJ and Norman GL, “Autoantibodies in the Diagnosis and Management of Liver Disease,” J Clin Gastroenterol, 2003, 37(4):315-29.
Strassburg CP and Manns MP, “Autoantibodies and Autoantigens in Autoimmune Hepatitis,” Semin Liver Dis, 2002, 22(4):339-52.
Czaja AJ, “Autoantibodies in Autoimmune Liver Disease,” Adv Clin Chem, 2005, 40:127-64

References:

Luxon BA, “Autoimmune Hepatitis. Making Sense of All Those Antibodies,” Postgrad Med, 2003, 114(1):79-82, 85-8.

Test 1094

SuperUser Account — Tue, 16 Sep 2008 22:06:05 GMT

Test: Salicylate, Serum
Number: 007849
CPT: 80196
Synonyms: Acetylsalicylic Acid, Blood ; Aspirin, Blood ; Salicylic Acid, Blood
Specimen: Serum or plasma
Volume: 2 mL
Minimum Volume: 0.6 mL
Container: Red-top tube or green-top (heparin) tube
Collection: Transfer separated serum or plasma to a plastic transport tube. Do not use a gel-barrier tube. The use of gel-barrier tubes is not recommended due to slow absorption of the drug by the gel. Depending on the specimen volume and storage time, the decrease in drug level due to absorption may be clinically significant.

Optimal sampling time after dosage is 2-6 hours. Optimal resampling time after change in dosage is 6 hours.

Storage Instructions: Refrigerate
Causes for Rejection: Gel-barrier tube
Reference Interval: Therapeutic (anti-inflammatory): 30-250 μg/mL
Methodology: Immunoassay
Additional Information: Optimal sampling time after dosage is 2-6 hours. Serum half-life is 2-3 hours on low-dose therapy, 15-30 hours on high-dose treatment. Optimal resampling time after change in dosage is 6 hours. In patients on chronic therapy, small dose changes may produce disproportionate changes in serum level. Use of antacids, which increase renal excretion, can lower serum levels. Steady-state concentrations for an individual patient are not adequately predicted from nomograms or standard dose schedules. In salicylate poisoning, the following symptoms may occur: initial alkalosis followed by acidosis in the blood, ketosis, and possible elevated plasma glucose. Glucose should be measured when levels >250 μg/mL are detected. Salicylate can be done on urine or gastric juice.

The following Done nomogram is used to estimate blood level and prognosis following a single dose ingestion. The level measured 4 hours or more following ingestion is plotted. Specimens drawn earlier may not reflect the peak. The nomogram is not useful when accumulation over several ingestions exists. Urine pH and volume hourly are advocated with plasma pH, potassium and other electrolytes, prothrombin time, AST, ALT, serum bilirubin, and arterial blood gases for care of serious pediatric salicylate poisoning.¹

Salicylate hepatitis, usually at blood levels of 200-250 μg/mL, occurs. Salicylates are believed to play a role in the hepatonecrosis of Reye syndrome in children. They are no longer recommended for use in children.

Footnotes:

Paulson JA, “Poisonings From Food, Drugs, Chemicals, Pollutants, and Venomous Bites; Mammalian Bites,” Nelson Textbook of Pediatrics, 13th ed, Behrman RE, Vaughn VC III, and Nelson WE, eds, Philadelphia, PA: WB Saunders Co, 1987, 1491, 1516

Test 1130

SuperUser Account — Tue, 16 Sep 2008 22:07:43 GMT

Test: Stool Culture
Number: 008144
CPT: 87045; 87046; 87427
Synonyms: Culture, Stool, Comprehensive ; Enteric Pathogens Culture, Routine ; Feces Culture, Routine ; Routine Culture, Stool
Test Includes: Culture; isolation and identification (at an additional charge) of Salmonella, Shigella, and Campylobacter, and detection of enterohemorrhagic E. coli (EHEC) Shiga toxin by EIA. If culture results warrant, susceptibility testing (additional charges/CPT code[s] may apply) may be performed. CPT coding for microbiology and virology procedures often cannot be determined before the culture is performed. Requests with only a written order and no test number indicated will be processed according to Default Test Order for Ambiguous Orders .
Special Instructions: Specify specific pathogen if not Salmonella, Shigella, Campylobacter, or enterohemorrhagic E. coli (EHEC). Check expiration date of transport; do not use expired devices.

