Shore Health Laboratories Test Directory 2017

SHORE HEALTH LABORATORIES

TEST DIRECTORY

2017

Client Services (410) 8209355 (800) 6663222

Shore Health Laboratories Queen Anne Emergency Center Lab 219 S. Washington Street 115 Shoreway Drive Easton, MD 21601 Queenstown, MD 21658 410-822-1000 410-827-3900

Dorchester General Hospital 300 Byrn Street Cambridge, MD 21613 410-228-5511 OVERVIEW

Greetings from Easton! Here at Shore Health Laboratories, our technologists, office staff, administrators, and pathologists are proud to have developed a local laboratory that provides clinical services to hundreds of Delmarva's doctors and nurse practioners, and to many insurance plans. But we're not resting on our laurels. We know that our laboratory has to offer you the highest quality results at the lowest cost to compete effectively with the national laboratories that have been moving onto the Eastern Shore. And we want to continue to offer you that special quality of service and sense of confidence that only a neighbor can provide. I know that any of our highly trained and motivated staff would be glad to assist you in any way they can. But I hope that you will also feel free to call on me personally, with any question or problem you may have. It's no more than any neighbor should do.

Sincerely,

David B. Danner, M.D., Ph.D., F.C.A.P Medical Director 410-924-2423 [email protected]

CONTENTS

PERSONNEL ______4 POLICIES ______5 SPECIMEN PACKAGING AND COURIER SERVICES ______8 SPECIMEN COLLECTION AND PREPARATION ______9 INSTRUCTIONS FOR COMPLETION OF ROUTINE REQUEST FORM ______17 INSTRUCTIONS FOR COMPLETION OF CONSENT FORMS ______19 REQUESTS / REPORTING ______22 Outpatient Instructions for Scotch-Tape Preparation for Pinworms ______23 Outpatient Instructions for Semen Collection ______24 Semen Analysis Questionnaire ______25 Outpatient Instructions for Collection of Sputum ______26 SUPPLIES ______27 CRITICAL VALUES ______29 Test Panels ______31 Alphabetical Test Listing ______35 SPECIAL INSTRUCTIONS ______240 Allergens ______240 Amino Acid Disorders ______243 Catecholamine Fractionation ______244 Coagulation Studies ______245 Biopsy Collection and Transport ______246 Hepatitis Clinical Interpretation Guide ______248 Human Immunodeficiency Virus Clinical Interpretive Guide ______249 IgG Subclasses Reference Values ______250 Lipids and Lipoproteins in Blood Plasma (Serum) ______251 Cholesterol and Triglyceride Values in Serum Lipoprotein Fractions* ______254 Metals Analysis — Collection and Transport ______259 Microbiology Specimen Guide for Viral and Mycoplasma Specimens* ______260 Parathyroid Hormone Assays ______261 Pediatric Literature References ______263 Porphyrinogens. Porphyrins, and Porphyrias ______264 Renin Aldosterone Studies ______267 Stool Collections ______269

2 DXylose ______270 PSA (PROSTATE SPEC AG), SCREEN NORMAL RANGE ______271 INDEX ______272 APPENDIX ______273

PERSONNEL Consultants, Medical

David B. Danner, M.D., Ph.D. Reinhardt Sahmel, M.D., Ph.D. Medical Director Associate Pathologist

Our consultants are available to Shore Health Laboratories’ clients by calling 410-820-9355 or 800-666-3222 For Pathology call (410) 820-0019

Administration Technical Specialists Gary Shortall, BS, MT (ASCP), SM Karen Bitter, BS, MT (ASCP) Acting Administrative Director Chemistry/Hematology

Gary Shortall, BS, MT (ASCP), SM Helen McQuay, BS, MT (ASCP), SM Laboratory Manager, MHE Microbiology/Immunology

Kathy Davidson, BS, MT (ASCP) Patricia Schwaninger , MT (HEW) Client Service Specialist Blood Bank

Lisa Lyons, BS, MT (ASCP) Bonnie Niebuhr, CT (ASCP) Clinical Specialist Anatomic Pathology Quality Assurance and point of care

POLICIES

Animal Specimens We do not accept animal specimens for laboratory testing except by special arrangement.

Billing Patient — If you elect to have Shore Health Laboratories bill your patients, please include the following necessary billing information: patient birth date, sex, social security number, responsible party, complete address (including zip code), and home phone number. Providing this information will avoid additional correspondence to your office at some later date. Insurance/Third Party — We provide direct third-party billing to the carriers listed below on our “BILLING INFORMATION — QUICK REFERENCE GUIDE.” Fill in the appropriate insurance information on the requisition required by that third-party payor on the list. A copy of the insurance card attached to the lab requisition form can also be provided. The patient’s birth date, sex, social security number, address, and diagnosis are required in addition to the insurance information.

BILLING INFORMATION — QUICK REFERENCE GUIDE

AETNA: The employer’s name, subscriber’s name and social security number, group number and diagnosis are essential.

BLUE CROSS/BLUE SHIELD: The diagnosis and subscriber number and group number are essential. The subscriber name is needed if other than the patient. If carrier is Blue Cross from out of state, specify which state. If Federal Blue Cross, give the FEP number. Provide “Plan Code,” if applicable. Subscriber number anything other than Federal must have 3-letter prefix.

COMMERCIAL: The name of the insurance company, subscriber’s name, social security number, group number, and relationship to patient are essential. Please include the subscriber’s employer’s name and address. If applicable, the name of the union, local or teamster should be provided. Address for insurance company is mandatory.

MEDICAL ASSISTANCE: The membership number (eleven digits) and diagnosis are required. Please verify the validity of the number by checking the EVS 800-492-2134.

MEDICARE: The membership number is essential and should include a suffix (A, M, D, Cl, T). A UPIN will identify each physician when we bill Medicare. If the patient has secondary insurance, please provide the insurance name and policy number. A Medicare secondary payor form should accompany the requisition.

MA/MCO PRIORITY PARTNERS-patient is insured with own policy number.

Cancellation of Tests Cancellations received prior to test setup will be honored at no charge. Requests received following test setup cannot be honored. A report will be issued automatically and charged appropriately.

Specimen Labeling ALL specimens must be labeled with patient's FULL NAME and the lab requisition number. Nicknames are NOT acceptable. Unlabelled specimens will not be tested.

Rejected Sample The physician will be notified of any specimen rejection, and a request will be made to submit a new sample. A written report will be sent with the reason for rejection. See below, “Unacceptable Specimens.”

Supplies Mailing cartons, specimen vials, special specimen collection containers and kits, sterile vials, stool containers, and request forms are provided without charge upon request. Other specimen containers are provided by the referring laboratory. See p. 27, for a complete listing of supplies available.

Test Turnaround Time This catalog lists the days on which the test is set up and the analytical time as a guide to expected turnaround times. Repeated tests take additional time.

Unacceptable Specimens Some specimens cannot be analyzed because of improper collection or degradation in transit. Other specimens may have prolonged turnaround times because of lack of necessary ancillary specimens or patient information.

You will be notified of rejected or problem specimens upon receipt. To avoid specimen rejection, please use the following checklist. Are the following conditions correct? Please check the test catalog.

• Full 24 hours for timed urine collection • Lack of hemolysis • Patient information requested • Patient/specimen properly identified • pH of urine • Specimen container (metal-free, separation gel, sterile, etc.) • Specimen type (plasma, serum, whole blood, etc.) • Specimen volume • Temperature (ambient, refrigerated, frozen) • Transport medium

GENERAL LABORATORY POLICY TITLE: IDENTIFICATION OF PATIENTS

Correct identification of the patient is critical for specimen collection. With this is mind, the following procedures should be adhered to for collecting of samples.

A. Outpatient Samples When approaching the patient with the appropriate orders, ask the patient to state their name and date of birth. If name does not match requisition, do not collect sample until problem can be resolved. If patient (usually small child) is unable to respond concerning name and date of birth, have responsible party identify the patient before collecting the sample.

ANTIMICROBIAL SUSCEPTIBILITY TESTING POLICY

We routinely report susceptibility results on all organisms that have published interpretive standards for the indicated source, unless the organism would not routinely be considered a pathogen for that source, or if the organism is normal flora for the source. Some organisms do not routinely have susceptibilities reported due to their predictable susceptibility. The standards we use are mandated by the College of American Pathologists and agencies of the federal and state government, by whom we are accredited and licensed.

We will try to accommodate special cases, if advance notice is given along with the order for culture. When requesting susceptibility testing on organisms that do not routinely have susceptibility reports, please write the following on the requisition:

“ATTENTION MICRO – SPECIAL SUSCEPTIBILITY REQUEST”

Additionally, a phone call to the Micro Lab at ext. 5526 will enable us to discuss all of the testing options available.

Some organisms may not be viable in susceptibility test systems. Certain organisms may not have standardized interpretative criteria and may need to be reported with a disclaimer statement.

SPECIMEN PACKAGING AND COURIER SERVICES

Ambient Specimens Our standard mailing containers are designed to transport serum and urine specimens that do not require special temperatures or handling. If you have any concerns regarding the effect of extreme weather conditions on routine or refrigerated specimens, please call Client Services personnel.

Courier Services It is important to pay particular attention to adequate packaging and handling to ensure constituent stability for the required tests. Of critical importance are transport conditions that are too hot (summer) or too cold (winter).

If there is a major snowstorm on the Eastern Shore, Shore Health Laboratories will contact each physicians’ office to check if they are closed, closing early, opened for regular hours, or what altered courier schedule is necessary.

Your patients and their lab studies are very important to us. Our employees are also important. So, in cases where the safety of our drivers is in jeopardy, Shore Health Laboratories will contact the physicians’ offices with instructions of what to do with specimens if the courier pickup is unavailable.

Exposure to Light It is important to avoid exposing blood specimens for photosensitive analytes to artificial light or sunlight for any length of time. Examples: vitamins A and B6, betacarotene, porphyrins, vitamin Ds, or vitamin B12. These specimens are to be protected with an aluminum foil wrap or equivalent.

Frozen Specimens Place specimen in plastic vials (not glass). Send each frozen vial not more than three-fourths full to allow for expansion when frozen. Store in freezer or on dry ice until picked up by courier.

Please label each vial with the patient’s name, date, and type of specimen (EDTA plasma, serum, urine, etc).

Refrigerated (on coolant) Specimens Place specimen in the refrigerator for storage before pickup by the courier. When packing for pickup, place specimen (culture, tube, or urine cup) into ziplock portion of bag and the requisition form in the outer pouch. Place coolant in transport bag (box) along with any specimens in a way so that there is not direct contact of the specimens with the coolant. You may use some paper to separate the two.

NOTE: OSHA requires that all shipments containing clinical specimens be marked with a “Biohazard Label.” Bags and labels for shipments sent to Shore Health Laboratories will be provided.

SPECIMEN COLLECTION AND PREPARATION

Laboratory test results are dependent on the quality of the specimen submitted. It is important that all specimens and request slips be properly labeled with the name of the patient, collection date, and the origin (source) of the sample, when applicable. Each container submitted must be tightly sealed with no external spillage.

If there is any doubt or question regarding the type of specimen that should be collected, it is imperative that our Client Services be called to clarify the order and sample requirements.

To help ensure patient identification, every Shore Health Laboratories’ request slip has pre-numbered specimen labels that provide unique patient identification.

Blood Collection Most laboratory tests are performed on anticoagulated plasma, serum, or whole blood. In general, specimens should be refrigerated until placed in the courier box for transport to the laboratory. Please see our individual test directory section for specific requirements.

• Plasma: Draw a sufficient amount of blood with the indicated anticoagulant to yield the necessary plasma volume. Gently mix the blood collection tube by inverting six to ten times immediately after collection. If required, separate plasma from cells by centrifugation within 20-30 minutes. • Serum: Draw a sufficient amount of blood to yield the necessary serum volume. Invert tube 5 to 10 times to activate clotting. Allow blood to clot at room temperature for 30 minutes. Separate serum from clot by centrifugation for 10 minutes. Caution: avoid hemolysis • Whole Blood: Draw a sufficient amount of blood with the indicated anticoagulant. Gently mix the blood collection tube by inverting 6 to 10 times immediately after collection. Caution: Do not centrifuge and separate tubes intended for whole blood analysis.

Centrifugation Centrifugation should be performed at 1,000-1,300 Gs for 10 minutes. Tubes of plasma, blood, and serum are to be kept closed at all times. This prevents possible exogenous contamination, evaporation, concentration changes, or possible spillage and aerosols.

Fasting Specimens An overnight fast is required for most fasting specimens. Some tests, however, particularly for lipids, triglycerides, and lipoproteins, require further dietary restriction. For these tests, nothing should be eaten for 14 hours prior to specimen collection. The evening before the specimen is drawn, the meal should contain no fatty foods or alcohol, and the meal should be completed before 6 p.m.

Metals Collection Avoid iodine-containing disinfectants and always cleanse arm with alcohol swab. Use only stainless steel phlebotomy needles. Use only Monoject® trace element blood collection tubes as follows: product #8881-307006 for specimens that require serum — no additive; product #8881-307022 for specimens that require whole blood — EDTA is additive. When multiple blood samples are to be collected from one patient, the trace metal specimens should be collected first. Once the needle has punctured another stopper, it is contaminated and should not be used for trace metal specimen collection.

• Metal-Free Tubes: Special metal-free tubes are available for tests that indicate their use. They are the navy- blue top Monoject® tubes. The standard Vacutainer® tubes contain metals in the stoppers. See p. 257,

“Metals Analysis, Collection and Transport.”

Microbiological Collection Containers Available The following is a list of microbiological collection containers referred to in Shore Health Laboratories’ specimen requirements:

Blood Collection Bottle Sets: Each set contains two bottles of a special media and atmosphere for culturing blood specimens. The purple-labeled bottle contains lytic broth, which supplies an anaerobic atmosphere. The blue- labeled bottle contains tryptic soy broth, which supplies an aerobic atmosphere. ( See Directions for Blood Culture Collection on page 14)

Chlamydia trachomatis by Nucleic Acid Amplification (Hologic-Genprobe® -Aptima®): Genprobe Aptima Unisex Swab collection kit for female cervical and male urethral specimens . The special swab provided in the transport package for specimen collection must be used. Follow the instructions on the package for specimen procurement. NOTE : Chlamydia trachomatis and Neisseria gonorrhoeae may be detected in cervical or urethral specimens using a single sample. Genprobe ® Aptima ® Vaginal Swab collection kit for female vaginal specimens.

Chlamydia/Ureaplasma/Mycoplasma/Viral Culture Transport Media: This media must be stored in the refrigerator before & after inoculation. Bring Multimicrobe Media  to room temperature before inoculating. Collect the specimen using sterile nonwooden shafted swab.

Clean-Catch Urine Collection Kit: This is used for collection of urine for culture. The kit includes a sterile specimen container, a container lip protector, a screw cap and protector, three castile soap towelettes, and a patient label and instructions.

Influenza & Viral Transport Media: This media must be stored in refrigerator before and after inoculation. Inoculate with specimen on a swab.

Mini-Tip Cultureswab : This is a smaller tip rayon swab on a flexible and extendable aluminum wire with Amies clear transport medium. The suggested use for this mini-tip Cultureswab® is for culture of urethral, nasopharyngeal and ocular areas. The directions for use are on the package.

Para-Pak® C&S Kit (Stool for Culture) Para-Pak® vial contains modified Cary-Blair transport medium to insure survival of bacterial pathogens and prevent over-growth of commensal organisms.

Gray Specimen Cup: Stool for C. difficile and Rotavirus

Para-Pak® PVA/Formalin (Stool for Ova & Parasites): The Para-Pak® kit consists of one vial containing Formalin fixative and one vial of PVA fixative, to preserve stool for ova and parasites examination or Giardia and Cryptosporidium Antigen assays.

Sputum Collection Container: This is a sterile container used for the collection and transport of sputum for culture.

Culture-swab  Contains Amies clear transport medium that ensures organism viability. A sterile rayon swab is included for specimen collection of culture.

Transgrow  Media: This is a screw-top bottle containing GC media with trimethoprim. Keep bottle stored in refrigerator until ready for use. Bring bottle to room temperature before inoculating with patient specimen. After inoculation, keep specimen at room temperature.

Neisseria gonorrhoeae by Nucleic Acid Amplification (Genprobe®-Aptima®) For female cervical and male urethral specimens. See above – Chlamydia trachomatis by Nucleic Acid Amplification (Genprobe® -Aptima®): NOTE : Chlamydia trachomatis and Neisseria gonorrhoeae may be detected in cervical or urethral specimens using a single sample.

Specimen Collection Tubes Available The following is a list of tubes referred to in Shore Health Laboratories’ specimen requirements:

Green-Top Tube (Sodium Heparin): This tube contains sodium heparin -used for the collection of heparinized plasma or whole blood for special tests. NOTE: After the tube has been filled with blood, immediately invert the tube several times in order to prevent coagulation.

Grey-Top Tube (Potassium Oxalate/Sodium Fluoride): This tube contains potassium oxalate as an anticoagulant and sodium fluoride as a preservative -used to preserve glucose in whole blood and for some special chemistry tests. NOTE : After the tube has been filled with blood, immediately invert the tube several times in order to prevent coagulation.

Lavender-Top Tube (K2 EDTA): This tube contains K2 EDTA as an anticoagulant -used for most hematological procedures. NOTE : After the tube has been filled with blood, immediately invert the tube several times in order to prevent coagulation.

Light Blue-Top Tube (Sodium Citrate): This tube contains sodium citrate as an anticoagulant -used for collection of blood for coagulation studies, such as prothrombin times. 3.2% Na Citrate is preferred for accuracy of results. NOTE: It is imperative that the tube be completely filled. The ratio of blood to anticoagulant is critical for valid prothrombin time results. Immediately after draw, invert the tube 6 to 10 times in order to activate the anticoagulant.

Pink-Top Tube (K2 EDTA ): For Blood Bank specimens. This tube contains K2 EDTA as an anticoagulant. After filling with blood, immediately invert tube several times to prevent clotting.

Royal Blue-Top Tube: There are two types of royal blue-top Monoject® tubes -one with the anticoagulant EDTA and the other plain. These are used in the collection of whole blood or serum for trace element analysis. Refer to the individual metals in the individual test listings to determine the tube type necessary.

Red-Top Tube: This tube is a plain Vacutainer® containing no anticoagulant -used for collection of serum for selected chemistry tests as well as clotted blood for immunohematology.

Serum Separator Tube (SST): This tube contains a clot activator and serum gel separator — used for routine chemistries. NOTE : Invert the tube to activate the clotting; let stand for 20-30 minutes before centrifuging for 10 minutes. If frozen serum is required, pour off serum into plastic vial and freeze. Do not freeze Vacutainer® tubes.

Special Collection Tubes: Some tests require specific tubes for proper analysis. Please contact Shore Health Laboratories prior to patient draw to obtain the correct tubes for metal analysis or other tests as identified in the individual test listings.

White or Pearl - Top Tube : PPT (Plasma Preparation tube) contains Potassium EDTA as the anticoagulant. This tube is used for both HIV and Hepatitis C Viral Loads and phenotyping.

Yellow-Top Tube (ACD): This tube contains ACD Solution A or B—used for the collection of whole blood for special tests.

Stool Specimen Collection Containers Available

24-Hour Stool: Special Metal containers for the collection and processing of fecal specimens are supplied by Shore Health Laboratories. See p. 267, for further information regarding the use of these containers.

Urine Collection

Random Collections: For routine analysis and microscopic evaluation, have the patient void into a clean container. The specimen should be capped, labeled, and refrigerated until courier pickup time. A clean-catch or midstream specimen is preferred. The patient should first void a small amount of urine, which is discarded. Some of the urine should then be collected in a clean container before voiding is completed.

24-Hour Urine Collections: Shore Health Laboratories provides 24-hour urine collection containers with various types of preservatives depending on the test requested. Use the following procedure for the correct specimen collection and preparation.

• Instruct the patient to discard the first morning specimen and to record the time of voiding. • The patient should collect all subsequent voided urine for the remainder of the day and night. • Collect the first morning specimen on day two at the same time as noted on day one. • Send the entire 24-hour specimen to the laboratory. If only an aliquot is submitted, please mix well before aliquoting and provide the total volume of the 24-hour urine collection. Include the height and weight of the patient.

DIRECTIONS FOR BACTEC BLOOD CULTURE SPECIMEN COLLECTION

NOTE: 23 sets of blood cultures are routinely ordered and should be drawn 15 minutes apart and from separate sites unless otherwise specified by the physician .

Successful recovery of bacteria from a blood culture is highly dependent on collection of an adequate volume of blood without overfilling the Bactec® bottles. Under-filling the bottles may cause bacteremia to go undetected, and overfilling the bottles causes false positive readings on the Bactec® instrument. Strictly aseptic technique must be followed throughout the collection procedure to avoid blood culture contamination. Blood cultures should NEVER be collected through an IV catheter , whether it is a newly inserted IV catheter or an established IV, unless simultaneous catheter and venous specimens are being collected to investigate possible established IV line catheter-caused bloodstream infections. Drawing blood from an IV catheter can significantly increase blood culture contamination with skin organisms, even if the IV catheter is newly inserted.

SPECIMEN COLLECTION:

Maintain Aseptic Technique During All Aspects of Arm Preparation, Drawing the Blood, and Inoculation of the Culture Bottles.

Skin Preparation of the Venipuncture Site

1. Locate the vein to be used.

2. Remove the ChloraPrep  One-Step Frepp  from kit and hold by center of handle in a horizontal position with sponge surface downward. Gently squeeze wings, releasing solution for a controlled flow. (Do not use Chloraprep  OneStep FREPP on patients less than 2 months of age. Substitute a sterile alcohol prep for the Chloraprep  and follow directions below.)

3. Press sponge against skin surface to be cleansed once or twice to saturate.

4. Cleanse area thoroughly, scrubbing vigorously using a back- and- forth friction scrub ensuring the solution reaches into the cracks and fissures of the skin for a full 30 seconds. Adequate skin decontamination at the site of the venipuncture is the single most important factor in avoiding skin- organism contaminated blood cultures.

5. Allow area to dry for approximately 30 seconds.

6. Avoid touching the site of venipuncture. All site locating should be done prior to cleansing the site. If it is absolutely necessary to touch the site after it has been cleansed, then your fingers (gloved) need to be cleansed thoroughly with ANOTHER Frepp and allowed to dry before touching the site.

Two options of Venipuncture methods for blood cultures:

Option 1 – Sterile SafetyLok™ Blood Collection set (butterfly) with PreAttached Holder (“Direct Draw”)

This method MUST NOT BE USED if

• Using a PedsPlus® bottle for collection Syringe collection is the only method that is reliable in determining if a sufficient minimum blood volume is collected in the bottle

• After inspecting the patient’s veins, difficulty in obtaining an adequate volume of blood is anticipated. The vacuum in the Bactec® bottles is very strong and may cause collapse of delicate veins.

NOTES: Option 1 – Sterile SafetyLok™ Blood Collection set (butterfly) with PreAttached Holder (“Direct Draw”)

• The vacuum in the bottles may exceed the maximum blood fill volume of the Bactec® Bottles. The bottles must ALWAYS be marked prior to drawing the sample. The blood volume being drawn must be closely monitored so that the optimum volume of blood is drawn without exceeding the maximum fill volume.

• The bottles must always be remain in an upright position to avoid backflow of the contents of the bottle into the patient’s arm

• Closely observe the flow of the blood into the butterfly tubing and into the bottles when starting the sample collection

NEVER draw blood directly into Bactec® bottles using a needle and tube holder, as the contents of the bottle may backflow into the patient’s arm! Bottles must always be sitting upright during specimen collection by using a Sterile SafetyLok™ Blood Collection set (butterfly) with Pre Attached Holder.

Preparation of Bactec® Bottles When Using Option 1 – Sterile SafetyLok™ Blood Collection set (butterfly) with PreAttached Holder (“Direct Draw”)

1. Note the media fluid level of the un-inoculated Bactec® Culture bottles being used. Mark the bottles at the maximum fill level so when monitoring volume during collection, the optimum volume can be drawn without exceeding the maximum fill volume.

The optimum fill volume for Standard Aerobic, Lytic, and Plus Aerobic bottles is 810 ml. for each bottle. Do not exceed bottle maximum fill volume of 10 ml. per bottle.

Note: Do not use bottles beyond the expiration date stamped on the bottle label.

2. Remove the flip-off caps from the bottles and scrub the tops of the blood culture bottles with a sterile 70% Isopropyl alcohol pad and allow to dry. DO NOT USE IODINE TO DISINFECT TOPS OF BOTTLES! (Iodine compromises the integrity of the rubber septa of the bottles.)

Venipuncture – Option 1 – Sterile SafetyLok™ Blood Collection set (butterfly) with PreAttached Holder (“Direct Draw”)

1. Peel apart Safety-Lok™ Blood Collection set (butterfly) with Pre-Attached Holder and make sure that butterfly luer and screw connections to tube holder are tight.

2. Remove sheath covering needle at wings.

3 Perform venipuncture holding wings. Do not hold by grasping the yellow safety shield.

4. Fill the aerobic bottle first . Be sure to hold bottle upright .

5. Push and hold the holder over the top of the bottle to puncture bottle septum.

6. Carefully observe the flow of the blood into the butterfly tubing and into the bottle when starting the sample collection to ensure that blood is properly flowing into the bottle.

7. Carefully monitor the blood volume collected in the bottle by means of the mark you made in bottle preparation and the 5 ml. graduation marks on the bottle label.

8. Collect blood to desired fill level.

9. When desired fill level is achieved in aerobic bottle, remove holder from bottle and immediately push and hold holder on anaerobic bottle. Fill as directed below in a-d:

a. Inoculate both a Standard 10 Aerobic/F Bottle (Blue/Blue Top) and a

Lytic/10 Anaerobic/F Bottle (Purple/Magenta Top) with 810 ml. of blood each.

b. If unable to obtain 16-20 of patient's blood, a minimum of 10 cc may be divided equally (5cc to each bottle) between the Standard 10 Aerobic/F and the Lytic/10 Anaerobic/F bottles.

c. If only 3-9cc of patient's blood can be obtained, place the entire amount in the Standard 10 Aerobic/F (Blue) Bottle .

d. (Note: On physician's request for use of Antimicrobial Removal Resins Bottles for Blood Cultures, the Bactec ® Plus Aerobic/F Bottle (Gray/Blue Top) should be substituted for the Standard 10 Aerobic/F Bottle , and requires 3-10 cc of patient's blood per bottle)

10. When final bottle is filled, withdraw the needle by grasping the wings (not the yellow safety device) and gently pull. Cover the venipuncture site with sterile gauze and apply pressure.

11. Label bottles with patient name, location, date and time of draw and initials of phlebotomist, being careful not to obliterate the bar code labels on the media bottles .

12. The appropriately labeled bottles should then be left at room temperature and forwarded to Microbiology as soon as possible. DO NOT PLACE BOTTLES IN INCUBATOR!

Option 2 Syringe and Transfer Device

A syringe and transfer device MUST be used for collection if:

• Using a PedsPlus® bottle for collection Syringe collection is the only method that is reliable in determining if a sufficient minimum blood volume is collected in the bottle

NOTES : Option 2Syringe and Transfer Device

When using a syringe, pull back on plunger before use to break the seal, but DO NOT TOUCH THE PART OF THE PLUNGER THAT GOES BACK INTO THE SYRINGE.

DO NOT TOUCH THE HUB OF THE SYRINGE OR THE ENDS OF THE LUER ADAPTORS Of The BUTTERFLY, NEEDLE, or TRANSFER DEVICE .

Preparation of Bactec Bottles When Using Option 2 Syringe and Transfer Device

1. Scrub the tops of the blood culture bottles with a sterile 70% Isopropyl alcohol pad, and allow to dry. DO NOT USE IODINE TO DISINFECT TOPS OF BOTTLES! (Iodine compromises the integrity of the rubber septa of the bottles.)

Venipuncture – Option 2 – Syringe and Transfer Device

1. Draw 16 cc to 20 cc of blood into a syringe and inoculate the Bactec® Bottles , using a Blood Transfer safety device as follows:

Note: Do not use bottles beyond the expiration date stamped on the bottle label.

a. Equally inoculate both a

Standard 10 Aerobic/F Bottle (Blue/Blue Top) and a

Lytic/10 Anaerobic/F Bottle (Purple/Magenta Top).

Fill the aerobic bottle first! * Do not exceed bottles maximum fill volume of 10 ml. per bottle.

b. If unable to obtain 16-20 of patient's blood, a minimum of 10 cc may be divided equally (5cc to each bottle) between the Standard 10 Aerobic/F and the Lytic/10 Anaerobic/F bottles.

* Do not exceed bottles' maximum fill volume of 10 cc per bottle.

c. If only 3-9cc of patient's blood can be obtained, place the entire amount in the Standard 10 Aerobic/F (Blue) Bottle . Do not exceed Bottle's maximum fill volume of 10 cc!

d. If less than 3cc of patient's blood can be obtained, place a minimum of 0.5cc to 3.0 cc of patient's blood in a: _ Bactec® Peds Plus/F Bottle (Pink/Silver Top)

Do not exceed bottle's maximum fill volume of 5 ml.

e. (Note: On physician's request for use of Antimicrobial Removal Resins Bottles for Blood Cultures, the Bactec ® Plus Aerobic/F Bottle (Gray/Blue Top) should be substituted for the Standard 10 Aerobic/F Bottle , and requires 3-10 cc of patient's blood per bottle)

Do not exceed bottle's maximum fill volume of 10 ml.!

2. Label bottles with patient name, location, date and time of draw and initials of phlebotomist, being careful not to obliterate the bar code labels on the media bottles .

3. The appropriately labeled bottles should then be left at room temperature and forwarded to Microbiology as soon as possible. DO NOT PLACE BOTTLES IN INCUBATOR!

INSTRUCTIONS FOR COMPLETION OF ROUTINE REQUEST FORM

Please refer to the copy of the Laboratory Request Form , located in the Appendix , for the fields that correspond to the following explanations.

1. Enter “DATE” and “PHYSICIAN” name.

2. Enter “PATIENT LAST NAME”; “JR, SR, III,” “FIRST NAME”, “MI” Mark “SEX”-- many tests are sex-related. Enter “SOCIAL SECURITY NUMBER” and “BIRTHDATE”- for patient identification. Enter “DIAGNOSIS or ICD-9 CODE”--for billing. THIS IS MANDATORY Enter “PATIENT ADDRESS”-- for the registration process.

3. Enter patient’s primary insurance in “INSURANCE#1” and enter “POLICY NUMBER, GROUP NUMBER”. If the patient has secondary insurance, enter the information in “INSURANCE#2”

A COPY OF THE PATIENT’S INSURANCE CARD (FRONT&BACK) CAN BE PROVIDED IN LIEU OF WRITING THIS INFORMATION.

Enter the Parent/Guarantor and relationship for all minors.

4. To order special handling of results: a. STAT- Doctor or doctor on-call will be called when results are complete unless otherwise documented. b. Faxing- Provide FAX number c. Call results. d. Additional copies to other physicians. Please provide first and last name of physician.

5. Mark an “X” in the box preceding test(s) desired.

a. PROFILES: For quick reference, reverse side of request form has each defined and includes specimens required. b. BLOOD TESTS: Listed in alphabetical order, those not listed may be entered in the space labeled “OTHER.” Listed tests are followed with a specimen collector code (example: “L” for lavender tube). c. CULTURES: Specimen collector and storage temperature are provided. Any culture not listed on the request may be entered under “Miscellaneous” along with the source. Refer to the test directory for appropriate collection directions or call Client Services.

6. Ordering a PAP requires a separate form from Chesapeake Pathology Associates. Please provide the appropriate patient history.

7. After specimen collection, label samples with patient’s name, date, and affix a unique numbered label from the request form. This number further ensures proper identification of the specimen(s).

8. Mark where specimen was collected along with time drawn. This will assist our Client Service personnel in contacting the appropriate facility concerning questions about specimens.

INSTRUCTIONS FOR COMPLETION OF CONSENT FORMS

Shore Health Laboratories Informed Consent and Agreement for HIV Testing Form

With my signature below, I acknowledge that I have read (or have had read to me) and understand the following information. Facts About HIV Testing

I HAVE BEEN TOLD THAT: (1) my blood will be tested for signs of an infection by the human immunodeficiency virus, the virus that causes AIDS; (2) my consent to have my blood tested for HIV should be FREELY given; and (3) every attempt will be made to keep the results of this test confidential, but that confidentiality cannot be guaranteed.

What a NEGATIVE Result Means A negative test means that the laboratory has not found evidence of HIV infection in my blood sample.

What a POSITIVE Result Means A. A positive HIV test means that I have HIV infection and can spread the virus to others by having sex or by sharing needles. B. A positive HIV test DOES NOT mean that I have AIDS — other tests are needed. C. If my test result is positive, I may experience emotional discomfort, and, if my test result becomes known to the community, I may experience discrimination in work, personal relationships, and insurance.

What will be done for me if My Test is Positive? A. I will be given a copy of the Department of Health and Mental Hygiene’s publication, “Directory of Counseling and Referral Resources for HIV Seropositive Persons,” which contains information about medical, social, psychological, and legal services that will be helpful to me. B. I will be told how to keep from spreading my HIV infection by: (1) avoiding sexual intercourse, or practicing SAFER sex; (2) not sharing drug needles — better still, getting off drugs; (3) not donating or selling my blood, plasma, organs, or sperm; (4) avoiding pregnancy; and (5) not breast-feeding or donating breast milk. C. Unless my test is performed at a designated anonymous test site approved by the Department of Health and Mental Hygiene, my unique patient identifying number will be given to the local health department, and if I have signs or symptoms of HIV infection, my name will be reported to the local health department to assist me in obtaining services and help the health department understand and control the AIDS problem. D. I know that my local health department or doctor may assist me in notifying and referring my partners for medical services — without giving my name to my partners. E. If I refuse to notify my partners, my doctor may either notify them or have the local health department do so. In this case, my name will not be used. Maryland law requires that, when a local health department knows of my partners, it must refer them for care, support, and treatment. F. I have had a chance to have my questions about this test answered. My counselor has explained to me about the use of a portion of my Social Security number in the unique patient identifying number and I have indicated below whether or not a portion of my Social Security number can be used for this purpose.

YES, I allow the use of a portion of my Social Security number. NO, I DO NOT allow the use of a portion of my Social Security number.

I hereby agree to have my blood drawn for an HIV test.

Name of Person Tested Date

Signature of Patient or Authorized Substitute

Shore Health Laboratories Consent to Use a Portion of the Social Security Number Form

I have been informed that some diagnostic test results must be reported to the local or state health department for statistic analysis and/or monitoring.

A unique numbering system has been designated as an anonymous reporting mechanism for CD4 lymphocyte counts <200/mm 3 in Maryland. This unique reporting number includes the last four numbers of my Social Security number.

I understand that in using this number, my identification will be kept anonymous.

Please indicate which of the following statements you agree to by placing your initials on the line before the statement.

______I hereby give my consent for using the last four digits of my Social Security number for reporting test results to the local or state health department.

______I do not give my consent for using the last four numbers of my Social Security number for reporting test results to the local or state health department.

Name and Date: ______

Signature: ______

Witness and Date: ______

Name of Physician: ______

Instructions to Generate a “Unique Identifier” Number

Maryland state law (COMAR 10.52.09) requiring laboratories to report confirmed HIV infections and CD4 lymphocyte counts <200/mm 3 by “Unique Identifier” (U.I.) took effect June 1, 1994. Confirmed HIV infection is indicated by a positive Western blot antibody test, a positive HIV antigen test, or a positive HIV culture confirmed by either specific HIV antigen test or reverse transcriptase detection.

Each health-care provider is responsible for generating the 12 digits of the patient’s U.l. number as follows: Example ••• FIRST 4 NUMBERS Last four digits of patient’s social security number 1234

••• NEXT 6 NUMBERS Six digits of patient’s birthdate (month, day, year) (NOTE: Use 0 before single digit, i.e., if patient’s birthdate is January 12, 1972) 011272

••• NEXTTOLAST NUMBER One digit for patient’s racial or ethnic group, i.e., if patient is Hispanic: 3

White, not Hispanic Use 1 African-American Use 2 Hispanic Use 3 Asian or Pacific Islander Use 4 Native American or Alaskan Native Use 5 Other Use 6

••• LAST NUMBER One digit for patient’s gender, i.e., if patient is female: 2

Male Use 1 Female Use 2

Therefore, using the above criteria for a Hispanic female born January 12, 1972, the U.l. will be 123401127232 . NOTE: If particular information is unavailable, use 9.

In order to comply with this new state law, please write the U.I. in the “Other” section of the Shore Health Laboratories’ request form when ordering HIV testing or CD4+ lymphocyte counts. If this information is incomplete or missing, the laboratory will call for the U.I. number.

As a service to you, we have revised our “Human Immunodeficiency Virus (HIV) Consent Form” (p. 19) so that the patient can give the physician permission to use his/her social security number to create the U.l. A second consent form (p. 20) is available for use when CD4 testing is ordered.

REQUESTS / REPORTING

CPT Coding It is your responsibility to determine the correct CPT Codes to use for billing. While this catalog lists CPT Code(s) in an effort to provide some guidance, the CPT Codes listed only reflect our interpretation of CPT coding requirements and are not necessarily correct. Particularly, in the case of a test involving several component tests, this catalog attempts to provide a comprehensive list of the CPT Codes for all of the possible components of the test. Only a subset of the component tests may be performed on your specimen. You should verify the accuracy of the codes listed and, where multiple codes are listed, you should select the codes for the tests actually performed on your specimen. SHORE HEALTH LABORATORIES ASSUMES NO RESPONSIBILITY FOR BILLING ERRORS DUE TO RELIANCE ON THE CPT CODES LISTED IN THIS CATALOG. For further reference, please consult the CPT Coding Manual published by the American Medical Association, and if you have any questions regarding the use of a code, please contact your local Medicare carrier.

Interfering Substances The most common interfering substances are listed on the specimen requirement column of the test listing. A more comprehensive listing is available in Young DS: Effects of Drugs on Clinical Laboratory Tests; fourth edition. Washington DC, AACC Press, 1995.

Request Slips Specific test request forms are provided for: allergen-specific IgE antibodies, cytogenetics/AFP congenital disorders, laboratory services, and pathology/dermatology/cytology. Additional clinical information is required on the cytogenetics/AFP congenital disorders, and pathology/dermatology/cytology forms for diagnostic reasons. Check ( ) tests desired and provide all required information. Type or clearly print all information, always including the patient’s age, sex and diagnosis code.

STAT Requests Selected tests may be ordered on a “STAT” basis. Testing will be done in a timely manner, and results will be called to the physician. Use the “Call Result Report” to aid in recording data as results are given over the phone. Written follow-up reports will be sent.

Written Reports The completed test report will be mailed, returned by courier, or transmitted via a teleprinter. Teleprinters are provided to high-volume offices.

Critical Values and readback policy The physician, or other licensed care-giver, will be called if a critical value result is obtained on testing the patient’s specimen. Verbal critical value results require confirmation by “readback” by the person receiving the results. The printed test report will have the critical value results flagged. Critical values are listed on pages 29-30.

Reference Values All reference values listed are for adult normals unless otherwise indicated.

Outpatient Instructions for ScotchTape Preparation for Pinworms

Items provided: 1 Slide container 2 Slides with clear cellophane-tape applied.

Instructions: Avoid using powder or talc around rectal area the night before obtaining the specimen. Specimens should be taken in the morning before bathing or going to the bathroom.

