Last Modified:
3/27/2019 2:40:31 PM
Medical Necessity Documentation:
Client Notes:
Patient Preparation:
Overnight Fasting required
Specimen Requirements:
2.0 mL Plasma from a Lavender Top Tube - EDTA in a Plastic Vial
Collection Instructions:
Centrifuge and separate from cells immediately
Minimum Volume:
1.1 mL Plasma
Transport & Storage: Temperature/Stability:
28 days Frozen
Rejection Criteria:
Ambient or Refrigerated Specimen; Gross hemolysis or icterus
Reference Range:
Cord Blood: 215 pg/mL or less
Day 1: 240 pg/mL or less
Day 2: 400 pg/mL or less
Day 3: 420 pg/mL or less
Day 4 - 3 years: Not Established
4 years - 14 years: <or= 148 pg/mL
Male and Female: 60 pg/mL or less
Critical Ranges:
Test Comments:
Methodology:
Extraction Radioimmunoassay
Clinical Significance:
Documentation:
Custom Panel:
No
PRODUCTION SCHEDULE
Turn Around Time:
7 to 12 days
Days Performed:
Tuesday, Friday
Sites Performed:
Quest - Chantilly
PHL Test Code:
GLUCO
EPIC Test Code:
LAB1005
Send Out Test Code:
519
Included Tests:
CPT Coding:
82943
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