Fecal specimens for different tests often need different transport containers and different transport conditions (eg, frozen, raw stool). Specimens should be portioned out to separate devices of each type for each test requested before sending to the laboratory. Stool for bacterial culture and enterohemorrhagic E. coli Shiga toxin by EIA should be submitted in the C&S transport vial. Only a thumbnail-size portion of stool, about 1 g or 1 mL, should be added to the vial. Overfilling the vial will reduce recovery of stool pathogens.

Specimens from sources, such as genital, stool, urine, and upper and lower respiratory specimens, cannot be cultured under the aerobic bacterial culture test number. If specimens are incorrectly submitted with an order for aerobic bacterial culture, the laboratory will process the specimen for the test based on the source listed on the request form. The client will not be telephoned to approve this change, but the change will be indicated on the report.

Specimen: Stool or rectal swab placed in stool culture transport vial
Volume: 1 g, 1 mL, or one swab in stool C&S transport vial (the usual bacterial swab transport is not acceptable although the swab may be used).
Container: Stool culture transport vial is required; diapers are not acceptable. Culture collection swab may be used to collect rectal swabs or a swab of fecal material, then swab should be placed in C&S vial (fecal transport system).
Collection: A single stool specimen cannot be used to rule out bacteria as a cause of diarrhea. It is recommended that two or three stool specimens, collected on separate days, be submitted to increase the probability of isolating a bacterial pathogen. Hospitalized patients who develop diarrhea while hospitalized and more than 72 hours after admission should be tested for Clostridium difficile by detection of Toxin A and/or Toxin B.

Studies have shown that patients who did not have gastroenteritis or other GI symptoms on admission are unlikely to have diarrheal illness due to Salmonella, Shigella, Campylobacter, or enterohemorrhagic E. coli.

Stool: Specimen should be collected in sterile bedpan, not contaminated with urine, residual soap, or disinfectants. Those portions of stool that contain pus, blood, or mucous should be transferred to a sterile specimen container.

Rectal swab: Pass swab beyond anal sphincter, carefully rotate, and withdraw. Swabbing of lesions of rectal wall or sigmoid colon during proctoscopy or sigmoidoscopy is preferred.

Duodenal or sigmoid aspirate: Specimen should be collected by a physician trained in this procedure.

Stool specimen can be divided for other types of cultures by the laboratory. Miscellaneous tests and ova and parasites tests should be split into appropriate containers and transported prior to shipping to the laboratory.

Storage Instructions: Maintain specimen at room temperature.
Causes for Rejection: Specimen received in grossly leaking transport container; diapers; dry specimen; specimen submitted in fixative or additive; specimen received in expired transport media or incorrect transport device; inappropriate specimen transport conditions (not in a C&S vial or in an overfilled C&S vial); specimen received after prolonged delay in transport (usually more than 72 hours); specimen stored or transported frozen; wooden shaft swab in transport device; unlabeled specimen or name discrepancy between specimen and request label
Use: Detect bacterial pathogenic organisms in the stool; diagnose typhoid fever, enteric fever, bacillary dysentery, Salmonella infection.

Indications for stool culture include:¹

bloody diarrhea
fever
tenesmus
severe or persistent symptoms
recent travel to a third world country
known exposure to a bacterial agent
presence of fecal leukocytes

Limitations: Yersinia sp and Vibrio parahaemolyticus will not be isolated unless specifically requested; these will each be done with an additional charge. These organisms are fastidious and have very specific requirements for growth.
Methodology: Aerobic culture on selective media; detection of EHEC Shiga-like toxins by enzyme immunoassay (EIA)
Contraindications: A rectal swab culture is not as effective as a stool culture for detection of the carrier state.
Additional Information: In enteric fever caused by Salmonella typhi, S. choleraesuis, or S. enteritidis, blood culture may be positive before stool cultures, and blood cultures are indicated early; urine cultures may also be helpful.

Diarrhea is common in patients with the acquired immunodeficiency syndrome (AIDS). It is frequently caused by the classic bacterial pathogens as well as unusual opportunistic bacterial pathogens and parasitic infestation. (Giardia, Cryptosporidium, and Entamoeba histolytica frequently reported.) Cryptosporidium, Isospora, and Pneumocystis can occur with AIDS. Rectal swabs are useful for the diagnosis of Neisseria gonorrhoeae and Chlamydia infections. AIDS patients are also subject to cytomegalovirus, Salmonella, Campylobacter, Shigella, C. difficile, herpes, and Treponema pallidum gastrointestinal tract involvement.