1. Using the glass slide with the clear cellophane-tape that you have been given, remove the tape from the slide. With the sticky side of the tape outward, wrap the tape over one finger and touch the perianal area (area around the rectum) with the tape. Do not touch the sticky side of the tape with your fingers except on the ends where it is grasped. 2. Replace the tape smoothly and firmly onto the slide with the sticky side down against the slide, making sure there are no bubbles in the tape. 3. Wash your hands thoroughly; dry. 4. Replace the slides in the slide container. Label with the patient's name and return it to the nearest Shore Health Laboratories draw site location. 5. These slides are stable and do not need special handling.

Note: Your physician may order this test for three (3) consecutive mornings. DO NOT COLLECT ALL THE SPECIMENS AT THE SAME TIME. COLLECT ONE EACH MORNING FOR THREE (3) MORNINGS.

Outpatient Instructions for Semen Collection

Items provided: Clean wide-mouth screw-top plastic or glass jar.

NOTE: • Semen analysis is performed in the hospital laboratory Monday - Friday from 7 a.m. - 11 a.m. Specimens are not accepted on weekends or holidays. • The complete analysis involves several hours of work; therefore specimens should be delivered to the lab early in the morning. • Semen is best collected by masturbation after a three (3) day period of abstinence from intercourse or masturbation. The sample may be collected at home or in a bathroom close to the laboratory. • Do not abstain more than 4 days because this diminishes the quality of the semen and the motility of the sperm. However, if your doctor has given you specific instructions in this regard, his orders should be followed. • Coitus interruptus (early withdrawal during intercourse) is unacceptable. The first ejaculate, that contains the majority of spermatozoa, may be lost. • The semen must be ejaculated into the clean, dry, wide-mouth jar given to you by the laboratory or your doctor to avoid introducing trace amounts of detergent or other harmful contaminants into the specimen. • A condom is unacceptable because many contain a spermicide, and it is impossible to retrieve the entire sample for analysis.

Instructions 1. Do not use any lubricant during collection. 2. After ejaculating the entire specimen into the container, replace the lid and secure it tightly. 3. Wash hands thoroughly, dry. 4. Label the container with your name and the time of collection. 5. If the specimen is collected away from the lab, bring to the lab as quickly as possible and keep close to body temperature by placing the jar inside your shirt during transport. 6. The specimen must be received in the lab within 30 minutes of collection. 7. Patients collecting semen samples for fertility testing are required to fill out a questionnaire. See next page.

Semen Analysis Questionnaire

DEAR PATIENT:

IN ORDER TO ACCURATELY EVALUATE YOUR SEMEN SAMPLE, WE REQUIRE THE FOLLOWING INFORMATION: BE TRUTHFUL!!!

ALL INFORMATION OBTAINED IS CONFIDENTIAL.

PLEASE PRINT

NAME:(LAST)______(FIRST)______

DATE OF SPECIMEN COLLECTION:______

TIME OF SPECIMEN COLLECTION:______

TYPE OF CONTAINER USED:

GLASS PLASTIC OTHER ______

WHERE WAS THE SPECIMEN COLLECTED ?

AT HOSPITAL AT HOME

IF THE SAMPLE WAS TRANSPORTED TO THE HOSPITAL, WAS IT KEPT WARM ?

YES NO

DAYS SINCE LAST EJACULATION:

1 2 3 4 5 GREATER THAN 6

HOW WAS THE SPECIMEN COLLECTED ?

MASTURBATION OTHER METHOD

WAS THE COMPLETE SAMPLE COLLECTED IN THE CONTAINER?

YES NO - EXPLAIN BELOW ______

Outpatient Instructions for Collection of Sputum

Items provided: Sterile specimen cup

Instructions:

1. It is preferable that sputum be collected in the morning, shortly after arising and before breakfast. 2. Blow your nose prior to the collection of the sputum. 3. Sputum should be collected by means of a deep chest cough in the container provided. Saliva or "spit" is not acceptable. 4. Please tighten the specimen lid securely. Label the container with your name and the date and time of collection. Please place the label on the container NOT the container lid. 5. Deliver the sputum sample to the nearest Shore Health Laboratories draw site location as soon as possible after collection. 6. Do not expose the specimen to extreme temperatures .

SUPPLIES

The following supplies are available through our packaging area. Please use our special supply requisition form when ordering.

Bags Small Transport (Individual with Pouch) Large Transport (Clear)

Blood Collection (Specify Box of 100 each) Blue (Citrate) Red (Plain) Grey (Fluoride) Royal Blue (EDTA) Dark Green (Na heparin) Royal Blue (No Additive) Light Green (Li Heparin) Serum Separator Tube (SST) Lavender (K2 EDTA) White / Pearl (Potassium EDTA) Pink (EDTA) Yellow Jungle (Ascorbic Acid) Yellow (ACD)

Centrifuge Provided if Necessary (Back-up Centrifuge and Service as Needed)

Cytology/Histology Plastic Slide mailers (50) Cytolyte Filled Containers For FNA Cytology Brushes (Bag of 25) Thin Prep Vials for PAP Cytology Fixatives Body fluid & FNA’s 10% Formalin Jar (20 & 60 ml) Alcohol filled slide containers Frosted End Slides (Box) Cyto Scrapers-plastic (Package of 25) Rubber Bands (Bunch) Cytobrooms (bag of 25)

Forms Allergen (Individual Tests and Panels) Request Form Call Result Forms Chesapeake Pathology Request Form Client Supply Requisition Cytogenetics/AFP Congenital Disorders Request Form Laboratory Services Request Form

Instructional Pamphlets for Patients A series of informational pamphlets are available for patient use and can be ordered on the “Client Supply Requisition” form. These are intended to aid in patient preparation and in the collection of proper specimens by giving explanations and instructions. These pamphlets are as follows:

Laboratory Outpatient Instructions for Collection of Clean-Caught Midstream Urine for Culture Laboratory Outpatient Instructions for Pediatric Urine Collections Laboratory Outpatient Instructions for Scotch-Tape Preparation for Pinworms Laboratory Outpatient Instructions for Semen Collection Laboratory Outpatient Instructions for Sputum Collection Laboratory Outpatient Instructions for Stool for Ova & Parasites, Stool Culture, Clostridium difficile & Rotavirus Laboratory Outpatient Instructions for Urine Cytology Patient Instructions for 24-Hour Urine Collection Patient Preparation for Glucose Tolerance Test Understanding Your Laboratory Tests — Bacterial/Viral Serology

Kits or Vials for Special Tests Digene® Specimen Collection Kit Digene® Specimen Transport Medium Metal-Free Vacutainer® Tubes (Royal Blue Top) with and without EDTA ParaPak PVA/Formalin for Ova& Parasites® Kit ParaPak C&S for stool culture® Kit ParaPak Triple Pak for Stool culture and Ova & Parasite ordered together Serotonin Tubes

Microbiology Blood Culture Bottle (Set of 2) Chlamydia trachomatis — Genprobe® Aptima® Unisex Swab Collection kits (Each) Influenza Viral Transport Tube (Each) — Store Refrigerated Mini-Tip Cultureswab® (Each) Multi-Microbe (Viral/Ureaplasma/Mycoplasma/Chlamydia/Herpes) Culture tube (each). Store refrigerated. Neisseria gonorrhoae - Genprobe® Aptima® Unisex Swab Collection kits (Each) Pertussis Collection Kit (Each) Sterile Cup (Each) Culture swab Plus® (Each) Transgrow® (Each) — Store Refrigerated

Miscellaneous Bags, ERA Tissue Specimen Bags, Refrigerate (6 x 6) Bags, Routine (6 x 6) Colcemid Solution and a Bottle Containing 40 ml of KCI Solution Container, Serum Vial (4 ml) Container, Serum Vial (8 ml) Container, Sterile Vial Container, Stool, Random, Small Container, Stool, Timed, Each Glucose Tolerance Beverage, 75 mg (Non-Pregnant Adults) Glucose Tolerance Beverage, 50 mg (OB Glucose Challenge) Glucose Tolerance Beverage, 100 mg (Pregnant Female) Interpretive Handbook Other Items as Requested in Order to Obtain Proper Specimen

Needles Needle Box, Large (Each) Needle Box, Medium (Each) Needle Box, Small (Each) Syringe, 12 cc (Each) Syringe Needles, 21 g x 1 1/2” (Each) Vacutainer®, 21 g x 1” (Box of 100) Vacutainer® Holder (Each)

Urine Collection 24-Hour Urine Container (Each — Call if Preservative is needed) Non-Sterile Cups (Package of 20) Pediatric (Each) Sterile Clean Catch Kit (Each)

CRITICAL VALUES CRITICAL VALUE SHORE HEALTH SYSTEM LABORATORIES

DR. ______DATE : ______NOTIFICATION

PATIENT ’S NAME : ______

BIRTHDATE : ______/ ______/ ______CALLED TO: ______

TEST NAME : ______CALLED BY: ______

DATE : ______TIME : ______TECH : ______COLLECTION TIME : ______

PATIENT CRITICAL CRITICAL TEST AGE RESULT LOW HIGH ACETAMINOPHEN ALL >150 BILIRUBIN , NEONATAL 0 DAYS OLD >8.0 2 DAYS OLD >13.0 3-6 DAYS OLD >15.0 7-21 DAYS OLD >20.0 BUN CHILD >70 20 YRS - ADULT >104 CALCIUM ALL <6.6 >12.9 CALCIUM , IONIZED ALL <3.3 >6.2 CARBAMAZEPINE ALL >20 CHLORIDE 0 DAYS -17 YRS . <77 >121 18 YRS . - ADULT <75 >126 CO2 ALL <11 >40 CREATININE 0 DAYS -18 YRS >3.8 19 YRS -ADULT >7.4 DIGOXIN ALL >2.5 DILANTIN ALL >30.0 FIBRINOGEN ALL <100 GENTAMICIN ,TROUGH ALL >3.0 GENTAMICIN , PEAK ALL >12.0 GLUCOSE NEWBORN (0- <32 >328 7DAYS ) CHILD <46 >445 18 YRS-ADULT <46 >484 GLUCOSE , CSF ALL <37 HEMATOCRIT CHILD <20 16 YRS OLD - <18.0 ADULT HEMOGLOBIN CHILD <6.9 16 YRS OLD - <6.6 >20.0 ADULT LACTIC ACID CHILD >4.1 18 YRS -ADULT >2.9 LIDOCAINE ALL >7.1 LITHIUM ALL >1.5

PATIENT CRITICAL CRITICAL TEST AGE RESULT LOW HIGH MAGNESIUM CHILD <1.1 >4.3 19 YRS -ADULT <1.0 >4.9 OSMOLALITY 0 DAYS -17 YRS <253 >317 18 YRS -ADULT <250 >326 PHENOBARBITAL ALL >60 PHOSPHORUS CHILD <1.3 >8.9 16 YRS .-ADULT <1.2 >8.9 PLATELETS 0 DAYS -17 YRS . <53,000 >916,000 17 YRS -ADULT <30,000 POTASSIUM NEWBORN <2.8 >7.8 (<1 MONTH ) CHILD <2.8 >6.4 16 YRS -ADULT <2.8 >6.2 PT/INR ALL >5.0 PTT ALL >90 SALICYLATE ALL >30 SODIUM CHILD <121 >156 16 YRS -ADULT <120 >158 THEOPHYLLINE ALL >25.0 TROPONIN 18 YRS – ADULT >0.5 URIC ACID ALL >13.0 VALPROIC ACID ALL >200 VANCOMYCIN , TROUGH ALL >20.0 VANCOMYCIN , PEAK ALL >80.0 WBC CHILD <2,000 >30,000 18 YRS OLD - <2,000 >40,000 ADULT CSF SMEAR OR CULTURE ALL BACTERIA SEEN BLOOD CULTURE ALL BACTERIA SEEN MALARIA SMEAR ALL POSITIVE NEWBORN STAPH AUREUS INFANT CULTURE (UP TO 1 Y/OLD ) OR GROUP B STREP

TEST PANELS

ARTHRITIS PANEL

No longer available. Please order individual tests as needed.

LIPID PANEL Cholesterol Cholesterol HDL Ratio HDL LDLCalculated, VLDLCalculated Triglycerides

NOTE: For specific lipoprotein fractionation, see “Lipoprotein Profile, Serum.”

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 2.0 ml of serum) from a fasting patient. Draw specimen following an overnight (12-14 hour) fast. Patient must not consume any alcohol for 24 hours before the specimen is drawn. Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: See individual test listings. Analytic Time: 2 days Day(s) Test Set Up: Daily CPT Code(s): 80061

ACUTE HEPATITIS PROFILE Hepatitis A Antibody, IgM (AntiHAV IgM) Hepatitis Bc Antibody, IgM (AntiHBc lgM) Hepatitis Bs Antigen (HBsAg) Hepatitis C Antibody (AntiHCV)

Test Performed At: Dorchester General Hospital Lab

Specimen: 1 SST tube (minimum: 3.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen. NOTE: 1. If collecting blood for other tests also, obtain a separate tube dedicated for this profile. 2. Collection date is required on request form for processing.

Reference Values: See individual test listings. Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 80074

LUPUS (SLE) ANALYSIS Antibodies to Extractable Nuclear antigens, antinuclear antibodies, ANA (Hep2 Substrate), Double Stranded (dsDNA) Antibody, RNP, Smith AB, C4, SCL 70, TPO, Mitochondrial AB, Paratiel Cell AB, Actin, Striated Muscle AB

Test Performed At: LabCorp

Specimen: 3 SST tubes (minimum: 5.0 ml of serum). Centrifuge SST 30 minutes after draw.

Refrigerate specimen. NOTE: 1. If collecting blood for other tests also, obtain a separate tube dedicated for this profile. 2. Collection date is required on request form for processing.

Reference Values: See individual test listings. Analytic Time: 3-5 days Day(s) Test Set Up: Monday - Saturday CPT Code(s): 86235x5 86376 86225x2 86038 83516x3 86160

NMR LIPOPROTEIN PROFILE, SERUM (WITH IR MARKERS) Ultracentrifugation, Electrophoresis, and Quantitation recommended for determining existence and type of dyslipoproteinemia. Includes total cholesterol, total triglycerides, and quantitation of cholesterol and triglycerides in VLDL, beta-LDL,, alpha-1 HDL, Lp(a), and any other significant lipoprotein fraction.

Test Performed At: LabCorp

Specimen: 1 plain, red-top tube or NMR Lipotube (2.0 ml of serum). Draw specimen following an overnight (12-14 hour) fast. Patient must not consume any alcohol for 24 hours before the specimen is drawn. Refrigerate specimen. NOTE: Patient’s age and sex are required on request form for processing.

Reference Values: See individual test listings. Analytic Time: 7 days Day(s) Test Set Up: Monday - Saturday CPT Code(s): 80061 83704

HEPATIC FUNCTION PANEL Total Protein Albumin Globulin A/G Ratio ALT (SGPT) AST (SGOT) Alkaline Phosphatase Bilirubin, Total & Direct

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 2.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: Globulin: Female 1.8-3.5 g/dl Male: 1.9-3.5 g/dl See individual test listings for other reference values. Analytic time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 80076

BASIC METABOLIC PANEL Creatinine Glucose Potassium Calcium BUN Sodium Carbon Dioxide Chloride

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 2.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen after collection.

Reference Values: See individual test listings for reference values. Analytic time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 80048

COMPREHENSIVE METABOLIC PANEL Albumin Creatinine Alkaline Phosphatase Glucose AST (SGOT) Bilirubin, Total Potassium BUN Protein, Total Calcium Sodium ALT (SGPT) Carbon Dioxide Chloride

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum: 2.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: See individual test listings for other reference values. Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 80053

RENAL FUNCTION PANEL BUN Glucose Albumin Calcium Phosphorus Carbon Dioxide Chloride Potassium Creatinine Sodium

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: See individual test listing Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 80069

MULTIPLE SCLEROSIS (MS) PANEL Cerebrospinal Fluid (CSF) IgG Index Oligoclonal Banding

Test Performed At: LabCorp

Specimen Both serum and CSF are required for this test. Specimens must be drawn at same time. Serum: 1 plain, red-top tube or 1 SST tube (minimum 2.0 ml serum): 2 pouroffs - #1=1.5 ml, #2=0.5 ml) Centrifuge 30 minutes after draw. Refrigerate. CSF: 1 plain red-top tube (minimum 1.5 ml of CSF). Divide sample: #1=1.0 ml CSF Refrigerate #2=0.5 ml CSF Freeze.

NOTE: Label specimens appropriately (serum or CSF). Total of 4 samples to send.

Reference Values: See report Analytic Time: 2-3 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 82040 albumin, serum 82042 albumin, CSF 82784 x 2 IgG, serum and CSF 83916 Oligoclonal immunoglobulin, serum & CSF

PRENATAL PANEL Blood Count Type and Screen Hepatitis Bs Antigen (HBsAg) Rapid Plasma Reagin (RPR) Rubella Serology, IgG

Test Performed At: Shore Health Laboratories

Specimen: Whole Blood and Serum are required for this test. Blood: 1 pink-top blood bank tube and 1 lavender-top (EDTA) tube (minimum 3.0 ml of EDTA whole blood). Refrigerate specimens. Serum: 2 SST tubes (minimum 3.0 ml of serum), Centrifuge SST 30 minutes after draw.

Reference Value: See individual test listing. Analytic time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 80055

ALPHABETICAL TEST LISTING

A1 HEMOGLOBIN /A1C See: “Glycated Hemoglobin, Blood ”

A2 HEMOGLOBIN See: “Hemoglobin A 2, Column, Blood” “Hemoglobin Electrophoresis, Blood” "Thalassemia and Hemoglobinopathy Evaluation"

ABO AND Rh See: “Prenatal Profile” “Type” “Type and Screen (TS)”

ABSOLUTE CELL COUNT See: “CBC”

ACETAMINOPHEN, SERUM Enzymatic

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen. Collect first sample 4 hours after poisoning. Collect second sample 12 hours later.

Reference Values: Normal: 10- 30 ug/ml Liver damage unlikely if <150 4 hour post ingestion Critical Value: > 150 ug/ml Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82003

ACETAMINOPHEN (TYLENOL) See: “Acetaminophen, Serum” “Drug Screen, Plasma” “Drug Screen, Plasma and Urine”

ACETONE, SERUM Nitroprusside Tablets, Manual

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: Negative Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82009 – screen

ACETONE, URINE See “Ketones, Urine”

ACETYLCHOLINE RECEPTOR (AChR) BINDING ANTIBODIES, SERUM Radioimmunoassay (RIA). This is the primary diagnostic test for Myasthenia Gravis.

Test Performed At: LabCorp

Specimen: 1 plain red-top tube or 1 SST tube (minimum 1.0 ml of serum). Centrifuge 30 minutes after draw. Refrigerate specimen.

Reference Values: Negative 0.00-0.24 nmol/L Borderline 0.25-0.40 nmol/L Positive >0.40 nmol/L Analytic Time: 1-2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 83519

ACETYLCHOLINESTERASE, ERYTHROCYTES (CHOLINESTERASE, RBC) Kinetic/Colorimetric

Test Performed At: LabCorp Specimen: 1 EDTA (lavender) tube. Refrigerate specimen. Do not separate. Send whole blood. Note: Collect Monday-Thursday only. Stable for 48 hours. Reference Values: 5300-10000 IU/L Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 82482

ACETYLSALICYLATE (ASPIRIN) See: “Salicylate, Serum”

ACID PHOSPHATASE, PROSTATIC, SERUM Alpha-naphthylphosphate

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube. Centrifuge SST 30 minutes after draw. Refrigerate. This test cannot be done as an “add-on” procedure. Do not uncap tube once specimen is collected.

Reference Values: <2.0 U/L Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84066

ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT), PLASMA Photo Optic Clot Detection

Test Performed At: Shore Health Laboratories

Specimen: 1 light blue-top (citrate) tube (minimum 2.0 ml of 3.2 sodium citrate whole blood). Fill light blue-top (citrate) tube to blue band on the label of the tube. Please state whether patient is on anticoagulant.

Reference Values: 23-36 seconds Critical Value: > 90 seconds Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 85730

ADRENOCORTICOTROPIC HORMONE (ACTH), PLASMA (ICMA)

Test Performed At: LabCorp

Specimen: 1 ice chilled lavender top (EDTA) tube (minimum 1.0 ml EDTA plasma) from a fasting patient. Separate plasma in a refrigerated centrifuge. Freeze immediately in a plastic vial. Due to diurnal variation, draw between 8 and 10 am.

Reference Values: 6-48 pg/ml Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 82024

ADRENOCORTICOTROPIC HORMONE (ACTH) STIMULATION, SERUM

Outpatient must call hospital ext 5919 for appointment

Test Performed At: Shore Health Laboratories- call scheduling office to set up appointment x2600

Specimen: 3 serum specimens drawn in SST tubes; minimum 1 ml of serum. Draw baseline specimen prior to ACTH injection (250ug Cosyntropin IM by physician). Draw 2 nd specimen 30 minutes post injection, and 3 rd specimen 60 minutes post injection. Label each specimen with the time of collection. Centrifuge SST 30 minutes after draw; refrigerate. Cortisol Levels are tested

Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 82533 x 3

ADVIL® (IBUPROFEN) See: “Drug Screen, Plasma” “Drug Screen, Plasma and Urine” “Ibuprofen, Serum” “Ibuprofen, Urine”

AFB (ACIDFAST BACILLI) See: “Culture, Acid-Fast Bacillus”

AFP (ALPHAFETOPROTEIN) See: “Alpha-Fetoprotein (AFP- MS), Maternal/Initial (MAP1)" “Alpha-Fetoprotein (AFP), Quad Screen (MAP4)” “Alpha-Fetoprotein (AFP) Triple Screen, Serum (MAP3)” “Alpha-Fetoprotein (AFP) Tumor Marker, Serum”

A/G (ALBUMIN/GLOBULIN) RATIO Cannot be ordered separately See: “Albumin/Globulin (A/G) Ratio, Serum”

ALANINE AMINOTRANSFERASE (ALT/SGPT) See: “Alanine Aminotransferase (ALT/SGPT), Serum" “Hepatic Panel"

ALANINE AMINOTRANSFERASE (ALT/SGPT), SERUM Spectrophotometry

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: 10-65 U/L Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84460

ALBUMIN See: “Albumin/Globulin (A/G) Ratio, Serum” “Albumin, Serum” “Hepatic Function Panel” “Comprehensive Metabolic Panel” “Microalbuminuria, 24-Hour Collection, Urine” “Microalbuminuria, Random, Urine”

ALBUMIN/GLOBULIN (A/G) RATIO, SERUM BCP-Dye Binding. Includes albumin, A/G ratio, globulin, and total protein.

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: Albumin: 2.9 - 5.0 g/dl A/G Ratio: 1.0 - 2.5 Globulin : Male: 1.9 - 3.5 g/dl Female: 1.8-3.5 g/dl Protein, Total: 6.0-8.2 g/dl Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82040 - Albumin 84155 - Protein, total

ALBUMIN, SERUM BCP-Dye Binding

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: 2.9-5.0 g/dl Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82040

ALCOHOL, ETHYL, SERUM Enzymatic

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate centrifuged tube with top on. NOTE: 1. A non-alcohol germicide must be used to cleanse the skin. 2. Do not use alcohol wipes for venipuncture. 3. Do not uncap tube once specimen is collected. 4. For diagnostic purposes only.

Reference Values: < 5 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82055

ALDOLASE, SERUM Kinetic, Spectrophotometric (Enzymatic)

Test Performed At: LabCorp

Specimen: 1 plain, red-top tube or 1 SST tube (minimum 2.0 ml of serum) (pediatric 0.5 ml serum. Centrifuge 30 minutes after draw. Freeze serum.

NOTE: Hemolyzed specimens are not acceptable.

Reference Values: 1.2 – 7.6 IU/L Analytic Time: 1 day Day(s) Test Set Up: Sunday - Friday CPT Code(s): 82085

ALDOSTERONE, SERUM Liquid chromatography/tandem mass spectrometry (LC/MS-MS)

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate serum.

Reference Values: See report. Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 82088

ALDOSTERONE, URINE Liquid chromatography/tandem mass spectrometry (LC/MS-MS)

Test Performed At: LabCorp

Specimen: Submit 20 ml of urine collection in a urine container with 1 gm boric acid Preservative during collection. Urine Containers are supplied by Shore Health Laboratories. NOTE: Follow guidelines in “Patient Instructions for 24-Hour Urine Collection supplied by Shore Health Laboratories.

Reference Values: See report. Analytic Time: 2 day Day(s) Test Set Up: Tuesday - Thursday CPT Code(s): 82088

ALKALINE PHOSPHATASE See: “Alkaline Phosphatase lsoenzymes, Serum” “Alkaline Phosphatase, Serum” “Leukocyte Alkaline Phosphatase (LAP) Score” “Hepatic Panel” “Comprehensive Metabolic Panel”

ALKALINE PHOSPHATASE ISOENZYMES, SERUM Electrophoresis. Includes total Alkaline Phosphatase

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 2.0 ml of serum) from a fasting patient. Centrifuge SST 30 minutes after draw. Refrigerate specimen after collection.

Reference Values: Liver 26% - 86% Bone 11% - 68% Intestine 0% - 16% Analytic Time: 1 day from set up Day(s) Test Set Up: Monday - Friday CPT Code(s): 84080, 84075

ALKALINE PHOSPHATASE, LEUKOCYTE See: “Leukocyte Alkaline Phosphatase (LAP) Score”

ALKALINE PHOSPHATASE, SERUM p-Nitrophenol Phosphate

Test Performed At: Shore Health Laboratories Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Reference Values: 30-140 U/L, age related Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84075

ALKALINE PHOSPHATASE STAIN See: “Leukocyte Alkaline Phosphatase (LAP) Score"

ALPHA1ANTITRYPSIN PHENOTYPING, SERUM Phenotype: isoelectric focusing (IEF); total: immunologic

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 2.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate.

Reference Values: See report Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 82104 82103

ALPHA1ANTITRYPSIN, SERUM Nephelometry

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw.

Reference Values: 90-200 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 82103

ALPHAFETOPROTEIN (AFPAF), AMNIOTIC FLUID ICMA. Includes chromosome analysis on Amniotic fluid.

Test Performed At: LabCorp

Specimen: 1 plain red-top tube (minimum 1.0 ml of amniotic fluid). Do not centrifuge. Keep the specimen at room temperature. Protect from light.

NOTE: 1. The following information is required for processing: A. First day of last menstrual period B. Date ultrasound performed C. Gestational age by ultrasound D. Collection Date 2. Gestational age must be between 13 and 23 weeks; 14-18 weeks preferred. 3. If chromosome studies are also requested, see “Chromosome analysis, Amniotic Fluid”. The specimen for alpha-fetoprotein, amniotic fluid testing when requested cannot be frozen. 4. Please complete a “Cytogenetics/AFP Congenital Disorders Request Form” and forward it with the specimen. This form is supplied by Shore Health Laboratories.

Reference Values: 2.0 multiples of median (MOM) for gestational group. Interpretive report will be provided. Analytic Time: 2-3 weeks Day(s) Test Set Up: Monday - Friday

CPT Code(s): 82103 88235 88280 88269 88291

If AFP has a MOM greater than or equal to 2.0, Acetylcholinesterase, AF and HgbF, AF will automatically be performed.

ALPHAFETOPROTEIN (AFPMS), MATERNAL SERUM, INITIAL Immunometric chemiluminescencs

Test Performed At: LabCorp

Specimen: 2 SST tubes (minimum 3.0 ml of maternal serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

NOTE: Please fill out an AFP request form. The following information is required for processing: A. Gestational age, maternal age, weight, and race B. First day of last menstrual period C. Is patient an insulin-dependent diabetic? D. Specify single or twin pregnancy

Reference Values: Interpretive report will be supplied. Abnormally high values are called back and discussed with ordering physician. Analytic Time: 3-5 weeks Day(s) Test Set Up: Monday - Friday CPT Code(s): 82105

ALPHAFETOPROTEIN (AFP), QUAD (MAP4) (TETRA) Chemiluminescence; Enzyme Linked Immunoabsorbent Assay

Test Performed At: LabCorp

Specimen: 2 SST tubes (minimum 5.0 ml of serum). Centrifuge 30 minutes after draw. Refrigerate. Send original tubes, do not pour off.

Reference Values: Reported with patient results Analytic Time: 3-5 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 82105, 86336, 84702,82677

ALPHAFETOPROTEIN (AFP), TRIPLE SCREEN, SERUM (MAP3), AFP XTRA PROFILE Chemiluminescence. Includes alpha-fetoprotein, beta-human chorionic gonadotropin, and estriol

Test Performed At: LabCorp

Specimen: 2 SST tubes (minimum 3.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate. Send original tubes, do not pour off.

NOTE: Please submit Marker Assessment Request Form. The following information is required for processing: A. Gestational age, maternal age, weight, and race B. First day of last menstrual period C. Is patient an insulin-dependent diabetic? D. Specify single or twin pregnancy

Reference Values: An interpretive report will be issued. Abnormally high values are called back and discussed with ordering physician. Analytic Time: 3-5 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 82105, 84702, 82677

ALPHAFETOPROTEIN (AFP) TUMOR MARKER, SERUM Microparticle Enzyme Immunoassay (MEIA)

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen. Amniotic fluid should not be sent because this test is only used as a tumor marker. Diagnosis should be confirmed by other tests or procedures. We will not routinely analyze specimens from females of childbearing age unless a suspected tumor diagnosis is specified.

Reference Values: 05 IU/ml Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 82105

ALPHA hCG (HUMAN CHORIONIC GONADOTROPIN) See: “Alpha-subunit of Pituitary Glycoprotein Hormones (a-PGH), Serum"

ALPHA 2 MACROGLOBULIN, SERUM Rate Nephelometry

Test Performed At: LabCorp

Specimen: 1 plain red-top tube or 1 SST tubes (minimum 1.0 ml of serum). Centrifuge 30 minutes after draw. Refrigerate.

Reference Values: 110-276 mg/dl Analytic Time: 2 days Day(s) Test Set Up: Monday – Friday CPT Code(s): 83883

ALPHASUBUNIT, SERUM, FREE Measures the alpha subunit of LH, DSH, TSH, and HCG (Pituitary glycoproteins) Radioimmunoassay (RIA)

Test Performed At: LabCorp

Specimen: 1 SST tubes. Centrifuge 30 minutes after draw. Separate and f eeze. Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Monday and Thursday CPT Code(s): 83520

ALT/SGPT (ALANINE AMINOTRANSFERASE) See: “Alanine Aminotransferase (ALT/SGPT), Serum”

AMINOPHYLLINE See: “Drug Screen, Plasma” “Drug Screen, Plasma and Urine” “Theophylline, Serum”

ALUMINUM, SERUM OR PLASMA Flameless Atomic Absorption Spectrometry

Test Performed At: LabCorp

Specimen: 1 Royal navy blue-top without EDTA (serum) or 2 Royal navy blue-top with EDTA (plasma) metal free tubes. For plasma, send minimum of 7 ml whole blood in unopened tube at room temperature. For serum, send minimum of 1 ml serum at room temperature. Serum must be transferred to plastic tube within 45 minutes of draw.

Reference Values: 0-9 ug/L Dialysis patients <40 ug/L Reference values are for serum and do not apply to plasma specimens. Analytic Time: 2 days Day(s) Test Set Up: Tuesday - Saturday CPT Code(s): 82108

AMIKACIN, SERUM Immunoassay

Test Performed At: LabCorp

Specimen: 1 plain red-top tube (minimum 1.0 ml of serum). Serum for a peak level should be taken 30 minutes after completion of infusion of an intraveneous dose or 60 minutes after an intramuscular or oral dose of amikacin. The trough specimen should be collected 30 minutes before dose. Refrigerate specimen.

NOTE: 1. The plain red-top tube should NOT contain gel or silicone. 2. Clearly mark tubes with “TROUGH” or “PEAK”

Reference Values: Therapeutic ranges Peak: 20-25 ug/ml Trough: 1.0-8.0 ug/ml Analytic Time: 1 day Day(s) Test Set Up: Monday - Saturday CPT Code(s): 80150

AMINOLEVULINIC ACID (ALA), URINE (24 HR OR RANDOM) Colorimetric

Test Performed At: LabCorp

Specimen: 24 hour urine container with 30 ml of 30% glacial acetic acid. Random specimen should be collected in container with 0.5 ml of 30% glacial acetic acid. Submit 10 ml aliquot in AMBER tube and freeze. pH<6

Note: Random sample should NOT be the first morning void, or after 8pm in the evening and not after excessive fluid intake.

Reference Values: 24hr sample = 1.5-7.5 mg/24 hour Random sample = 0.0-5.4 mg/L Analytic Time: 2 days Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 82135

AMIODARONE, SERUM (CORDARONE) Includes Desethylamiodarone High-Pressure Liquid Chromatography (HPLC)

Test Performed At: LabCorp

Specimen: 1 plain red-top tube (minimum 1.0 ml of serum). DO NOT use gel tube. Separate and freeze.

Reference Values: Therapeutic: Amiodarone 1.0-2.5 ug/ml Noramiodarone 1.0-2.5 ug/ml Analytic Time: 3 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 82542

AMITRIPTYLINE AND NORTRIPTYLINE High Pressure Liquid Chromatography (LCMS-MS)

Test Performed At: LabCorp

Specimen: 1 plain red-top tube or 1 LAV EDTA tube (minimum 1.0 ml of serum or plasma). Do not use barrier gel tubes. Note time of last dose and dosage. Refrigerate.

Reference Values: Amitriptyline & Nortriptyline Total therapeutic concentration: 80-250 ug/L Analytic Time: 3 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 80152 - amitriptyline

AMMONIA, PLASMA Enzymatic

Test Performed At: Shore Health Laboratories

Specimen: 1 green-top (heparin) tube (minimum 0.2 ml of heparinized plasma). Specimen should be placed on wet ice immediately after drawing and kept refrigerated until centrifugation. Centrifuge within 15 minutes of draw. Separate plasma into a plastic vial. Place in 70º C freezer if specimen cannot be delivered immediately to the laboratory .

NOTE: EDTA plasma is not acceptable.

Reference Values: 11-35 umol/L Analytic time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82140

AMNISURE (PAMG1) Immunochromatographic method

Test Performed At: Shore Health Laboratories

Specimen: Amnisure collection swab and vial

Reference Values : Negative denotes intact fetal membranes Positive denotes ruptured fetal membranes

Analytic Time : Same day results Day(s) Test Set Up : Daily CPT Code: 84112

AMOEBA SEROLOGY, SERUM (E.histolytica) Enzyme Immunoassay [EIA]

Test Performed At: Maryland State Health Dept

Specimen: 2 SST tubes (minimum 6.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen. NOTE: 1. Acute and convalescent specimens are needed to interpret the results. The convalescent specimen should be obtained 2-3 weeks after onset. 2. Label specimen appropriately (acute or convalescent).

Reference Values: Negative Analytic Time: 3-4 weeks Day(s) Test Set Up: Monday - Friday CPT Code(s): 86753

AMPHETAMINES See: “Drug Screen, Urine” “Drug Screen, Plasma and Urine”

AMPHETAMINES, URINE Includes gas chromatography/mass spectrometry (GC/MS) confirmation with quantitation

Test Performed At: LabCorp

Specimen: 20 ml from a random urine collection in a urine sample cup supplied by Shore Health Laboratories. Store at Room Temperature. If delay getting to LabCorp more than 7 days, refrigerate.

Reference Values: None detected. Positive results are quantitated. Cutoff conc: 500 ng/ml Analytic Time: 2-3 days Day(s) Test Set Up: Daily CPT Code(s): 82145

AMYLASE, BODY FLUIDS Enzymatic

Test Performed At: Shore Health Laboratories

Specimen: 1 plain, red-top tube (minimum 0.2 ml of fluid). Refrigerate specimen. NOTE: The plain, red-top tube should NOT contain gel or silicone.

Reference Values: No established reference range Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82150

AMYLASE, SERUM Enzymatic

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: 25 - 115 U/L Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82150

AMYLASE, URINE Enzymatic

Test Performed At: Shore Health Laboratories

Specimen: Submit an entire 2-hour timed urine collection in a urine sample cup supplied by Shore Health Laboratories. Refrigerate specimen. May also be performed on a 24 hour urine collection.

Reference Values: 5 - 54 U/2 hrs 59 - 401 U/24 hrs

Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82150

ANA (ANTINUCLEAR ANTIBODIES) See: “Antinuclear Antibodies (ANA) Screen, Serum” “LE Package” “Lupus Comprehensive Panel”

ANACIN3® (ACETAMINOPHEN) See: “Acetaminophen, Serum” “Drug Screen, Plasma” “Drug Screen, Plasma and Urine"

ANGIOTENSION CONVERTING ENZYME (ACE)

Test Performed At: LabCorp

Specimen: 1 SST tubes (minimum 2.0 ml of serum). Centrifuge 30 minutes after draw. Refrigerate specimen.

Reference Values : >14 years = 12 – 68 U/L Analytic Time : 2 days Day(s) Test Set Up : Sunday - Friday CPT(s) Code: 82164

ANTEPARTUM RhoGAM WORKUP See:” RhoGAM” – indicate if an Antepartum

ANTIBIOTIC ASSAY See: “Amikacin, Serum” “Ganciclovir, Serum” “Gentamicin, Serum” “Tobramycin, Serum” “Vancomycin, Serum”

ANTIBODIES TO EXTRACTABLE NUCLEAR ANTIGENS, SERUM Enzyme Immunoassay Includes RNP and Smith Antibodies

Test Performed At: LabCorp

Specimen: 1 SST tubes (minimum 1.0 ml of serum). Centrifuge 30 minutes after draw. Refrigerate specimen.

Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 86235 x2

ANTIBODY IDENTIFICATION See: “Antibody Identification, Blood” “Antibody Screen” ”Prenatal Profile”

ANTIBODY IDENTIFICATION, BLOOD Solid Phase Agglutination (Red cell antigen typing will be performed to verify antibody Identification)

Test Performed At: Shore Health Laboratories

Specimen : 1 pink-top blood bank tube. Avoid hemolysis.

NOTE: Include report of diagnosis and history of transfusions, pregnancy, and drug therapy.

Reference Values: Negative A consultation service is offered regarding the clinical relevance of red cell antibodies. Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 86870 - antibody identification 86905 - each red cell antigen typing

ANTIBODY SCREEN See: “Antibody Screen, Blood” “Prenatal Panel”

ANTIBODY SCREEN, BLOOD Solid Phase Agglutination (If positive, antibody identification will be performed at an additional charge)

Test Performed At: Shore Health Laboratories

Specimen: 1 pink-top blood bank tube. Avoid hemolysis. NOTE: Include report of diagnosis and history of transfusions, pregnancy, and drug therapy.

Reference Values: Negative If positive, antibody identification will be performed. Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 86870 antibody identification 86850 – antibody screen 86905 -each red cell antigen typing

ANTIBODY TO HEPATITIS C VIRUS See: “Hepatitis C Antibody (Anti-HCV), Serum” “Hepatitis Profile”

ANTIBODY WORKUP See: “Antibody Identification, Blood” “Antibody Screen” “Prenatal Panel”

ANTIDIURETIC HORMONE (VASOPRESSIN), RIA (ADH) Radioimmunoassay (RIA)

Test Performed At: LabCorp

Specimen: Serum and Plasma required 1 SST tubes (minimum 1.0 ml of serum). Centrifuge 30 minutes after draw. Refrigerate specimen. 1 Lavender-top (EDTA) tube (minimum of 2.0 ml of EDTA plasma). Prechill lavender top tube at 40 degrees C before drawing sample. Separate plasma from cells immediately after collection and freeze in plastic vial.

