Last Modified:
6/21/2023 6:17:22 AM
Medical Necessity Documentation:
Client Notes:
Patient Preparation:
Specimen Requirements:
0.6 mL Serum from a SST Gold Top Tube
and
15.0 mL Whole Blood in 4 Lavender Top Tube(s) - EDTA
Collection Instructions:
1. Include recent transfusion information.
2. Include most recent CBC results
3. Include ferritin results
Do not aliquot send in original tubes
Serum Centrifuged within 2 hours of collection. Label tube as Serum
Complete and send with specimen Metabolic Hematology Patient Information & Informed Consent
Minimum Volume:
0.5 mL Serum & 2.5 Whole Blood
Transport & Storage: Temperature/Stability:
7 days Refrigerated
Rejection Criteria:
Gross Hemolysis
Reference Range:
Definitive results and an interpretive report will be provided.
Critical Ranges:
Test Comments:
Methodology:
Multiple
Clinical Significance:
Evaluation of microcytosis
Extensive and economical diagnosis and classification of hemoglobinopathies or thalassemia including complex disorders
Diagnosis of hereditary persistence of hemoglobin
Documentation:
Custom Panel:
No
PRODUCTION SCHEDULE
Turn Around Time:
2 days up to 25
Days Performed:
Monday, Tuesday, Wednesday, Thursday
Sites Performed:
Mayo Laboratory
PHL Test Code:
THEV1
EPIC Test Code:
LAB3303
Send Out Test Code:
THEV1
Alternate Test Names:
Thalassemia and Hemoglobinopathy Evaluation, Blood
Included Tests:
Ferritin; 26-Hemoglobinopathy Interpretation; Hb Variant, A2 and F Quantitation; HPLC Hb Variant
CPT Coding:
83020 x2, 83021,82728 (82664, 83068, 83789, 88184)
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