Diarrhea Syndromes Classified by Predominant Features

Syndrome (anatomic site)	Features	Characteristic Etiologies
Gastroenteritis (stomach)	Vomiting	Rotavirus
Norwalk virus
Staphylococcal food poisoning
Bacillus cereus food poisoning
Enteritis (small bowel)	Watery diarrhea Large-volume stools, few in number	Enterotoxigenic Escherichia coli
Vibrio cholerae
Any enteric microbe
Inflammatory bowel disease
Dysentery, colitis (colon)	Small-volume stools containing blood and/or mucus and many leukocytes	Shigella
Campylobacter
Salmonella
Invasive E. coli
Plesiomonas shigelloides
Aeromonas hydrophila
Vibrio parahaemolyticus
Clostridium difficile
Entamoeba histolytica
Inflammatory bowel disease

In acute or subacute diarrhea, three common syndromes are recognized: gastroenteritis, enteritis, and colitis (dysenteric syndrome). With colitis, patients have fecal urgency and tenesmus. Stools are frequently small in volume and contain blood, mucus, and leukocytes. External hemorrhoids are common and painful. Diarrhea of small bowel origin is indicated by the passage of few large volume stools. This is due to accumulation of fluid in the large bowel before passage. Leukocytes indicate colonic inflammation rather than a specific pathogen. Bacterial diarrhea may be present in the absence of fecal leukocytes and fecal leukocytes may be present in the absence of bacterial or parasitic agents (ie, idiopathic inflammatory bowel disease).² See table. Although most bacterial diarrhea is transient (1-30 days) cases of persistent symptoms (10 months) have been reported. The etiologic agent in the reported case was Shigella flexneri diagnosed by culture of rectal swab.³ In infants younger than 1 year of age, a history of blood in the stool, more than 10 stools in 24 hours, and temperature greater than 39°C have a high probability of having bacterial diarrhea.^4,5 Diarrhea is also a common side effect of long term antibiotic treatment. Although often associated with Clostridium difficile, other bacteria and yeasts have been implicated.⁶

Footnotes:

Bishop WP and Ulshen MH, “Bacterial Gastroenteritis,” Pediatr Clin North Am, 1988, 35(1):69-87 (review).
DuPont HL, “Subacute Diarrhea to Treat or to Wait?” Hosp Pract, 1989, 24(3A):111-8.
Clements D, Ellis CJ, and Allan RN, “Persistent Shigellosis,” Gut, 1988, 29(9):1277-8.
Finkelstein JA, Schwartz JS, Torrey S, et al, “Common Clinical Features as Predictors of Bacterial Diarrhea in Infants,” Am J Emerg Med, 1989, 7(5):469-73.
Cohen MB, “Etiology and Mechanisms of Acute Infectious Diarrhea in Infants in the United States,” J Pediatr, 1991, 118(4 Pt 2):S34-9.
Bartlett JG, “Antibiotic-Associated Diarrhea,” Clin Infect Dis, 1992, 15(4):573-81

References:

DeWitt TG, “Acute Diarrhea in Children,” Pediatr Rev, 1989, 11(1):6-12.

Farmer RG, “Infectious Causes of Diarrhea in the Differential Diagnosis of Inflammatory Bowel Disease,” Med Clin North Am, 1990, 74(1):29-38.

Gavin PJ and Thomson RJ, “Diagnosis of Enterohemorrhagic Escherichia coli Infection by Detection of Shiga Toxins,” Clin Microbiol Newslet, 2004, 26:49-54.

Guerrant RL, “Nausea, Vomiting, and Noninflammatory Diarrhea,” Principles and Practice of Infectious Diseases, 3rd ed, Chapter 82, Mandell GL, Douglas RG Jr, and Bennett JE, eds, New York, NY: Churchill Livingstone, 1990, 851-63.

Guerrant RL, Hughes JM, Lima NL, et al, “Diarrhea in Developed and Developing Countries: Magnitude, Special Settings, and Etiologies,” Rev Infect Dis, 1990, 12(Suppl 1):541-50.