Reference Values: 0.0-4.7 pg/ml Additional interpretive information provided with report. Analytic Time: 5 days Day(s) Test Set Up: Tuesday, Thursday, Saturday CPT Code(s): 84588 83930

ANTIDNAse B (STREP AB) Radioimmunoassay (RIA)

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum of 1.0 ml of serum). Store at Room Temperature.

Reference Values: See report. Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 86215

ANTIGEN IDENTIFICATION, BLOOD Agglutination

Test Performed At: Shore Health Laboratories

Specimen: 1 pink top (blood bank) tube. NOTE: Test will not be valid if patient was transfused within 3 months prior to collection.

Reference Values: Antigen specific Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 86905

ANTIHCV (HEPATITIS C VIRUS) See: "Hepatitis C Antibody (Anti HCV), Serum" "Hepatitis Panel"

ANTIHEPATITIS Bc See: “Hepatitis Bc Antibody, lgG and IgM (Anti-HBc lgG and IgM), Serum” “Hepatitis Panel”

ANTIHEPATITIS Bs See: “Hepatitis Bs Antibody (Anti-HBs), Serum”

ANTINUCLEAR ANTIBODIES (ANA) See: “Antinuclear Antibodies (ANA) Screen, Serum” “LE Package" “Lupus Comprehensive Panel”

ANTINUCLEAR ANTIBODIES (ANA) SCREEN, SERUM Indirect Immunofluorescence

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: Negative (If positive, results are titered). Analytic Time: 1-2 days Day(s) Test Set Up: Monday- Friday CPT Code(s): 86038 - screen 86039 - titer

ANTISTREPTOLYSINO ANTIBODIES

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 2.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: 0-200 IU/ml Analytic Time: 1-2 days Day(s) Test Set Up: Monday- Friday CPT Code(s): 86060

ANTITPO (THYROID PEROXIDASE ANTIBODIES) See: “Thyroid Peroxidase Antibodies, FIA”

A1 ANTITRYPSIN See: “Alpha-1-Antitrypsin Phenotyping, Serum” “Alpha-1-Antitrypsin, Serum”

APOLIPOPROTEIN A&B, SERUM Nephelometry

Test Performed At: LabCorp

Specimen: 2 SST tube (minimum 4.0 ml of serum). Patient must not consume any alcohol for 24 hours before the specimen is drawn. Refrigerate specimen.

Note: Patient should be fasting for 12 to 14 hours. Reference Values: See report Analytic Time: 3 days Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 82172 x2

APT TEST FOR FETAL HGB Alkali Denaturation

Test Performed at: Shore Health Laboratories.

Specimen: Bloody stool or emesis. Bloody vaginal discharge.

Reference Values: Negative Analytic Time: 1day Days Test Set Up: Daily CPT Code(s): 83033

ARSENIC, WHOLE BLOOD Atomic Absorption Spectrometry

Test Performed at: LabCorp

Specimen: 1 royal-blue top EDTA trace element blood collection tube (2.0 ml whole blood). It is important the specimen be obtained, processed, and transported according to instructions on page 257 “Metals Analysis Collection and Transport”. Store at Room Temperature.

Reference Values: 2-23 ug/L Analytic Time: 3 days Days Test Set Up: Monday, Wednesday, Friday CPT Code(s): 82175

ARSENIC, URINE (24 HOUR) Inductively Coupled Plasma/Mass Spectrometry (ICP/MS)

Test Performed at: LabCorp

Specimen: Submit a 10 ml aliquot of a 24 hour urine collection in a urine container washed with acid. A random specimen in an acid-washed container is also acceptable. Urine containers with preservative are supplied by Shore Health Laboratories. It is important that he specimen be obtained, processed, and transported according to the instructions on page 257, “Metal Analysis Collection and Transport”. Store at Toom Temperature.

NOTE: 1. Patient should not eat seafood for 48 hours prior to start of collection. 2. Follow patient instructiosn for “24 Hour Urine Collections” supplied by Shore Health Laboratories.

Reference Values: Normal Concentration: <80 ug/L / 24 hr urine Analytic Time: 4 days Days Test Set Up: Monday, Wednesday, Friday CPT Code(s): 82175 82570

ASA (ASPIRIN) See: “Drug Screen, Plasma” "Drug Screen, Plasma and Urine" “Salicylate, Serum”

ASCORBIC ACID (VITAMIN C) HPLC

Test Performed at: LabCorp Specimen: 1 SST tube (minimum 2 ml serum ). Separate and Freeze specimen. Wrap in foil to protect. Chill tube before collection. Reference Values: 0.4 – 2.0 mg/dl Analytic Time: 2 day Days Test Set Up: Tuesday, Thursday CPT Code(s): 82180

ASO (ANTISTREPTOLYSINO) SLIDE TEST, (QUALITATIVE) See: “Streptozyme, Serum”

ASOT (Streptozyme) See: “Streptozyme”

ASPARTATE AMINOTRANSFERASE (AST/SGOT) See: “Aspartate Aminotransferase (AST/SGOT), Serum" “Hepatic Panel” “Comprehensive Metabolic Panel”

ASPARTATE AMINOTRANSFERASE (AST/SGOT), SERUM Enzymatic

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: 7 - 40 U/L Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84450

ASPERGILLUS SEROLOGY Latex Agglutination

Test Performed At: Maryland State Health Department

Specimen: 1 SST tube (minimum 2.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen. Reference Value: Negative Analytic Time: 21-28 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86331 x 3

ASPIRIN (ACETYLSALICYLATE) See: “Drug Screen, Plasma” “Drug Screen, Plasma and Urine” “Salicylate, Serum”

AST/SGOT (ASPARTATE AMINOTRANSFERASE) See: “Aspartate Aminotransferase (AST/SGOT), Serum" “Hepatic Function Panel” “Comprehensive Metabolic Panel”

AUSTRALIA ANTIGEN See: “Hepatitis Bs Antigen (HBsAg), Serum” “Acute Hepatitis Profile”

AUSTRALIA Bs ANTIBODY See: “Hepatitis Bs Antibody (Anti-HBs), Serum”

AUTOANTIBODIES TO Scl 70, Serum EIA. Useful for evaluation of patients suspected of having scleroderma

Test Performed At: LabCorp

Specimen: 1 plain red-top tube or 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Store at Room Temperature.

Reference Value: Negative <1.00 Positive >1.06 Analytic Time: 2 days

Day(s) Test Set Up: Monday - Friday CPT Code(s): 86235

AUTOANTIBODIES TO Sm, Serum Enzyme Immunoassay (EIA)

Test Performed At: LabCorp

Specimen: 1 plain red-top tube or 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate Specimen. Ship at Room Temperature. Can be stored 7 days at refrigerated temperature.

Reference Value: Expected values <1.0 Index - Negative >1.0 Index - Positive Analytic Time: 1 day Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 86235

AUTOANTIBODIES TO SSA (Ro), Serum Enzyme Immunoassay (EIA)

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Ship at Room Temperature. Can be stored 7 days at refrigerated temperature.

Reference Value: See report Analytic Time: 1 day Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 86235

AUTOANTIBODIES TO SSB (La), Serum Enzyme Immunoassay (EIA)

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Ship at Room Temperature. Can be stored 7 days at refrigerated temperature.

Reference Value: See report Analytic Time: 1 day Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 86235

AUTOANTIBODIES TO RNP, Serum Enzyme Immunoassay (EIA)

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Ship at Room Temperature. Can be stored 7 days at refrigerated temperature.

Reference Value: See report Analytic Time: 1 day Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 86235

AUTOANTIBODIES TO SSA(Ro) AND SSB(La), Serum Enzyme Immunoassay (EIA)

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Ship at Room Temperature. Can be stored 7 days at refrigerated temperature.

Reference Value: See report Analytic Time: 1 day Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 86235 X2

AUTOMATED REAGIN TEST (ART) SEROLOGY See: “Syphilis Serology”

B12 ASSAY See: “Vitamin B 12 and Folate, Serum”

BACILLUS, ACID FAST See: “Culture, Acid-Fast Bacillus”

BACTERIA CULTURE See: “Culture, Bacteria (Not Listed)”

BACTERIAL MENINGITIS ANTIGENS See: “Directigen, Spinal Fluid”

BACTERIAL SEROLOGY, SERUM Available for Tetanus antitoxins, Tularemia, and Typhoid & Paratyphoid.

Test Performed At: Maryland State Health Department

Specimen: 1 SST tube (minimum 5.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen. NOTE: 1. Acute and convalescent specimens are needed to interpret the results. The convalescent specimen should be obtained 2-3 weeks after onset.

2. Label specimen appropriately (acute or convalescent). 3. Type of bacteria is required on request form for processing .

Reference Values: Antigen dependent TETANUS ANTIBODY 0.01 IU/ml: indicates immunity Analytic Time: 21-28 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86280

BARBITURATES See: “Drug Screen, Urine” “Drug Screen, Plasma and Urine”

BART'S HEMOGLOBIN See: “Hemoglobin Electrophoresis, Blood”

BENZEDRINE® (AMPHETAMINES) See: “Amphetamines, Urine” “Drug Screen, Plasma and Urine"

BENZODIAZEPINES See: “Diazepam and Nordiazepam, Serum” “Drug Screen, Urine” “Drug Screen, Plasma and Urine"

BETACAROTENE See: “Carotene, Serum"

BETAhCG (Human Chorionic Gonadotropin) See: “Alpha-Fetoprotein (AFP) Triple Screen, Serum” “Chorionic Gonadotropin, Beta-Subunit (Quantitative), Serum”

BETAHYDROXYBUTYRATE, SERUM Photometric

Test Performed At: LabCorp

Specimen: 1 plain red-top tube or 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Separate and Freeze.

Reference Value: <0.4 mmol/L Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82010

BETA2MICROGLOBULIN, SERUM Microparticle Enzyme Immunoassay (MEIA)

Test Performed At: LabCorp

Specimen: 1 plain red-top tube or 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate.

Reference Value: See copy of report Analytic Time: 1 day Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 82232

BETATHALASSEMIA See: “Hemoglobin Electrophoresis, Blood”

BETATOCOPHEROL See: “Vitamin E, Serum”

BILIRUBIN See: “Bilirubin, Direct, Serum” “Bilirubin, Total, Neonatal, Serum” “Bilirubin, Total, Serum” “Hepatic Function” “Comprehensive Metabolic Panel”

BILIRUBIN, DIRECT, SERUM Spectrophotometry

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml serum; pediatric 0.2 ml serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen. Protect specimen from light.

Reference Values: 0.0-0.3 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82251

BILIRUBIN, TOTAL, NEONATAL, SERUM Spectrophotometry

Note: This assay is performed on infants from birth to 21 days of age only.

Test Performed At: Shore Health Laboratories

Specimen: 1 full Capiject® — usually from heel. Refrigerate specimen. NOTE: Protect specimen from light . Specimen should be transported to laboratory as soon as possible.

Reference Values: Age dependent Critical Value: Age dependent. See page 29. Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82250

BILIRUBIN, TOTAL, SERUM Spectrophotomerty

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml; pediatric- 0.2 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen after collection. Protect specimen from light.

Reference Values: 0.1-1.4 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82250

BLADDER CANCER, DNA (FISH) (UroVysion)

Test Performed At: LabCorp

Specimen: TCC monitoring kit to collect urine. Follow instructions provided by LabCorp. Submit 33-60 ml TCC preserved urine. Refrigerate . Must be at LabCorp within 72 hours . Reference Value: See copy of report Analytic Time: Day(s) Test Set Up: CPT Code(s): Determined upon completion of testing.

BLOOD COUNT See: “Blood Count” “Prenatal Panel”

BLOOD COUNT Automated. Includes WBC, RBC, hemoglobin, hematocrit, platelets, MCV, MCH, MCHC, RDW, 5 part differential: granulocytes, lymphocytes, monocytes, eosinophils, and basophils.

Test Performed At: Shore Health Laboratories

Specimen: 1 lavender-top (K2 EDTA) tube (minimum: 3.0 ml blood) or 1 pediatric lavender-top (K2 EDTA) tube (minimum 0.5 ml blood).

Reference Values: See Report Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 85025 - CBC

BLOOD CULTURE See: “Culture, Blood”

BLOOD FILMS FOR MALARIAL PARASITES See: “Malaria Smear”

BLOOD SUGAR See: “Glucose, Plasma or Serum” “Basic Metabolic Panel” “Renal Function Panel"

BLOOD UREA NITROGEN (BUN) See: “Basic Metabolic Panel” “Renal Function Panel” “Urea Nitrogen, Serum"

BLOOD TYPE See: “Type, Blood”

BNP (Brain Natriuretic Peptide) FIA

Test Performed At: Shore Health Laboratories

Specimen: 1 large lavender top (EDTA) tube (minimum 3 ml whole blood).

Reference Values: 5-99 pg/ml Analytic Time: 1 day Day(s) Test Set Up: Daily

BODY FLUID CULTURE See: “Culture, Fluid (Not Spinal Fluid)"

BONE MARROW STUDY Includes staining and interpretation.

Test Performed At: Shore Health Laboratories

Specimen: Call Chesapeake Pathology in Easton at (410) 820-0019. Bone marrow aspirate requires air-dried smear slides and a peripheral blood smear, if possible. When available, the clot section of marrow is fixed and sent to the lab in formalin. A bone marrow core biopsy requires the biopsy to be fixed in Bouin’s fixative for 1-2 hours and transported to the lab.

Reference Values: The laboratory will provide an interpretive report. Analytic Time: 2 days Day(s) Test Set Up: By appointment CPT Code(s): 85095 - aspiration 85102 - biopsy

BORRELIA BURGDORFERI (LYME DISEASE SPIROCHETE) DETECTION BY POLYMERASE CHAIN REACTION (PCR) PCR and DNA Probe Hybridization. Useful for diagnosis of active Lyme disease.

Test Performed At: LabCorp

Specimen: Blood: 1 ml lavender-top (EDTA) tube. Maintain at Room Temperature. CSF or Synovial Fluid: 1 plain red-top tube (minimum 1.0 ml of fluid). Refrigerate specimen in screw-capped sterile vial after collection. Maintain sterility and forward promptly. NOTE: 1. The plain red-top tube should NOT contain gel or silicone. 2. Indicate CSF, synovial fluid, or whole blood on request form. 3. Label tube with type of specimen.

Reference Values: Not detected Analytic Time: 3 days Day(s) Test Set Up: Monday, Thursday CPT Code(s): 87476 83890

BRUCELLA CULTURE See: “Culture, Blood, Brucella”

BRUCELLA SEROLOGY, SERUM IgG Antibody Titers to B.abortus and B.canis

Test Performed At: Maryland State Health Department

Reference Values: B.abortus < 1:160 B.canis < 1:80 Analytic Time: 21 – 28 days Day(s) Test Set Up: Monday – Friday CPT Code(s): 86622

BUN (BLOOD UREA NITROGEN) See: “Basic Metabolic Panel” “Renal Function Panel” “Urea Nitrogen, Serum”

BUPRENORPHINE, URINE (SUBOXONE) Lateral flow chromatographic immunoassay

Test Performed At: Shore Health Laboratories Specimen: 10 ml from a random urine collection in a urine sample cup supplied by Shore Health Laboratories. Minimum volume of 1ml. No preservative. Refrigerate specimen.

Reference Values: Negative Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 80300

C1 ESTERASE INHIBITOR, FUNCTIONAL (SERUM OR PLASMA) EIA

Test Performed At: LabCorp

Specimen: Serum: 1 plain red top tube (minimum 0.5 ml serum). Separate and freeze serum. Plasma: 1 EDTA lavender tube (minimum 0.5 ml plasma). Separate and freeze.

Reference Values: Normal >67% normal activity. Analytic Time: 5-7 days Day(s) Test Set Up: Tuesday & Thursday CPT Code (s): 86161

C1 ESTERASE INHIBITOR, SERUM Immunologic, Quantitative

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml serum) from a fasting patient. Separate from cells within 30 minutes. Store at room temperature.

Reference Values: 21-39 mg/dl Analytic Time: 2 days Day(s) Test Set Up: Monday, Wednesday, & Friday CPT Code(s): 86160

C1q (COMPLEMENT COMPONENT C1q), SERUM

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml serum). Separate and store at room temperature.

Reference Values: 11.8-23.8 mg/dl Analytic Time: 5 days Day(s) Test Set Up: Monday and Friday CPT Code(s): 86160

C2 FUNCTION, SERUM Radial Immunodiffusion. This test is useful to measure hemolytic activity of Complement C2.

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml serum). Separate and store at room temperature.

Reference Values: 1.6-4.0 mg/dl Analytic Time: 5 days Day(s) Test Set Up: Wednesday, Friday CPT Code(s): 86160

C3 (THIRD COMPONENT OF COMPLEMENT) See: “C3 (Third Component of Complement), Serum" “Lupus Comprehensive Panel”

C3 (THIRD COMPONENT OF COMPLEMENT), SERUM Turbidimetric

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: 75-135 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 86160

C4 (FOURTH COMPONENT OF COMPLEMENT), SERUM Turbidimetric

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: 16-37 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 86160

C5 (COMPLEMENT FUNCTIONAL), SERUM

Test Performed At: LabCorp

Specimen: 1 plain red-top tube (minimum 0.5 ml serum). Separate and freeze (-70C) serum. Reference Values: See report Analytic Time: 3 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86160

C6 COMPLEMENT COMPONENT Radioimmunoassay (RIA)

Test Performed At: LabCorp

Specimen: 1 Lavender (EDTA) tube (minimum 1.0 ml plasma). Separate and freeze plasma.

Reference Values: See report Analytic Time: 2 days Day(s) Test Set Up: Tuesday, Thursday CPT Code(s): 86160

CA (CALCIUM) See: “Calcium, Feces” “Calcium, Ionized, Serum” “Calcium Load, Urine” “Calcium, Serum” “Calcium, Urine” “Comprehensive & Basic Metabolic Panel” “Renal Function Panel”

CA 2729

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: 0.0-38.6 U/ml Analytic Time: 3 days Day(s) Test Set Up: Monday through Friday CPT Code(s): 86300

CA 153 (CANCER ANTIGEN 153) See: “Cancer Antigen 15-3 (CA 15-3), Serum”

CA 125 (CANCER ANTIGEN 125) See: “Cancer Antigen 125 (CA 125), Serum”

CA 199 (CARBOHYDRATE ANTIGEN 199) See: “Carbohydrate Antigen 19-9 (CA 19-9), Serum”

CADMIUM, BLOOD (ICP/MS)

Test Performed At: LabCorp

Specimen: 1 royal blue top(EDTA) trace element blood collection tube. Submit original tube. It is important that the specimen be obtained, processed, and transported according to

instructions on page 257 “Metal Analysis – Collection and Transport.” Send at Room Temperature

Reference Values: <5.0 ug/ml Analytic Time: 2 days Day(s) Test Set Up: Monday-Friday CPT Code(s): 82300

CAFFEINE, SERUM Immunoassay

Test Performed At: LabCorp

Specimen: 1 plain red-top tube (minimum 1.0 ml serum). Refrigerate serum.

Reference Values: Therapeutic concentration: 315 ug/ml Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82491

CALCITONIN (ICMA)

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1 ml serum). Allow blood to clot 1-4 hrs. in refrigerator. Spin and separate. Freeze immediately.

Reference Values: ADULT BASAL Males: <=8.4 Females: <=5.0 Analytic Time: 2 days Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 82308

CALCIUM See: "Calcium Stool" "Calcium Ionized, Serum" "Calcium, Urine" "Comprehensive & Basic Metabolic Panel" "Renal Function Panel"

CALCIUM, IONIZED, SERUM Ion-Selective Electrode (ISE)

Test Performed At: LabCorp

Specimen: 1 SST tube. Must be kept intact – do not separate or remove stopper . Refrigerate.

NOTE: If other tests are ordered in conjunction with ionized calcium, a separate specimen must be drawn just for this test.

Reference Values: 4.5-5.6 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 82330

CALCIUM, IONZIED, SERUM, CALCULATED

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube Must be kept intact- do not separate or remove stopper. Refrigerate NOTE : If other tests are ordered in conjunction with ionized calcium, Separate specimens must be drawn .

Reference Values: 4.2 – 5.1 mg/dl Critical Value: < 3.3 or > 6.2 mg/dl Analytic time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82330

CALCIUM PYROPHOSPHATE CRYSTALS See: "Crystals, Body Fluids”

CALCIUM PYROPHOSPHATE DIHYDRATED (CPPD) See: “Crystals, Body Fluids"

CALCIUM, SERUM Indirect Potentiometry

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate.

Reference Values: 8.4-10.1 mg/dl Critical Value: < 6.6 or > 12.9 mg/dl Note : Patients given a radiological contrast agent can have falsely low or falsely normal calcium levels. Analytic time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82310

CALCIUM, URINE Indirect Potentiometry

Test Performed At: Shore Health Laboratories

Specimen: Submit an entire 24-hour urine collection. Urine containers are supplied by Shore Health Laboratories. Refrigerate specimen during and after collection. NOTE: 1. Follow guidelines in “Patient Instructions for 24-Hour Urine Collection” supplied by Shore Health Laboratories. 2. Urine creatinine must be >500 mg/24 hours for results to be valid.

3. Random urine may be submitted for testing. No normal ranges exist for random specimens.

Reference Values: 40-350 mg/24 hours Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82340 - calcium 81050 - urine timed measurement

CALCULUS, RENAL STONE Crystallographic Examination

Test Performed At: LabCorp

Specimen: Place entire specimen in a snap cap vial or similar vial. Do not tape the specimen to anything – tape interferes with the analytical procedure. Sample must be completely dry. Send at room temperature.

Reference Values: Quantitative report Analytic Time: 14-21 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 82360

CAMPYLOBACTER PYLORI (HELICOBACTER PYLORI) See: “Helicobacter pylori lgG Antibody, Serum”

CANCER ANTIGEN 199 (CA 199) See: “Carbohydrate Antigen 19-9 (CA 19-9), Serum ”

CANCER ANTIGEN 153 (CA 153), SERUM (BR MONITOR) Chemiluminescence

Test Performed At: Shore Health Laboratories Specimen: 1 plain, red-top tube or 1 SST tube (minimum 3.0 ml of serum). Refrigerate specimen.

Reference Values: 0.0 – 31.0 U/ml Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 86316

CANCER ANTIGEN 125 (CA 125), SERUM (OV MONITOR) Chemiluminescence

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen. Reference Values: 0 - 35 U/ml Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 86316

CANDIDA ANTIGEN/ANTIBODY, SERUM (IgG, IgA, IgM) EIA

Test Performed At: LabCorp

Specimen: 2 plain red-top tubes or 2 SST tubes (minimum 3.0 ml serum). Centrifuge SST within 30 minutes of draw. Refrigerate serum.

NOTE: Positive results are titered.

Reference Values: Negative Analytic Time: 3 days Day(s) Test Set Up: Tuesday, Friday CPT Code(s): 86628

CARBAMAZEPINE10,11 EPOXIDE High-Performance Liquid Chromatography (HPLC) Useful for monitoring serum concentrations in patients who may be producing significant levels of the active metabolite epoxide.

Test Performed At: LabCorp

Specimen: 1 plain red-top tube (minimum 1.0 ml serum). Refrigerate serum.

NOTE: The plain red top tube should NOT contain gel or silicone.

Reference Values: Therapeutic concentration: 0.2-2.0 ug/ml Analytic Time: 3-5 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 82542

CARBAMAZEPINE, SERUM PETINIA Technique

Test Performed At: Shore Health Laboratories

Specimen: 1 plain red-top tube (minimum 0.5 ml of serum). Refrigerate specimen. NOTE: 1. The plain, red-top tube should NOT contain gel or silicone. 2. With patient at steady state (chronic oral dosing of 2-6 days), draw trough specimen immediately before next dose.

Reference Values: Therapeutic concentration: 4-12 ug/ml Critical Value: > 20 ug/ml Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 80156

CARBAMAZEPINE (TEGRETOL) See: “Carbamazepine-10, 11 -Epoxide, Plasma” “Carbamazepine, Serum”

CARBOHYDRATE ANTIGEN 199 (CA 199) SERUM (GI MONITOR) Chemiluminescence

Test Performed At: Shore Health Laboraories

Specimen: 1 plain, red-top tube or 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: 0.8 – 35 U/ml NOTE: This test is for investigational use only. Its analytic performance has been validated, but the reagents are not FDA approved. Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 86301

CARBOHYDRATE DEFICIENT TRANSFERRIN, SERUM ESI/MS and Affinity Chromatography Useful for detecting carbohydrate deficient glycoprotein syndrome.

Test Performed At: LabCorp

Specimen: 1 SST tubes (minimum 1.0 ml serum). Centrifuge 30 minutes after collection. Separate and freeze serum.

Reference Values: See report Analytic Time: 3-5 days Day(s) Test Set Up: Monday and Thursday CPT Code(s): 82373

CARBON DIOXIDE See: “Basic & Comprehensive Metabolic Panel” “Carbon Dioxide” “Electrolyte Panel” “Renal Function Panel”

CARBON DIOXIDE ISE

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml serum). Centrifuge SST 30 minutes after draw. Do not remove stopper from tube. Refrigerate specimen.

Reference Values: 24 - 35 meq/L Critical Value: < 11 or > 40 meq/L Analytic Time: 1 day Days Test Set Up: Daily CPT Code(s): 82374

CARBON MONOXIDE SCREEN See: “Carboxyhemoglobin"

CARBOXYHEMOGLOBIN Spectrophotometry. Used for the determination of CO poisoning and toxicity.

Test Performed At: Respiratory Therapy-SHL

Specimen: 1 green-top (Sodium Heprin) tube or 1 EDTA lavender top tube or 1 gray (sodium fluoride) tube (minimum 2 ml whole blood). Do NOT transfer to another vial. Place on wet ice for transport.

Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82375

CARCINOEMBRYONIC ANTIGEN (CEA), SERUM Chemiluminescence

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: 0-3 ng/ml Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82378

CARISOPRODOL, BLOOD GC

Test Performed At: LabCorp

Specimen: 1 plain red-top tube (minimum 2.0 ml serum). Refrigerate serum.

NOTE: The plain red top tube should NOT contain gel or silicone.

Reference Values: Therapeutic concentration: 6-12 ug/ml Analytic Time: 5-7 dayS Day(s) Test Set Up: Tuesday and Thursday CPT Code(s): 82491

CARNITINE, TOTAL AND FREE LCMS-MS

Test Performed At: LabCorp

Specimen: 2 SST tubes(minimum 3.0 ml serum). Separate from cells within 5 hours of collection and freeze.

Reference Values: See report Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 82379

CAROTENE, SERUM HPLC

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 2.0 ml serum). Draw specimen following an overnight (12-14 hour) fast. Patient must not consume any vitamin supplements or foods containing Vitamin A or carotene for 48 hours before specimen is collected. Freeze specimen. Protect specimen from light.

Reference Values: 10-85 ug/dl Analytic Time: 2 days Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 82380

CATECHOLAMINE FRACTIONATION, PLASMA, FREE High Pressure Liquid Chromatography (HPLC) Includes unconjugated norepinephrine, epinephrine, total catecholamines, and dopamine.

Test Performed At: LabCorp

Specimen: Patient should avoid alcohol, coffee, tea, tobacco, and strenuous exercise prior to collection. Draw 2 green top (Sodium Heparin) tubes. Patients should be at rest for 30 minutes. Draw specimen with patient in the supine position. Patient should then sit up for 15 minutes. Draw another specimen with patient in an upright position. Label respective specimens supine and upright. Uses 3 ml plasma from each green top Sodium heparin tube. Separate and pour off in correctly labeled tubes and freeze as soon as possible. Serum is not acceptable.

NOTE: Discontinue epinephrine and epinephrine-like drugs as least 1 week prior to obtaining sample.

Reference Values: Age related, see report Analytic Time: 3 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 82384

CATECHOLAMINE FRACTIONATION, URINARY, FREE (24 hour or random sample) High Pressure Liquid Chromatography (HPLC)

Test Performed At: LabCorp

Specimen: Submit 30 ml of a 24 hour urine collection in a brown urine container with 30 ml 6N HCL (pH <=3.0). Refrigerate specimen during and after collection. Urine containers are supplied by Shore Health Laboratories. This assay is most valuable when the specimen is collected during an hypertensive episode. Mandelamine interferes with the test procedure and should be discontinued 48 hours prior to collection of specimen.

Random urine samples can also be submitted. Send 10 ml of a random collection. Adjust pH < 3.0 with 6N HCL.

Refrigerate sample.

NOTE: Follow guidelines in “Patient Instructions for 24 hour Urine Collection” supplied by Shore Health Laboratories.

Reference Values: See report Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 82384

CBC (COMPLETE BLOOD COUNT) See: “Blood Count”

CBC / DIFF (COMPLETE BLOOD COUNT / DIFFERENTIAL) See: "Blood Count"

CEA (CARCINOEMBRYONIC ANTIGEN) See: “Carcinoembryonic Antigen (CEA), Serum”

CELIAC COMPHRENSIVE AB PANEL (6) Includes Gliadin IgG + IgA; t-Transgluataminase IgG+ IgA; Endomysial IgA and Total IgA. EIA; indirect immunofluorescence

Test Performed At: LabCorp

Specimen: 2 SST tubes (minimum 3.0 ml of serum). Centrifuge 30 minutes after draw. Refrigerate specimen.

Reference Values : See report Analytic Time : 2 days Day(s) Test Set Up : Monday - Friday CPT(s) Code: 82784, 83516 x 4, 86255

CELL COUNT, DIFFERENTIAL See: “Cell Count, CSF” “Cell Count, Differential, Peritoneal Dialysate, Body Fluids/ Dialysis Fluid”

CELL COUNT, CSF Manual Count NOTE: This cell count does not include spinal fluid chemistries.

Test Performed At: Shore Health Laboratories

Specimen: 1 plain, red-top tube (minimum 3.0 ml of spinal fluid) divided into 3 plastic tubes each containing 1.0 ml.

NOTE: 1. The plain, red-top tube should not contain gel or silicone. 2. Label specimens appropriately (1, 2, and 3).

Reference Values: RBC: 0 WBC: 0-5/mm 3

Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 89051

CELL COUNT, DIFFERENTIAL, PERITONEAL DIALYSATE, FLUID Manual Count Cell count includes a 5-part differential: polys, eosinophils, basophils, lymphocytes, monocytes, and segs.

Test Performed At: Shore Health Laboratories

Specimen: 1 green-top (heparin) tube (minimum 2.0 ml of heparinized fluid).

Reference Values: RBC: 0 WBC: < 100/mm 3 (Culture if WBC is > 100/mm 3)

Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 89051

CELL COUNT, BODY FLUID Manual Count. Includes differential, RBC, and WBC.

Test Performed At: Shore Health Laboratories

Specimen: 1 green-top (heparin) tube (minimum 2.0 ml of heparinized joint fluid). Indicate type of fluid.

Reference Values: RBC: 0 WBC: < 500/mm 3

(granulocytes:< 25%/mm 3)

Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 89051

CENTROMERE B ANTIBODIES, SERUM Immunofluorescence. If positive, a titer will be performed

Test Performed At: LabCorp

Specimen: 1 plain red-top tube or 1 SST tube (minimum 1.0 ml serum). Centrifuge SST 30 minutes after draw. Store at room temperature.

Reference Values: Normal: titer <1:40 Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 86235

CERULOPLASMIN, SERUM Immunoassay

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml serum) from a fasting specimen. Centrifuge 30 minutes after draw. Separate and refrigerate serum.

Reference Values: Adult males: 16.2-35.6 mg/dl Adult females: 17.9-53.3 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 82390

CG (CHORIONIC GONADOTROPIN) See: “Alpha-Fetoprotein (AFP) Triple Screen, Serum” “Alpha-Subunit of Pituitary Glycoprotein Hormones (a-PGH), Serum” “Chorionic Gonadotropin, Beta-Subunit (Quantitative), Serum” “Chorionic Gonadotropin, Beta-Subunit (Quantitative), Spinal Fluid” “hCG (Human Chorionic Gonadotropin), Quantitative (Titer), Serum” “Pregnancy Test, Qualitative, Serum” “Pregnancy Test, Urine”

CHLAMYDIA CULTURE See: "Culture, Chlamydia trachomatis”

CHLAMYDIA trachomatis by Nucleic Acid Amplification (Genprobe® Aptima®) Useful for detection of Chlamydia trachomatis from female endocervical and male urethral swab specimens.

Note: Chlamydia trachomatis and Neisseria gonorrhoeae may be detected in cervical or urethral specimens using a single sample.

Test Performed At: Shore Health Laboratories

Specimen: Acceptable sites are female endocervix and male urethral. Must use Genprobe - Aptima® Unisex Swab collection kit. Collect specimen as follows:

Endocervix (Females Only) 1. Remove excess mucus from cervical os and surrounding mucosa using the Aptima® Cleaning Swab provided in the collection kit. Dispose of the cleaning swab. 2. Insert the Aptima® Unisex Collection Swab (blue shaft) into endocervical canal. 3. Gently rotate swab clockwise for 10-30 seconds in the endocervical canal to ensure adequate sampling. 4. Withdraw swab without touching the vaginal mucosa. 5. Remove the cap from the swab specimen transport tube and immediately place the specimen collection swab into the the transport tube. 6. Carefully break swab shaft at score marking. Use care to avoid splashing or spilling of the transport media in the transport tube. 7. Replace cap tightly and transport to the laboratory.

Urethra (Males Only) Note: The patient should not have urinated for at least 1 hour prior to specimen collection. 1. Insert the Aptima® Unisex Collection Swab (blue shaft) 2-4 cm into urethra. 2. Gently rotate the swab clockwise for 2-3 seconds to ensure adequate sampling. 3. Withdraw the swab carefully. 4. Remove the cap from the swab specimen transport tube and immediately place the specimen collection swab into the the transport tube. 5. Carefully break swab shaft at score marking. Use care to avoid splashing or spilling of the transport media in the transport tube. 6. Replace cap tightly and transport to the laboratory.

NOTE : 1. Culture site is required on request form for processing. 2. Vaginal specimens are not acceptable.

Reference Values: Negative Analytic Time: 1 day Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 87491

CHLAMYDIA PNEUMONIAE ANTIBODY PANEL (IGG AND IGM) Micro Indirect Fluorescent Antibody (IFA) Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml serum). Refrigerate serum. Reference Values: Index <0.91 Negative Additional interpretive information provided with report. Analytic Time: 2 days Day(s) Test Set Up: Monday - Saturday CPT Code(s): 86632 86631

CHLAMYDIA SEROLOGY IgG ANTIBODY, SERUM EIA Tests for Chlamydia group IgG antiboby

Test Performed At: Maryland State Health Department

Specimen: 1 SST tube (minimum 2.0 ml of serum). Centrifuge SST 30 minutes after draw . Refrigerate specimen. NOTE : 1. Acute and convalescent specimens recommended. Convalescent specimen should be obtained 2-3 weeks after onset. 2. Label specimens appropriately (acute or convalescent).

Reference Values: 0.01 – 1.09 Analytic Time: 3-4 weeks Day(s) Test Set Up: Monday - Friday CPT Code(s): 86631

CHLAMYDIA TRACHOMATIS See: “Chlamydia by Nucleic Acid Amplification – Genprobe ®-Aptima®” “Chlamydia Pneumoniae Antibody Panel, Micro IFA” “Culture, Chlamydia trachomatis ”

CHLORIDE See: "Basic Metabolic Panel" “Chloride, Serum” “Chloride, Urine” “Comprehensive Metabolic Panel” “Renal Function Panel” “Electrolyte Panel”

CHLORIDE, SERUM Ion specific electrode

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: 95 – 108 meq/L Critical Value: 0 days - 17 yrs old: < 77 or > 121 meq/L 18 yrs old Adult: < 75 or > 126 meq/L Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82465

CHLORIDE, URINE Ion specific electrode

Test Performed At: Shore Health Laboratories

Specimen: 2.0 ml from a random urine collection in a urine sample cup supplied by Shore Health Laboratories, or an entire 24-hr urine collection in a urine container with no preservative. 24-hr urine containers are supplied by Shore Health Laboratories. Refrigerate 24-hr urine specimen during and after collection. NOTE: Follow guideslines in “Patient instructions for 24-hr urine collection” supplied by Shore Health Laboratories.

Reference Values: 110-250 meq/24 hrs No normal ranges for random specimens. Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82465

CHOLESTEROL See: “HDL Cholesterol, Serum” “Lipid Panel"

CHOLESTEROL CRYSTALS See: “Crystals, Body Fluids or Urine”

CHOLESTEROL, HDL (HIGH DENSITY LIPOPROTEIN) See: “Lipid Panel” “HDL Cholesterol, Serum”

CHOLESTEROL, LDL (LOW DENSITY LIPOPROTEIN) See: “Lipid Panel”

CHOLESTEROL, SERUM Spectrophotometry

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum: 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen. NOTE : Include patient’s age and sex on request form.

Reference Values: Reference values vary with age and sex. Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82465

CHOLINESTERASE See: “Acetylcholinesterase, Erythrocytes” “Pseudocholinesterase, Total, Serum”

CHORIONIC GONADOTROPIN (CG) See: “Alpha-Fetoprotein (AFP) Triple Screen, Serum” “Alpha-Subunit of Pituitary Glycoprotein Hormones (a-PGH), Serum” “hCG (Human Chorionic Gonadotropin), Quantitative (titer), Serum” “Pregnancy Test, Qualitative, Serum” “Pregnancy Test, Urine”

CHROMIUM, PLASMA Flameless Atomic Absorption Spectrometry

Test Performed At: LabCorp

Specimen: 2 royal blue top (EDTA) trace element tubes (minimum 3.0 ml plasma). It is important that the specimen be obtained, processed, and transported according to instructions on page 257 “Metals Analysis – Collection and Transport.” Store at room temperature.

Reference Values: <2.1 ug/L Analytic Time: 1 day Day(s) Test Set Up: Tuesday and Thursday CPT Code(s): 82495

CHROMIUM, URINE Atomic Absorption Spectrometry

Test Performed At: LabCorp

Specimen: Submit 5 ml of random urine collection in an acid washed urine container. It is important that the specimen be obtained, processed, and transported according to instructions on page 257 “Metal Analysis – Collection and Transport.” Store at room temperature.

NOTE: Patient should refrain from taking vitamins with minerals 1 week prior to collection.

Reference Values: See report Analytic Time: 7 days Day(s) Test Set Up: Wednesday CPT Code(s): 82495 82570

CHROMOSOME ANALYSIS, AMNIOTIC FLUID Does not include alpha-fetoprotein.

Test Performed At: LabCorp (052040)

Specimen: Obtain specimen durint the 15 th -16 th week of gestation. Draw 20 ml of amniotic fluid in a sterile syringe. Remove needle and transfer the specimen to 2 screw-capped, sterile 15 ml centrifuge tubes. Bloody specimens are undesirable. If the specimen does not grow in culture, you will be notified within 10 days of receipt. Label container with patient’s name. Keep specimen at room temperature after collection. SPECIMEN CANNOT BE FROZEN.

NOTE: Please complete a “Cytogenetics/AFP Congenital Disorders Request Form” and forward it with the specimen. This form is supplied by Shore Health Laboratories.

Reference Values: See report Analytic Time: 12-14 days Day(s) Test Set Up: Daily CPT Code(s): 88291 88280 88269 88235 88285

CHROMOSOME ANALYSIS, FOR CONGENITAL & HEMATOLOGIC DISORDERS, BLOOD Tissue Cultures

Test Performed At: LabCorp

Specimen: 1 green top (heparin) tube (minimum 5 ml.; pediatric 1-2 ml of sodium heparin whole blood). Maintain sterility. Invert several times to mix blood. (Clotted blood is not acceptable). Other anticoagulants may be harmful to the viability of the cells. Label vial with patient’s name and laboratory control number. ROOM TEMP ONLY. Do not collect on Fridays or Holidays. May refrigerate if there is a delay.

