Attached Docs:Comprehensive Thrombosis Panel Reconfigured (3/06)
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25911:COAGULATION STUDY, THROMBOSIS EVALUATION, VENOUS
Alias Names:Thrombosis Eval, Comprehensive
Methodology:Polymerase Chain Reaction (PCR) / Enzyme-Linked Immunosorbent Assay (ELISA) / Mechanical Clot Detection
Edit Date:11/16/2009
Components:Activated Protein C Assay / Antithrombin (ATIII) / Anticardiolipin Antibodies (IgG and IgM) / Beta-2 Glycoprotein Antibodies, IgG & IgM / Lupus Anticoagulant / Protein C Activity / Protein S Activity / Prothrombin Gene Mutation.
Performed:Varies
Released:Next day
CPT Code:83891-3G / 83896-3G x2 / 83898-3G / 83903-3G / 83912-3G / 85300 / 85303 / 85306 / 85307 / 85613 / 85730 / 86146 x2 / 86147 x2
Specimen Collection Details
Collection:Total of six tubes collected: Four 4.5 mL light blue top tubes (sodium citrate) AND one 4 mL lavender top tube (EDTA) AND one 5 mL red top tube or 7.5 mL serum separator tube (SST). Collect by careful venipuncture to avoid tissue fluid contamination or hemolysis. Do not use needles smaller than 23 gauge. Fill blue tubes to maximum draw, at least 90% full. Mix by gentle inversion. Call the Special Coagulation Department (541-687-2134 x4612) when urgent testing is needed in order to assure STAT testing.
Handling:Due to short stability, specimens must either be sent STAT to arrive at the laboratory within 4 hours, or sent frozen. For STAT, refrigerate whole blood in unopened tubes and call for STAT pick-up. For standard delivery, centrifuge blue tubes to produce platelet-poor plasma (at least 1700 X g for 15 minutes to produce PLT CT less than 10,000 per cumm) and using a plastic pipette, transfer the top 2/3 of the plasma into 3-4 plastic vials. Label each tube of citrated plasma with patient name, I.D. number, test, and “citrated plasma.” Freeze immediately. Centrifuge the red top tube and transfer serum into two tubes, each labeled with patient name, test, and “serum.” The EDTA tube must be submitted as unopened refrigerated whole blood. Send to the laboraotry within 7 days. If multiple tests are ordered, freeze a separate aliquot for this test.
Stability:Original tubes: 4 hours refrigerated; citrated plasma: 7 days frozen; whole blood: 7 days refrigerated.
Standard Volume:Four 4.5 mL light blue top tubes (or 4 mL plasma) AND one 4 mL lavender top tube (whole blood), AND one 5 mL red top tube (or 1 mL serum).
Minimum Volume:Two 2.7 mL light blue top tubes (or 2 mL plasma) AND one 4 mL lavender top tube (whole blood) AND one 5 mL red top (or 1 mL serum).
Transport:Original tubes refrigerated if sent STAT; citrated plasma frozen on dry ice; whole blood and serum refrigerated.
Rejection Criteria:Frozen whole blood; visible fibrin; marked hemolysis; specimen received in laboratory beyond the stated stability.

MEDICARE MAY REQUIRE A SIGNED ADVANCE BENEFICIARY NOTICE (ABN) FOR THIS TEST