Pickering LK, “Therapy for Acute Infectious Diarrhea in Children,” J Pediatr, 1991, 118(4 Pt 2):S118-28.

Test 1233

SuperUser Account — Tue, 16 Sep 2008 22:12:37 GMT

Test: Susceptibility Testing, Aerobic and Facultatively Anaerobic Organisms
Number: 008680
CPT: 87184
Synonyms: Sensitivity Testing
Test Includes: Qualitative determination of an isolated organism antimicrobial susceptibility. Identification is required to perform or provide an accurate interpretation for susceptibility testing, it will be done at an additional charge if not provided by the client.
Specimen: Pure isolate of aerobic or facultatively anaerobic rapidly growing organism. Testing of multiple isolates will result in additional fee(s).
Container: Chocolate or blood agar slant in screw-cap container packaged as an etiologic agent
Storage Instructions: Maintain specimen at room temperature.
Causes for Rejection: Organism does not grow well on test media; isolated organism not provided; inadequate labeling. CLSI interpretive standards do not exist.
Use: Determine antimicrobial susceptibility of organisms involved in infectious processes when the susceptibility of the organism cannot be predicted from its identity. The pattern of antibiotic susceptibility is sometimes used to monitor nosocomial infections such as methicillin-resistant Staphylococcus aureus and to evaluate or follow the development of resistance to new antimicrobial drugs.^1,2
Limitations: Interpretive criteria do not exist for all bacteria. Susceptible, intermediate, and resistant categories are based on levels of antibiotics achieved in the serum of people with normal kidney and liver function. Drugs concentrated in urine may be effective for urinary tract infection even when the categorical interpretation is resistant. Conversely, drugs that do not penetrate well to a poorly vascularized area may not be effective even though the interpretation is susceptible.
Methodology: Manual or Automated MIC methodology
Additional Information:

Susceptible: This category implies that an infection due to the strain may be appropriately treated with the dosage of antimicrobial agent recommended for that type of infection and infecting species, unless otherwise contraindicated.

Intermediate: This category provides a “buffer zone,” which should prevent small, uncontrolled, technical factors from causing major discrepancies in interpretations (eg, species that should have few or no endpoints in this range, or drugs with in vitro results affected by media variation or drugs with narrow pharmacotoxicity margins).

Resistant: Strains falling in this category are not inhibited by the usually achievable systemic concentrations of the agent with normal dosage schedules and/or fall in the range where specific microbial resistance mechanisms are likely (eg, beta-lactamases), and clinical efficacy has not been reliable in treatment studies.

Major Mechanisms of Bacterial Antimicrobial Resistance

Enzymatic inactivation or modification of drug:

β-lactamase hydrolysis of βlactam ring with subsequent inactivation of β-lactam antibiotics
Modification of aminoglycosides by acetylating, adenylating, or phosphorylating enzymes
Modification of chloramphenicol by chloramphenicol acetyltransferase

Decreased drug uptake or accumulation

Intrinsic or acquired lack of outer membrane permeability
Faulty or lacking antibiotic uptake and transport system
Antibiotic efflux system (eg, tetracycline resistance)

Altered or lacking antimicrobial target

Altered penicillin-binding proteins (β-lactam resistance)
Altered ribosomal target (eg, aminoglycoside, macrolide, and lincomycin resistance)
Altered enzymatic target (eg, sulfonamide, trimethoprim, rifampin, and quinolone resistance)

Circumvention of drug action consequences

Hyperproduction of drug targets or competitive substrates (eg, sulfonamide and trimethoprim resistance)

Uncoupling of antibiotic attack and cell death

Bacterial tolerance and survival in the presence of usually bactericidal drugs (eg, β-lactams and vancomycin)

Footnotes:

Grayson ML and Eliopoulos GM, “Antimicrobial Resistance in the Intensive Care Unit,” Semin Respir Infect, 1990, 5(3):204-14.
Parry MF, “Epidemiology and Mechanisms of Antimicrobial Resistance,” Am J Infect Control, 1989, 17(5):286-94

References:

Gill VJ, Witebsky FG, and MacLowry JD, ?Multicategory Interpretive Reporting of Susceptibility Testing With Selected Antimicrobial Concentrations. Ten Years of Laboratory and Clinical Experience,? Clin Lab Med, 1989, 9(2):221-38.