NOTE: Patient should refrain from taking vitamins with minerals 1 week prior to collection.

Reference Values: See report of the representative karyotype. Analytic Time: 2-3 weeks Day(s) Test Set Up: Monday - Sunday CPT Code(s): 88262 88291 88230

CHROMOSOME ANALYSIS, FOR HEMATOLOGIC DISORDERS, BONE MARROW Includes 2-banded karyotypes, analysis of 20 or more metaphases whenever possible, and other banding techniques when required.

Test Performed At: LabCorp

Specimen: 2 ml bone marrow aspirate in a green top (sodium heparin) tube. Other anticoagulants may be harmful to the viability of the cells. Label vial with patient’s name and laboratory control number. ROOM TEMP ONLY. Bone marrow is the recommended specimen for most

neoplastichematologic disorders, because only about 60% of blood specimens produce adequate metaphases for interpretation. Studies on blood are informative mainly in advanced myeloproliferative disorders.

NOTE: Please include diagnosis.

Reference Values: See report Analytic Time: 3-4 weeks Day(s) Test Set Up: Monday - Friday CPT Code(s): 88237 88264 88291 88280 x2

CK (CREATINE KINASE See: “Creatine Kinase (CK) MB Isoenzyme, Serum” “Creatine Kinase (CK), Serum”

CLINITEST® ON STOOL See: “Reducing Substance, Feces”

CLONAZEPAM, SERUM HPLC

Test Performed At: LabCorp

Specimen: 2 plain, red top tubes (minimum 4.0 ml of serum). Refrigerate specimen.

NOTE: The plain red top tube should NOT contain gel or silicone.

Reference Values: Therapeutic concentration: 15-60 ng/ml Toxic concentration (automatic callback): >=70 ng/ml

Analytic Time: 1 day Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 80154

CLOSTRIDIUM DIFFICILE TOXIN A & B, FECES (NAAT)

Test Performed At: Shore Health Laboratories Specimen: Suitable specimens are unformed stool specimens (liquid or soft stool) of patients suspected of having Clostridium difficile associated disease (CDAD). Formed stool specimens will be rejected.

Using a clean, non-sterile or sterile container:

1. Place a minimum of 1.5 g of liquid or soft stool into the container, taking care not to transfer toilet paper, urine, water or soap. Refrigerate specimen if transport is delayed. Forward specimen promptly on wet ice.

Reference Values: Negative Analytic Time: 1 day Day(s) Test Set Up: Sunday - Friday CPT Code(s): 87493

CLOZAPINE (CLOZARIL), SERUM LC/TMS

Test Performed At: LabCorp

Specimen: 1 plain red top tube (minimum 1.0 ml of serum). Refrigerate. NOTE: The plain red top tube should NOT contain gel or silicone.

Reference Values: Peak: 102-771 ng/ml Trough: 41-343 ng/ml Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 80154

COAGULATION, SPECIFIC FACTOR ASSAYS, PLASMA Photometric Clot Detection FACTOR II ACTIVITY – LABCORP 086231 FACTOR V ACTIVITY – LABCORP 086249 FACTOR VII ACTIVITY – LABCORP 800599 FACTOR VIII ACTIVITY—LABCORP 086264 FACTOR IX ACTIVITY – LABCORP 086298 FACTOR X ACTIVITY – LABCORP 086306 FACTOR XI ACTIVITY – LABCORP 086314 FACTOR XII ACTIVITY – LABCORP 086322 FACTOR XIII ACTIVITY—LABCORP 500185 Coagulation testing is highly complex, often requiring the performance of multiple assays and correlation with clinical information. Factor assays are available individually. Each assay utilizes the same specimen requirements that are listed once to prevent repetition. Order the specific factor required.

Test Performed At: LabCorp

Specimen: Draw blood in a 3.2 sodium citrate (light blue) tube. Centrifuge, remove plasma, spin plasma again, and FREEZE. Need 3 ml plasma.

Reference Values: 50-150% of Normal for all factors Analytic Time: 1 day Day(s) Test Set Up: Varies CPT Code(s): 88210 – Factor II 85220 – Factor V 85230 – Factor VII 85240 – Factor VIII 85250 – Factor IX 85260 – Factor X 85270 – Factor XI 85280 – Factor XII 85290 – Factor XIII

COBALAMIN See: “Vitamin B 12 and Folate, Serum”

COCAINE See: “Cocaine Confirmation, Urine” “Drug Screen, Urine” “Drug Screen, Whole Blood”

COCAINE CONFIRMATION, URINE Gas Chromatography/Mass Spectrometry (GC/MS) for Confirmation

Test Performed At: LabCorp

Specimen: 20 ml from a random urine collection in a urine sample cup supplied by Shore Health Laboratories. No preservative. Room Temperature.

Reference Values: None detected Analytic Time: 3 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 82520

COCCIDIOIDES See: “Fungus Serology, Serum”

CODEINE, QUANTITATIVE (OPIATE CONFIRMATION, BLOOD) Gas Chromatography/ MS

Test Performed At: LabCorp

Specimen: 2 gray top tubes (12 ml). Store at Room Temperature.

Reference Values: See report Analytic Time: 3-5 days Day(s) Test Set Up: Tuesday and Friday CPT Code(s): 83925

COLD AGGLUTININ TITER, SERUM Cold Hemagglutination. Red cell agglutination at 4 °C.

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Do not refrigerate prior to separation of serum from red cells. Separate serum from red cells immediately after blood clots. Refrigerate specimen after separation.

Reference Values: < 1:32 Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 86157

COMPLEMENT See: “Cl Esterase Inhibitor, Serum” “C2 Function, Serum” “C1q (Complement Component C1q), Serum” “C3 (Third Component of Complement), Serum” “C4 (Fourth Component of Complement), Serum” “C5 (Fifth Component of Complement), Serum” “C6 Complement Component” “Complement, Total, Serum”

COMPLEMENT, C3 See: “C3 (Third Component of Complement), Serum” “Lupus Comprehensive Panel”

COMPLEMENT, C4 See: “C4 (Fourth Component of Complement), Serum” “Lupus Comprehensive Panel”

COMPLEMENT, TOTAL SERUM (CH50) Enzyme Colorimetry

Test Performed At: LabCorp

Specimen: 1 plain red top tube or 1 SST tube (minimum 1.0 ml of serum). Centrifuge, separate from clot, and freeze serum immediately in plastic vial. Avoid hemolysis.

Reference Values: 26-58 U/ml Analytic Time: 1 day Day(s) Test Set Up: Monday - Saturday CPT Code(s): 86162

CONJUGATED BILIRUBIN See: “Bilirubin, Direct, Serum”

COOMBS, DIRECT, BLOOD (DAT) Anti-Human Globulin

Test Performed At: Shore Health Laboratories

Specimen: 1 pink-top blood bank tube (minimum 5 ml whole blood). Avoid hemolysis.

NOTE: Include report of diagnosis and history of transfusions, pregnancy, and drug therapy.

Reference Values: Negative (Agglutination or hemolysis indicates a positive test) Day(s) Test Set Up: Daily Analytic time: 1 day CPT Code(s): 86880

COPPER, SERUM/PLASMA ICP/MS

Test Performed At: LabCorp

Specimen: 1 royal blue top trace element collection tube – no additive. Minimum 1.0 ml of serum. It is important that the specimen be obtained, processed , and transported according to the instructions on page 257, “Metals Analysis – Collection and Transport.” Serum – 1 red top tube. Send at room temperature.

Reference Values: Environmental exposure – 70-155 ug/dl Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 82525

COPPER, URINE Inductively Coupled Plasma (ICP) Spectroscopy/MS

Test Performed At: LabCorp

Specimen: Submit 5 ml of random or 24 hour urine collection in plastic urine collection. It is important that the specimen be obtained, processed, and transported according to instructions on page 257 “Metal Analysis – Collection and Transport.” Store at room temperature.

NOTE: Follow guidelines in “Patient Instructions for 24 hour Urine Collection” supplied by Shore Health Laboratories.

Reference Values: 2-30 ug/L Analytic Time: 3 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 82525 82570

CORD BLOOD WORKUP, BLOOD Hemoagglutination - Group Agglutination - Group Solid Phase - DAT Anti-Human Globulin - DAT

Test Performed At: Shore Health Laboratories

Specimen: 1 pink-top Blood Bank Tube (minimum 5.0 ml of whole cord blood)

Reference Values: Negative Solid Phase - DAT (adherence of Capture-Ready Indicator Red Cells to part or all of reaction surface indicates a Positive Test) Negative Coombs - DAT (Agglutination or hemolysis indicates a Positive Test)

Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 86900 – ABO Type 86901 – Rh Type 86880 – Coombs, Direct

CORTICOSTEROIDS See: “Cortisol, Serum"

CORTISOL, FREE URINE LC/MS Useful for patients who are not, or are not suspected to be, taking exogenous glucocorticoids. This is the recommended routine procedure.

Test Performed At: LabCorp

Specimen: Submit 10-100 ml of a 24 hour urine collection in a 24 hour urine container. 24 hour containers with no preservative or with 1 gram boric acid or 6N HCl are all acceptable. Refrigerate container during collection.

NOTE: Follow guidelines in “Patient Instructions for 24 hour Urine Collection” supplied by Shore Health Laboratories.

Reference Values: Age dependant – See report. Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 82530

CORTISOL, SERUM

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 2.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: A.M. 5 - 25 ug/dl P.M. 2.5 -12.5 ug/dl Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s) : 82533

CORTISOL STIMULATION, SERUM See: “Adrenocorticotrophic Hormone (ACTH) Stimulation, Serum”

COXSACKIE VIRUS A ANTIBODY SERUM, IGG (A7, A9, A16, A24) Complement Fixation

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Label specimen appropriately (acute or convalescent). Refrigerate.

NOTE: Acute and convalescent specimens are needed to interpret the results. The convalescent specimen should be obtained 2-3 weeks after onset.

Reference Values: Negative <1:8 Analytic Time: 3-5 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86658 x4

COXSACKIE VIRUS A ANTIBODY SERUM, IGM (A7, A9, A16, A24) Complement Fixation

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Label specimen appropriately (acute or convalescent). Refrigerate.

NOTE: Acute and convalescent specimens are needed to interpret the results. The convalescent specimen should be obtained 2-3 weeks after onset.

Reference Values: Negative <1:8 Analytic Time: 3-5 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86658 x4

COXSACKIE VIRUS B ANTIBODY (TYPES 16), SERUM Complement Fixation

Test Performed At: LabCorp

Specimen: 3 ml serum from 2 SST tubes. Refrigerate.

Reference Values: See report. Analytic Time: 3 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86658 x6

CPEPTIDE Chemiluminescence

Test Performed At: LabCorp

Specimen: 1 ml serum from a red top or SST tube. Centrifuge, separate serum and refrigerate specimen.

Reference Values: 1.1-4.4 ng/ml Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 84681

CPK (CREATINE PHOSPHOKINASE See: “Creatine Kinase (CK) MB lsoenzyme, Serum” “Creatine Kinase (CK), Serum"

CREACTIVE PROTEIN (NONCARDIO) Turbidimetric Immunoassay

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube supplying 1 ml serum. Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Value: 0.0-0.75 mg/dl Analytic time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 86140

CREACTIVE PROTEIN HIGH SENSITIVITY Turbidimetric Immunoassay

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube supplying 1 ml serum. Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Value: 0.0-0.3 mg/dl Analytic time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 86141

CREATINE KINASE (CK) MB ISOENZYME, SERUM Enzyme Immunoassay Useful for predicting the presence of an acute myocardial infarction.

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

NOTE: 1. Include date and time of collection on request form. 2. Strenuous exercise or intramuscular injections may cause transient elevation of CK isoenzymes.

Reference Values: MB: < 5 ng/ml Relative Index < 4 Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82553 - CK isoenzymes

CREATINE KINASE (CK), SERUM Spectrophotometry

Test Performed At: Shore Health Laboratories Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen after collection.

NOTE: 1. Include date and time of collection on request form. 2. Strenuous exercise or intramuscular injections may cause transient elevation of CK isoenzymes.

Reference Values: Males: 35-232 U/L Females: 21-215 U/L Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82550

CREATINE PHOSPHOKINASE See: “Creatine Kinase (CK), Serum"

CREATINE, URINE Enzymatic Colorimetric

Test Performed At: LabCorp (003475)

Specimen: Submit 10 ml from 24 hour urine collection in a urine container with no preservative. Urine containers are supplied by Shore Health Laboratories. Refrigerate specimen during and after collection. Send aliquot frozen.

NOTE: Follow guidelines in “Patient Instructions for 24 Hour Urine Collection” supplied by Shore Health Laboratories.

Reference Values: Males: 0-40 mg/24 hr. Females: 0-80 mg/24 hr. Analytic Time: 1 day Day(s) Test Set Up: Tuesday, Friday CPT Code(s): 82540

CREATININE See: “Creatinine Clearance, Serum and Urine” “Creatinine, Serum” “Creatinine, Urine” “Comprehensive and Basic Metabolic Panel” “Renal Function Panel"

CREATININE CLEARANCE, SERUM AND URINE Jaffe Reaction

Test Performed At: Shore Health Laboratories

Specimen: Both serum and urine are required for this test. Blood specimen should be obtained sometime during the 24-hour period of urine collection. Serum: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen after collection. Urine: Submit an entire 24-hour urine collection in a urine container with no preservative. Urine containers are supplied by Shore Health Laboratories. Refrigerate specimen during and after collection.

NOTE: 1. Follow guidelines in “Patient Instructions for 24-Hour Urine Collection” supplied by Shore Health Laboratories. 2. Patient’s height and weight are required on request form for processing.

Reference Values: 70-120 ml/min Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82575 - creatinine clearance 81050 - urine timed measurement

CREATININE, SERUM Jaffe Reaction

Test Performed At: Shore Health Laboratories Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: 0.6-1.3 mg/dl Critical Value: Age 0 days-18yrs=>3.8 mg/dl. Age 19yrs-Adult = >7.4 mg/dl. Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82565

CREATININE, URINE 24 hr Jaffe Reaction

Test Performed At: Shore Health Laboratories Specimen: Submit an entire 24-hour urine collection in a urine container with no preservative. Urine containers are supplied by Shore Health Laboratories. Refrigerate specimen during and after collection. Random specimens also acceptable. NOTE: Follow guidelines in “Patient Instructions for 24-Hour Urine Collection” supplied by Shore Health Laboratories.

Reference Values: 600-2500 mg/24 hr. No normal ranges established for random specimens. Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82570 - creatinine 81050 - urine timed measurement

CRP (CREACTIVE PROTEIN) See: “C-Reactive Protein (CRP), High Sensitivity" “C-Reactive Protein (Non-Cardio)”

CRYOGLOBULIN, SERUM Manual, Qualitative

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 2.0 ml of serum). Centrifuge SST 30 minutes after draw. NOTE: Keep specimen at room temperature until after centrifugation and separation of cells.

Reference Values: Negative Analytic Time: 3 days Day(s) Test Set Up: Daily CPT Code(s): 82595

CRYPTOCOCCUS ANTIGEN, SERUM Latex Agglutination

Test Performed At: LabCorp

Specimen: 1 SST tube or plain red top tube (minimum 2.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen in a screw-capped, sterile vial after collection. Maintain sterility and forward promptly.

Reference Values: Negative If positive, results are titered. Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 86406

CRYPTOCOCCUS ANTIGEN, SPINAL FLUID Complement Fixation

Test Performed At: LabCorp

Specimen: 0.5 ml CSF in sterile plastic tube. Refrigerate.

Reference Values: Negative If positive, results are titered Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 87899

CRYPTOSPORIDIUM ANTIGEN, FECES Immunoassay Useful for screening for the detection of Cryptosporidium antigen present in stool specimens.

Test Performed At: Shore Health Laboratories

Specimen: Patient should avoid using Imodium® AD prior to collecting specimen as it can interfere with detection of low levels of Cryptosporidium.

Collect approximately 2 grams of fresh stool and use a Formalin/PVA ParaPak® supplied by Shore Health Laboratories for transport. Refrigerate fresh stool specimen and forward promptly on wet ice. Formalin preserved or ParaPak PVA/Formalin ® tightly sealed specimen should be kept at ambient temperature.

Reference Values: Negative Analytic Time: 1 day Day(s) Test Set Up: Monday-Friday CPT Code(s): 87328

CRYSTALS See: “Crystals, Body Fluids”

CRYSTALS, BODY FLUIDS Polarized Microscopy

Test Performed At: Shore Health Laboratories

Specimen: Body Fluid : 1 green-top (heparin) tube (minimum 2.0 ml of heparinized fluid). NOTE: Type of fluid is required on request form for processing .

Reference Values: No crystals seen AnalyticTime: 1 day Day(s) Test Set Up: Daily CPT Code(s): 89060

CULTURE, ACIDFAST BACILLUS Includes acid-fast smear.

Test Performed At: Shore Health Laboratories

Specimen: Blood and Body Fluids: 2 green-top (sodium heparin) tube (minimum 4.0 ml). Send specimen in a tightly screwed, capped sterile vial. Maintain sterility and forward promptly at ambient temperature. NOTE: 1. If specimen is used for bacterial culture, keep specimen at ambient temperature only. 2. Culture site is required on request form for processing.

Bronchial Washings, Gastric Contents, Lung Aspirates, or Sputum: Refrigerate specimen in a tightly screwed, capped sterile container after collection. Maintain sterility and forward promptly, ideally within 30 minutes of collection, but at least the same day. NOTE: 1. Sputum must be obtained from first morning specimen. It is recommended to collect 3 first- morning specimens on 3 separate days. 2 .No more than 1 specimen collection per day will be accepted. 3. If routine bacterial culture is also desired, collect another specimen and forward promptly at ambient temperature. 4. Culture site is required on request form for processing .

Tissue: 1 g of tissue. Refrigerate specimen in a tightly screwed, capped sterile container. Maintain sterility and forward promptly. NOTE: 1. If bacterial culture is also desired, keep specimen at ambient temperature only. 2. Culture site is required on request form for processing.

Urine: Submit entire fully voided, first a.m. specimen. It is recommended to collect 3 first morning specimens on 3 separate days. Refrigerate specimen in a screw-capped, sterile container after collection. Maintain sterility and forward promptly. NOTE: No more than 1 specimen collection per day will be accepted.

Reference Values: Not applicable Positive cultures are referred to the Maryland State Health Department for identification and sensitivity. Certain positive cultures may be referred to Lab Corp for susceptibilities. Analytic Time: 1 day - acid-fast smear

56 days (8 weeks) - culture Day(s) Test Set Up: Daily CPT Code(s): 87206 - acid-fast smear 87117 – culture

CULTURE, BACTERIA (NOT LISTED) Includes both aerobic and anaerobic culture.

Test Performed At: Shore Health Laboratories

Specimen: Sample should arrive within 24 hours of collection. Acceptable sources normally are abscesses, skin, drainages, tissue, catheter tips, and wounds. Collect specimen in a sterile tightly sealed container or by using a Culture swab® which is supplied by Shore Health Laboratories. Forward promptly at ambient temperature only NOTE: Culture site is required on request form for processing.

Reference Values: Not applicable AnalyticTime: 2-5 days Day(s) Test Set Up: Daily CPT Code(s): 87076

CULTURE, BETA STREP, THROAT

Test Performed At: Shore Health Laboratories

Specimen: Swab of affected area placed in transport media. NOTE: This is a test for Group A Strep and Beta Strep, Not Group A only. When physician requests other pathogens isolated, you must order Culture, Throat

Reference Values: Not applicable Analytic Time: 2-3 days Days(S) Test Set Up: Daily CPT Code(s): 87081

CULTURE, BLOOD

Test Performed At: Shore Health Laboratories

Specimen: See page 14 for complete collection instructions. 2 blood culture bottles (aerobic [blue] and anaerobic [purple]). 5 –10 ml of whole blood in each bottle. Forward promptly at ambient temperature only. NOTE: If 3 -9 ml of blood is collected, place all of the collected blood in the blue-top bottle. If < 3.0 ml of blood collected put a minimum of 0.5ml to 3.0 ml in the Peds Plus bottle (pink top)

Reference Values: Not applicable Positives results will be called upon initial detection. Analytic Time: 5 days Day(s) Test Set Up: Daily CPT Code(s): 87040

CULTURE, BLOOD, BRUCELLA

Test Performed At: Shore Health Laboratories

Specimen: 3 blood culture bottles: 1 standard aerobic (blue), 1 lytic (purple), and 1 Mycolytic (red). 5 - 10 ml of whole blood in each bottle. Forward promptly at ambient temperature only. See page 14 for sterile technique for arm prep and bottle collection, but use 1 Standard Aerobic, 1 Lytic and 1 Mycolytic broth bottles.

Reference Values: Not applicable Analytic Time : 28 days Day(s) Test Set Up: Daily CPT Code(s): 87040

CULTURE, BLOOD, FUNGUS

Test Performed At: Shore Health Laboratories

Specimen: 2 Mycolytic blood culture bottles (Mycolytic broth). Minimum 5.0 ml of whole blood in each bottle. Forward promptly at ambient temperature only. See page 14 for sterile technique for arm prep and bottle collection, but use Mycolytic broth blood culture bottles.

Reference Values: If positive for molds, isolate will be referred to Lab Corp for identification. Positives for yeast are identified at Shore Health Laboratories.

Analytic Time : Positives are reported when detected. Negatives are reported in 28 days. Day(s) Test Set Up: Daily CPT Code(s): 87103

CULTURE, BODY FLUID See: “Culture, Fluid (Not Spinal Fluid)”

CULTURE, BONE MARROW

Test Performed At: Shore Health Laboratories

Specimen: Bone Marrow aspirate collected in lavender top tube or in aerobic (blue) and anaerobic (purple) blood culture bottles

Reference Values: Not applicable Analytic Time: 5 days Day(s) Test Set Up: Daily CPT Code(s): 87070

CULTURE, BORDETELLA PERTUSSIS

Test Performed At: Maryland State Health Department

Specimen: 2 nasopharyngeal (not throat) swabs collected using a “Pertussis Collection Kit” supplied by the Maryland State Health Department or Shore Health Laboratories. NOTE: Follow guidelines in “Pertussis Collection Kit.”

Reference Values: Negative Analytic Time: 14-28 days culture Days(s) Test Set Up: Daily CPT Code(s): 87163 – additional identification methods required 87140 – culture, typing, fluorescent method

CULTURE, CHLAMYDIA TRACHOMATIS Cell Culture Isolation

Test Performed At: LabCorp

Specimen: Acceptable Culture Sites: Endocervix, eye, nasopharynx, throat, rectum, urethra, fluid aspirate or tissue. Unacceptable Culture Sites: Urine, vagina, any discharges, stool.

1. Use Viral, Chlamydia, or Mycoplasma Culture Transport Medium. Bring to room temperature before inoculation. 2. Collect specimen using a sterile non-wooden shafted swab. 3. Obtain epithelial cells from infected site (i.e. Insert swab 2-3 cm into male urethral or endocervix) 4. Place swab in media. 5. Tightly cap the tube and place in a tightly sealed plastic bag. 6. Refrigerate immediately.

NOTE: Culture site is required on request form for processing.

Reference Values: Negative (reported as positive or negative). Asymptomatic, sexually active persons may harbor C. trachomatis in rates ranging from 0-7%. However these apparently asymptomatic individuals will commonly have pyuria demonstrated by urinalysis. Analytic Time: 3 days Day(s) Test Set Up: Monday - Saturday CPT Code(s): 87110 87140

CULTURE, CYTOMEGALOVIRUS (CMV), URINE Spin Amplification Culture

Test Performed At: LabCorp (008201)

Specimen: 4 ml urine from first morning or random collected specimen in a sterile screw capped container. Maintain sterility and forward promptly. Refrigerate specimen.

Reference Values: See report

Analytic Time: 2 weeks Day(s) Test Set Up: Daily CPT Code(s): 87252 87254

CULTURE, CSF See: “Culture, Spinal Fluid (with Gram Stain)

CULTURE, DOCTOR’S OFFICE WORKUP

Test Performed At: Shore Health Laboratories

Specimen: Culture plate of urine, throat, etc. Forward promptly at ambient temperature only. NOTE: Culture site is required on request form for processing.

Reference Values: Not applicable Analytic Time: 2-4 days Day(s) Test Set Up: Daily CPT Code(s): 87070

CULTURE, ENVIRONMENTAL

Test Performed At: Shore Health Laboratories

Specimen: Environmental swab collected using a Culture swab Plus® which is supplied by Shore Health Laboratories. NOTE: Culture site is required on request form for processing.

Reference Values: Not applicable Analytic Time: 2-5 days Day(s) Test Set Up: Daily CPT Code(s): 87070

CULTURE, FLUID (NOT SPINAL FLUID)

Test Performed At: Shore Health Laboratories

Specimen: 1 green-top (sodium-heparin) tube (minimum 0.2 ml of heparinized fluid other than spinal fluid). Forward promptly at ambient temperature only. Do not refrigerate . NOTE: Culture site is required on request form for processing.

Reference Values: Not applicable Analytic Time: 2-5 days Day(s) Test Set Up: Daily CPT Code(s): 87070

CULTURE, FUNGUS

Test Performed At: Shore Health Laboratories

Specimen: For all specimens- Culture site is required on request form for processing.

Body Fluids: 1 green-top (sodium heparin) tube, minimum: 5.0 ml of heparinized fluid. Refrigerate specimen in a tightly screw-capped, sterile container. Maintain sterility and forward promptly. NOTE: If specimen is used for bacterial culture, keep specimen at ambient temperature only.

Bronchial Washings, Gastric Contents, Lung Aspirates, or Sputum: Refrigerate specimen in a tightly screw-capped, sterile container. Maintain sterility and forward promptly. NOTE: Sputum must be obtained from first a.m. specimen. If specimen is used for bacterial culture, keep specimen at ambient temperature only.

Tissue: 1 g of tissue. Refrigerate specimen in a tightly screw-capped, sterile container. Maintain sterility and forward promptly. NOTE: If specimen is used for bacterial culture, keep specimen at ambient temperature only.

Urine: Submit entire fully voided, first a.m. specimen. Refrigerate specimen in a tightly screw-capped, sterile container. Maintain sterility and forward promptly.

Reference Values: Negative. If positive for molds, isolate will be referred to Lab Corp for identification. Positives for yeast are identified at Shore Health Laboratories. Analytic Time: Positives are reported when detected, Negatives are reported in 28 days Day(s) Test Set Up: Daily CPT Code(s): 87106 - culture, fungus, definitive 871 02 - culture, fungus, isolation, other

CULTURE, GARDNERELLA VAGINALIS NOTE: This is a test for Gardnerella ONLY. If physician requests other Pathogens isolated, you must order “Culture, Genital.”

Test Performed At: Shore Health Laboratories

Specimen: Sample must arrive within 4 hours of collection. Cervical, urethral, or vaginal swab placed in transport medium. NOTE: Culture site is required on request form for processing.

Reference Values: No Gardnerella vaginalis isolated Analytic Time: 3 days Day(s) Test Set Up: Daily CPT Code(s): 87081

CULTURE, GC See: “Culture, Transgrow ®”

CULTURE, GENITAL

Acceptable sources: cervix, labia, lochia, penis, urethra, vagina, vaginal wash, and vulva

Test Performed At: Shore Health Laboratories

Specimen: Swab of genital area placed in transport medium. NOTE: For GC culture, refer to “Culture, Transgrow®. Culture site is required on request form for processing.

Reference Values: Not applicable Analytic Time: 2-5 days Day(s) Test Set Up: Daily CPT Code(s): 87070

CULTURE, GENITAL + ANAEROBE

Acceptable Sources: Amniotic fluid, bartholin, endometrium, fallopian tube, perineum, placenta, prostatic fluid, scrotum, semen, umbilical cord, uterus, uterine curettings

Test Performed At: Shore Health Laboratories Specimen: Swab of affected area placed in transport medium or specimen in tightly sealed sterile container. Specimen in sterile container should be received within 1 hour of collection. Forward promptly at ambient temperature. Culture site is required on requent form for processing. Reference Values: Not applicable Analytic Time: 3 - 5 days Day(s) Test Set Up: Daily CPT Code(s): 87070

CULTURE, GROUP B STREP SCREEN NOTE: This is a test for Group B Strep ONLY. When Physician requests other pathogens isolated, you must order “Culture, Genital”

Test Performed At: Shore Health Laboratories

Specimen: Vaginal/Rectal swab(s) placed in transport medium.

Reference Values: Not applicable AnalyticTime: 3-5 days Day(s) Test Set Up: Daily CPT Code(s): 87081

CULTURE, MRSA (METHICILLIN (OXACILLIN)RESISTANT STAPH AUREUS) SCREEN

• This test is for Infection Control Surveillance Use only. • Order Culture, Nose and comment, “R/O MRSA” for clinical cultures

Test Performed at: Shore Health Laboratories Specimen: Use one Culture swab Plus transport and swab both nares of the nose. Swab tip must be inserted up to 1 inch from edge of nares or until resistance is met at the level of the turbinates (which may be slightly less than 1 inch in neonates and infants). Roll the swab 5 times in each nares. Forward promptly at ambient temperature.

1. Nose (nares) is the only approved site for MRSA Screen Culture. Do not submit specimens other than nose for Culture MRSA Screen. 2. This culture is used to look for MRSA colonization. No antimicrobial susceptibilities will be reported. If physician requests other pathogens isolated, you must order Culture, Nose. Results from MRSA Screen cultures should be used as an adjunct to infection control efforts to identify patients needing isolation precautions. The test is not intended to identify patients with Staphylococcal infection. Results should not be used to guide or monitor treatment for MRSA infections.

Reference Values: No MRSA Isolated Analytic Time: 1 day Day(s) Set Up: Daily CPT Code(s): 87081

CULTURE, MYCOBACTERIA See: “Culture, Acid-Fast Bacillus"

CULTURE, MYCOPLASMA, RESPIRATORY Triphasic Culture System

Test Performed At: LabCorp

Specimen: Respiratory swab placed in special M4 transport media (blue cap). Refrigerate specimen. DO NOT use wooden shafted swabs. See p. 258 “Microbiology Specimen Guide for Mycoplasma and Viral Specimens.”

Reference Values: Not detected Analytic Time: 14 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 87109

CULTURE, MYCOPLASMA, GENITAL Triphasic Culture System

Test Performed At: LabCorp

Specimen: Urethral, vaginal, or cervical swab placed in special M4 transport media (blue cap). Refrigerate specimen. DO NOT use wooden shafted swabs.

Reference Values: Not detected Analytic Time: 6 days from inoculation Day(s) Test Set Up: Monday - Saturday CPT Code(s): 87109

CULTURE, NEISSERIA GONORRHOEAE See: “Culture, Transgrow "

CULTURE, NOCARDIA See: “Culture, Fungus”

CULTURE, NOSE

Test Performed At: Shore Health Laboratories

Specimen: Swab of affected area placed in transport medium.

Reference Values: Not applicable

Analytic Time: 2-3 days Day(s) Test Set Up: Daily CPT Code(s): 87060

CULTURE, PERITONEAL DIALYSATE

Test Performed At: Shore Health Laboratories

Specimen: At least 10cc of peritoneal dialysate collected in a sterile non-gel red top tube. Forward promptly at ambient tempreture.

Reference Values: Not applicable Analytic Time: 1 5 days Day(s) Test Set Up: Daily CPT Code(s): 87070

CULTURE, RESPIRATORY SECRETIONS

Acceptable specimens: sputum (exporated), bronchial brushings, bronchial washings, tracheal aspirate, trans- tracheal aspirate.

Test Performed At: Shore Health Laboratories

Specimen: Submit in a tightly sealed sterile container. Forward promptly at ambient tempreture; do not refrigerate.

Reference Values: Not applicable Analytic Time: 2 4 days Day(s) Test Set Up: Daily CPT Code(s): 87070

CULTURE, SPINAL FLUID (WITH GRAM STAIN)

Test Performed At: Shore Health Laboratories

Specimen: 1 plain (no additives) STERILE tube (tightly sealed). Minimum 1.0 ml of spinal fluid. Maintain sterility and forward immediately after collection at ambient temperature only . Do not refrigerate.

Reference Values: No growth Positive results will be called upon initial detection. Analytic Time: 5 days Day(s) Test Set Up: Daily CPT Code(s): 87070 - Culture 87205 - Gram stain

CULTURE, SPUTUM See: “Culture, Respiratory Secretions”

100

CULTURE, STOOL, FORMED

NOTE: Yersinia enterocolitica, Vibrio, Aeromonas, Plesiomonas, and E. coli: 0157 are tested by REQUEST ONLY. Campylobacter is tested on formed stools by request only.

1. No more than two specimens per patient should be submitted for routine bacterial culture without consulting with the Medical Director of Microbiology or the Infectious Disease Specialist, who may approve testing additional specimens under special circumstances.

2. Specimens for routine bacterial culture should not be submitted from inpatients after the third hospital day, without prior consultation with the Medical Director of Microbiology or the Infectious Disease Specialist, who may approve such testing under special circumstances.

3. Testing stool specimens for Clostridium difficile on patients over six months of age, with significant diarrhea and a history of exposure to antibiotics should be considered, especially for inpatients.

Test Performed At: Shore Health Laboratories

Specimen: 4.0 g of formed stool collected in a tightly sealed Para-Pak C&S® vial. Gray specimen cup for INPATIENT ONLY! Forward promptly at ambient temperature. Gray cups must be received within 1 hr of collection.

Reference Values: Not applicable Analytic Time: 2-4 days Day(s) Test Set Up: Daily CPT Code(s): 87045

CULTURE, STOOL, NOT FORMED

NOTE: Yersinia enterocolitica, Vibrio, Aeromonas, Plesiomonas, and E. coli:0157 are tested by REQUEST ONLY.

Test Performed At: Shore Health Laboratories

Specimen: 4.0 g of soft or liquid stool collected in a tightly sealed Para-Pak C&S® vial or on a rectal swab placed in transport media. Gray specimen cup for INPATIENT ONLY! Forward promptly at ambient temperature. Gray cups must be received within 1 hr of collection.

Reference Values: Not applicable Analytic Time: 2-4 days Day(s) Test Set Up: Daily CPT Code(s): 87045

101

87046

CULTURE, TB (TUBERCULOSIS) See: “Culture, Acid-Fast Bacillus”

CULTURE, THROAT

Test Performed At: Shore Health Laboratories

Specimen: Swab of affected area placed in transport medium.

Reference Values: Not applicable Analytic time: 2-4 days Day(s) Test Set Up: Daily CPT Code(s): 87060

CULTURE, TRANSGROW® NOTE: This is the preferred method for transport of specimens for GC culture.

Test Performed At: Shore Health Laboratories

Specimen: Transgrow® bottle inoculated with swab. Do not expose to extreme temperatures. Forward promptly at ambient temperature only. NOTE: Hold Transgrow® bottle vertically while inoculating. Culture site is required on request form for processing.

Reference Values: Not applicable Analytic Time: 3-5 days Day(s) Test Set Up: Daily CPT Code(s): 87081

CULTURE, UREAPLASMA UREALYTICUM See: “Culture Mycoplasma, Genital”

CULTURE, URINE

Test Performed At: Shore Health Laboratories

Specimen: Collect specimen from a clean-catch urine or from a catheterized patient. Refrigerate specimen in a tightly screwed capped, sterile container. Maintain sterility and forward promptly. NOTE: 1. Indicate if specimen is from a catheterized patient. 2. For adult urine collections, follow guidelines in “Laboratory Outpatient Instructions for Collection of Clean-Caught Midstream Urine for Culture” supplied by Shore Health Laboratories. 3. For pediatric urine collections, follow guidelines in “Laboratory Outpatient Instructions for Pediatric Urine Collections” supplied by Shore Health Laboratories.

Reference Values: No growth or no significant growth Analytic Time: 2-4 days Day(s) Test Set Up: Daily

102

CPT Code(s): 87086

CULTURE, URINE (CYSTOBLADDER)

Test Performed At: Shore Health Laboratories

Specimen: Collect specimen from a cystoscopic procedure in a sterile urine cup. Maintain sterility, refrigerate and forward promptly. NOTE: Indicate if specimen is cystoscopic, bladder or kidney urine.

Reference Values: No growth Analytic Time: 2-4 days Day(s) Test Set Up: Daily CPT Code(s): 87086

CULTURE, VIRAL

Test Performed At: Maryland State Health Laboratory

Specimen: Variable; depends on virus. See page 258, “Microbiology Specimen Guide for Mycoplasma and Viral Specimens.” Refrigerate specimen after collection and forward promptly. NOTE: Specific virus desired and culture site are required on request form for processing.

Reference Values: No virus isolated Analytic Time: 21-28 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 87253

CULTURE, WATERDIALYSIS UNIT

Test Performed At: Shore Health Laboratories Specimen: Refrigerate water in a screw-capped, sterile vial after collection. Maintain sterility and forward promptly.

Reference Values: No growth Analytic Time: 2-4 days Day(s) Test Set Up: Daily CPT Code(s): 87070

CULTURE, YEAST See: “Culture, Fungus” “Culture, Fungus, Blood”

CYANIDE, BLOOD

103

HPLC-FL

Test Performed At: LabCorp

Specimen: 1 gray top tube-whole blood specimen. Do not open, send whole tube. Refrigerate.

Reference Values: <10 ug/dl Analytic Time: 2 day Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 82600

CYANOCOBALAMIN See: “Vitamin B12 and Folate, Serum"

CYCLIC CITRULLINATED PEPTIDE AB (CCP) ELISA

Test Performed At: LabCorp

Specimen: 1 SST tubes (minimum 1.0 ml of serum). Centrifuge 30 minutes after draw. Refrigerate specimen.

Reference Values : 0 – 19 units Analytic Time : 2 days Day(s) Test Set Up : Monday - Friday CPT(s) Code: 86200

CYCLOSPORINE, BLOOD FPIA

Test Performed At: LabCorp

Specimen: 1 lavender top (EDTA) tube (minimum 2.0 ml of EDTA whole blood). DO NOT CENTRIFUGE. Send in original tube. Refrigerate specimen after collection.

NOTE: Therapeutic range applies to trough samples collected just prior to a.m. dose.

Reference Values: Trough therapeutic: 100-400 ng/ml Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 80158

CYSTIC FIBROSIS, CARRIER SCREEN (SCREENING FOR 32 MUTATIONS) PCR and Allele-Specific Hybridization, DNA Sequencing

Test Performed At: LabCorp Specimen: 2 EDTA lavender tube (minimum 4 ml of whole blood). Room temperature.

Reference Values: An interpretive report will be issued Analytic Time: 5 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 81220

104

CYSTIC FIBROSIS PLUS, CARRIER SCREEN (SCREENING FOR 97 MUTATIONS) PCR and Allele-Specific Hybridization, DNA Sequencing

Test Performed At: LabCorp Specimen: 2 EDTA lavender tube (minimum 4 ml of whole blood). Room temperature.

Reference Values: An interpretive report will be issued Analytic Time: 5 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 81220

CYSTINE, QUANTITATIVE, URINE HPLC

Test Performed At: LabCorp Specimen: 5 ml aliquot of 24 hour urine collection. Keep urine refrigerated during 24 hr urine collection. Add 30 ml 6N HCl. Check pH <=3.0. Freeze specimen. NOTE: Collect before IVP.

