Medical Necessity Documentation:
Client Notes:
Patient Preparation:
Specimen Requirements:
6.0 mL Whole Blood in a Pink Top Tube - EDTA
Collection Instructions:
Must be drawn within 24 hours after delivery or miscarriage
Specimen should be labeled with the patient's name, date and time of collection, [date of birth and/or social security number] and the phlebotomist's (collector's) initials
Minimum Volume:
0.5 mL Plasma & 0.5 mL RBC
Transport & Storage: Temperature/Stability:
24 hours Ambient
72 hours Refrigerated
This Blood Bank test should be performed within 72 hours. If longer than 72 hours patient should be redrawn.
Rejection Criteria:
Serum Separator Tube (SST or PST)
Reference Range:
ABO & RH: Not Applicable
Antibody Screen: Negative
Fetal Screen: Negative
Critical Ranges:
Test Comments:
Antibody Screen: This test reflexes an Antibody Identification if a positive result is reported
Fetal Screen: If positive, a Fetal Hemoglobin for Fetal Maternal hemorrhage test will automatically be performed and charged. Kleihauer-Betke Report: Percentage of fetal cells in maternal circulation [Acid Stain]
Methodology:
Hemagglutination, SPRCA
Clinical Significance:
Documentation:
Custom Panel:
No
PRODUCTION SCHEDULE
Stat Eligible:
Yes
Days Performed:
Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday
Sites Performed:
Parkview Dekalb Hospital, Parkview Huntington Hospital, Parkview LaGrange Hospital, Parkview Noble Hospital, Parkview Randallia Hospital, Parkview Regional Medical Center, Parkview Whitley Hospital
PHL Test Code:
RGSC2
EPIC Test Code:
LAB2767
Alternate Test Names:
RHIG SCREEN (RhoGAM Screen); Rhogam Screen
Included Tests:
ABO; Antibody Screen; Fetal Screen; RH
CPT Coding:
85461 (Reflex 85460), 86850 (Reflex - 86870), 86900, 86901