Hindler JA and Thrupp LD, ?Interpretive Guidelines for Antimicrobial Susceptibility Test Results: What Do They Mean?? Clin Microbiol Newslet, 1989, 17:129-36.

´´Performance Standards for Antimicrobial Susceptibility Testing; Seventeenth Informational Supplement´´ CLSI Document M100-S17, Clinical and Laboratory Standards Institute, Villanova, PA, 2007.

Rosenblatt JE, ?Laboratory Tests Used to Guide Antimicrobial Therapy,? Mayo Clin Proc, 1991, 66(9):942-8.

Sherris JC, ?Antimicrobic Susceptibility Testing. A Personal Perspective,? Clin Lab Med, 1989, 9(2):191-202.

Silver LL and Bostian KA, ?Discovery and Development of New Antibiotics: The Problem of Antibiotic Resistance,? Antimicrob Agents Chemother, 1993, 37(3):377- 83.

Test 1266

SuperUser Account — Tue, 16 Sep 2008 22:14:11 GMT

Test: Sputum Cytology Series
Number: 009076
CPT: 88108
Synonyms: Cytology, Sputum
Special Instructions: Include patient´s name, date of birth, sex, Social Security number, previous malignancy, drug therapy, radiation therapy, exposure to carcinogen, and all other pertinent clinical information on the request form. For induced sputa, contact Inhalation Therapy. Include admitting diagnosis and pertinent clinical history (ie, age, clinical diagnosis, exposure to carcinogen) on the request form.
Specimen: Expectorated sputum, not saliva or nasal aspirates
Volume: 30 mL
Minimum Volume: 3-5 mL
Container: Plastic sputum container with Saccomanno fixative added
Collection: Patient should perform oral hygiene and collect first morning sputum directly into Saccomanno or 50% ethyl alcohol fixative in container for three consecutive mornings. (Note: Specimens prepared with fixatives that contain 50% ethyl alcohol, eg, Saccomanno fixative, are not acceptable for microbiology testing.) Close container and shake vigorously after collection.
Storage Instructions: Maintain specimen at room temperature.
Patient Preparation: Instruct the patient to thoroughly cleanse mouth before collection.
Causes for Rejection: Improper labeling; specimen without fixative, saliva, or nasal aspirates
Use: Establish the presence of primary or metastatic neoplasms; aid in the diagnosis of respiratory infections with herpesvirus, Cryptococcus, Coccidioides, Histoplasma, Blastomyces, Phycomycetes, Strongyloides, Echinococcus, Paragonimus, and asbestosis.
Limitations: If pulmonary macrophages are not identified, specimen will be reported as unsatisfactory for adequate evaluation.
Methodology: Direct smears or slides prepared using the Saccomanno method. Pap stained: microscopic examination is performed.

Test 1304

SuperUser Account — Tue, 16 Sep 2008 22:15:51 GMT

Test: Semen Analysis, Postvasectomy
Number: 009233
CPT: 89321
Synonyms: Postvas
Test Includes: Presence and motility of sperm are assessed. Ejaculate volume and pH are also reported.
Specimen: Ejaculate
Volume: Entire ejaculate
Minimum Volume: The laboratory will attempt to analyze any volume of specimen submitted.
Container: Clean container
Collection: Optimally, the specimen should be delivered to the laboratory within 1 hour of collection in order to determine whether any sperm present are motile. The presence of sperm in the ejaculate, however, can be determined for 3 days. For additional information, see Patient Instructions for Semen Collection.
Storage Instructions: Maintain specimen at room temperature. It is recommended that specimen containers be kept close to the body (inside a shirt or coat) to avoid temperature extremes during transport.
Patient Preparation: It is recommended that the patient observe between 2 and 7 days of sexual abstinence before producing the specimen.
Reference Interval: There should be no sperm in the ejaculate.
Use: Determine the success of the vasectomy procedure
Methodology: Macroscopic and microscopic examination of semen
Additional Information: Ejaculates are centrifuged to improve the detection and motility of sperm. In addition, specimen pH and volume are reported. When the vas deferens is severed, the pH should <7.0, and the ejaculate volume is generally less than prevasectomy.
References:

World Health Organization, WHO Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction, 4th ed, Cambridge, England: Cambridge University Press, 1999.