Reference Values: See report Analytic Time: 5-6 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 82131

CYTOLOGY, FINE NEEDLE ASPIRATE

Test Performed At: Shore Health Laboratories

Specimen: 1 slide container with 95% alcohol, Cytolyte® Filled Specimen Container, 10 positively charged slides, and 2 empty slide holders for air dried slides, labeled each with patient’s name in pencil. NOTE: 1. The following steps are done for each 'pass’. Five passes are typically done. 2. When there is sample in the syringe, draw air into the syringe. Place the open end of the needle against the slide about ½ inch from the frosted boundary and gently push a 2-3mm drop onto the slide. 3. Place another slide crosswise upside down on the 1 st slide and gently rotate until the slides fully contact, and the drop just begins to spread out. 4. Gently pull the slides apart. Place one slide into the alcohol jar immediately and the other slide is left to air dry. 5. After making the slides, rinse the needle and syringe in Cytolyte. Repeat steps four more times. 6. Please complete Chesapeake Pathology Associates Request Form and forward with the specimen. This form is supplied by Shore Health Laboratories. A copy of this form is also printed in the appendix. Requisitions for this procedure cannot be processed unless the requested information is supplied.

Reference Values: Negative for malignant cells Analytic Time: 3 days Day(s) Test Set Up: Monday – Friday CPT Code(s): 88173, 88305, 88162-59, 88160-59, 88112

CYTOLOGY, NIPPLE DISCHARGE

105

Test Performed At: Shore Health Laboratories

Specimen: 1 slide container with 95% alcohol. Slide(s) labeled with patient’s name in pencil. NOTE: 1. Gently massage the breast until the discharge is seen. Touch a glass slide to the discharge. Immediately place slide into 95% alcohol. Repeat if necessary. DO NOT allow the specimen on the slide to dry out. 2. Please complete Chesapeake Pathology Associates Request Form and forward with the specimen. This form is supplied by Shore Health Laboratories. A copy of this form is also printed in the appendix. Requisitions for this procedure cannot be processed unless the requested information is supplied.

Reference Values: Negative for Malignant Cells Analytic Time: 3 days Day(s) Test Set Up: Monday – Friday CPT Code(s): 88104

CYTOLOGY, THIN PREP Thin Prep®

Test Performed At: Shore Health Laboratories

Specimen: For non-pregnant women, the cytobrush/spatula is inserted into the cervical os and rotated one-quarter turn. Brush any other suspicious area of the ectocervix. Use the spatula/brush on any other suspicious areas. Thick areas of blood and mucus are to be avoided. We recommend the cytobroom for pregnant women or women with a stenotic os. After specimen collection, take the cytobrush and spatula and in a clockwise circular motion, rotate 10 X in the vial of Thin Prep® fixative. If using a broom, be sure to knock the tip against the bottom of the vial to dislodge cells. Dispose of applicator when done. Tightly close vial and label with patient’s full name.

NOTE: 1.The patient should be mid cycle. If a large amount of mucus or pus is on the cervix, gently remove it with a moistened cotton-wool swab prior to obtaining the sample. 2. FDA states that a cytobrush and plastic spatula combination, or cytobroom be used for obtaining pap smears using the Thin Prep process. A wooden spatula CANNOT be used. 3. Please complete “Chesapeake Pathology Associates Request Form” and forward it with the specimen. This form is supplied by Shore Health Laboratories. A copy of this form is also printed in the Appendix. Requisitions for this procedure cannot be processed unless the requested information requested supplied.

Reference Values: See report AnalyticTime: 2 weeks Day(s) Test Set Up: Monday - Friday CPT Code(s): 88142 – Thin Prep

CYTOLOGY, PAP SMEAR WITH MATURATION INDEX ThinPrep or Conventional

Test Performed At: Shore Health Laboratories

Specimen: For accurate Maturation Index the specimen must be taken from the lateral vaginal wall, NOT the cervix. Once the specimen is obtained, place in ThinPrep vial as for routine gyn cytology. Label with patient's full name.

Reference Values: See report Analytic Time: 2 weeks

106

Day(s) Test Set Up: Monday - Friday CPT Code(s): 88155

CYTOLOGY, SPUTUM

Test Performed At: Shore Health Laboratories

Specimen: Collect early morning deep cough in a specimen container. NOTE: 1. Follow guidelines in “Laboratory Outpatient Instructions for Sputum Collection” supplied by Shore Health Laboratories. 2. Please complete “Part B” of a “Chesapeake Pathology Associates Request Form” and forward it with the specimen. This form is supplied by Shore Health Laboratories. A copy of this form is also printed in the appendix. Requisitions for this procedure cannot be processed unless the information requested is supplied.

Reference Values: Descriptive report Analytic Time: 3 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 88107

CYTOLOGY, TISSUE See:" Histology, Tissue”

CYTOLOGY, URINE, PLEURAL FLUIDS, ABDOMINAL FLUIDS

Test Performed At: Shore Health Laboratories

Specimen: Urine, Pleural Fluids or Abdominal Fluids: Submit specimens in a screw-capped plastic container. DO NOT ADD ANY FIXATIVE TO THE CONTAINER. NOTE: 1. Include type of fluid on request form. 2. Please complete “Part B” of a “Chesapeake Pathology Associates Request Form” and forward it with the specimen. This form is supplied by Shore Health Laboratories. A copy of this form is also printed in the appendix. Requisitions for this procedure cannot be processed unless the information requested is supplied. Urine: Completely empty bladder and discard sample. Any urine other than the first morning urine is acceptable. Drink plenty of fluids (no alcoholic beverages), and try to move around before urinating. Start collecting urine in a specimen container; stop collecting urine before you have completely emptied your bladder. Try to collect at least 50 ml. Label all specimen cups with patient’s name. If the physician has ordered 3 consecutive day collection, you may store the first 2 days' urine in the refrigerator. NOTE: 1. Date and time of collection are required on request form for processing. 2. Follow guidelines in “Laboratory Outpatient Instructions for Urine Cytology” supplied by Shore Health Laboratories. 3. Please complete a “Chesapeake Pathology Associates Request Form” and forward it with the specimen. This form is supplied by Shore Health Laboratories. A copy of this form is also printed in the appendix. Requisitions for this procedure cannot be processed unless the information requested is supplied

Reference Values: Descriptive report Analytic Time: 3 days

107

Day(s) Test Set Up: Monday - Friday CPT Code(s): 8810

CYTOMEGALIC INCLUSION DISEASE (CMID) See: “Cytomegalovirus (CMV) Detection by Polymerase Chain Reaction (PCR), Spinal Fluid” “Cytomegalovirus (CMV) Serology, Serum"

CYTOMEGALOVIRUS (CMV) See: “Culture, Cytomegalovirus (CMV), Blood” “Culture, Cytomegalovirus (CMV), Urine” "Cytomegalovirus (CMV) Detection by Polymerase Chain Reaction (PCR), Spinal Fluid” “Cytomegalovirus (CMV) Serology, Serum"

CYTOMEGALOVIRUS (CMV) ANTIBODY (IgG), SERUM Enzyme-Linked Fluorescent Immunoassay (ELFIA)

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen. NOTE: 1. Acute and convalescent specimens are needed to interpret the results. The convalescent specimen should be obtained 3 weeks after onset. 2. Label specimens appropriately (acute or convalescent).

Reference Values: Negative: < 0.90 ISR Equivocal: 0.91-1.09 ISR A test value ≥ 1.10 ISR indicates exposure to CMV. A critical ratio value of > 4 determines a significant increase in antibody level, comparable to a fourfold rise in antibody titer. Critical ratio = Convalescent AU/ml Acute AU/ml A critical ratio of 2-4 is suggestive of an increasing antibody level. An additional convalescent sample should be retested in 7-14 days and used with the acute sample to recalculate the critical ratio. A critical ratio of < 2 indicates no significant change in antibody titer. Analytic Time: 1 day Day(s) Test Set Up: Tuesday & Friday CPT Code(s): 86644

CYTOPLASMIC NEUTROPHIL ANTIBODIES, SERUM (ANCA) Enzyme Immunoassay Includes cANCA, pANCA, MPO, and PR3

Test Performed At: LabCorp

Specimen: 2 SST tubes (minimum 3.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate. Avoid hemolysis.

NOTE: This test should not be mistaken for granulocyte antibodies.

Reference Values: See report

108

Analytic Time: 2 days Day(s) Test Set Up: Monday - Saturday CPT Code(s): 83520 x2 86256 x3

DARKFIELD SMEAR See: “Smear, Darkfield"

DDIMER, QUANTITATIVE Immunoturbidimetry

Test Performed At: Shore Health Laboratories

Specimen: MHE and QAEC: 1 blue-top (sodium citrate) tube. DGH: 1 Lavender (EDTA) tube

Reference Values: MHE and QAEC: 0.19-0.52 mg/L DGH: 100-400 ng/ml Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 85379

DEHYDROEPIANDROSTERONE SULFATE (DHEAS), SERUM

Test Performed At: Shore Health Laboratories

Specimen: 1 plain, red-top tube or 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: Age Dependent Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 82627

DEOXYCORTICOSTERONE Mass Spectrometry (MS)

Test Performed At: LabCorp (500138)

Specimen: 3.0 ml serum from 2 plain red top or 2 SST tubes. Freeze serum.

Reference Values: See report Analytic Time: 2 days Day(s) Test Set Up: Tuesday CPT Code(s): 82633

109

DEPAKENE® (VALPROIC ACID) See: “Valproic Acid, Serum”

DEPAKOTE® (VALPROIC ACID) See: “Valproic Acid, Serum”

DERMATOPATHOLOGY See: “Histology, Tissue”

DERMATOPHYTES See: “Culture, Fungus” “Culture, Fungus, Blood”

DESIPRAMINE (NORPRAMIN ) See: “Drug Screen, Plasma” “Drug Screen, Plasma and Urine” “Imipramine and Desipramine, Plasma” “Tricyclic Assay, Serum”

DEXAMETHASONE SUPPRESSION TEST, SERUM Fluorescent Polarization Immunoassay (FPIA)

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen. Morning (8 a.m.) and afternoon (4 p.m.) specimens are desirable. For diagnosis of depression disorders, give a 1 mg dose of oral dexamethasone at 11:30 p.m. Draw specimens the following day at 4 p.m. and 11 p.m. for cortisol levels. NOTE: 1. Include time of collection on request form. 2. If multiple specimens are collected, send separate request form for each specimen.

Reference Values: Cortisol levels Negative: 0-2.5 ug/dL Borderline: 2.5-4 ug/dL Positive: > 4 ug/dL Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82539

DHEA (DEHYDROEPIANDROSTERONE See: “Dehydroepiandrosterone (DHEA), Serum”

DHEA (DEHYDROEPIANDROSTERONE), UNCONJUGATED See: “Dehydroepiandrosterone (DHEA), Serum”

110

DHEAS (DEHYDROEPIANDROSTERONE SULFATE) See: “Dehydroepiandrosterone Sulfate (DHEA-S), Serum”

DIALYSIS FLUID COUNT See: “Cell Count, Differential, Peritoneal Dialysate, Body Fluids/Dialysis Fluid”

DIAZEPAM, SERUM HPLC

Test Performed At: LabCorp

Specimen: 1 plain red top tube (minimum 1.0 ml of serum). Draw prior to next dose. Refrigerate.

NOTE: 1. Record time of last dose, dosage level and time specimen was drawn. 2. The plain red top tube should NOT contain gel or silicone.

Reference Values: 0.1-2.5 ng/ml Analytic Time: 3 days Day(s) Test Set Up: Daily CPT Code(s): 80154

DIGOXIN, SERUM Microparticle Enzyme Immunoassay (MEIA)

Test Performed At: Shore Health Laboratories

Specimen: Peak: 1 SST tube (minimum 1.0 ml of serum) drawn 60-90 minutes after dose. Centrifuge SST 30 minutes after draw. Refrigerate specimen . Trough: 1 SST tube (minimum 1.0 ml of serum) drawn 8-24 hours after dose. Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: Therapeutic concentration: 0.8 -2.0 ng/ml Critical Value: > 2.5 ng/ml Pediatric toxic concentrations may be higher. Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 80162

DILANTIN® (PHENYTOIN) See: “Phenytoin, Total, Serum”

DIPHENYLHYDANTOIN See: “Drug Screen, Plasma” “Drug Screen, Plasma and Urine” “Phenytoin, Total, Serum”

DIPHTHERIA ANTITOXIN TITER, SERUM Indirect Hemagglutination

111

Test Performed At: Maryland State Health Department

Specimen: 1 SST tube (minimum 2.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: 0.01 IU/ml (indicates immunity) Analytic Time: 21-28 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86648

DIRECT BILIRUBIN See: “Bilirubin, Direct, Serum"

DIRECTIGEN, SPINAL FLUID Latex Agglutination. Includes Haemophilus influenza type B, Streptococcus pneumoniae, Neisseria meningitides, groups A, B, C, Y, W135, and Group B streptococcus.

Test Performed At: LabCorp

NOTE: This test can ONLY be used as an adjunct to bacterial culture. An order for bacterial culture MUST accompany this order.

Specimen: 1 plain red top tube (minimum 1.0 ml spinal fluid). Forward promptly. Refrigerate.

The plain red top should NOT contain gel or silicone.

Reference Values: Negative Analytic Time: 1 day Day(s) Test Set Up: Monday - Saturday CPT Code(s): 87802 87899 x3

DISOPYRAMIDE, SERUM (NORPACE) FPIA

Test Performed At: LabCorp

Specimen: 1 ml serum, collected before next dose. Do not use gel barrier tubes. Note time of last dose, dosage and collection time. Refrigerate.

Reference Values: Therapeutic concentration: 2.0-5.0 mcg/ml Toxic concentration: >8.0 mcg/ml Analytic Time: 1 day Day(s) Test Set Up: Monday - Saturday CPT Code(s): 80299

DIURNAL CORTICOIDS See: “Cortisol, Serum”

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DNA, ANTI See: “DNA Double Stranded (ds-DNA) Antibody, IgG, Serum” “LE Package (Quest)” “Lupus Comprehensive Panel"

DNA DOUBLE STRANDED (dsDNA) ANTIBODY, IGG, SERUM Enzyme-Linked Immunosorbent Assay (ELISA)

Test Performed At: LabCorp

Specimen: 1 plain red top tube or 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate.

Reference Values: <5 IU/ml >9.0 IU/ml Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 86225

DNA PLOIDY OF SOLID TUMOR BY FLOW CYTOMETRY, PARAFFIN BLOCK Flow Cytometry

Test Performed At: LabCorp

Specimen: Acceptable sources are: bladder, breast, colon, endometrium, kidney, prostate, and thyroid. Send paraffin-embedded specimen block at room temperature.

NOTE: Tumor description, diagnosis, pathologist’s name, address, and telephone number are required on request form for processing.

Reference Values: DNA diploid Analytic Time: 4 days Day(s) Test Set Up: Monday - Saturday CPT Code(s): 88182

DOXEPIN (SIN EQUAN) NDESMETHYLDOXEPIN, SERUM LCMS-MS

Test Performed At: LabCorp

Specimen: 1 ml serum from red top tube. Do not use gel barrier tubes. Collect 12 hours after last dose. Refrigerate.

Reference Values: Therapeutic concentration: 100-250 ug/L Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 80166

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DRUG SCREEN, URINE Immunochemical Drugs tested: Amphetamines, Barbiturates, Benzodiazepines, Cocaine, Opiates, Cannabinoids, & Oxycodone

Test Performed At: Shore Health Laboratories Specimen: 10 ml from a random urine collection in a urine sample cup supplied by Shore Health Laboratories. No preservative. Refrigerate specimen.

Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 80100 x13 - drug screen, urine

DRUG SCREEN COMPREHENSIVE, WHOLE BLOOD AND SERUM (COMA OVERDOSE) Immunochemical

Test Performed At: LabCorp (007022)

Specimen: 2 red top tube and 2 grey top (oxalate fluoride) tube (4 ml serum and 7 ml whole blood). Do not use gel barrier tubes. Refrigerate specimen.

Reference Values: Identification and quantitation when possible Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 80154 80101 x3 80185 80196 82003 82980 84600

DYSMORPHIC RBC Microscopy

Test performed At: LabCorp

Specimen: 10 ml random urine. Refrigerate.

Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 81001

ECHINOCOCCUS ANTIBODY, SERUM WB Confirmation

Test Performed At: LabCorp

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Specimen: 1 plain red top tube or 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

NOTE: For investigational use only. Not for use in diagnostic procedures without confirmation of the diagnosis by another medically established diagnostic product or procedure. Reference Values: Negative Analytic Time: 2 days Day(s) Test Set Up: One day a week CPT Code(s): 86682

EHRLICHIA CHAFFEENSIS ANTIBODY, SERUM Indirect Fluorescent Antibody (IFA)

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. NOTE: 1. Acute and convalescent specimens are needed to interpret the results.

Reference Values: See LabCorp Report. Analytic Time: 1-2 days Day(s) Test Set Up: Monday-Friday CPT Code(s): 86753

ELAVIL® (AMITRIPTYLINE) See: “Amitriptyline and Nortriptyline, Plasma” “Drug Screen, Plasma” “Drug Screen, Plasma and Urine”

ELECTROLYTES, FECES Ion selective electrode Includes sodium, potassium and chloride stool

Test Performed At: LabCorp (823262)

Specimen: 10 grams of 24 hr. timed stool collection. Refrigerate during collection.

NOTE: Patient should be experiencing diarrhea. Random specimens are acceptable. Liquid specimen only – freeze specimen. Solid samples will be rejected.

Reference Values: See report Analytic Time: 4 days Day(s) Test Set Up: Tuesday & Thursday CPT Code(s): 82438 84302 84999

ELECTROPHORESIS, PROTEIN, SERUM Agarose Electrophoresis-Helena. Includes total protein.

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

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Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: 2 times per week CPT Code(s): 84165 - electrophoresis, protein, 84155 - total protein

ELECTROPHORESIS, PROTEIN, URINE

Agarose Electrophoresis / Concentration. Includes total protein.

Test Performed At: Shore Health Laboratories

Specimen: 10 ml from a random urine collection in a urine sample cup supplied by Shore Health Laboratories. Refrigerate specimen.

Reference Values: Albumin only (present in small amount) NOTE: Factors cannot be separated if protein is < 25 mg/dl. Analytic Time: 1 day Day(s ) Test Set Up: twice weekly CPT Code(s): 84999 - concentration 84165 - electrophoresis, protein 84155 - total protein

ENVIRONMENTAL CULTURE See: “Culture, Environmental”

EOSINOPHILS, NASAL SMEAR See: “Nasal Smear for Eosinophils”

EOSINOPHILS, TOTAL, BLOOD Automated

Included as part of the CBC

Tes t Performed At: Shore Health Laboratories

Specimen: 1 lavender-top (K2 EDTA) tube (minimum: 1 .0 ml of K2 EDTA whole blood). Invert several times to mix blood.

Reference Values: 0-5% Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 85025

EPO (ERYTHROPOIETIN) See: “Erythropoietin (EPO), Serum”

EPSTEINBARR VIRUS (EBV) ANTIBODIES, SERUM

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Immunofluorescence. Includes viral capsid antigens (VCA), IgG and IgM and Epstein-Barr nuclear antigen (EBNA). These tests are recommended only when a screening procedure (e.g. Monospot) is negative and Infectiour Mononucleosis is still suspected.

Test Performed At: LabCorp

Specimen: 1 plain red top tube or 1 SST tube (minimum 2.0 ml of serum). Centrifuge 30 minutes after draw. Send at room temperature.

Reference Values: See report. In most populations, at least 90% of the adult population will have been infected with EBV sometime in the past and, therefore, will have a measurable anti-VCA IgG and anti-EBNA titer. Antibodies to EBNA develop 6-8 weeks after primary infection and remain present for life. Presence of VCA/IgM antibodies indicates recent primary infection with EBV. Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86663

ERYTHROCYTE SEDIMENTATION RATE (ESR) See: “Sedimentation Rate (ESR)

ERYTHROPOIETIN (EPO), SERUM Enzyme Immunoassay (EIA) Useful for diagnosis of anemia and polycythemia as well as a tumor marker.

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum: 2.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: 2.59-18.5 mIU/ml Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 82668

ESR (ERYTHROCYTE SEDIMENTATION RATE) See: “Sedimentation Rate (ESR)”

ESTRADIOL, SERUM Chemluminescense

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum: 2.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate.

NOTE: Patient’s sex is required on request form for processing.

Reference Values: See report Analytic Time: 1 day or STAT Day(s) Test Set Up: Daily CPT Code(s): 82670

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ESTRIOL, SERUM Radioimmunoassay (RIA)

Test Performed At: LabCorp

Specimen: 1 plain red top tube or SST (minimum 1.0 ml of serum). Refrigerate specimen.

Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Monday - Saturday CPT Code(s): 82677

ESTROGEN / PROGESTERONE RECEPTOR ICA (PARAFFIN), IMMUNOPEROXIDASE STAIN

Test Performed At: Shore Health Laboratories

Specimen: 1 paraffin block. NOTE: Submit also H&E slide and a copy of the pathology report with specimen. Store at room temperature.

Reference Values: Negative Analytic Time: 3 days Day(s) Test Set Up: Sunday - Friday CPT Code(s): 88342 x 2

ESTROGEN RECEPTOR ASSAY (ERA) WITH PROGESTERONE RECEPTOR ASSAY (PRA), TISSUE See: “Estrogen/Progesterone Receptor (Paraffin), Immunoperoxidase Stain”

ESTROGEN See: “Estradiol, Serum” "Total Estrogen, Serum"

ESTRONE, SERUM Radioimmunoassay (RIA) After Column Chromatography

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 0.5 ml of serum). Refrigerate specimen.

Reference Values: See report Analytic Time: 2 days Day(s) Test Set Up: Tuesday, Thursday, Saturday CPT Code(s): 82679

ETHANOL See: “Alcohol, Ethyl, Serum”

ETHOSUXIMIDE, SERUM (ZARONTIN) FPIA

Test Performed At: LabCorp

Specimen: 1 ml serum. Do not use gel barrier tubes. Refrigerate.

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Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Monday - Saturday CPT Code(s): 80168

ETHYL ALCOHOL See: “Alcohol, Ethyl, Serum”

ETOH See: “Alcohol, Ethyl, Serum”

EXCEDRIN® (ACETAMINOPHEN) See: “Salicylate, Serum”

FACTOR II, DNA ANALYSIS See: “Prothrombin Gene Mutation”

FACTOR V (LEIDEN) MUTATION

Test Performed At: LabCorp

Specimen: 2 Lavendar (EDTA) tubes. Send original tubes (whole blood) at room temperature.

Reference Values: See report Analytic Time: 5 days Day(s) Test Set Up: Monday - Saturday CPT Code(s): 83891 83894 83912 83898 x2

FACTOR VIII ACTIVITY

Test Performed At: LabCorp

Specimen: 1 light blue top 3.2 (citrate) tube (minimum 2.0 ml of citrate plasma). Freeze.

NOTE: Patient must not be receiving heparin.

Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Monday - Saturday

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CPT Code(s): 85240

FACTORS II, V, VII, IX, X, XI, XII ACTIVITY See: “Coagulation, Specific Factor Assays, Plasma”

FARR TEST See: “DNA Double Stranded (ds-DNA) Antibody, lgG, Serum”

FAST HEMOGLOBIN See: “Glycated Hemoglobin, Blood”

FAT, QUALITATIVE, FECES Sudan Stain

Test Performed At: Shore Health Laboratories Specimen: A minimum of 15 g of stool collected in a gray cup or tightly covered container. Refrigerate collection.

Reference Values: <60: Normal, >60: Increased Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 89125

FAT, QUALITATIVE, URINE Sudan Stain

Test Performed At: Shore Health Laboratories Specimen: 5.0 ml of random urine collected in a urine sample cup supplied by Shore Health Laboratories.

Reference Values: None seen Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 89125

FAT, QUANTITATIVE, FECES

Test Performed At: LabCorp

Specimen: Entire stool specimen (48 or 72 hour). Keep refrigerated during collection. See page 267 “Stool Collections.”

NOTE: 1. Length of collection period is required on request form for processing. 2. Barium interferes with the procedure. 3. Patient should be on a diet including 100 g of fat per day for 3 days prior to collection period.

Reference Values: <7 g/24 hrs Analytic Time: 4 day

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Day(s) Test Set Up: Monday - Thursday CPT Code(s): 82710

FEBRILE AGGLUTININS ** Test discontinued ** Physicians should order specific test based on clinical syndromes.

See: “Q Fever Antibodies, Serum ”

FEBRILE ANTIBODY PROFILE (Includes IGG and IGM antibodies for brucella,spotted fever, and typhus fever). Enzyme immunoassay (EIA) and immunofluorescence

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 2.0 ml serum). Separate and refrigerate specimen.

Reference Values: See report Analytic Time: 2 days Day(s) Test Set Up: Tuesday, Thursday, Saturday CPT Code(s): 86622 x 2, 86757 x 4

FECAL BLOOD See: “Occult Blood, Feces”

FECAL FAT See: “Fat, Qualitative, Feces” “Fat, Quantitative, Feces”

FECAL LEUKOCYTES See: “WBC, Feces”

FECAL pH See: “pH, Feces”

FECAL UROBILINOGEN See: “Urobilinogen”

FELBAMATE (FELBATOL), SERUM High-Performance Liquid Chromatography (HPLC)

Test Performed At: LabCorp

Specimen: 1 plain red top tube (minimum 2.0 ml serum) drawn 1 hour prior to next dose. Refrigerate specimen.

NOTE: Do not use gel barrier tubes.

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Reference Values: Trough 30-50 ug/ml Analytic Time: 2 days Day(s) Test Set Up: Tuesday, Thursday, Saturday CPT Code(s): 82491

FEP (FREE ERYTHROCYTE PROTOPORPHYRIN) See: “Zinc Protoporphyrin (FEP, Free Erythrocyte Protoporphyrin)”

FERRITIN, SERUM Chemiluminescence

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: Males: 23.9-336.2 ng/ml Females: 11.0-306.8 ng/ml Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82728

FERTILITY TEST Call Lab before collection See: “Semen Analysis Complete” “Semen Analysis, Post Vasectomy”

FETAL CELL STAIN See: “Fetaldex, Blood”

FETALDEX, BLOOD Betke-Kleihauer Stain Includes: Fetal Cells, Maternal Cells, Fetal/Maternal Ratio, Volume of Fetal/Maternal Hemmorage

Test Performed At: Shore Health Laboratories

Specimen: 1 lavender-top (EDTA) tube (minimum 1.0 ml of EDTA whole blood) from mother immediately after delivery or as soon as possible. Store at 4 °. Can be analyzed up to 24 hrs. post collection.

NOTE: Cord blood is NOT acceptable.

Reference Values: 0- fetal cells present Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 85460

FETAL FIBRONECTIN (FFN)

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Test Performed At: Shore Health Laboratories

Specimen: A swab from vaginal pool-placed in special FFN container. Send to laboratory for STAT testing.

Reference Values: Negative Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82731

FETAL HEMOGLOBIN See: “APT Test” “Fetaldex, Blood” “Hemoglobin Electrophoresis, Blood”

FETAL LUNG MATURITY (LAMELLAR BODY COUNTS) Optical impedance

Test Performed At: LabCorp

Specimen: 4 ml amniotic fluid. Amniotic fluid is obtained by needle aspiration into the amiotic sac. DO NOT CENTRIFUGE. DO NOT FREEZE . Refrigerate.

Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Monday - Saturday CPT Code(s): 83664

FETAL MATERNAL RATIO See: “Fetaldex, Blood”

FIBRINOGEN, PLASMA Derived from Prothrombin Time

Test Performed At: Shore Health Laboratories

Specimen: 1 light blue-top tube 3.2 (citrate) tube (minimum 4.0 ml of citrate whole blood). Fill light blue-top (citrate) tube to blue band on the label of the tube.

Reference Values: 180-460 mg/dl Critical Value: < 100 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 85384

FIBRIN SPLIT PRODUCTS (FDP), PLASMA See: “D-Dimer”

FIFTH DISEASE See: “Parvovirus B19 Antibodies, IgG and IgM (Separate Determinations), Serum”

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FK506 See: “Tacrolimus”

FLECAINIDE, SERUM (TAMBOCOR) HPLC

Test Performed At: LabCorp (085662)

Specimen: Serum: 2 plain red top tubes (minimum 3.0 ml serum). Refrigerate.

NOTE: Do not use gel barrier tubes.

Reference Values: 0.2-1.0 ug/ml Analytic Time: 1 day Day(s) Test Set Up: Monday - Saturday CPT Code(s): 82491

FLUORESCENT TREPONEMAL ANTIBODY, ABSORBED (FTAABS) See: “Syphilis Serology”

FLUORIDE, SERUM Ion-Chromatography

Test Performed At: LabCorp (070060)

Specimen: 2 plain red top tubes or 2 royal navy blue EDTA tubes (3 ml serum or plasma). Separate and maintain at room temperature.

NOTE: Do not use gel barrier tubes.

Reference Values: <0.2 mg/L Analytic Time: 2-8 days Day(s) Test Set Up: Batched CPT Code(s): 82735

FLUOXETINE, SERUM (PROZAC®) Liquid Chromatography/ MS. Includes the pharmacologically active metabolite, norfluoxetine, which is also quantitated and reported.

Test Performed At: LabCorp (706838)

Specimen: 1 plain red top tube (minimum 2.0 ml of serum). Refrigerate specimen.

NOTE: Do not use gel barrier tubes.

Reference Values: Fluoxetine: 91-302 ng/ml Norfluoxetine: 72-258 ng/ml Analytic Time: 1 day

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Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 84022

FLUPHENAZINE (PROLIXIN) Liquid Chromatography, TMS

Test Performed At: LabCorp

Specimen: 1 plain red top tube (minimum 2.0 ml of serum). Refrigerate specimen.

NOTE: Do not use gel barrier tubes.

Reference Values: Therapeutic 0.3-4.0 ng/ml Analytic Time: 2 days Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 84022

FOLATE See: “Folate, Erythrocytes” “Vitamin B 12 and Folate, Serum”

FOLATE, ERYTHROCYTES Chemiluminescence

Test Performed At: LabCorp

Specimen: 2 lavender top (EDTA) tubes. Transfer 1 EDTA tube whole blood to purple plastic tube and freeze. Refrigerate second EDTA tube.

NOTE: If “Folate, Erythrocytes” is not specifically indicated on the request form, “Vitamin B12 and Folate, Serum” will be performed.

Reference Values: >280 ng/ml Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 82747

FOLIC ACID See: “Folate, Erythrocytes” “Vitamin B 12 and Folate, Serum”

FOLLICLESTIMULATING HORMONE (FSH), SERUM Chemiluminescence

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

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Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 83001

FRAGILE X PCR WITH REFLEX PCR followed by agarose get and capillary electrophoresis and if required, Southern blot hybridization.

Test Performed At: LabCorp

Specimen: 3 lavender top (EDTA) tubes. Forward unprocessed whole blood promptly at ambient temperature only.

NOTE: Reason for Referral Plus Relevant Clinical and Family Information must be submitted with specimen in order to provide correct interpretation of test results.

Reference Values: An interpretive report will be issued. Analytic Time: 21 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 81243

FREE CALCIUM See: “Calcium, Ionized, Serum”

FREE TESTOSTERONE See: “Testosterone, Total and Free, Serum”

FREE TRIIODOTHYRONINE See: “T3 (Triiodothyronine), Free, Serum”

FREE T4 (THYROXINE) See: “T4 (Thyroxine), Free, Serum”

FREE T3 (TRIIODOTHYRONINE See: “T3 (Triiodothyronine), Free, Serum”

FRUCTOSAMINE, SERUM Colorimetric

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Send at Room Temperature.

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Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 82985

FSH (FOLLICLESTIMULATING HORMONE) See: “Follicle-Stimulating Hormone (FSH), Serum”

FSP (FIBRIN SPLIT PRODUCTS) See: “D-Dimer”

FTAABS (FLUORESCENT TREPONEMAL ANTIBODY, ABSORBED) See: “STS (Syphilis EIA IgG/IgM) Serum”

FT3 (FREE TRIIODOTHYRONINE) See: “T3 (Triiodothyronine), Free, Serum”

FUNGUS CULTURE See: “Culture, Fungus” “Culture, Fungus, Blood”

GALACTOKINASE, BLOOD Radioisotopic Galactose-1-phosphate uridyltransferase deficiency is the most common cause of galactosemia. Galactokinase deficiency is the second most common cause of galactosemia.

Test Performed At: LabCorp

Specimen: 1 green top (heparin) tube (minimum 5.0 ml; pediatric 2.0 ml of heparinized whole blood). Refrigerate specimen. Only collect Monday – Wednesday.

Reference Values: <2 years: 20.1-79.8 mU/g of hemoglobin >=2 years: 12.1-39.7 mU/g of hemoglobin (literature values) Analytic Time: 8 days Day(s) Test Set Up: Tuesday CPT Code(s): 82759

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GALACTOSE1PHOSPHATE URIDYL TRANSFERASE (GPUT) Ultraviolet, Kinetic This assay is a quantitative measurement of the enzyme GPUT and provides an approximation of the patient’s genotype. A deficiency of this enzyme is the most common cause of galactosemia. A galactokinase deficiency is the second most common cause of galactosemia. Those patients with GPUT values of 10.0 U/g hemoglobin or less should be definitively characterized by genotyping, see: “Galactose-1-Phosphate Uridyltransferase (GPUT) Genotyping, Erythrocytes.” This assay is not useful for diet monitoring of galactosemics.

Test Performed At: LabCorp

Specimen: 2,green sodium heparin tubes (minimum 3.0 ml whole blood). Refrigerate specimen. Stable 5 days.

Reference Values: See report. Analytic Time: 5 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 82775

GALACTOSE, QUANTITATIVE, URINE Thin-Layer Chromatography (TLC). Confirmed by galactose dehydrogenase. Galactose-1-phosphate uridyltransferase deficiency is the most common cause of galactosemia. Galactokinase deficiency is the second most common cause of galactosemia.

Test Performed At: LabCorp

Specimen: 5.0 ml from a random urine collection in a urine sample cup. Collect specimen 2 hours after patient has drank a glass of milk. Freeze specimen.

Reference Values: See report. Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 84375

GALACTOSE, PLASMA QUANTITATIVE Spectrophotometry

Test Performed At: LabCorp

Specimen: 1.0 ml FROZEN plasma from heparinized (green top tube) plasma.

Reference Values: See report. Analytic Time: 5 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 82760

GAMMAGLOBULIN See: “Electrophoresis, Protein, Serum” “Electrophoresis, Protein, Urine ”

GAMMAGLOBULINS, QUANTITATIVE

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See: “Immunoglobulin A (IgA), Serum” “Immunoglobulin G (lgG), Serum” “Immunoglobulin M (IgM), Serum” “Immunoglobulins (lgG, IgA, and IgM), Serum”

GAMMAGLUTAMYLTRANSFERASE (GGT), SERUM Photometric

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: Males: 15-85 U/L Females: 5-55 U/L Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82977

GAMMAGLUTAMYLTRANSPEPTIDASE (GGTP) See: “Gamma-Glutamyltransferase (GGT), Serum”

GAMMATOCOPHEROL See: “Vitamin E, Serum”

GANGLIOSIDE (GD1b AB) IGG & IGM Enzyme Immunoassay

Test Performed At: LabCorp (808620)

Specimen: 1 plain red top tube or 1 SST tube (minimum 1.0 ml serum). Centrifuge SST 30 minutes after collection. Maintain at room temperature. Stable for 5 days.

Reference Values: See Report Analytic Time: 5 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 83520 x2

GARAMYCIN® (GENTAMICIN) See: “Gentamicin, Serum”

GARDNERELLA VAGINALIS CULTURE See: “Culture, Gardnerella vaginalis”

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GASTRIN, SERUM Chemiluminescence

Test Performed At: LabCorp

Specimen: 1 plain red top tube or 1 SST tube (minimum 0.5 ml of serum) from a fasting patient. Centrifuge SST 30 minutes after draw. Serum should be removed and frozen within 1 hour of collection.

Reference Values: See report. Analytic Time: 2 days Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 82941

GC CULTURE See: “Culture, Transgrow®”

GC by Nucleic Acid Amplification – see Chlamydia trachomatis by Nucleic Acid Amplification (Genprobe® - Aptima®)

GENITAL CULTURE See: “Culture, Genital”

GENTAMICIN, SERUM Petinia Technique

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Serum for a peak level should be taken 30 minutes after complete infusion of an intravenous dose or 60 minutes after an intramuscular or oral dose of gentamicin. Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: Therapeutic ranges Peak: 4 - 8 ug/ml Trough: 0.2 – 1.9 ug/ml Critical Value: > 3 ug/ml (trough), > 12 ug/ml (peak) Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 80170

GERMAN MEASLES VIRUS See: “Prenatal Profile” “Rubella Antibodies, IgM Only, Serum” “TORCH Panel”

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GGT (GAMMAGLUTAMYLTRANSFERASE) See: “Gamma-Glutamyltransferase (GGT), Serum”

GGTP (GAMMAGLUTAMYLTRANSPEPTIDASE) See: “Gamma-Glutamyltransferase (GGT), Serum”

GIARDIA ANTIGEN, FECES Immuno- assay Useful for screening for the detection of Giardia antigen present in stool specimens.

Test Performed At: Shore Health Laboratories

Specimen: Fresh stool, formalin preserved, or tightly sealed ParaPak® PVA/Formalin specimen. Refrigerate fresh stool specimen. Formalin preserved or ParaPak® PVA/Formalin tightly sealed specimen should be kept at ambient temperature.

Reference Values: Negative Analytic Time: 1 day Day(s) Test Set Up: Monday-Friday CPT Code(s): 87329

GLOBULIN See: “Albumin/Globulin (A/G) Ratio, Serum” “Hepatic panel”

GLOMERULAR BASEMENT MEMBRANE ANTIBODY IGG, SERUM Enzyme Immunoassay (EIA) Useful for evaluation of patients with rapidly progressive renal disease and/or pulmonary hemorrhage.

Test Performed At: LabCorp

Specimen: 1 plain red top tube or 1 SST tube (minimum 1.0 ml serum). Centrifuge SST 30 minutes after draw. Send at Room Temperature.

Reference Values: 0.0 – 3.0 units/ml Analytic Time: 1 day Day(s) Test Set Up: Monday - Saturday CPT Code(s): 83516

GLUCAGON, PLASMA Radioimmunoassay (RIA) following extraction

Test Performed At: LabCorp

Specimen: Requires a Trasylol kit before collecting. Collect 2 prechilled lavender (EDTA) tubes. Transfer 6 ml whole blood to red top tube containing 0.25 Trasylol solution. Mix well, centrifuge, and transfer 1.0 ml plasma to labeled transport tube. Freeze. (See LabCorp instructions)

Reference Values: 40-130 pg/ml

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Analytic Time: 3 days Day(s) Test Set Up: Monday CPT Code(s): 82943

GLUCOSE See: "Basic Metabolic Panel" “Glucose Challenge, Serum” “Glucose, 2-Hour Post-Prandial, Plasma” "Glucose-6-Phosphate Dehydrogenase (G-6-PD) Quantitative, Erythrocytes” “Glucose Phosphate Isomerase, Erythrocytes” “Glucose, Plasma or Serum” “Glucose, Spinal Fluid” “Glucose Tolerance, 2-Hour, Serum” “Glucose Tolerance, 3-Hour Prenatal, Serum” “Glucose Tolerance, 5-Hour, Serum” “Comprehensive Metabolic Panel” “Renal Function Panel”

GLUCOSE CHALLENGE, SERUM Glucose Oxidase or Hexokinase

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube or 1 gray sodium fluoride tube collected 1 hour after a 50 g glucose load from a fasting patient. Fasting patient is preferred, non-fasting patient is acceptable. Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: 72-139 mg/dl Analytic Time: 1 day Day(s) Test Set Up : Daily CPT Code(s): 82950

GLUCOSE, 2HOUR POSTPRANDIAL, PLASMA Glucose Oxidase or Hexokinase

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum) collected 2 hours after a meal. Centrifuge SST 30 minutes after draw. Refrigerate specimen. NOTE: Draw specimen in gray-top (sodium fluoride) tube if unable to centrifuge sample within 30 minutes of draw.