Test 1419

SuperUser Account — Tue, 16 Sep 2008 22:21:36 GMT

Test: Sjögren Antibodies (Anti-SS-A/Anti-SS-B)
Number: 012708
CPT: 86235 (x2)
Synonyms: Anti-La ; Anti-Ro
Test Includes: Semiquantitative result of IgG class antibodies
Specimen: Serum
Volume: 1 mL
Minimum Volume: 0.5 mL (Note: This volume does not allow for repeat testing.)
Container: Red-top tube or gel-barrier tube
Storage Instructions: Maintain specimen at room temperature.
Causes for Rejection: Hemolysis; icterus; lipemia; bacterial contamination
Reference Interval:

Negative: 0-99 units/mL
Equivocal: 100-120 units/mL
Positive: >120 units/mL

Use: Aids in the diagnosis of Sjögren syndrome (especially with vasculitis) and lupus patients with Sjögren overlap syndrome.
Methodology: Multiplex bead flow cytometry
Additional Information: SS-A(Ro) is found in 60% to 70% of patients with Sjögren syndrome and 30% to 40% of patients with SLE. SS-B(La) is found in 50% to 60% of Sjögren syndrome and 10% to 15% of SLE. SS-A cannot be demonstrated by immunofluorescence (it is soluble in the buffers used) but SS-B may be seen as a speckled antinuclear pattern. SS-A and SS-B are particularly useful in “ANA negative” cases of SLE, being present in a majority of such cases. Patients who are ANA positive and who have SS-A but not SS-B are very likely to have nephritis. Antibodies to SS-A are also associated with HLA loci DR3 and DR2 and with hereditary deficiency of C2. Anti-SS-A and anti-SS-B are found in virtually all children with neonatal lupus. Patients with SS-A may also have antibodies to cardiolipin, lupus anticoagulant, and clinical thromboses. This has been termed antiphospholipid antibody syndrome.

Test 1517

SuperUser Account — Tue, 16 Sep 2008 22:26:33 GMT

Test: Serum Integrated 1
Number: 017200
CPT: 84163
Synonyms: PAPP-A; Down Syndrome; Serum
Special Instructions: Test inquiries call CMBP Genetic Services at 800-345-GENE. The following information must be provided: gestational age, date on which the patient was the stated gestational age, how gestational age was determined (LMP, EDD, US), patient´s race, patient´s weight, patient´s date of birth, patient´s insulin dependent diabetic status and the number of fetuses. Also indicate patient history (ie prior Down syndrome pregnancy, ultrasound anomalies). Complete information is necessary to interpret the test. Patient information may be provided to the laboratory using the Maternal Prenatal Screening requisition 0900. Testing provided from 10.0 to 13.9 weeks gestation.
Specimen: Serum
Volume: 3 mL
Minimum Volume: 1 mL
Container: Gel-barrier tube, no thrombin additive
Collection: Avoid hemolysis; send complete specimen in the original tube. Do not pour off.
Storage Instructions: Refrigerate
Causes for Rejection: Gross hemolysis; gross lipemia; quantity not sufficient for analysis; improper specimen type
Use: Screening test for open neural tube defects, Down Syndrome, and Trisomy 18.
Limitations: Serum Integrated screening requires two specimens: one collected in the first trimester and one in the second trimester. This test number is for the first trimester portion of the test. Result interpretation will be provided only when the second trimester specimen is received and tested. This is a screening test. A positive result means that diagnostic testing may be offered to the pregnant woman to determine if a neural tube defect or chromosome abnormality is present.
Methodology: Enzyme Immunoassay (EIA)
References: Wald NJ, Watt HC, Hackshaw AK. Integrated Screening for Down´s Syndrome Based on Tests Performed During the First and Second Trimesters. New Eng. J. Med, 1999; 341(7): 461-467.