Reference Values: 72-139 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82950

GLUCOSE6PHOSPHATE DEHYDROGENASE (G6PD) Kinetic/Spectrophotometric

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Test Performed At: LabCorp

Specimen: 2 lavender EDTA tubes. Send original whole blood tubes. Do not separate. Refrigerate.

Reference Values: See report. Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 82955 85041

GLUCOSE, PLASMA or SERUM Glucose Oxidase or Hexokinase

Test Performed At: Shore Health Laboratories

Specimen: Plasma: 1 gray-top (sodium fluoride) tube (minimum 0.5 ml of sodium fluoride plasma) from a fasting patient. Refrigerate specimen. Serum: 1 SST tube (minimum 0.5 ml of serum) from a fasting patient. Centrifuge SST tube 30 minutes after draw. Refrigerate. NOTE: 1. Indicate plasma or serum on request form. 2. Label specimen appropriately (plasma or serum).

Reference Values: 70 - 109 mg/dl Critical Value: Newborn < 32 or > 328 mg/dl Child < 46 or > 445 mg/dl Adult < 46 or > 484 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82947

GLUCOSE, SPINAL FLUID Glucose Oxidase or Hexokinase

Test Performed At: Shore Health Laboratories

Specimen: 1 plain, red-top tube (minimum 0.2 ml of spinal fluid). Refrigerate specimen in a screw capped, sterile vial after collection. Maintain sterility and forward promptly. NOTE : The plain, red-top tube should NOT contain gel or silicone.

Reference Values: 40 - 75 mg/dl Critical Value: < 37 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82947

GLUCOSE TOLERANCE, 2HOUR, SERUM Glucose Oxidase or Hexokinase

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum: 0.5 ml of serum) for each of the following: Fasting and 2 hrs post- prandial. After obtaining fasting specimen, give 75 g of glucose orally before collecting the remaining specimen. Centrifuge SST 30 minutes after draw. Refrigerate specimens. NOTE: 1. Draw specimen in gray-top (sodium fluoride) tube if unable to centrifuge sample within 30 minutes

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of draw. 2. Follow guidelines in “Patient Preparation for Glucose Tolerance Test” supplied by Shore Health Laboratories. 3. Label specimens appropriately (corresponding collection time). Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82952 – each additional specimen 82951 - 3 specimens

GLUCOSE TOLERANCE, 3HOUR PRENATAL, SERUM Glucose Oxidase or Hexokinase

NOTE: Use this test for pregnant females with glucose of > 140 mg/dl.

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum) for each of the following: - Fasting, 1 hour post- prandial, 2 hours post-prandial and 3 hours post-prandial. After obtaining fasting specimen, give 100g of glucose orally before collecting the remaining specimens. Centrifuge SST 30 minutes after draw. Refrigerate specimens. NOTE: 1. Draw specimen in gray-top (sodium fluoride) tube if unable to centrifuge sample within 30 minutes of draw. 2. Follow guidelines in “Patient Preparation for Glucose Tolerance Test” supplied by Shore Health Laboratories. 3. Label specimens appropriately (corresponding collection time).

Reference Values: Fasting: 70 - 95 mg/dl 1 hour: 70 -180 mg/dl 2 hours: 70 -155 mg/dl 3 hours: 70 - 140 mg/dl Critical Value: Fasting > 484 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82952 - each additional specimen 82951 - 3 specimens

GLUCOSE TOLERANCE, 5HOUR, SERUM Glucose Oxidase or Hexokinase

Test Performed At: Shore Health Laboratories

Specimen : 1 SST tube (minimum 0.5 ml of serum) for each of the following: Fasting,1/2 Hour post- prandial,1 Hour post-prandial, 2 Hours post-prandial, 3 Hours post-prandial, 4 Hours post- prandial, 5 Hours post-prandial. After obtaining fasting specimen, give 75 g of glucose orally before collecting the remaining specimens. Centrifuge SST 30 minutes after draw. Refrigerate specimens. NOTE : 1. Draw specimen in gray-top (sodium fluoride) tube if not able to centrifuge sample within 30 minutes of draw. 2. Follow guidelines in “Patient Preparation for Glucose Tolerance Test” supplied by Shore Health Laboratories. 3. Label specimens appropriately (corresponding collection time).

Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Daily

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CPT Code(s): 82952 - each additional specimen 82951 - 3 specimens

GLYCATED HEMOGLOBIN, BLOOD HPLC

Test Performed At: Shore Health Laboratories

Specimen: 1 lavender-top (EDTA) tube (minimum 1.0ml of EDTA whole blood). Refrigerate.

Reference Values: 4 – 6.4 % A 1C Analytic Time: 1 day Day(s) Test Set Up: Monday - Saturday CPT Code(s): 83036

GLYCOSYLATED HEMOGLOBIN See: “Glycated Hemoglobin, Blood”

GONADOTROPIN, CHORIONIC See: “Alpha-Fetoprotein (AFP) Triple Screen, Serum” “Chorionic Gonadotropin, Beta-Subunit (Quantitative), Spinal Fluid” “hCG (Human Chorionic Gonadotropin), Quantitative (Titer), Serum” “PregnancyTest, Qualitative, Serum” “Pregnancy Test, Urine”

GOUT (URATES) See: “Crystals, Body Fluids”

G6PD (GLUCOSE6PHOSPHATE DEHYDROGENASE) See: “Glucose-6-Phosphate Dehydrogenase (G-6-PD) Quantitative, Erythrocytes”

GRAM STAIN SMEAR See: “Smear, Gram Stain”

GRANULOCYTE ANTIBODIES, SERUM (HUMAN GRANULOCYTE EHRLICHIOSIS (HGE) IGG & IGM IFA

Test Performed At: LabCorp

Specimen: 1 plain red top or SST tube (minimum 1.0 ml of serum). Refrigerate.

Reference Values: IgG negative <1:64 IgM negative <1:20 Analytic Time: 8 days Day(s) Test Set Up: Wednesday CPT Code(s): 86666 x2

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GROWTH HORMONE, SERUM Immunochemiluminometric Assay (ICMA)

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 1.0 ml serum) from a fasting patient. Centrifuge SST 30 minutes after draw. Refrigerate specimen.

NOTE: If multiple specimens are collected, send separate request form for each specimen and label specimens with corresponding collection times.

Reference Values: Children: age dependent Adults: <6.0 ng/ml Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 83003

GUIAC See: “Occult Blood, Feces”

HAA (HEPATITIS A ANTIBODY) See: “Hepatitis Bs Antigen (HBsAg), Serum” “Acute Hepatitis Panel”

HALOPERIDOL, SERUM (HALDOL) High-Performance Liquid Chromatography (HPLC)

Test Performed At: LabCorp

Specimen: 2 plain red top, lavender top, or green (heparin) tubes (minimum 4.0 ml serum or plasma). Refrigerate specimen.

NOTE: No gel barrier tubes. Record time of last dose, dosage level, and specimen collection time.

Reference Values: Therapeutic range: 4-26 ng/ml Toxic: >50 ng/ml Analytic Time: 1 day

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Day(s) Test Set Up: Monday - Friday CPT Code(s): 80173

HAPTOGLOBIN, SERUM Nephelometry

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: 32-205 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 83010

HBeAg (HEPATITIS Be ANTIGEN) See: “Hepatitis Be Antigen and Antibody (HBeAg and Anti-HBe), Serum” “Hepatitis Be Antigen (HBeAg), Serum”

HBsAg (HEPATITIS Bs ANTIGEN) See: “Hepatitis Bs Antigen (HBsAg), Serum” “Acute Hepatitis Panel”

hCG (HUMAN CHORIONIC GONADOTROPINS) See: “Alpha-Fetoprotein (AFP) Triple Screen, Serum” “Chorionic Gonadotropin, Beta-Subunit (Quantitative), Serum” “hCG (Human Chorionic Gonadotropin), Quantitative (Titer), Serum” “hCG (Human Chorionic Gonadotropin), Tumor Marker “Pregnancy Test, Qualitative, Serum” “Pregnancy Test, Urine”

hCG (HUMAN CHORIONIC GONADOTROPIN), QUANTITATIVE (TITER), SERUM Chemiluminescence

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: < 3 mlU/ml (negative) 3-4.9 mlU/ml (grey zone) > 4.9 mlU/ml (positive) Analytic Time: 1 day Day(s) Test Set Up : Daily CPT Code(s): 84702

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hCG (HUMAN CHORIONIC GONADOTROPIN), TUMOR MARKER

Test Performed At: LabCorp Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen. NOTE: Performed on males.

Reference Values: < 10 mlU/ml (negative) Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84702

HCT (HEMATOCRIT) See: “Hemoglobin and Hematocrit, Blood”

HCV (HEPATITIS C VIRUS) RNA DETECTION See: “Hepatitis C Virus (HCV) RNA by PCR Quantitative” “Hepatitis C Virus RNA (HCV-RNA) "Hepatitis C Virus RNA, Genotype"

HDL CHOLESTEROL, SERUM Detergent Soluble. HDL cannot be run by this method if triglyceride is > 2000 mg/dl.

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Draw specimen following an overnight (12-14 hour) fast. Patient must not consume any alcohol for 24 hours before the specimen is drawn. Centrifuge SST 30 minutes after draw. Refrigerate. NOTE: Patient’s age and sex are required on request form for processing.

Reference Values : >39 mg/dl Analytic Time : 1 day Day(s) Test Set Up : Daily CPT Code(s): 83718- HDL 84478 - Triglycerides

HDL (HIGH DENSITY LIPOPROTEIN CHOLESTEROL) See: “Lipid Profile” “HDL Cholesterol, Serum” “Lipoprotein Profile, Serum”

HELICOBACTER PYLORI, IGG ANTIBODY, SERUM FIAX Titer. Useful as a screening test to identify patients with active Helicobacter pylori associated gastritis.

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Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml serum). Centrifuge SST 30 minutes after draw. Transfer serum to a screw-capped, sterile vial after collection. Maintain sterility and forward promptly at room temperature.

NOTE: Heat inactivated specimens will not be tested.

Reference Values: Expected values <0.91 Negative 0.91-1.09 Borderline >1.09 Positive Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86677

HEMATEST See: “Occult Blood, Feces”

HEMOGLOBIN AND HEMATOCRIT, BLOOD Electronic Impedance

Test Performed At: Shore Health Laboratories

Specimen: 1 lavender-top (K2 EDTA) tube (minimum 3.0 ml of K2 EDTA whole blood). Refrigerate. SPECIMEN CANNOT BE FROZEN.

Reference Values: See report Critical Value: See page 29. Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 85021

HEMOCCULT See: “Occult Blood, Feces”

HEMOGLOBIN A 1C See: “Glycated Hemoglobin, Blood”

HEMOGLOBIN A2 See “Hemoglobin Electrophoresis “ or “Hemoglobin Evaluation” tests.

HEMOGLOBIN ELECTROPHORESIS, BLOOD Electrophoresis In the event that a rare hemoglobin variant is present, please refer to Hemoglobinopathy Evaluation for further testing.

Test Performed At: Shore Health Laboratories

Specimen: 1 lavender-top (EDTA) tube. Refrigerate. SPECIMEN CANNOT BE FROZEN. Reference Values: See report Analytic Time : 1 week Day(s) Test Set Up : Batched

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CPT Code(s) : 83021

HEMOGLOBIN F, BLOOD HPLC

Test Performed At: LabCorp

Specimen: 1 lavender top (EDTA) tube. Send whole blood. Do not transfer blood to other containers. Refrigerate. DO NOT FREEZE.

Reference Values: See report. Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 83021

HEMOGLOBINOPATHY EVALUATION Electrophoresis In the event that a rare hemoglobin variant is present, the appropriate tests will be performed and the results interpreted to identify the hemoglobinopathies or thalassemias.

Test Performed At: LabCorp

Specimen: 1 lavender-top (EDTA) tube. Refrigerate. SPECIMEN CANNOT BE FROZEN.

Reference Values: See report Analytic Time : 1 week Day(s) Test Set Up : Batched CPT Code(s) : 83021

HEMOGLOBIN SOLUBILITY See: “Hemoglobinopathy Evaluation”

HEMOGLOBIN 5, SCREEN See: “Sickle Cell Testing, Blood”

HEMOSIDERIN, URINE Microscopic stain

Test Performed At: LabCorp

Specimen: 5 ml of the first morning urine collected in a urine sample cup supplied by Shore Health Laboratories. Refrigerate specimen no longer than 24 hours before returning to Lab. Lab should freeze specimen.

Reference Values: None detected Analytic Time: 3 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 83070

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HEPATIC PANEL See: “Acute Hepatic Panel”

HEPATITIS A ANTIBODY See: “Hepatitis A Antibody, lgG and IgM (Anti-HAV), Serum” “Acute Hepatitis Panel”

HEPATITIS A ANTIBODY, IgM (ANTIHAVM/ HAVABM), SERUM Chemiluminescence

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 2.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate. Collection date is required on request form for processing.

Reference Values: Negative Analytic Time: 1 day Day(s) Test Set Up : Monday – Friday CPT Code(s): 86296

HEPATITIS A ANTIBODY, IGG AND IGM (ANTIHAV/HAVAB TOTAL), SERUM Microparticle Enzyme Immunoassay (MEIA)

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml serum). Centrifuge SST 30 minutes after draw. Refrigerate.

NOTE: Collection date is required on request for processing.

Reference Values: Negative Analytic Time: 1 day Day(s) Test Set Up: Sunday Friday CPT Code(s): 86708

HEPATITIS Bc Ab, IgM Chemiluminescence

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube, minimum 1.0 ml of serum. Centrifuge SST 30 minutes after draw.

Reference Values: Negative Analytic Time: 1 day Days Set Up: Monday -Friday CPT Code(s): 86705

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HEPATITIS Bc AB, IGG AND IGM (ANTIHBc IGG AND IGM), SERUM (HBc A, TOTAL) Enzyme Immunoassay (EIA)

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml serum). Centrifuge SST 30 minutes after draw. Refrigerate

NOTE: Collection date is required on request form for processing.

Reference Values: Negative Analytic Time: 1 day Day(s) Test Set Up: Monday- Friday CPT Code(s): 86704

HEPATITIS Be ANTIBODY (ANTIHBe), SERUM Enzyme Immunoassay (EIA)

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml serum). Centrifuge SST 30 minutes after draw. Refrigerate.

NOTE: Heat inactivated specimens will not be tested.

Reference Values: Non-reactive Analytic Time: 2 days, if non-reactive Day(s) Test Set Up: Monday - Friday CPT Code(s): 86707

HEPATITIS Be ANTIGEN (HBeAg), SERUM Enzyme Immunoassay (EIA)

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml serum). Centrifuge SST 30 minutes after draw. Refrigerate.

NOTE: Heat inactivated specimens will not be tested.

Reference Values: Non-reactive Analytic Time: 2 days, if non-reactive Day(s) Test Set Up: Monday - Friday CPT Code(s): 87350

HEPATITIS Bs See: “Hepatitis Bs Antibody (Anti-HBs), Serum” “Hepatitis Bs Antigen (HBsAg), Serum” “Acute Hepatitis Panel”

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HEPATITIS Bs ANTIBODY (ANTIHBs), SERUM Chemiluminescence

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 2.0 ml of serum). Centrifuge SST 30 minutes after draw. NOTE: Collection date is required on request form for processing.

Reference Values: Negative Interpretation depends on clinical setting. See page 246 “Hepatitis Clinical Interpretation Guide.” Analytic Time: 1days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86291

HEPATITIS Bs ANTIGEN (HBsAg), SERUM Chemiluminescence

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 2.0 ml of serum). Centrifuge SST 30 minutes after draw.

NOTE: 1. If also collecting blood for other tests, obtain a separate tube dedicated for HBsAg testing. 2. Collection date is required on request form for processing.

Reference Values: Negative Interpretation depends on clinical setting. See page 246, “Hepatitis Clinical Interpretation Guide.” Analytic Time: 1 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86287

HEPATITIS C ANTIBODY See: “Hepatitis C Antibody (Anti-HCV), Serum” “Hepatitis Profile”

HEPATITIS C ANTIBODY (ANTIHCV), SERUM Chemiluminescence

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. NOTE: Collection date is required on request form for processing.

Reference Values: Negative Interpretation depends on clinical setting. See page 246, “Hepatitis Clinical Interpretation Guide.” Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday

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CPT Code(s): 86302

HEPATITIS C VIRUS (HCV) RNA BY PCR (VIRAL LOAD)

Test Performed At: LabCorp

Specimen: 1 PPT Plasma Preparation tube (Ivory top). Minimum 2.3-3.5 ml. Spin and freeze immediately.

NOTE: This test is intended to be used to monitor known HCV positive infections. It is not intended for primary detection of HCV infections.

Reference Values: See report Analytic Time: 5 days Day(s) Test Set Up: Monday - Saturday CPT Code(s): 87902

HEPATITIS C VIRUS (HCV) RNA, GENOTYPE NON REFLEX (LIPA) PCR, DNA Sequencing

Test Performed At: LabCorp

Specimen: 2 PPT (Plasma Prepartation Tube) (ivory top). Centrifuge and freeze entire tubes within 4 hours.

Reference Values: See report Analytic Time: 1-4 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 87902

HERPES SIMPLEX CULTURE See: “Culture, Herpes”

HERPES SIMPLEX VIRUS (HSV) ENCEPHALITIS DETECTION BY POLYMERASE CHAIN REACTION (PCR), (TYPES 1 & 2)

Test Performed At: LabCorp

Specimen: CSF: 1 sterile tube (minimum 0.5 ml spinal fluid). Refrigerate. Stable 7 days. Serum: 1 SST tube (minimum 1.0 ml of serum). Refrigerate. Stable 7 days. Plasma: 1 lavender (EDTA) tube (minimum 1.0 ml of plasma). Refrigerate. Stable 7 days. Whole Blood: 1 lavender (EDTA) tube (minimum 1.0 ml whole blood). Refrigerate. Stable 7 days.

Reference Values: Not detected Analytic Time: 5 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 87529 x2

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HERPES SIMPLEX VIRUS (HSV) 1/2 SPECIFIC IGG IFA

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.5 ml serum). Refrigerate.

Reference Values: Negative Additional interpretive information provided with report. Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 86695, 86696

HERPES SIMPLEX VIRUS (HSV) 1/2 SPECIFIC IGM IFA

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml serum). Refrigerate.

Reference Values: Negative Additional interpretive information provided with report. Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 86695, 86696

HERPES (VARICELLA) ZOSTER CULTURE See: “Culture, Viral”

HETEROPHILE ABSORPTION See: “Mononucleosis Slide Test, Serum”

HETEROPHILE ANTIBODY See: “Mononucleosis Slide Test, Serum”

HGB (HEMOGLOBIN) See: “Hemoglobin and Hematocrit, Blood” “Hemoglobin A 2, Column, Blood” “Hemoglobin Electrophoresis, Blood” “Hemoglobinopathy Evaluation"

HGB (HEMOGLOBIN) ELECTROPHORESIS See: “Hemoglobin Electrophoresis, Blood” “Hemoglobinopathy Evaluation"

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HIGH DENSITY CHOLESTEROL (HDC) See: “Lipid Profile” “HDL Cholesterol, Serum” “Lipoprotein Profile, Serum”

HIGH DENSITY LIPOPROTEIN See: “Lipid Profile” “HDL Cholesterol, Serum” “Lipoprotein Profile, Serum”

HIGH DENSITY TRIGLYCERIDE (HDT) See: “Lipoprotein Profile, Serum”

HISTAMINE, 24 HOUR, URINE

Test Performed At: LabCorp

Specimen: Submit and entire 24 hour urine collection in a urine container supplied by Shore Health Laboratories. Refrigerate Specimen. SHS lab will aliquot 10-15 ml and freeze to send for testing.

NOTE; Follow guidelines in “Patient Instructions for 24 hour Urine Collection” supplied by SHL.

Reference Values: See results Analytic Time: 3 days Day(s) Test Set Up: Tuesday & Thursday CPT Code(s): 83088

HISTOLOGY, TISSUE

Test Performed At: Shore Health Laboratories

Specimen: Tissue specimens must be fixed in 10% formalin and placed in a plastic, white- capped specimen jar supplied by Shore Health Laboratories. NOTE: 1. Specimen source is required on request form for processing. 2. Please complete “Part B” of a “Chesapeake Pathology Associates Request Form” and forward it with the specimen. This form is supplied by Shore Health Laboratories. A copy of this form is also printed in the appendix. Requisitions for this procedure cannot be processed unless the information requested is supplied.

Reference Values: Descriptive report Analytic Time: 3 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 88300- 88309

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HISTONE AUTOANTIBODIES, SERUM EIA

Test Performed At: LabCorp Specimen: 1 plain red top or 1 SST tube (minimum 1.0 ml serum) from a fasting patient. Centrifuge SST 30 minutes after draw. Maintain at room temperature.

Reference Values: Negative: <1.0 units Analytic Time: 2 days Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 86235

HISTOPLASMA See: “Fungus Serology, Serum”

HIV (HUMAN IMMUNODEFICIENCY VIRUS) See: “Human Immunodeficiency Virus Antibody Type 1 (Anti-HIV-1+2), Serum” “Human Immunodeficiency Virus.1 (HIV-1+2) Antibody Confirmation by Multispot,” “Human Immunodeficiency Virus Type 1 (HIV-1) RNA by Polymerase Chain Reaction (PCR), Quantitative, Plasma”

HLAB27 ANTIGEN, DISEASE ASSOCIATION, BLOOD PCR

Test Performed At: LabCorp

Specimen: 2 lavender (EDTA) tubes. Send whole blood at room temperature.

Reference Values: see report Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 81374

HOMOCYSTEINE, SERUM Chemiluminescence

Test Performed At: Shore Health Laboratories

Specimen: 1.0 ml serum from red top tube.

Reference Values: 3.7-13.9 umol/L Analytic Time: 1 day Day(s) Test Set Up: Tuesday & Friday CPT Code(s): 82131

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HOMOVANILLIC ACID (HVA), URINE (Random or 24hour) LCMS/MS

Test Performed At: LabCorp

Specimen: Submit 30 ml from a 24 hour urine collection or random sample. Refrigerate specimen. Follow guidelines in “Patient Instructions for 24 hour Urine Collection” supplied by SHL.

NOTE: Robaxin, L-dopa interferes with the procedure. It should be discontinued at least 48 hours prior to collection of specimen.

Reference Values: 0.0-10.0 mg/24 hr Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 83150

HPV, THIN PREP

Test Performed At: Shore Health Laboratories

Specimen: Cytobrush/spatula is inserted into the cervical os and any other suspicious area of the ectocervix. Thick areas of blood and mucus are to be avoided. Dispose of applicator when done. Tightly close the vial and label with patient’s full name and date of birth.

NOTE: 1. The patient should be mid cycle. 2. The HPV test can be run on the same vial as the Thin Prep PAP. 3. Please complete “Chesapeake Pathology Associates Request Form” and forward it with the specimen. This form is supplied by Shore Health Laboratories.

Reference Values: Negative = Not Detected Analytic Time: <= 9 days Day(s) Test Set Up: Volume Dependent CPT Code(s): 87621

HSTSH (HIGH SENSITIVITY THYROIDSTIMULATING HORMONE) See: “Thyroid-Stimulating Hormone - Sensitive (S-TSH), Serum”

HTG (HUMAN THYROGLOBULIN) See: “Thyroglobulin, Serum”

HTLVI/II (HUMAN TCell LYMPHOTROPIC VIRUSI/II) ANTIBODIES (these viruses do NOT cause AIDS)

Test Performed At: LabCorp

Specimen: 1 SST or plain red-top or 1 EDTA tube (minimum 1.5 ml serum or plasma). Centrifuge and separate serum or plasma. Maintain sample at room temperature.

Reference Values: Negative Analytic Time: Set up and reported twice per week Day(s) Test Set Up:

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CPT Code(s): 83790

HTLVI/II (HUMAN TCell LYMPHOTROPIC VIRUSI/II) ANTIBODIES with reflex confirmation by Immunblot (these viruses do NOT cause AIDS)

Test Performed At: LabCorp

Specimen: 1 SST or plain red-top or 1 EDTA tube (minimum 1.5 ml serum or plasma). Centrifuge and separate serum or plasma. Refrigerate specimen. Auto reflex to Immunoblot confirmation test if screen is positive.

Reference Values: Negative Analytic Time: Set up and reported twice per week Day(s) Test Set Up: CPT Code(s): 83790

HTLVI/II (HUMAN TLYMPHOTROPIC VIRUSI/II) ANTIBODIES, CONFIRMATION BY IMMUNOBLOT

Test Performed At: LabCorp

Specimen: Su1 SST or plain red-top or 1 EDTA tube (minimum 0.5 ml serum or plasma). Centrifuge and separate serum or plasma. Refrigerate specimen.

Reference Values: See report Analytic Time: Day(s) Test Set Up: CPT Code(s): 86687,86688

HUMAN CHORIONIC GONADOTROPIN (hCG) See: “Alpha-Fetoprotein (AFP) Triple Screen, Serum” “Chorionic Gonadotropin, Beta-Subunit (Quantitative), Serum” “hCG (Human Chorionic Gonadotropin), Quantitative (titer), Serum” “hCG (Human Chorionic Gonadotropin), Tumor Marker, Serum” “PregnancyTest, Qualitative, Serum” “Pregnancy Test, Urine”

HUMAN GROWTH HORMONE See: “Growth Hormone, Serum”

HUMAN IMMUNODEFICIENCY VIRUS ANTIBODY TYPE 1/Type2 (ANTIHIV1/2), SERUM Enzyme Immunoassay (EIA). Reflexed to Western blot assay if reactive.

NOTE: In Maryland, the physician must provide a “Unique Identifier” (U.l.) number. A copy of the “Informed Consent and Agreement for HIV Testing Form” for use of the patient’s social security number is on p. 19. Instructions for generating a U.l. number are on p. 21.

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate.

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NOTE: If also collecting blood for other tests, obtain a separate tube dedicated for HIV testing.

Reference Values: Negative All positive results will be confirmed with the Western blot assay at an additional charge. Analytic Time : 1 day Day(s) Test Set Up: Monday through Friday CPT Code(s): 86701

HUMAN IMMUNODEFICIENCY VIRUS1 (HIV1+2) ANTIBODY, CONFIRMATION BY MULTISPOT Immunosorbent Blot Technique. Repeat testing performed if indeterminate.

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST UNOPENED tube. Centrifuge SST 30 minutes after draw. Refrigerate.

Reference Values: See report Analytic Time: 3 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 86701, 86702

HUMAN IMMUNODEFICIENCY VIRUS1 (HIV1) RNA BY PCR, QUANTITATIVE, PLASMA (VIRAL LOAD)

Test Performed At: LabCorp

Specimen: 1 PPT Plasma Preparation Tube (Ivory top). Centrifuge and freeze. 2 Lavender top (EDTA) tubes also acceptable (minimum 1.5 ml of plasma). Freeze.

NOTE: This test is used to monitor known HIV positive infections. It is not intended for primary detection of HIV infections.

Reference Values: See report Analytic Time: 5 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 87536

5HYDROXYINDOLE ACETIC ACID (5HIAA), URINE HPLC

Test Performed At: LabCorp

150

Specimen: Submit 10-30 ml from an entire 24 hour urine collection. No preservative (1 g/L boric acid is acceptable). Refrigerate specimen. Follow guidelines in “Patient Instructions for 24 Hour Urine Collection” supplied by SHL.

NOTE: Patient should not eat avocados, bananas, eggplant, pineapples, plums, tomatoes, or walnuts for a 72 hour period prior to start of collection.

Reference Values: See report Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 83497

17HYDROXYPROGESTERONE, SERUM LC/TMS

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 1.0 ml serum). Refrigerate specimen.

Reference Values: See report Analytic Time: 4 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 83498

IBUPROFEN, SERUM (ADVIL, MOTRIN, NUPRIN) HPLC

Test Performed At: LabCorp

Specimen: 1 plain red top tube (minimum 1.0 ml serum). Refrigerate specimen.

NOTE: The plain red top tube should NOT contain gel or silicone. Plasma from lavender (EDTA) or grey top tube is also acceptable.

Reference Values: See report Analytic Time: 2 days Day(s) Test Set Up: Daily CPT Code(s): 80299

IBUPROFEN, URINE (ADVIL, MOTRIN, NUPRIN) HPLC

Test Performed At: LabCorp

Specimen: 10 ml from a random urine. Refrigerate.

Reference Values: See report Analytic Time: 2 days

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Day(s) Test Set Up: Monday - Friday CPT Code(s): 82491

IgA, IgG, IgM (IMMUNOGLOBULINS A, G, M) See: “Immunoglobulin A (IgA), Serum” “Immunoglobulin G (IgG), Serum” “Immunoglobulin M (IgM), Serum” “Immunoglobulins (lgG, IgA, and IgM), Serum”

IgA (IMMUNOGLOBULIN A) See: “Immunoglobulin A (IgA), Serum” “Immunoglobulins (IgG, IgA, and IgM), Serum”

IgE (IMMUNOGLOBULIN E) See: “Immunoglobulin E (IgE), Serum”

IgG (IMMUNOGLOBULIN G) See: “lgG Subclasses, Serum” “Immunoglobulin G (lgG), Serum” “Immunoglobulins (lgG, IgA, and IgM), Serum”

IGG SUBCLASSES, SERUM Nephelometry

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 2.0 ml serum). Centrifuge 30 minutes after draw. Refrigerate specimen.

Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Monday - Saturday CPT Code(s): 82784 82787 x4

IgM (IMMUNOGLOBULIN M) See: “Immunoglobulin M (IgM), Serum” “Immunoglobulins (lgG, IgA, and IgM), Serum”

IMIPRAMINE AND DESIPRAMINE (Tofranil, Imavate, Presamine) HPLC

Test Performed At: LabCorp

Specimen: 1 plain red top (minimum 1.0 ml serum) drawn 12 hours after last dose. Do NOT use gel barrier tubes. Refrigerate specimen. Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday

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CPT Code(s): 80174

IMMUNE COMPLEX C1q BINDING

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 1.0 ml serum). Freeze specimen.

Reference Values: See report Analytic Time: 2-3 days Day(s) Test Set Up: Tuesday & Thursday CPT Code(s): 86332

IMMUNOFIXATION, SERUM Includes protein electrophoresis and immunofixation (includes IGA, IGG, and IGM)

Test Performed At: LabCorp

Specimen: 2 plain red top or 2 SST tube (minimum 5.0 ml serum) from a fasting patient. Centrifuge SST 30 minutes after draw. Refrigerate specimen. Fasting specimen preferred.

Reference Values: See report Analytic Time: 3 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 84155 82784 x3 84165 86334

IMMUNOFIXATION, URINE (RANDOM OR 24 HOUR URINE) Includes protein electrophoresis and immunofixation

Test Performed At: LabCorp

Specimen: Submit 10-30 ml from a 24 hour urine collection or 10-30 ml from a first morning voided specimen (random urines are also acceptable). Refrigerate specimen during and after collection.

Reference Values: See report Analytic Time: 3 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 84156 84166 86335

IMMUNOGLOBULIN A (IgA) See: “Immunoglobulin A (IgA), Serum” “Immunoglobulins (lgG, IgA, and IgM), Serum”

IMMUNOGLOBULIN A (IgA), SERUM Immunoturbidimetric method

Test Performed At: Shore Health Laboratories

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Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: See report Day(s) Test Set Up: Daily CPT Code(s): 82784

IMMUNOGLOBULIN, CSF See: “Immunoglobulin, Spinal Fluid”

IMMUNOGLOBULIN D (IgD), SERUM Radial Immunodiffusion

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml serum). Centrifuge SST 30 minutes after draw. Refrigerate.

Reference Values: 0.13-15.27 mg/dl Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 82784

IMMUNOGLOBULIN E (IgE), SERUM Chemiluminesence

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: See report; age specific results. Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82785

IMMUNOGLOBULIN G (IgG) See: “IgG Subclasses, Serum” “Immunoglobulin G (IgG), Serum” “Immunoglobulins (IgG, IgA, and IgM), Serum”

IMMUNOGLOBULIN G (IgG), SERUM Turbidimetric method

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Daily

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CPT Code(s): 82784

IMMUNOGLOBULIN M (IgM) See: “Immunoglobulin M (IgM), Serum ” “Immunoglobulins (lgG, IgA, and IgM), Serum”

IMMUNOGLOBULIN M (IgM), SERUM Turbidimetric method

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82784

IMMUNOGLOBULINS (lgG, IgA, AND IgM), SERUM Turbidimetric method

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen after collection.

Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82784 x 3

IMMUNOGLOBULIN IGG, SPINAL FLUID

Test Performed At: LabCorp

Specimen: 1 plain, red-top tube (minimum 0.30 ml of spinal fluid). Refrigerate. NOTE: The plain, red-top tube should NOT contain gel or silicone. Routinely third CSF tube is used.

Reference Values: 0.0-8.6 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 82784

INDIA INK SMEAR See: “Smear, India Ink, Spinal Fluid”

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INDIRECT ANTIGLOBULIN TEST See: “Antibody Screen, Blood” “Coombs, Direct and Indirect, Blood” “Coombs, Indirect, Blood” “Prenatal Profile”

INDIRECT COOMBS See: “Antibody Screen, Blood” “Prenatal Profile”

INFECTIOUS MONONUCLEOSIS ANTIBODY See: “Epstein-Barr Virus (EBV) Antibodies, Serum” “Epstein-Barr Virus (EBV) lgG Antibody to Early Antigen, Serum”

INSULIN ANTIBODIES, SERUM (INSULIN AUTOANTIBODIES, IAA) Antibodies to beef, human, and pork insulin are tested routinely. Radiobinding assay.

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 0.5 ml serum) from a fasting specimen. Centrifuge 30 minutes after draw. Freeze specimen.

Reference Values: Negative Analytic Time: Day(s) Test Set Up: Set up and reported once per week. CPT Code(s): 86337

INSULIN ASSAY See: “Insulin, Serum”

INSULIN, SERUM Chemiluminesence

Test Performed At: Shore Health Laboratories

Specimen: 1 plain, red-top tube or 1 SST tube (1.0 ml of serum) from a fasting patient. (Non- fasting specimens accepted for special studies.) Refrigerate specimen. NOTE: 1.If multiple specimens are collected, send separate request form for each specimen. 2. Label specimens appropriately (corresponding collection time).

Reference Values: 1.9-23.0 uIU/ml Analytic Time: 1 day Day(s) Test Set Up: Daily

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CPT Code(s): 83525

INTACT PTH (PARATHYROID HORMONE) See: “Parathyroid Hormone (PTH) Whole Molecule, Serum”

INTRINSIC FACTOR BLOCKING ANTIBODY, SERUM Radioimmunoassay

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 2.0 ml serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: Negative Analytic Time: 2 days Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 86340

IONIZED CALCIUM See: “Calcium, Ionized, Serum”

IRON AND TOTAL IRONBINDING CAPACITY, SERUM Spectrophotometry Includes iron, total binding capacity unsaturated binding capacity and percent saturation.

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 3.0 ml; pediatric 2.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate.

Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 83540 - iron 83550 - total binding capacity

IRON, SERUM Spectrophotometry

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 3.0 ml; pediatric 2.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: 35-150 ug/dL Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 83540

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ISLET CELL ANTIBODY, SERUM (PANCREATIC) Immunofluorescence Assay

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 1.0 ml serum). Centrifuge 30 minutes after draw. Refrigerate specimen.

Reference Values: Negative Analytic Time: 7 days Day(s) Test Set Up: Thursday CPT Code(s): 86341

ISOENZYME OF CREATINE KINASE (CK) See: “Creatine Kinase (CK) MB lsoenzyme, Serum”

IVY BLEEDING TIME Test no longer available.

JOINT FLUID COUNT See: “Cell Count, Joint Fluid” “Crystals, Body Fluids or Urine”

KAPPA / LAMBDA FREE LIGHT CHAINS

Test Performed At: Labcorp

Specimen: 1 SST or red-top tube (minmum 0.5 ml serum). Centrifuge and separate 30 minutes after collection. Refrigerate specimen.

Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Set up and reported on Tuesday and Thursday

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CPT Code(s): 83883 x 2

KETONES See: “Acetone, Serum”

KETONES, URINE Nitroprusside Tablets, Manual

Test Performed At: Shore Health Laboratories

Specimen: 1.0 ml from a random urine collection in a urine sample cup supplied by Shore Health Laboratories. Refrigerate specimen.

Reference Values: Negative Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82009 - screen

KOH SMEAR See: “Smear, KOH”

K (POTASSIUM) See: “Basic & Comprehensive Metabolic Panel” “Renal Function Panel” “Potassium, Quantitative, Feces” “Electrolyte Panel” "Potassium, Serum” “Potassium, Urine”

LACTATE See: “Lactic Acid, Plasma”

LACTATE DEHYDROGENASE (LD) See: “Lactate Dehydrogenase (LD) lsoenzymes, Serum” “Lactate Dehydrogenase (LD), Serum”

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LACTATE DEHYDROGENASE (LD) ISOENZYMES, SERUM Electrophoresis. Includes total LD

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 1.0 ml serum) from a fasting patient. Centrifuge 30 minutes after draw. Send at room temperature.

NOTE: Include date and time of collection on request form.

Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Sunday - Friday CPT Code(s): 83625 83615

LACTATE DEHYDROGENASE (LD), SERUM Spectrophotometry

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw.

Reference Values: 100-205 lU/L Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 83615

LACTIC ACID, PLASMA Spectrophotometry

Test Performed At: Shore Health Laboratories

Specimen: 1 gray-top (sodium fluoride) tube (minimum: 1.2 ml of sodium fluoride plasma). Place specimen on wet ice. Centrifuge upon draw, separate plasma into a plastic vial, and transport specimen to Shore Health Laboratories immediately.

Reference Values: 0.4-2.0 mmol/L Critical Value: Child > 4.1 mmol/L Adult > 2.9 mmol/L Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 83605

LACTOFERRIN, FECAL

Test Performed At: Shore Health Laboratories

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Specimen: Stool

NOTE: Fecal specimens from infants (<2 years) receiving breast milk should not be tested using this assay.

Reference Values: Specimens that do not have increased numbers of leukocytes, or are from patients not experiencing intestinal inflammation, should produce a negative result at the dilution tested.

Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 83630

LACTOSE TOLERANCE TEST, SERUM Glucose Oxidase

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum: 0.5 ml of serum) from each of the following: Fasting (12 hours), 1/2 hour, 1 hour, 1 1/2 hours, 2 hours. After obtaining fasting specimen, give 50 g of lactose dissolved in 500 ml (16 oz) of water before collecting the remaining specimens. The lactose solution should be prepared a day ahead of specimen draw and refrigerated until use. Centrifuge SST 30 minutes after draw. Refrigerate specimens.

NOTE: 1. Children can be given less volume of lactose solution. Use 2 g of lactose per kg of body weight. Add water to make a 1:10 ratio. For example, if 30 g of lactose is needed, add 300 ml of water. 2. Label specimens appropriately with corresponding collection time.

Reference Values: A flat blood sugar curve associated with diarrhea following the test dose is found in lactose intolerance, but it must be noted that it may also be found in asymptomatic adults. With adequate intestinal lactase, there is a rise in blood glucose of at least 20 mg/dl over the fasting level. An abnormally low rise in blood glucose correlates more than 80% of the time with actual measurement of a low intestinal lactase in the small bowel biopsy. Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82951 - first 3 samples 82952 - each additional sample

LANOXIN® (DIGOXIN) See: “Digoxin, Serum”

LAP (LEUKOCYTE ALKALINE PHOSPHATASE) See: “Leukocyte Alkaline Phosphatase (LAP) Score”

LDA (LEGIONNAIRES’ DISEASE ANTIBODY) See: “Legionnaires’ Disease titer, Serum"

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LDH (LACTATE DEHYDROGENASE) See: “Lactate Dehydrogenase (LD) Isoenzymes, Serum” “Lactate Dehydrogenase (LD), Serum” “Hepatic Panel”

LDL (LOW DENSITY LIPOPROTEIN) CHOLESTEROL) See: “LDL, Direct” “Lipid Profile” “Lipoprotein Profile, Serum”

LDL, DIRECT Detergent Soluble

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube; minimum 1 ml serum. Centrifuge 30 mins after draw. Refrigerate.

Reference Values: <100 mg/dl Analytic Time: 1day Day(s) Test Set Up: Daily CPT Code(s): 83721

LEAD, BLOOD Anodic Stripping Voltametry

Test Performed At: LabCorp

Specimen: 1 Royal blue -top (EDTA) tube or tan-top tube,lead free tube. Send UNOPENED tube. (For pediatric patient can use 0.5 ml in Capiject. If using Capiject by fingerstick, wash and dry skin and then clean skin with alcohol). Send whole blood and maintain at room temperature.

Reference Values: See report.

Critical Values: Child >10 ug/dl Adult >80 ug/dl Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 86355

LECITHIN/SPHINGOMYELIN (L/S) RATIO, AMNIOTIC FLUID (includes Creatinine) Thin-Layer Chromatography (TLC)

Note: Schedule testing with laboratory in advance of specimen collection.

Test Performed At: LabCorp

Specimen: Protect specimen from light. Transport specimen to lab immediately Transfer 3-7 ml of amniotic fluid to clean plain red-top tube. Immediately after collection, centrifuge for

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EXACTLY 3 MINUTES AT 500xg. Transfer supernatant to clean, labeled red-top tube and freeze. Discard original tube and pellet.

The plain red top tube should NOT contain gel or silicone. .

NOTE: Include estimate of duration of pregnancy in weeks and diabetic state of mother on request form.

Reference Values: <1.5 (pulmonary immaturity) >2 (probable maturity) 1.5-1.9 Indeterminate Analytic Time: 1 day Day(s) Test Set Up: Call LabCorp for pickup. CPT Code(s): 83661 84081

LEGIONELLA URINARY ANTIGEN Immunochromatographic assay for Legionella pneumophila serogroup 1

Test Performed At: Shore Health Laboratories

Specimen: Minimum volume of 2-3 ml urine collected in a urine sample cup. Avoid contamination with other body fluids/materials when collecting urine specimen for testing. Seal cup tightly and forward promptly. Refrigerate if transport is delayed.

Reference Values: Negative Analytic Time: 1day Day(s) Test Set Up: Daily CPT Code(s): 87449

LEGIONNAIRES DISEASE TITER, SERUM, Indirect Immunofluorescence

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 2.0 ml of serum) is required for each specimen. Centrifuge SST 30 minutes after draw. Refrigerate specimen in a screw-capped, sterile vial after collection. Maintain sterility and forward promptly. NOTE: 1. Acute and convalescent specimens are needed to interpret results. The convalescent specimens should be obtained at 3 and 6 weeks after onset. 2. Label specimens appropriately (acute or convalescent and 3 or 6 weeks).

Reference Values: See report. Analytic Time: 1-2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86713

LE (LUPUS ERYTHEMATOSUS) PREP See: “Antinuclear Antibodies (ANA) Screen, Serum”

LEUKEMIA/LYMPHOMA IMMUNOPHENOTYPING BY FLOW CYTOMETRY (LEUKEMIA/LYMPHOMA PANEL)

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Includes a panel of lymphocyte and/or myeloid associated surface markers. The appropriate panel is chosen based on clinical information, specimen type, cellular characteristics, and previous history. This test also includes review of morphology and morphologic correlation with immunophenotypic results.

NOTE: This procedure is applicable for cases of acute lymphoblastic leukemia, acute myelogenous leukemia, chronic lymphoproliferative disorders, and malignant lymphomas. See “T and B Cell Quantitation by Flow Cytometry” for evaluation of acquired or inherited immunodeficiencies.

Test Performed At: LabCorp

Specimen: Peripheral Blood: 1 green (heparin) tube (preferred) or 1 lavender (EDTA) or yellow (ACD) tube (3 ml blood preferred, 1 ml minimum) or Bone Marrow: 1 green (heparin) tube (preferred) or 1 lavender (EDTA) or yellow (ACD) tube (2 ml bone marrow preferred, 1 ml minimum) or Body Fluid: 1 lavender (EDTA) tube. (2 ml body fluid required) or Fresh Tissue: Place 0.5-1.0 cubic centimeter rof fresh tissue in a bottle containing RPMI.

Send specimens at Room Temperature. Specimens should be at lab within 24 hours of collection.

NOTE: For all specimens, a pathology/diagnostic report, the name and telephone of the ordering physician, and a brief history are essential to achieve a consultation fully relevant to the ordering physician’s needs. Reference Values: This test will be processed as a laboratory consultation. An interpretation of the immunophenotypic findings and correlation with the morphologic features will be provided for every case. Analytic Time: 2 days Day(s) Test Set Up: Monday - Saturday CPT Code(s): See report.

LEUKOCYTE ALKALINE PHOSPHATASE (LAP) SCORE Cytochemical Stain

Test Performed At: LabCorp

Specimen: 1 green top (heparin) tube (5 ml of heparinized whole blood). Store at Room Temperature. 6 slides should be made with 24 hours of collection. Smears are stable up to 7 days at room temperature.

Reference Values: 25-130/100 segs Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 85540

LEVETIRACETAM (KEPPRA) SERUM OR PLASMA LC/MS-MS

Test Performed At: LabCorp

Specimen: 1 plain red-top tube, or 1 EDTA lavender tube or 1 green top(heparin) tube (minimum 1.0 ml of serum or plasma). Centrifuge 30 minutes after draw. Maintain at room temperature. .

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Note: DO NOT USE GEL-BARRIER TUBE. Reference Values : 5.0 – 63.0 ug/ml Analytic Time : 2 days Day(s) Test Set Up : Tuesday - Friday CPT(s) Code: 82542

LH (LUTEINIZING HORMONE) See: “Luteinizing Hormone (LH), Serum”

LIDOCAINE, SERUM (XYLOCAINE ) EIA

Test Performed At: Shore Health Laboratories

Specimen: 1 plain, red-top tube (minimum 0.5 ml of serum). Refrigerate.

Reference Values: Therapeutic concentration: 1.2-5.5 ug/ml Critical Value: > 7.1 ug/ml Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 80176

LIPASE, SERUM Panteghini methodology

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate.

Reference Values: 10-51 U/L Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 83690

LIPID PHENOTYPING See: “Lipoprotein Profile, Serum”

LIPIDS, STOOL See: “Fat, Qualitative, Feces” “Fat, Quantitative, Feces”

LIPOPROTEIN (a) Immunoprecipitin

Test Performed At: LabCorp

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Specimen: 1 SST or 1 lavender (EDTA) tube. (1.0 ml serum or plasma). Refrigerate specimen.

Reference Values: See report Analytic Time: 2 days Day(s) Test Set Up: Monday - Saturday CPT Code(s): 83695

LIPOPROTEIN ELECTROPHORESIS See: “Lipoprotein Profile, Serum”

LIPOPROTEIN FRACTIONATION See: “Lipoprotein Profile, Serum”

LITHIUM, SERUM Spectrophotometric endpoint method

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum) 8-12 hours after evening dose (trough). Centrifuge SST 30 minutes after draw. Refrigerate.

Reference Values: Therapeutic concentration: 0.6 -1.2 mEq/L Critical Value: > 1.5 mEq/L Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 80178

LIVER BIOPSY See: “Histology, Tissue"

LIVER/KIDNEY MICROSOME TYPE 1 ANTIBODIES, SERUM EIA

Test Performed At: LabCorp

Specimen: 1 plain red top tube or 1 SST tube (minimum 1.0 ml of serum). Centrifuge 30 minutes after draw. Separate and freeze serum.

Reference Values: Negative <20 units If positive, results are tittered. Analytic Time: 2 days Day(s) Test Set Up: Tuesday, Thursday, Saturday CPT Code(s): 86376

LOW DENSITY LIPOPROTEIN (LDL) CHOLESTEROL See: “Lipid Profile” “Lipoprotein Profile, Serum” “LDL, Direct”

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LUPUS ANTICOAGULANT, PLASMA DRVTT – Dilute Russell Viper Venom Test Time An APTT and DRVTT will be performed. If abnormal, reflex testing to Lupus Anticoagulant – Hexagonal Phospholipid Neutralization or Lupus Anticoagulant Confirmation test will be performed.

Test Performed At: LabCorp

Specimen: 3 blue citrate tubes. 3-6 ml sodium citrate plasma from light blue top tube. Freeze plasma. Plasma should be spun down twice before freezing.

Reference Values: See report. Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 85613 85670 85705 85732

LUPUS (SLE) COMPREHENSIVE PANEL Indirect Fluorescent Antibody (IFA), Enzyme Immunoassay (EIA), Farr Radiobinding Assay (RBA), Immunoblot, Hemagglutination, Nephelometry, Enzyme-Linked Immunosorbent Assay (ELISA)

Test Performed At: LabCorp

Specimen: 3 plain, red top tube or 3 SST tubes (minimum 5.0 ml of serum). Refrigerate.

Reference Values: See report. Analytic Time: 2-3 days Day(s) Test Set Up: Monday - Saturday CPT Code(s): 86038 86235 x5 86225 86160 x2 86376 86255 x6 86341

LUTEINIZING HORMONE (LH), SERUM Chemiluminescence

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum: 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate.

Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up : Daily CPT Code(s): 83002

LYME DISEASE See: “Borrelia burgdorferi (Lyme Disease Spirochete) Detection by Polymerase Chain Reaction (PCR)” “Lyme Disease Antibody, Confirmation, Serum” “Lyme Disease Antibody, IgG and 1gM, Serum” “Lyme Disease Serology, IgA, lgG, and 1gM, Serum or Spinal Fluid”

LYME DISEASE ANTIBODY CONFIRMATION, SERUM (WESTERN BLOT)

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Western Blot. This is a confirmatory test for samples positive by ELISA.

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (1.0 ml of serum) from a fasting patient. Centrifuge 30 minutes after draw . Send at room temperature.

Reference Values: See report. Analytic Time: 3 - 5 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86617 x2

LYME DISEASE ANTIBODY, IgG AND IgM, SERUM SEPARATE DETERMINATIONS Enzyme-Linked Fluorescent Immunoassay (ELFIA) Separate Determinations – must order which one or ones to be tested,

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimens.

NOTE: 1. Acute and convalescent specimens are needed to interpret results. The convalescent specimens should be obtained at 3 and 6 weeks after onset.

1. Label specimens appropriately (acute or convalescent and 3 or 6 weeks).

NOTE 2: All Positive Lyme IgG Antibody specimens will be referred to Lab Corp for Lyme Serum Western Blot test. All Positibve and Equivocal Lyme Igm Antibody specimens will be referred to Lab Corp for Lyme Serum Western Blot Test.

Reference Values: See Lab Report Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 86618

LYME DISEASE, PCR

Test Performed At: LabCorp

Specimen: Whole Blood: 5 ml whole blood collected in a lavender (EDTA) tube. Send at room temperature. Spinal Fluid: 1 ml CSF in a sterile tube. Refrigerate specimen. Synovial Fluid: 1 ml synovial fluid in ACD tube. Refrigerate specimen.

NOTE: Positives do not require Western Blot confirmation.

Reference Values: See report. Analytic Time: 10 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 87476

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LYMPHOCYTE PANELS Lympho 1 (CD3, 4, 8, 19, 56) Lympho 3 (CD3, 4, 8 + WBC) Lympho 4 (CD 3, 4, 8) Lympho 5 (Absolute CD4)

Test Performed At: LabCorp

Specimen: 1 lavender (EDTA) and 1 yellow ACD-A tube. Send whole blood at room temperature.

Reference Values: See report. Analytic Time: Day(s) Test Set Up: Monday - Friday CPT Code(s): Panel 1: 86355 86357 86359 86360 Panel 3 & 4: 86359 86360 Panel 5: 86361

LYSOZYME (MURAMIDASE), SERUM Radial immunodiffusion

Test Performed At: LabCorp

Specimen: 1 plain red or 1 SST tube (minimum 1.0 ml serum). Centrifuge SST 30 minutes after draw. Freeze.

Reference Values: Male: 3.0-12.8 ug/ml Female: 2.5-12.9 ug/ml Analytic Time: 2 days Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 85549

LYSOZYME (MURAMIDASE), URINE Radial immunodiffusion

Test Performed At: LabCorp

Specimen: 1 ml urine. No preservative. Maintain at room temperature.

Reference Values: <3.0 Ug/ml Analytic Time: 2 days Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 85549

MAG ANTIBODY (ANTI MYELIN ASSOCOCIATED GLY. IGM) (NERVE AB IGM) EIA

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Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml serum). Centrifuge SST 30 minutes after draw. Room Temperature. Overnight fast preferred.

NOTE: Positives reflex to Anti-MAG Ab (Western Blot)

Reference Values: Normal <1600 Analytic Time: Day(s) Test Set Up: CPT Code(s): 83520

MAGNESIUM See: “Magnesium, Serum” “Magnesium, Urine” “Renal Function Panel”

MAGNESIUM, SERUM Timed endpoint/calmagite chromogen

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw.

Reference Values: 1.8 -2.4 mg/dl Critical Value: Adults: <1.0 or >4.9 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 83735

MAGNESIUM, URINE Timed endpoint/calmagite chromogen

Test Performed At: Shore Health Laboratories

Specimen: Submit an entire 24-hour urine collection in a urine container or 50 ml of random urine. Refrigerate specimen during & after collection. NOTE: Follow guidelines in “Patient Instructions for 24-Hour Urine Collection” supplied by Shore Health Laboratories.

Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 83735

MALARIA SMEAR Buffered Giemsa Stain

Test Performed At: Shore Health Laboratories

Specimen: 3 thin blood film and 3 thick films made from fingerstick or, drops of blood from needle following venipuncture. There should be no contact with any type of anticoagulant. To

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prepare blood films, use only clean, frosted-end, grease-free slides. NOTE: Call 410-822- 1000 ext. 5520 for questions on procedure. Do not send EDTA blood.

Thin Blood Films: Prepare with a “feathered edge;” should be no more than a single cell thick. Allow film to thoroughly air dry. Thick Blood Films: Place a large drop of blood (preferably from a fingerstick) on a slide. Using a corner of a second slide, spread the drop by literally scratching the carrier slide to make the blood adhere. Do not fix; air dry only. You should not be able to read newsprint on a good thick smear. Send slides in plastic slide containers. Ordering doctor will be notified of any positive result. Positive result includes the species of malaria and the amount of parasite present.

Reference Values: Negative Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 87207

MATURATION INDEX See: “Cytology, Pap Smear with Index”

MEASLES VIRUS See: “Prenatal Panel” “Rubella Antibodies, IgM Only, Serum” “Rubella Serology, Serum” “Rubeola Serology, Serum” “TORCH Panel”

MENINGITIS ANTIGENS See: “Directigen, Spinal Fluid”

MERCURY, BLOOD ICP/MS

Test Performed At: LabCorp

Specimen: 1-7 ml whole blood collected in EDTA Royal Blue tube. Send the whole tube at room temperature.

Reference Values: 0-14.9 ug/L Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 83825

METALS (HEAVY) SCREEN I, BLOOD Inductively Coupled Plasma/Mass Spectrometry (ICP/MS). Includes arsenic, lead, and mercury.

Test Performed At: LabCorp

Specimen: 1-7 ml EDTA Royal Blue tube. Send the whole tube at room temperature.

Reference Values: See report. Analytic Time: 3 days Day(s) Test Set Up: Monday - Friday

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CPT Code(s): 82175 83825 83655

METALS (HEAVY) SCREEN II, BLOOD Inductively Coupled Plasma/Mass Spectrometry (ICP/MS). Includes arsenic, lead, and mercury and cadmium.

Test Performed At: LabCorp

Specimen: 1-7 ml EDTA Royal Blue tube. Send the whole tube at room temperature.

Reference Values: See report. Analytic Time: 3 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 82175 83825 83655 82300

METALS (HEAVY) SCREEN I, URINE Graphite Furnace AA/Cold Vapor Absorption. Includes arsenic, lead, and mercury.

Test Performed At: LabCorp

Specimen: Submit 10-15 ml of urine from either a random or 24 hour urine sample. Maintain at room temperature. Record volume for 24 hour urine collection.

NOTE: Patient should not eat seafood for a 48 hour period prior to start of collection.

Reference Values: See report. Analytic Time: 3 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 82175 83825 83655 82570

METALS (HEAVY) SCREEN II, URINE Graphite Furnace AA/Cold Vapor Absorption. Includes arsenic, lead, mercury, and cadmium.

Test Performed At: LabCorp

Specimen: Submit 10-15 ml of urine from either a random or 24 hour urine sample. Maintain at room temperature. Record volume for 24 hour urine collection.

NOTE: Patient should not eat seafood for a 48 hour period prior to start of collection.

Reference Values: See report. Analytic Time: 3 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 82175 83825 83655

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82570 82300

METANEPHRINES, URINE LC/MSMS

Test Performed At: LabCorp

Specimen: Submit 10-25 ml of urine from 24 hour urine sample. Refrigerate specimen. Record volume for 24 hour urine collection.

NOTE: Methylgucamine (Renografin) interferes with the testing procedure. Allow at least 1 week after administration before collecting sample. Interfering drugs include Aldomet, chlorpromazine, imipramine, and phenothiazines. Caffeine should be avoided before and during collection.

Reference Values: See report. Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 83835

METHADONE (DOLOPHINE) Gas Chroatography - MS

Test Performed At: LabCorp

Specimen: Specimen types are listed in order of preference. Serum: 1 plain red top tube (minimum 1.0 ml serum). The plain red top tube should not contain gel. Refrigerate specimen. Plasma: 1 green top (heparin) or 1 lavender top (EDTA) tube (minimum 1.0 ml plasma). Refrigerate specimen.

NOTE: Label specimen and indicate on request form whether specimen is serum or plasma.

Reference Values: Therapeutic range: 100-400 ng/ml Analytic Time: 3 -5 days Day(s) Test Set Up: Wednesday & Friday CPT Code(s): 83840

METHSUXIMIDE, SERUM (CELONTIN) (SERUM OR PLASMA) HPLC

Test Performed At: LabCorp

Specimen: 1 plain red top, 1 lavender (EDTA) top, 1 green top (Na Hep) or 1 grey top tube (minimum 1.0 serum or plasma). Separate and freeze sample. Collect prior to next dose.

NOTE: The plain red top should NOT contain gel or silicone.

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Reference Values: See report. Analytic Time: 3 -5 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 83858

METHYLMALONIC ACID (MMA), QUANTITATIVE (SERUM OR PLASMA) Gas Chromatography/Mass Spectrometry (GC/MS) Serum methylmalonic acid is elevated in most patients with cobalamin deficiency.

Test Performed At: LabCorp

Specimen: 1 SST or 1 green top (Na Hep) tube (minimum 2.0 serum or plasma). Refrigerate.

Reference Values: 73-376 nmol/L Analytic Time: 6 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 83921

METHYLPHENIDATE (RITALIN) (SERUM OR PLASMA) Mass Spectrometry – Liquid Chromatography

Test Performed At: LabCorp

Specimen: 1 plain red top, 1 lavender (EDTA) top, or 1 green top (Na Hep) (minimum 3.0 serum or plasma). Freeze specimen.

NOTE: The plain red top should NOT contain gel or silicone.

Reference Values: 5-20 ng/ml Analytic Time: 2 days Day(s) Test Set Up: Tuesday, Thursday, Friday CPT Code(s): 80299

MICROALBUMIN, 24HOUR COLLECTION or RANDOM URINE Turbidimetric

Test Performed At: Shore Health Laboratories

Specimen: Submit an entire 24-hour urine collection in a urine container supplied by Shore Health Laboratories or 1.0 ml random urine. Refrigerate specimen during and after collection. NOTE: Follow guidelines in “Patient Instructions for 24-Hour Urine Collections” supplied by Shore Health Laboratories.

Reference Values: Random: <19.0 mg/L 24-hr: <30 mg/24 hr Excretion rate: <20 ug/min Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82043

MITOCHONDRIAL ANTIBODIES, SERUM

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ELISA

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 sst tube (minimum 1.0 ml serum ). Centrifuge 30 minutes after draw. Freeze.

Reference Values: 0-20.0 units Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 83516

MONONUCLEOSIS SLIDE TEST, SERUM Hemagglutination Slide Test

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: Negative Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 86308

MONOSODIUM URATES (MSU) See: “Crystals, Body Fluids or Urine”

MSU (MONOSODIUM URATES) See: “Crystals, Body Fluids or Urine”

MUMPS VIRUS ANTIBODY, SERUM Enzyme-Linked Fluorescent Assay (ELFA)

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 4.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate. NOTE: Used to determine patient’s immunological experience with Mumps virus.

Reference Values: 0.00-0.34 Negative 0.35-0.49 Equivocal ≥ 0.50 Positive Analytic Time: 1 day Day(s) Test Set Up: Tuesday and Thursday CPT Code(s): 86735

MYCOBACTERIA CULTURE See: “Culture, Acid-Fast Bacillus”

MYCOLOGY, CULTURE See: “Culture, Fungus”

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“Culture, Fungus, Blood”

MYCOPLASMA CULTURE See: “Culture, Mycoplasma”

MYCOPLASMA PNEUMONIAE ANTIBODIES IGG/IGM QUANTITATIVE, SERUM EIA

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 1.0 serum or plasma). Send at room temperature in a screw-capped sterile vial. Maintain sterility and forward promptly. Reference Values: Negative IgG <100 U/ml IgM <770 U/ml The presence of IgM class antibodies or a fourfold or greater rise in paired sera IgG titer indicates recent infection. The presence of demonstrable IgG generally indicates past exposure. Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86738 x2

MYCOPLASMA SEROLOGY See: “Mycoplasma pneumoniae Antibodies, lgG and IgM, Quantitative, Serum”

MYELOPEROXIDASE ANTIBODIES, SERUM (MPO) Enzyme Immunoassay (EIA). Useful for evaluation of patients with vasculitis abnd renal disease.

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 1.0 serum). Centrifuge 30 minutes after draw. Refrigerate specimen.

Reference Values: Negative 0-9 U/ml equivocal Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 83520

MYOCARDIAL ANTIBODIES, SERUM Indirect Immunofluorescence

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 1.0 serum). Centrifuge 30 minutes after draw. Maintain at room temperature.

Reference Values: Negative <1:20

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Analytic Time: 2 days Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 86256 x2

MYOGLOBIN, QUANTITATIVE, URINE (RANDOM) Nephelometry

Test Performed At: LabCorp

Specimen: 10 ml freshly voided urine. No preservatives. Freeze specimen. Collect specimen in early morning or immediately following exercise.

Reference Values: <13 ng/ml Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 83874

MYOGLOBIN, SERUM Chemiluminescence

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: Male: 17.4-105.7 ng/ml Female: 14.3-65.8 ng/ml Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 83874

NASAL SMEAR FOR EOSINOPHILS Wright’s Stain

Test Performed At: Shore Health Laboratories

Specimen: Star-swab® is used to swab the nasal mucous (swab for each nostril), and the mucous is smeared on clean glass slides. Allow to air dry. NOTE: Label slides appropriately (right

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and left nostril).

Reference Values: None seen Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 89190

Na (SODIUM) See: “Electrolyte Panel” “Basic Metabolic Panel” “Comprehensive Metabolic Panel” “Sodium and Potassium, Serum” “Sodium and Potassium, Urine” “Renal Function Panel”

NEISSERIA GONORRHOEAE CULTURE See: “Culture, Transgrow®”

NEISSERIA GONORRHOEAE by Nucleic Acid Amplification See: Chlamydia trachomatis by Nucleic Acid Amplification (Genprobe® - Aptima®) for collection details.

Note: Chlamydia trachomatis and Neisseria gonorrhoeae may be detected in cervical or urethral specimens using a single sample.

NORTHEAST RAST EIA (includes alternaria tenuis, cladosporium herbarum, D. farinae mite, Kentucky blue grass, timothy grass, Lamb’s quarters, ragweed, cat and dog epithelium, and oak)

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 2.0 serum). Refrigerate.

Reference Values: See report. Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 86003 x10

NORTRIPTYLINE (PAMELOR, AVENTYL) SERUM OR PLASMA HPLC

Test Performed At: LabCorp

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Specimen: 1 plain red top, 1 lavender (EDTA) top, or 1 green top (Na Hep) (minimum 1.0 serum or plasma). Refrigerate.

NOTE: The plain red top should NOT contain gel or silicone.

Reference Values: Therapeutic range: 50-150 ng/ml Toxic: >500 ng/ml

Analytic Time: 1 day Day(s) Test Set Up: Tuesday – Friday and Sunday CPT Code(s): 80182

NOSE CULTURE See: “Culture, Nose”

5’NUCLEOTIDASE, SERUM Enzyme Kinetic

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 1.0 serum or plasma). Centrifuge 30 minutes after draw. Refrigerate. Plasma also acceptable for lavender or green top tube.

Reference Values: 0.0-10.0 U/L Analytic Time: 7 days Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 83915

OCCULT BLOOD, FECES Modified Guaiac

Test Performed At: Shore Health Laboratories

Specimen: A minimum of 2 g of fresh (not older than 24 hrs.) stool collected in a gray cup, a tightly covered container, or on hemoccult cards supplied by Shore Health Laboratories. Hemoccult cards must be submitted within 14 days. Please designate if for screening or diagnostic testing.

Reference Values: Negative Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82270

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OCCULT BLOOD, GASTRIC CONTENTS Modified Guaiac

Test Performed At: Shore Health Laboratories

Specimen: Gastric contents collected in a gray cup or tightly covered container supplied by Shore Health Laboratories.

Reference Values: Negative Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82273

OLIGOCLONAL BANDING, SPINAL FLUID High Resolution Electrophoresis/ Immufixation

Test Performed At: LabCorp

Specimen: Both serum and spinal fluid are required for this test. Specimens must be draws with 24 hours of each other. Serum: 1 SST tube (minimum 0.5 ml serum). Centrifuge SST 30 minutes after draw. Freeze serum. Spinal Fluid: 1 plain red top tube (minimum 0.5 ml spinal fluid). Freeze spinal fluid. Label specimens appropriately (serum and spinal fluid).

NOTE: The plain red top should NOT contain gel or silicone.

Reference Values: Negative Analytic Time: 2 days Day(s) Test Set Up: Tuesday - Friday CPT Code(s): 83916

OSMOLALITY, FECES Freezing Point Depression

Test Performed At: LabCorp

Specimen: A minimum 15 ml of liquid stool collected in a gray cup or tightly covered container. A 24 hour timed specimen is recommended. Stool must be in liquid form. Freeze specimen.

Reference Values: None established Analytic Time: 3 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 84999

OSMOLALITY, SERUM Freezing Point Depression

Test Performed At: Shore Health Laboratories

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Specimen: 1 SST tube (minimum 2.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: Male: 275-295 mOsm/kg Female: 270-290 mOsm/kg Critical Value: < 250 or > 326 mOsm/kg Analytic Time: 1 hour Day(s) Test Set Up: Daily CPT Code(s): 83930

OSMOLALITY, URINE Freezing Point Depression

Test Performed At: Shore Health Laboratories

Specimen: 5.0 ml from a random urine collection in a urine sample cup supplied by Shore Health Laboratories. Refrigerate specimen.

Reference Values: Male 390 - 1100 mOsm/kg Female 300 -1100 mOsm/kg Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 83935

OSMOTIC FRAGILITY, ERYTHROCYTES Osmotic Lysis (Not specified for hereditary spherocytosis)

Test Performed At: LabCorp

Specimen: 1 green top (Na Hep) tube. Send 5 ml whole blood and 2 unfixed smears at room temperature. The specimen must reach the lab within 24 hours. DO NOT draw on Fridays.

Reference Values: See report. Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 85557

OSTEOCALCIN, SERUM ELISA

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 1.0 serum) from a fasting patient. Avoid hemolysis and lipemia. Freeze serum specimen.

Reference Values: See report. Analytic Time: 3 days Day(s) Test Set Up: Tuesday & Thursday CPT Code(s): 83937

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O’SULLIVAN SCREEN See: “Glucose Challenge, Serum”

OVA AND PARASITES, FECES

Giardia lamblia and Cryptosporidium Antigen Tests (EIA)

NOTE: When an Ova & Parasites test request is received, Shore Health System Laboratories will perform Giardia lamblia and Cryptosporidium sp. antigen tests by immunoassay (EIA).

1. The Giardia Antigen test or Cryptosporidium Antigen test may be ordered separately if desired .

2. If a traditional O&P with concentration and Trichrome stain is desired, specify “Comprehensive Ova &Parasites.” (See “Ova and Parasites, Comprehensive, Feces”)

3. Specimens received in Formalin/PVA Para-Paks™ will be saved for 2 weeks in case further testing (Ova and Parasites, Comprehensive) is desired.

Test Performed At: Shore Health Laboratories

Specimen: Patient should avoid using Imodium® AD prior to collecting specimen as it can interfere with detection of low levels of Cryptosporidium Collect approximately 2 g. of fresh stool using a Formalin/PVA ParaPak® supplied by Shore Health Laboratories. Do not expose to extreme temperatures.Follow guidelines in “Specimen Collection - Stool Culture, Clostridium difficile or Rotavirus, Ova and Parasites, Giardia/Cryptosporidium Screen” supplied by Shore Health Laboratories.

Reference Values: Giardia -Negative,Cryptosporidium - Negative Analytic Time: 1 day Day(s) Test Set Up : Monday - Friday CPT Code(s): 87329 & 87328

OVA AND PARASITES, COMPREHENSIVE, FECES

Concentration and Trichrome Stain

Test Performed At: LabCorp

Specimen: Collect 2 g of fresh stool using a Formalin/PVA ParaPak®. supplied by Shore Health Laboratories. Do not expose to extreme temperatures. It is strongly recommended that multiple specimens be submitted for ova and parasite analysis. At least 3 specimens should be collected, 1 each day.Follow guidelines in “Specimen Collection - Stool Culture, Clostridium difficile or Rotavirus, Ova and Parasites, Giardia/Cryptosporidium Screen” supplied by Shore Health Laboratories.

Reference Values: No ova or parasites seen Analytic Time: 1 day Day(s) Test Set Up : Monday - Friday CPT Code(s): 87177

OVARIAN CANCERRELATED ANTIBODIES

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See: “Cancer Antigen 125 (CA 125), Serum”

OXALATE, URINE 24 HOUR Spectrophotometry. Includes urine creatinine.

Test Performed At: LabCorp

Specimen: Submit 10 ml urine from a 24 hour urine collection. Refrigerate specimen during and after collection. Follow guidelines in “Patient Instructions for 24 Hour Urine Collection” pamphlet supplied by SHL. pH of aliquot should be adjusted to <3 with 6 N HCl prior to sending. Samples collected or sent in containers with metal caps and samples containing nitric acid will NOT be tested.

NOTE: Avoid taking large doses (>2.0 g orally/24 hours) of Vitamin C prior to and during specimen collection. High intakes of rhubarb, strawberries, tomatoes, chocolate, cocoa, and tea cause significant increase in oxalic acid excretion.

Reference Values: See report. Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 83945

OXYCODONE, URINE (PERCODAN) Gas Chromatography-GCMS

Test Performed At: LabCorp

Specimen: 20 ml from random urine collection in a urine cup. Maintain at room temperature.

Reference Values: None detected Analytic Time: 3 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 83925

PAP (PROSTATIC ACID PHOSPHATASE) See: “Acid Phosphatase, Prostatic, Serum”

PAP SMEAR See: “Cytology, Pap Smear” “Cytology, Pap Smear with Index"

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PARASITIC EXAMINATION See: “Malaria Smear”

PARASITE SEROLOGY, SERUM Method is agent dependent

Test Performed At: Maryland State Health Department

Specimen: 1 SST tube (minimum 2.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen. NOTE: 1. Acute and convalescent specimens are needed to interpret the results. The convalescent specimen should be obtained 2-3 weeks after onset. 2. Label specimen appropriately (acute or convalescent). 3. Type of parasite is required on request form for processing.

Reference Values: Agent dependent Analytic Time: 21-28 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86753

PARATHYROID HORMONE (PTH), Intraoperative Immunochemiluminometric Assay (ICMA) Concomitant calcium

TEST MUST BE SCHEDULED WITH THE LAB 48 HOURS PRIOR TO SURGERY

Test Performed At: Shore Health Laboratories

Specimen: 1 plain, red-top tube or 1 SST tube (minimum 1.0 ml of serum) from each site.

Reference Values : None Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82310 83970 - parathyroid hormone

PARATHYROID HORMONE (PTH) INTACT, SERUM Immunochemiluminometric Assay (ICMA) Concomitant calcium Primary test for hyperparathyroidism, secondary hyperparathyroidism, or hypoparathyroidism.

Test Performed At: Shore Health Laboratories

Specimen: 1 plain, red-top tube or 1 SST tube (minimum 1.0 ml of serum). Centrifuge 30 minutes after draw. Refrigerate specimens.

Reference Values : PTH: 12 - 88 pg/ml

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Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82310 83970 - parathyroid hormone

PARIETAL CELL ANTIBODIES, SERUM EIA

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 serum). Centrifuge 30 minutes after draw. Maintain at room temperature

Reference Values: Negative <20 units Analytic Time: 2 days Day(s) Test Set Up: Tuesday - Friday CPT Code(s): 83516

PARTIAL THROMBOPLASTIN TIME (PTT) See: “Activated Partial Thromboplastin Time (APTT), Plasma”

PARVOVIRUS B19 ANTIBODIES, IGG AND IGM (SEPARATE DETERMINATIONS), SERUM EIA Useful for detection of Parvovirus B19 IgG and IgM antibodies to aid in diagnosing erythema infectiosum, Parvovirus B19 aplastic crisis, and other Parvovirus B19 related diseases.

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 0.5 serum). Centrifuge 30 minutes after draw. Maintain at room temperature.

Reference Values: See report. The presence of IgM antibodies indicates recent infection. The presence of IgG antibodies only is suggestive of past exposure.

Analytic Time: 3 -5 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86747 x2

PATHOLOGY, SURGICAL See: “Histology, Tissue”

PERPHENAZINE (TRILAFON) (SERUM OR PLASMA) Liquid Chromatography-tandem MS-MS

Test Performed At: LabCorp

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Specimen: Collect specimen 10-14 hours after last dose or just prior to next dose. Protect specimen from light. Specimens are listed in order of preference. Serum: 2 plain red top tubes (minimum 3.0 ml serum). The red top tube should not contain gel or silicone. Refrigerate specimen. Plasma: 2 green sodium heparine tubes (minimum 3.0 ml plasma). Refrigerate specimen.

NOTE: Indicate serum on plasma on request form and specimen.

Reference Values: See report. Analytic Time: 2 days Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 82491

PHENOBARBITAL, SERUM PETIA Immunoassay

Test Performed At: Shore Health Laboratories

Specimen: 1 plain, red-top tube (minimum 0.5 ml of serum) drawn prior to next dose. NOTE: 1. The plain, red-top tube should NOT contain gel or silicone. 2. Therapeutic monitoring- draw blood prior to next dose. 3. Oral - times dependent on formulation and dosage due to its long elimination half-life. Actual sampling time is unimportant. When making comparative measurements, it is important for sample time to be consistent. Refrigerate specimen after collection.

Reference Values: Therapeutic concentration: 15-40 ug/ml Critical Value: > 60 ug/ml Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 80184

PHENOTYPE, BLOOD See: “Antigen Identification”

PHENYLALANINE, PLASMA Ion Exchange Chromatography

Test Performed At: LabCorp (700205)

Specimen: 1 green top (Na Hep) tubes (minimum 0.5 plasma) from a fasting patient; a fast of 4 hours or more in infants. Centrifuge, promptly separate plasma from cells, and freeze in plastic vial. Send specimen frozen.

NOTE: Include patient’s age, tentative diagnosis, therapy, and history on request form.

Reference Values: See report. Analytic Time: 5 days Day(s) Test Set Up: Sunday - Friday CPT Code(s): 84030

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PHENYLKETONURIA, BLOOD Gel Immunodiffusion. Includes T4.

Test Performed At: Maryland State Health Department

Specimen: Whole blood from a heel stick. Fill circles on form supplied by Maryland State Health Department. Let air dry. Send in envelope to Maryland State Health Department.

Reference Values: See report. Analytic Time: 30 days Day(s) Test Set Up: Varies CPT Code(s): 84030 84436

PHENYTOIN, TOTAL, SERUM (DILANTIN®) PETIA Immunoassay

Test Performed At: Shore Health Laboratories

Specimen: 1 plain, red-top tube (minimum 0.5 ml of serum) collected as follows: IV dose : draw 2-4 hours after dose. Oral : times dependent on formulation and dosage due to its long elimination half-life. Actual sampling time is unimportant. When making comparative measurements, it is important for sample time to be consistent. Refrigerate specimen.

NOTE : The plain, red-top tube should NOT contain gel or silicone.

Reference Values: Therapeutic concentration: 10-20 ug/ml Critical Value: > 30 ug/ml Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 80185

pH, FECES Nitrazine Paper

Test Performed At: Shore Health Laboratories

Specimen: A minimum of 2g of stool (not older than 24 hrs.) collected in a gray cup or tightly covered container.

Reference Values: 7.0 - 7.5 Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 83986

PHOSPHATASE See: “Acid Phosphatase, Prostatic, Serum” “Alkaline Phosphatase lsoenzymes, Serum” “Alkaline Phosphatase, Serum” “Leukocyte Alkaline Phosphatase (LAP) Score”

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“Hepatic Panel” “Comprehensive Metabolic Profile”

PHOSPHATE, INORGANIC PHOSPHORUS See: “Renal Function Panel” “Phosphorus, Inorganic, Serum”

PHOSPHOLIPID ANTIBODIES (CARDIOLIPIN ANTIBODIES), IGG, IGA, IGM, SERUM EIA

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 1.0 serum). Centrifuge 30 minutes after draw. Refrigerate.

Reference Values: See report. Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86147 x3

PHOSPHOLIPIDS, SERUM Spectrophotometry

Test Performed At: LabCorp

Specimen: 1 plain red top tube or 1 SST tube(minimum 0.5 serum). Draw specimen following an overnight (12-14 hour) fast. Patient must not consume any alcohol for 24 hours before the specimen is drawn. Refrigerate.

Reference Values: 150-250 mg/dl Analytic Time: 2 days Day(s) Test Set Up: Sunday - Friday CPT Code(s): 84311

PHOSPHORUS See: “Renal Function Panel” “Phosphorus, Inorganic, Serum” “Phosphorus, Urine”

PHOSPHORUS, INORGANIC, SERUM Molybdate

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate.