Test 1519

SuperUser Account — Tue, 16 Sep 2008 22:26:39 GMT

Test: Serum Integrated 2
Number: 017270
CPT: 82105 ; 82677 ; 84702 ; 86336
Synonyms: AFP ; Maternal ; Down Syndrome ; Serum
Special Instructions: Test inquiries call CMBP Genetic Services at 800-345-GENE. Patient must have submitted a previous specimen in the first trimester for the Serum Integrated 1 test. Gestational age will be based on information provided with the first trimester specimen. Patient information may be provided to the laboratory using the Maternal Prenatal Screening requisition 0900. Testing provided from 15.0 to 21.9 weeks gestation.
Specimen: Serum
Volume: 5 mL
Minimum Volume: 3 mL
Container: Gel-barrier tube, no thrombin additive
Collection: Avoid hemolysis; send complete specimen in the original tube. Do not pour off.
Storage Instructions: Refrigerate
Causes for Rejection: Gross hemolysis; gross lipemia; quantity not sufficient for analysis; improper specimen type
Use: Screening test for open neural tube defects, Down Syndrome, and Trisomy 18.
Limitations: Serum Integrated screening requires two specimens: one collected in the first trimester and one in the second trimester. This test number is for the second trimester portion of the test. This is a screening test. A positive result means that diagnostic testing may be offered to the pregnant woman to determine if a neural tube defect or chromosome abnormality is present.
Methodology: AFP, uE3, and hCG by chemiluminescent immunoassay; DIA by enzyme immunoassay (EIA)
References: ?????Wald NJ, Watt HC, Hackshaw AK. Integrated Screening for Down´s Syndrome Based on Tests Performed During the First and Second Trimesters. New Eng. J. Med, 1999; 341(7): 461-467.

Test 1536

SuperUser Account — Tue, 16 Sep 2008 22:27:36 GMT

Test: Sequential 1
Number: 017700
CPT: 84702 ; 84163
Synonyms: PAPP-A ; Down Syndrome ; Nuchal Translucency (NT)
Special Instructions: Test inquiries call CMBP Genetic Services at 800-345-GENE. Client must provide fetal nuchal translucency (NT) measurement and crown rump length measurement. The NT measurement must be performed by a sonographer credentialed by the Fetal Medicine Foundation or other equivalent entity. The sonographer´s credential/certification number must be provided. The following information also must be provided: patient´s race, patient´s weight, patient´s date of birth, patient´s insulin dependent diabetic status and the number of fetuses. Also indicate patient history (ie prior Down Syndrome pregnancy, ultrasound anomalies). Complete information is necessary to interpret the test. Patient information may be provided to the laboratory using the Maternal Prenatal Screening requisition 0900. Testing provided from 10.0 to 13.9 weeks gestation.
Specimen: Serum
Volume: 3 mL
Minimum Volume: 1 mL
Container: Gel-barrier tube, no thrombin additive
Collection: Avoid hemolysis; send complete specimen in the original tube. Do not pour off.
Storage Instructions: Refrigerate
Causes for Rejection: Gross hemolysis; gross lipemia; quantity not sufficient for analysis; improper specimen type
Use: Screening test for open neural tube defects, Down Syndrome, and Trisomy 18.
Limitations: Sequential screening requires two specimens: one collected in the first trimester and one in the second trimester. This test number is for the first trimester portion of the test. Result interpretation for the first trimester portion will be provided only for screen positive specimens. Result interpretation for all others will be provided only when the second trimester specimen is received and tested. This is a screening test. A positive result means that diagnostic testing may be offered to the pregnant woman to determine if a neural tube defect or chromosome abnormality is present.
Methodology: hCG by chemiluminescent immunoassay; PAPP-A by enzyme immunoassay
References: ?????Wald NJ, Rednicka AR, Bestwick JP. Sequential and contingent prenatal screening for Down syndrome. Prenat Diagn, 2006; 26:769-777.

Test 1540

SuperUser Account — Tue, 16 Sep 2008 22:27:50 GMT

Test: Sequential 2
Number: 017750
CPT: 82105 ; 84702 ; 82677 ; 86336
Synonyms: AFP ; Maternal ; Down Syndrome
Special Instructions: Test inquiries call CMBP Genetic Services at 800-345-GENE. Patient must have submitted a previous specimen in the first trimester for the Sequential 1 test. Gestational age will be based on crown rump length provided with the first trimester specimen. Patient information may be provided to the laboratory using the Maternal Prenatal Screening requisition 0900. Testing provided from 15.0 to 21.9 weeks gestation.
Specimen: Serum
Volume: 5 mL
Minimum Volume: 3 mL
Container: Gel-barrier tube, no thrombin additive
Collection: Avoid hemolysis; send complete specimen in the original tube. Do not pour off.
Storage Instructions: Refrigerate
Causes for Rejection: Gross hemolysis; gross lipemia; quantity not sufficient for analysis; improper specimen type
Use: Screening test for open neural tube defects, Down Syndrome, and Trisomy 18.
Limitations: Sequential screening requires two specimens: one collected in the first trimester and one in the second trimester. This test number is for the second trimester portion of the test. This is a screening test. A positive result means that diagnostic testing may be offered to the pregnant woman to determine if a neural tube defect or chromosome abnormality is present.
Methodology: AFP, uE3, and hCG by chemiluminescent immunoassay; DIA by enzyme immunoassay (EIA)
References: ?????Wald NJ, Rudnicka AR, Bestwick JP. Sequential and contingent prenatal screening for Down syndrome. Prenat Diagn, 2006; 26: 769-777.

Test 1553

SuperUser Account — Tue, 16 Sep 2008 22:28:33 GMT

Test: Streptococcus pneumoniae Antigen
Number: 018788
CPT: 87899
Synonyms: S. pneumoniae Antigen
Test Includes: Qualitative result
Special Instructions: Submit only one specimen per request form. State source.
Specimen: Serum, cerebrospinal fluid, urine (random)
Volume: 1 mL serum, 0.5 mL CSF, or 5 mL urine
Container: Red-top tube or plastic transport (CSF) tube or plastic urine container
Storage Instructions: Refrigerate
Reference Interval: Negative
Use: Aid in the diagnosis of Streptococcus pneumoniae infection
Methodology: Latex agglutination (LA)

Test 1706

SuperUser Account — Tue, 16 Sep 2008 22:35:48 GMT

Test: Scleroderma Diagnostic Profile
Number: 052373
CPT: 86038; 86235
Synonyms: Autoimmune Profile II, Scleroderma
Test Includes: Antinuclear antibody (ANA); antiscleroderma-70
Specimen: Serum
Volume: 2 mL
Minimum Volume: 1 mL
Container: Red-top tube or gel-barrier tube
Storage Instructions: Maintain specimen at room temperature.
Reference Interval: See individual tests.
Methodology: See individual tests.

Test 1712

SuperUser Account — Tue, 16 Sep 2008 22:36:04 GMT

Test: Systemic Lupus Erythematosus (SLE) Profile A
Number: 056499
CPT: 86225; 86235 (x5); 86431
Synonyms: SLE ; SLE Profile A
Test Includes: Anti-DNA (double-stranded) antibodies; antihistone antibodies; anti-RNP antibodies; anti-Smith antibodies; anti-SS-A antibodies; anti-SS-B antibodies; rheumatoid factor
Specimen: Serum
Volume: 4 mL
Minimum Volume: 2 mL
Container: Red-top tube or gel-barrier tube
Storage Instructions: Maintain specimen at room temperature.
Reference Interval: See individual tests.
Methodology: See individual tests.

Test 1739

SuperUser Account — Tue, 16 Sep 2008 22:37:24 GMT

Test: Stachybotrys chartarum
Number: 060017
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: Red-stopper tube or gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 1742

SuperUser Account — Tue, 16 Sep 2008 22:37:31 GMT

Test: Suxamethonium C
Number: 060023
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: 10 mL red-top tube or 10 mL gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 1746

SuperUser Account — Tue, 16 Sep 2008 22:37:41 GMT

Test: Sulfamethoxazol
Number: 060031
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: 10 mL red-top tube or 10 mL gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 1760

SuperUser Account — Tue, 16 Sep 2008 22:38:15 GMT

Test: Safflower Seed
Number: 060056
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: 10 mL red-top tube or 10 mL gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 1762

SuperUser Account — Tue, 16 Sep 2008 22:38:20 GMT

Test: Sardine
Number: 060060
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: 10 mL red-top tube or 10 mL gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 1771

SuperUser Account — Tue, 16 Sep 2008 22:38:42 GMT

Test: Sheep Wool (Treated)
Number: 060077
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: 10 mL red-top tube or 10 mL gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 1778

SuperUser Account — Tue, 16 Sep 2008 22:39:00 GMT

Test: Serpula lacrymans
Number: 060089
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: 10 mL red-top tube or 10 mL gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 1821

SuperUser Account — Tue, 16 Sep 2008 22:41:15 GMT

Test: Sage
Number: 060509
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: Red-stopper tube or gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test