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Reference Values: Adult: 2.3-4.5 mg/dl Critical Value: Child < 1.3 or > 8.9 mg/dl 16 yr old-Adult < 1.2 or > 8.9 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84100

PHOSPHORUS, URINE Molybdate

Test Performed At: Shore Health Laboratories

Specimen: Submit an entire 24-hour urine collection in a urine container with no preservative. Urine containers are supplied by Shore Health Laboratories. Place specimen on wet ice and transport to Shore Health Laboratories immediately. NOTE: Follow guidelines in “Patient Instructions for 24-Hour Urine Collection” supplied by Shore Health Laboratories.

Reference Values: 400 - 1300 mg/24 hours Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84105 - phosphorus 81050 - urine timed measurement

pH, URINE Nitrazine Paper

Test Performed At: Shore Health Laboratories

Specimen: 1.0 ml from random urine collection in a urine sample cup supplied by Shore Health Laboratories.

Reference Values: 5.0-8.0 Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 83986

PINWORM PREPARATION Scotch Tape Preparation

Test Performed At: Shore Health Laboratories

Specimen : Using clear cellulose tape, place preparation on glass slide. Do not use magic transparent tape. NOTE: 1. Follow guidelines in “Laboratory Outpatient Instructions for Scotch-Tape Preparation for Pinworms” supplied by Shore Health Laboratories. 2. Collect specimen in the early a.m. before bathing, changing clothes, or going to the bathroom.

Reference Values: None detected Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 87208

189

PKU (PHENYLKETONURIA) See: “Phenylalanine, Plasma” “Phenylketonuria, Blood”

PLATELET ANTIBODY TEST, DIRECT Flow Cytometry

Test Performed At: LabCorp

Specimen: 12 ml whole blood from 2 yellow ACD tubes or 3 EDTA lavender tubes.. Keep at room temperature. Must arrive within 72 hours. Specimen cannot be frozen.

Reference Values: Negative.

Analytic Time: 2 days Day(s) Test Set Up: Daily CPT Code(s): 86022

PLATELET COUNT See: “Platelet Count, Blood” “Blood Count”

PLATELET COUNT, BLOOD Electrical Impedence

Test Performed At: Shore Health Laboratories

Specimen: 1 lavender-top (K2 EDTA) tube (minimum 2.0 ml of K2 EDTA whole blood).

NOTE: 1 light blue top 3.2(citrate) tube and 1 lavender top (K2 EDTA) tube are used ONLY on patients with history of platelet clumping

Reference Value: 160,000-450,000 cells/mm 3 Critical Value: See page 29. Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 85595

PNEUMOCOCCAL IGG VACCINE RESPONSE, ELISA (14 Serotypes) Beade-based Fluoroimmunoassay

Test Performed At: LabCorp

190

Specimen: 1 plain red top or 1 SST tube (minimum 1.0 serum). Refrigerate.

NOTE: Pre and Post vaccination samples submitted at the same time are highly recommended.

Reference Values: See report. Analytic Time: 2 days Day(s) Test Set Up: Monday - Thursday CPT Code(s): 86317 x14

POLIOVIRUS (TYPES 13) ANTIBODY

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 2.0 ml serum). Refrigerate specimen.

Reference Values: See report. Analytic Time: 2 days Day(s) Test Set Up: CPT Code(s): 86658 x3

PORPHOBILINOGEN, URINE 24 HOUR Colorimetric

Test Performed At: LabCorp

Specimen: Send 3 ml from a 24 hour urine collection. Freeze specimen in amber tube. Protect from light. Random urine samples are also acceptable.

Reference Values: 0.0-1.5 mg/24 hr Analytic Time: 5 days Day(s) Test Set Up: Wednesday & Friday CPT Code(s): 84110

PORPHYRINS, FRACTIONATION, PLASMA HPLC

Test Performed At: LabCorp

Specimen: 2 green top (Na Hep) tubes (minimum 3.0 plasma). Transfer plasma to amber tube to protect from light. FREEZE.

Reference Values: See report. Analytic Time: 2 days Day(s) Test Set Up: CPT Code(s): 82491

PORPHYRINS, FRACTIONATED QUANTITATIVE, URINE HPLC with Fluorometric Detection

Test Performed At: LabCorp

191

Specimen: Submit 10 ml from a 24 hour urine collection. Place urine in amber bottle to protect from light. Refrigerate specimen. Random urine samples are also acceptable. Follow guidelines in “Patient Instructions for 24 hour Urine Collection” supplied by SHL.

NOTE: The patient should be off medications, if possible, for at least 1 week.

Reference Values: See report. Analytic Time: 2 days Day(s) Test Set Up: Tuesday - Friday CPT Code(s): 84120

POST VASECTOMY See: “Semen Analysis, Post Vasectomy”

POTASSIUM See: “Basic or Comprehensive Metabolic Panel” “Renal Function Panel” “Electrolyte Panel” “Potassium, Serum” “Potassium, Urine”

POTASSIUM, SERUM Ion Selective Electrode

Test performed At: Shore Health Laboratories

Specimen: 1 SST tube (Minimum 1 ml serum). Centrifuge and refrigerate - avoid hemolysis.

Reference Values: Adult: 3.5-5.1 mEq/L Critical Value: Newborn(<1 month old): <2.8 or >7.8 mEq/L Child: <2.8 or >6.4 mEq/L 16 yr old-Adult: <2.8 or >6.2 mEq/L Analytical Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84132

POTASSIUM, URINE Ion Selective Electrode

Test Performed At: Shore Health Laboratories

Specimen: 2.0 ml random urine or an entire 24 hr. urine collection.

Reference Values: 25 -125 mEq/24hrs. Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84133

PRA (PROGESTERONE RECEPTOR ASSAY) See: “Estrogen/Progesterone Receptor (Paraffin), Immunoperoxidase Stain”

192

PREALBUMIN (PAB), SERUM Turbidimetric method

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum) from a fasting patient. Centrifuge SST 30 minutes after draw.

Reference Values: Adult: 18 – 35.7 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84134

PREGNANCY TEST, QUALITATIVE, SERUM Immunochromatographic Assay

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: Negative Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84703

PREGNANCY TEST, QUANTITATIVE (TITER) See: “hCG (Human Chorionic Gonadotropin), Quantitative (Titer), Serum”

PREGNANCY TEST, URINE Rapid Chromatographic Immunoassay

Test Performed At : Shore Health Laboratories

Specimen : Submit first morning urine specimen in a urine sample cup supplied by Shore Health Laboratories. No preservative.

Reference Values: Negative Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 81025

PRIMIDONE, SERUM/PLASMA FPIA

Test Performed At: LabCorp

193

Specimen: 1 plain red top or 1 green top (Na Hep) tube (minimum 1.0 serum or plasma). Refrigerate.

NOTE: The plain red top should NOT contain gel or silicone.

Reference Values: Therapeutic concentration: 5-12 mcg/ml Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 80188 80184

PRL (PROLACTIN) See: “Prolactin, Serum”

PROCAINAMIDE, SERUM/PLASMA Immunoassay

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 green top (Na Hep) tube (minimum 1.0 serum or plasma). Refrigerate.

NOTE: The plain red top should NOT contain gel or silicone.

Reference Values: See report. Analytic Time: 3 -5 days Day(s) Test Set Up: Monday - Sunday CPT Code(s): 80192

PROGESTERONE RECEPTOR See: “Estrogen/Progesterone Receptor (Paraffin), Immunoperoxidase Stain”

PROGESTERONE, SERUM Chemiluminescense

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen. NOTE: This test should not be used for monitoring well-being during the 3rd trimester.

Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84144

PROINSULIN, SERUM EIA

Test Performed At: LabCorp

194

Specimen: 1 plain red top or 1 SST tube (minimum 1.0 serum) from a fasting patient. Separate serum and freeze immediately in plastic vial.

Reference Values: <10.0 pmol/L Analytic Time: 7-10 days Day(s) Test Set Up: Once per week CPT Code(s): 84206

PROLACTIN, SERUM Chemiluminescence

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84146

PROPAFENONE, SERUM (RYTHMOL) Liquid Chromatography, Mass Spectrometry useful for treatment of supraventricular and ventricular rhythm disturbances.

Test Performed At: LabCorp

Specimen: 2 plain red top (minimum 3.0 serum). Refrigerate.

NOTE: The plain red top should NOT contain gel or silicone.

Reference Values: See report. Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 80299

PROPOXYPHENE, BLOOD (DARVON) QUANTITATIVE GC/MS

Test Performed At: LabCorp

Specimen: 1 plain red top, 1 lavender (EDTA) top, or 1 green top (Na Hep) tube (minimum 1.0 serum or plasma). Refrigerate. Record time of last dose.

Reference Values: See report. Analytic Time: 3 days Day(s) Test Set Up: Monday, Friday CPT Code(s): 80367

195

PROSTATESPECIFIC ANTIGEN (PSA), SERUM Chemiluminescence

Must designate Screen or Diagnostic

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen after collection. NOTE: Include patient’s age on request form.

Reference Values: Age specific-see p. 269 Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84153

PROSTATE SPECIFIC ANTIGEN (TOTAL & FREE) Chemiluminescence

Test Performed At: Shore Health Laboratories

Specimen: 1 plain red top or 1 SST tube (minimum 1.0 serum). Refrigerate.

Reference Values: See report. Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84153 84154

PROSTATIC ACID PHOSPHATASE (PAP) See: “Acid Phosphatase, Prostatic, Serum”

PROTEIN See: "Comprehensive Metabolic Panel" “Albumin/Globulin (A/G) Ratio, Serum” “C-Reactive Protein (CRP), Serum” “Electrophoresis, Protein, Serum” “Electrophoresis, Protein, Urine” “Protein C Antigen, Plasma” “Protein, Quantitative, Urine” “Protein, Spinal Fluid” “Protein, Total, Serum”

PROTEIN C ANTIGEN, PLASMA ELISA

Test Performed At: LabCorp

196

Specimen: 1 light blue top tube (minimum 2.0 sodium citrated plasma). Freeze plasma immediately and send frozen.

Reference Values: See report. Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 85302

PROTEIN, CREACTIVE See: “C-Reactive Protein (CRP), Serum”

PROTEIN ELECTROPHORESIS See: “Electrophoresis, Protein, Serum” “Electrophoresis, Protein, Urine”

PROTEIN, QUANTITATIVE, URINE Turbidimetric

Test Performed At: Shore Health Laboratories

Reference Values: < 149 mg/24 hrs Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84155 - protein 81050 - urine timed measurement

PROTEIN, SPINAL FLUID Trichloroacetic Acid Precipitation

Test Performed At: Shore Health Laboratories

Specimen: 1 plain, red-top tube (minimum 0.5 ml of spinal fluid). Refrigerate specimen. Do not use gel barrier tubes.

Reference Values: 15-45 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84155

PROTEIN, TOTAL, SERUM Biuret

Test Performed At: Shore Health Laboratories

197

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: 6.0-8.2 g/dL Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84155

PROTHROMBIN TIME (PT), PLASMA Photo Optic

Test Performed At: Shore Health Laboratories

Specimen: 1 light blue-top 3.2 (citrate) tube. Fill tube completely.

Reference Values: 9 -13.0 seconds Critical Value: INR > 5.0 Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 85610

PROTHROMBIN GENE MUTATION (FACTOR II, DNA ANALYSIS)

Test Performed At: LabCorp

Specimen: 3 Lavender (EDTA) or 2 Yellow ACD tubes (minium 7.0ml whole blood). Send original tubes at room temperature

Reference Values: See report. Analytic Time: Day(s) Test Set Up: CPT Code(s): 81240

PRO TIME See: “Prothrombin Time (PT), Plasma”

PR (PROGESTERONE RECEPTOR) See: “Estrogen/Progesterone Receptor (Paraffin), Immunoperoxidase Stain”

PSA (PROSTATESPECIFIC ANTIGEN) See: “Prostate-Specific Antigen (PSA), Serum” "Prostate-Specific Antigen, Total & Free”

PTH (PARATHYROID HORMONE)WHOLE MOLECULE See: “Parathyroid Hormone (PTH) Intact, Serum”

198

PTH, RELATED PROTEIN (PEPTIDE) Immunoradiometric Assay

Test Performed At: LabCorp

Specimen: Collect blood into chilled lavender (EDTA) tube noting time of collection. Immediately immerse the tubes into an ice bath. Centrifuge specimen, separate and freeze plasma.

Reference Values: See report. Analytic Time: 2 -7 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 82397

PT (PROTHOMBIN TIME) See: “Prothrombin Time (PT), Plasma”

PTT (PARTIAL THROMBOPLASTIN TIME) See: “Activated Partial Thromboplastin Time (APTT), Plasma”

PYLORI, HELICOBACTER (CAMPYLOBACTER PYLORI) See: “Helicobacter pylori, lgG Antibody, Serum"

PYROPHOSPHATE CRYSTALS See: “Crystals, Body Fluids”

PYRUVATE KINASE, BLOOD (PYRUVIC ACID) Spectrophotometry

Test Performed At: LabCorp

Specimen: 1 grey top tube chilled. Immediately after draw, add 5 ml of whole blood to 5 ml of 8% perchloric acid. Shake vigorously for 30 seconds. Refrigerate for 5 minutes. Centrifuge for 5-10 minutes. Transfer clear supernatant to transport tube labeled “supernatant”. Note that second centrifugation may be required. Refrigerate.

Reference Values: 0.3-0.7 mg/dl Analytic Time: 1-2 days Day(s) Test Set Up: Tuesday, Thursday CPT Code(s): 84210

QUANTIFERON TB GOLD

199

IGRA

Test Performed At: LabCorp

Specimen: Requires a Quantiferon collection kit—3 tubes in kit. Follow instructions and maintain samples at room temperature.

Note: Time sensitive-draw only Monday through Friday. Reference Values: See report Analytic Time : 4 days Day(s) Test Set Up : Daily CPT(s) Code: 86480

Q FEVER ANTIBODIES, IGG, SERUM IFA

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 0.5 serum). Centrifuge 30 minutes after draw. Send at room temperature.

Reference Values: See report. Analytic Time: 7-10 days Day(s) Test Set Up: Wednesday, Friday CPT Code(s): 86638

Q FEVER ANTIBODIES, IGM, SERUM IFA

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 0.5 serum). Centrifuge 30 minutes after draw. Send at room temperature.

Reference Values: See report. Analytic Time: 5-7 days Day(s) Test Set Up: Tuesday, Thursday CPT Code(s): 86638

QUINIDINE, SERUM/PLASMA Immunoassay

Test Performed At: LabCorp

200

Specimen: 1 plain red top or 1 green top (heparin) tube (minimum 1.0 serum or plasma). Do not use gel barrier tube. Refrigerate.

Reference Values: Therapeutic concentration: 2.0-5.0 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 80194

RAPID PLASMA REAGIN (RPR) TEST See: “Prenatal Profile” “Syphilis Serology”

RA (RHEUMATOID ARTHRITIS) FACTOR See: “Lupus Comprehensive Panel” “Rheumatoid Factor, Serum”

RAPAMYCIN See: “Sirolimus”

RAPAMUNE See: “Sirolimus”

REDUCING SUBSTANCE, FECES Clinitest

Test Performed At: Shore Health Laboratories

Specimen: A minimum of 15 g of stool collected in a gray cup or tightly covered container. Refrigerate specimen. Must be received at Shore Health Laboratories within 24 hours.

Reference Values: Negative Analytic Time: 2 days Day(s) Test Set Up: Daily CPT Code(s): 84999

RENALCELL CARCINOMA See: “DNA Ploidy of Solid Tumor by Flow Cytometry, Paraffin Block” “Histology, Tissue”

201

RENAL STONE STUDY Gross Exam/ X-ray Diffraction

Test Performed At: LabCorp

Specimen: Entire renal stone, dried

Reference Values: Descriptive report Analytic Time: 7-14 days Day(s) Test Set Up: Daily CPT Code(s): 82370

RENIN ACTIVITY, PLASMA Immunochemiluminescence

Test Performed At: LabCorp

Specimen: 3.0 ml plasma from a lavender (EDTA) tube. Centrifuge and separate plasma at room temperature. FREEZE plasma immediately. The specimen is stable for 24 hours at room temperature if not frozen.

Reference Values: See report Analytic Time: 3 days Day(s) Test Set Up: Monday- Friday CPT Code(s): 84244

RESPIRATORY SYNCTIAL VIRUS (RSV) ANTIBODY, SERUM Complement Fixation

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 2.0 serum). Centrifuge 30 minutes after draw. Refrigerate.

Reference Values: See report Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86756

RESPIRATORY SYNCYTIAL VIRUS (RSV) ANTIGEN, NASOPHARYNGEAL ASPIRATE EIA

Test Performed At: Shore Health Laboratories

202

Specimen: Call Shore Health Laboratories for collection instructions.

Reference Values: Negative Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 86313

RETICULOCYTE COUNT, BLOOD New Methylene B Stain and Flow Cytometry

Test Performed At: Shore Health Laboratories

Specimen: 1 lavender-top (K2 EDTA) tube (minimum 3.0 ml of K2 EDTA whole blood).

Reference Values: 0.5-2.0% corrected retic Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 85044

RF (RHEUMATOID FACTOR) See: “Lupus Comprehensive Panel” “Rheumatoid Factor, Serum”

RHEUMATOID ARTHRITIS See: “Lupus Comprehensive Panel” “Rheumatoid Factor, Serum”

RHEUMATOID FACTOR See: “Lupus Comprehensive Panel” “Rheumatoid Factor, Serum”

RHEUMATOID FACTOR, SERUM Hemagglutination Slide Test

Tes t Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 2.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: Negative If positive, results are titered. Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 86430 - screen 86431 - titer

Rh IMMUNE GLOBULIN WORKUP, (POST PARTUM), BLOOD(RHOGAM) Agglutination Hemagglutination Solid Phase

203

Indicate if NOT Antepartum. Includes ABO/Rh typing, antibody screen, and fetomaternal hemorrhage rapid screen NOTE: This procedure is for 72 hours postpartum.

Test Performed At: Shore Health Laboratories

Specimen: 1 pink-top blood bank tube (minimum: 5.0 ml of whole blood)

Reference Values: Negative for Rh. Absence of anti-D in plasma Baby’s Rh type must be Rh (D) positive Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 86900 - ABO type 86901 - D typing 86850 - Screen

Rh IMMUNE GLOBULIN WORKUP, (ANTEPARTUM), BLOOD(RHOGAM) Agglutination Hemagglutination Solid Phase

Indicate if Antepartum. Includes ABO/Rh typing and antibody screen. NOTE: This procedure is for > 12 weeks to postpartum.

Test Performed At: Shore Health Laboratories

Specimen: 1 pink-top blood bank tube (minimum 5.0 ml of whole blood). NOTE: This procedure is for 28 weeks gestation.

Reference Values: Negative for Rh. Absence of anti-D in plasma Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 86900 - ABO type 86901 - D typing 86850 - Screen

RIBOFLAVIN (VITAMIN B2), PLASMA HPLC Useful for detection of riboflavin and evaluation of nutritional and nerve compression disorders.

Test Performed At: LabCorp

Specimen: 1.5 ml whole blood from lavender (EDTA) tube. Wrap in foil to protect from light. FREEZE.

NOTE: Patient must not consume any alcohol or ingest vitamin supplements for 24 hours before the specimen is drawn.

Reference Values: 137-370 ug/L Analytic Time: 2 days Day(s) Test Set Up: Daily CPT Code(s): 84252

204

RICKETTSIAL ANTIBODY See: “Q fever Antibodies, Serum” “Rocky Mountain Spotted Fever IgM Antibody, IFA”

RICKETTSIAL SEROLOGY, SERUM IFA

Test Performed At: Maryland State Health Department

Specimen: 1 SST tube (minimum 2.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen after collection. NOTE: 1. Acute and convalescent specimens are needed to interpret the results. The convalescent specimen should be obtained 2-3 weeks after onset. 2. Label specimen appropriately (acute or convalescent). 3. Specify rickettsial agent on request form.

Reference Values: Agent dependent Analytic Time: 21-28 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86256

RMSF (ROCKY MOUNTAIN SPOTTED FEVER) See: “Rocky Mountain Spotted Fever IgM Antibody, IFA” “Rocky Mountain Spotted Fever Serology, Serum”

ROCKY MOUNTAIN SPOTTED FEVER SEROLOGY, SERUM IFA

Test Performed At: LabCorp

Specimen: SST tube (minimum 3.0 ml of serum). Centrifuge SST 30 minutes after draw. NOTE: 1. Acute and convalescent specimens are needed to interpret the results. The convalescent specimen should be obtained 1-2 weeks after onset . 2. Label specimens appropriately (acute or convalescent).

Reference Values: See LabCorp report Analytic Time: 1-2 days Day(s) Test Set Up: Monday – Friday CPT Code(s): 86256

ROTAVIRUS ANTIGEN, FECES IMMUNOCHROMATOGRAPHY

Test Performed At: Shore Health Laboratories

205

Specimen: A minimum of 1.5 g of stool collected in a gray cup or tightly covered container. Do not retrieve the specimen from the toilet bowl or bedpan. Refrigerate specimen. Forward promptly.

Note: Rotavirus is excreted from the infected individual during the acute phase of illness. Collect the specimen as soon as possible after onset of symptoms.

Reference Values: Negative

Analytic Time: 1 day Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 87425

RPR (RAPID PLASMA REAGIN) TEST See: “Prenatal Panel” “Syphilis Serology”

RUBELLA See: “Prenatal Panel” “Rubella Antibodies, IgM Only, Serum” “Rubella Serology, Serum” “TORCH Panel”

RUBELLA ANTIBODIES, IGM ONLY, SERUM MEIA Test for IgM class antibodies is useful in differentiating congenital from primary infections. IgM class antibodies are present in the acute stage of primary rubella infections or in congenital rubella infections.

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST top tube (minimum 1.0 serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen and forward promptly.

NOTE: Include patient’s age on request form.

Reference Values: See report. Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86762

RUBELLA SEROLOGY, SERUM (IgG) Chemiluminescence

NOTE: This test is for immune status.

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum: 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen in a screw-capped, sterile vial after collection. Maintain sterility and forward promptly. NOTE: If looking for clinical illness, call Shore Health Laboratories.

206

Reference Values: Immune or non-immune Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 86762

RUBEOLA ANTIBODY IgG

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge and refrigerate.

Reference Values: See Lab Report Analytic Time: 2 days Day(s) Test Set Up: Tuesday and Thursday CPT Code(s): 86765

RUBEOLA ANTIBODY IgM

Test Performed At: Lab Corp

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge and refrigerate.

Reference Values: Negative Analytic Time: Positive reported within 4 days Day(s) Test Set Up: Tuesday and Friday CPT Code(s): 86765

SALICYLATE, SERUM Colorimetric/Timed Endpoint

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: Adult therapeutic range: 4.0-20 mg/dl Critical Value: > 30 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 80196

SCHILLING TEST, URINE See: “Gastrin, Serum"

207

SCOTCH TAPE PREP See: “Pinworm Preparation”

SEDIMENTATION RATE (ESR), SERUM Westergren, Modified

Test Performed At: Shore Health Laboratories

Specimen: 1 lavender-top (K2 EDTA) tube (minimum 3.0 ml of K2 EDTA whole blood).

Reference Values: Males: 0-15 mm/hour Females: 0-20 mm/hour Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 85651

SELENIUM, SERUM Atomic Absorption Spectrometry

Test Performed At: LabCorp

Specimen: 1 royal blue trace element blood collection tube. No additive. (minimum 1.0 ml serum). Specimen must be obtained, processed, and transported according to instructions on p. 257, “Metals Analysis Collection and Transport.” Send original collection tube at room temperature.

Reference Values: 76-326 ug/L Analytic Time: 2 days Day(s) Test Set Up: Tuesday - Friday CPT Code(s): 84255

SELENIUM, URINE GFAAS

Test Performed At: LabCorp

Specimen: 20 ml urine collected in plastic container. Maintain at room temperature.

Reference Values: 10-160 ug/L Analytic Time: 2 days Day(s) Test Set Up: Tuesday - Friday CPT Code(s): 84255

SEMEN ANALYSIS, COMPLETE Manual Procedure

208

Includes activity grade and viability, count, liquefaction, motility at 1 hour, morphology, pH, viscosity, and volume.

Test Performed At: Shore Health Laboratories

Specimen: Semen. Follow guidelines in “Laboratory Outpatient Instructions for Semen Collection” supplied by Shore Health Laboratories. NOTE: Specimen must be received in the laboratory within 30 minutes of collection. Due to the amount of technologist time required to perform this test, we ask that the specimen be delivered prior to 11 a.m. The reliability of the specimen and the ability to grade motility are compromised in delayed specimens. Patient is required to answer a questionnaire (see p. 25). Also see Semen analysis instructions on p. 24.

Reference Values: Results include count, motility, and morphology. Analytic Time: 1-2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 89320

SEMEN ANALYSIS, POST VASECTOMY Manual Procedure

Test Performed At: Shore Health Laboratories

Specimen: Semen . Follow guidelines in “Laboratory Outpatient Instructions for Semen Collection” supplied by Shore Health Laboratories. NOTE: Specimen must be received in the laboratory within 30 minutes of collection . Due to the amount of technologist time required to perform this test, we ask that the specimen be delivered prior to 11a.m. The reliability of the specimen and the ability to grade motility are compromised in delayed specimens.

Reference Values: No sperm seen Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 89300

SENSITIVE THYROIDSTIMULATING HORMONE See: “Thyroid-Stimulating Hormone - Sensitive (S-TSH), Serum”

SEROTONIN, SERUM HPLC

Test Performed At: LabCorp

Specimen: 1 plain red top tube (minimum 2.0 serum) from a fasting patient. Separate and freeze serum within 2 hours of collection. The patient should be medication free for 72 hours prior to collection.

NOTE: Avoid bananas, eggplant, pineapple, avocado, prunes, and walnuts.

Reference Values: 0-420 ng/ml Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 84260

209

SEX HORMONE BINDING GLOBULIN (SHBG), SERUM ICMA

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 1.0 serum or plasma). Centrifuge 30 minutes after draw. Refrigerate specimen after collection..

Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 84270

SGOT/AST (ASPARTATE AMINOTRANSFERASE) See: “Aspartate Aminotransferase (AST/SGOT), Serum" “Hepatic Panel” “Comprehensive Metabolic Panel”

SGPT/ALT (ALANINE AMINOTRANSFERASE) See: “Alanine Aminotransferase (ALT/SGPT), Serum” “Hepatic Panel” ”Comprehensive Metabolic Panel"

SICKLE CELL See: “Hemoglobin Electrophoresis, Blood” “Sickle Cell Testing, Blood"

SICKLE CELL TESTING, BLOOD Solubility Test-Qualitative

Test Performed At: Shore Health Laboratories

Specimen: 1 lavender-top (EDTA) tube (minimum 1.0 ml EDTA whole blood).

Reference Values: Negative Analytic Time: 1 day Day(s) Test Set Up: Friday CPT Code(s): 85660

SICKLEDEX See: “Hemoglobin Electrophoresis, Blood”

SICKLING TEST

210

See: “Hemoglobin Electrophoresis, Blood” “Sickle Cell Testing, Blood”

SIROLIMUS (RAPAMYCIN) LC/MS-MS

Test Performed At: LabCorp

Specimen: 1 lavender (EDTA). Send whole blood. Refrigerate.

NOTE: Trough level: draw 30-60 minutes before next dose.

Reference Values: See report. Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 80195

SKIN BIOPSY See: “Cutaneous Immunofluorescence, Biopsy” “Cutaneous Leukocyte Immunophenotyping, Biopsy” “Histology, Tissue”

SMEAR, ACID FAST BACILLIAFB See: “Culture, Acid-Fast Bacillus”

SMEAR, GRAM STAIN Gram Stain

Test Performed At: Shore Health Laboratories

Specimen: Maintain sterility and forward promptly on a Culture-swab® or in a tightly sealed sterile cup or tube. NOTE: Culture site required on request form for processing.

Reference Values: Site dependent Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 87205

SMEAR, INDIA INK, SPINAL FLUID India Ink Smear

Test Performed At: Shore Health Laboratories

Specimen: 1 plain (no additives) STERILE tube (minimum 1.0 ml of spinal fluid).Maintain sterility and forward tightly capped sterile vial immediately after collection.

NOTE: 1. If specimen is used for bacterial culture, forward immediately after collection at ambient temperature only. 2. The plain, red-top tube should NOT contain gel or silicone.

Reference Values: Negative Analytic Time: 1 day

211

Day(s) Test Set Up: Daily CPT Code(s): 87210

SMEAR, KOH, FUNGUS Microscopic

Test Performed At: Shore Health Laboratories

Specimen: Respiratory secretions, skin scrapings, or tissue. Maintain sterility and forward promptly in a tightly sealed sterile cup or tube. NOTE: Culture site required on request form for processing.

Reference Values: Negative Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 87220

SMEAR, TZANCK Papanicolaou Stain

Test Performed At: Shore Health Laboratories

Specimen: Smears prepared from base of blister. Immediately spray with spraycyte.

Reference Values: No herpes-like inclusions seen Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 88160

SMEAR, TRICHOMONAS Wet Prep

Test Performed At: Shore Health Laboratories

Specimen: Genital swab placed in a plain, red-top tube containing 2.0 ml saline. FORWARD PROMPTLY.

NOTE: The plain, red-top tube should not contain gel or silicone.

Reference Values: Negative Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 87210

SMOOTH MUSCLE ANTIBODIES, SERUM ( ACTIN ) ELISA

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 1.0 serum). Centrifuge 30 minutes after draw. Separate and refrigerate serum.

Reference Values: Negative <20 units Analytic Time: 2 days

212

Day(s) Test Set Up: Monday - Saturday CPT Code(s): 83516

SODIUM AND POTASSIUM See: “Electrolyte Panel” “Comprehensive Metabolic Panel" "Potassium, Serum” "Potassium, Urine" “Renal Function Panel” “Sodium Serum" “Sodium Urine"

SODIUM, SERUM Ion-Selective Electrode (ISE)

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate.

Reference Values: Adult:136-145 mEq/L Critical Value: Child: <121 or >156 mEq/L Adult: <120 or >158 mEq/L Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84295

SODIUM, URINE Ion-Selective Electrode (ISE)

Test Performed At: Shore Health Laboratories

Specimen: 2.0 ml from a random urine collection in a urine sample cup supplied by Shore Health Laboratories or an entire 24-hour urine collection in a urine container with no preservative. 24-Hour urine containers are supplied by Shore Health Laboratories. Refrigerate 24-hour urine specimen during and after collection. NOTE: Follow guidelines in “Patient Instructions for 24-Hour Urine Collection” supplied by Shore Health Laboratories.

Reference Values: Sodium 40-220 mEq/24 hours No established reference range for random specimens. Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84300

SOMATOMEDINC SERUM (IGF 1)

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Chemiluminescence

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 1.0 serum). Refrigerate.

NOTE: Include patient’s age and sex on request form.

Reference Values: See report. Somatomedin C is age and sex dependent. Analytic Time: 2 days Day(s) Test Set Up: Sunday - Friday CPT Code(s): 84305

SPERM COUNT See: “Semen Analysis Complete”

SPINAL FLUID COUNT See: “Cell Count, Differential, Spinal Fluid”

SPINAL FLUID CULTURE See: “Culture, Spinal Fluid (With Gram Stain)”

SPIROCHETE See: “Borrelia burgdorferi (Lyme Disease Spirochete) Detection by Polymerase Chain Reaction (PCR)” “Lyme Disease Antibody, Confirmation, Serum” “Lyme Disease Antibody, lgG and IgM, Serum”

SPUTUM CULTURE See: “Culture, Respiratory Secretions”

STOOL CYTOTOXICITY ASSAY FOR CLOSTRIDIUM DIFFICILE See: “Clostridium difficile Toxin-A, Feces”

STOOL CULTURE See: “Culture, Stool, Formed and “Culture Stool, Not Formed”

STREPTOZYME (ASOT), SERUM Hemagglutination

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate.

Reference Values: Negative Analytic Time: 1 day

214

Day(s) Test Set Up: Monday - Friday CPT Code(s): 86063

STRIATIONAL (STRIATED MUSCLE) ANTIBODIES, SERUM IFA

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 1.0 serum; pediatric 0.5 ml serum). Centrifuge SST 30 minutes after draw. Maintain at room temperature.

Reference Values: <1:40 Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86255

STSH (SENSITIVE THYROID.STIMULATING HORMONE) See: “Thyroid-Stimulating Hormone - Sensitive (STSH), Serum”

STS See: “Syphilis Serology”

SUDAN STAIN FOR FAT See: “Fat, Qualitative, Feces”

SYNOVIAL FLUID See: “Cell Count, Body Fluid” “Crystals, Body Fluids or Urine”

STS (RPR), SERUM, SYPHILIS SEROLOGY

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 2.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate.

Reference Values: Nonreactive If positive, Syphilis EIA IgG/IgM test will reflex and be referred to Maryland State Health Department for testing. Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 86592

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STS (SYPHILIS EIA IgG/IgM), SERUM

Note: The Maryland State Laboratories Administration has replaced the confirmatory Syphilis FTA-ABS test with the confirmatory Syphilis TREP-SURE™ EIA IgG/IgM test. A “Positive Trep-Sure™” result has the same significance as a “Reactive FTA-ABS” result, and a “Negative Trep-Sure™” result has the same significance as a “Non-Reactive FTA-ABS” result. Test Performed At: Maryland State Health Department

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate.

Reference Values: Negative Analytic Time: 14-21 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86781

STS, SPINAL FLUID Includes VDRL

Test Performed At: Maryland State Health Department

Specimen: 1 plain, red-top tube (minimum 1.0 ml of spinal fluid). Avoid hemolysis. Refrigerate. NOTE: The plain, red-top tube should NOT contain gel or silicone .

Reference Values: Nonreactive

Analytic Time: 14-21 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86781

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SUBOXONE, URINE See: Buprenorphine, urine

T3 (TRIIODOTHYRONINE), FREE, SERUM Chemiluminescence

Test Performed At: Shore Health Laboratories

Specimen: 1 plain red top or 1 SST tube (minimum 1.0 serum). Centrifuge 30 minutes after draw. Refrigerate.

Reference Values: 2.5-3.9 pg/ml Analytic Time: 1 day

216

Day(s) Test Set Up: Daily CPT Code(s): 84481

T3 (TRIIODOTHYRONINE), REVERSE, SERUM RIA

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen after collection.

Reference Values: See report. Analytic Time: 2 day Day(s) Test Set Up: Monday, Wednesday, Friday CPT Code(s): 84481

T3 (TRIIODOTHYRONINE), TOTAL, SERUM Chemiluminescence

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen after collection.

Reference Values: Adults: 87-178 ng/dL Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84480

T3 (TRIIODOTHYRONINE) UPTAKE, SERUM Chemiluminescence

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge 30 minutes after draw. Refrigerate.

Reference Values: 32-48% Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84479

T4 (THYROXINE) See: “T4 (Thyroxine), Total, Serum”

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T4 (THYROXINE), FREE, SERUM Chemiluminescence

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge 30 minutes after draw. Refrigerate.

Reference Values: 0.6-1.3 ng/dL Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84439 - Free T4

T4 (THYROXINE), TOTAL, SERUM Chemiluminescence

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge 30 minutes after draw. Refrigerate specimen.

Reference Values: 6.0-12.0 ug/dL Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84436

TACROLIMUS (FK506) (PROGRAF) Immunoassay

Test Performed At: LabCorp

Specimen: 1 lavender (EDTA) tube. Send whole tube or 1 ml whole blood. Refrigerate.

Reference Values: See report. Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 80197

T AND BCELL QUANTITATION BY FLOW CYTOMETRY See: “Lymphocyte Panels 1, 2, 4, 5”

TCT (THROMBIN CLOTTING TIME) See: “Thrombin Time, Plasma”

TEGRETOL® (CARBAMAZEPINE) See: “Carbamazepine-10,11 -Epoxide, Plasma” “Carbamazepine, Serum”

218

TESTOSTERONE, TOTAL AND FREE, SERUM Radioimmunoassay (RIA), Extraction Chromatography, Equilibrium dialysis, Calculation

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 2.5 ml of serum). Centrifuge 30 minutes after draw. Refrigerate serum.

NOTE: Patient’s age and sex are required on request form for processing. A morning specimen is preferred.

Reference Values: See report Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 84402 84403

TESTOSTERONE, TOTAL ONLY, SERUM Radioimmunoassay (RIA)

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: See Report. Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84403

TETANUS ANTIBODY See: “Bacterial Serology, Serum”

TG (THYROGLOBULIN) See: “Thyroglobulin, Serum”

THEODUR® (THEOPHYLLINE) See: “Theophylline, Serum”

THEOPHYLLINE (AMINOPHYLLINE), SERUM PETIA Immunoassay method

Test Performed At: Shore Health Laboratories

Specimen: Peak: 1 SST tube (minimum 0.5 ml of serum) drawn as follows: IV dosage: collect specimen prior to IV infusion; 30 minutes after completion of loading dose, (to measure adequacy of dose); 4-6 hours after beginning therapy. Oral dosage : collect specimen 2 hours after dose with rapid release drug; 4 hours after dose with sustained release drug. Centrifuge SST 30 minutes after draw. Refrigerate specimen. Trough: 1 SST tube (minimum 0.5 ml of serum) drawn prior to next dose. Centrifuge SST 30 minutes after draw. Refrigerate specimen.

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Reference Values: Therapeutic concentration: 10-20 ug/ml Critical Value: > 25 ug/ml Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 80198

THIOCYANATE, SERUM/PLASMA Ion Chromatography, Colorimetry

Test Performed At: LabCorp

Specimen: 1 plain red top, 1 lavender (EDTA) or 1 grey top tube (minimum 1.0 ml serum or plasma). Refrigerate. The plain red top tube should NOT contain gel or silicone.

Reference Values: See report. Analytic Time: 4-7 days Day(s) Test Set Up: Tuesday & Friday CPT Code(s): 84430

THREEDAY MEASLES See: “Prenatal Profile” “Rubella Antibodies, IgM Only, Serum” “Rubella Serology, Serum”

THROAT CULTURE See: “Culture, Throat”

THROMBIN TIME, PLASMA Photo-optic

Test Performed At: LabCorp

Specimen: 1 light blue top (citrate) tube (minimum 2.0 ml plasma). Mix well and centrifuge immediately after draw. FREEZE.

Reference Values: 0.0-20.0 sec. Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 85610

THYROGLOBULIN, SERUM Radioimmunoassay This is a monitoring test for differentiated thyroid cancer. Includes Thyroglobin Antibody.

NOTE: THIS TEST IS FOR “RESEARCH PURPOSES ONLY”.

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Test Performed At: LabCorp

Specimen: 2 plain red top or 2 SST tubes (minimum 3.0 ml serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen. This test is most sensitive for detection of thyroid cancer recurrence when the patients are off thyroid replacement long enough to have an elevated thyroid stimulating hormone (TSH) prior to collecting the specimen. The test also can be used to follow patients with normal TSH. However thyroglobulin values from specimens with high TSH should not be compared with values with normal TSH, because TSH stimulation changes the baseline determinations.

Reference Values: See report. Analytic Time: 3 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 84432 86800

THYROID ANTIBODY GROUP, SERUM Chemiluminescence Immumometric Assay. Includes thyroglobulin antibodies and thyroid microsomal antibodies (TPO)

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 1.0 ml serum). Centrifuge 30 minutes after draw. Refrigerate specimen.

Reference Values: Tg Ab: 0-40 IU/ml TPO: 0-34 IU/ml Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 86800 86376

THYROID PEROXIDASE ANTIBODIES (TPO) Immunoassay

Test Performed At: LabCorp

Specimen: 1 plain, red-top tube or 1 SST tube (minimum 1.0 ml of serum). Refrigerate specimen.

Reference Values: See LabCorp Report Analytic Time: 1-2 days Day(s) Test Set Up: Monday-Friday CPT Code(s): 86376

THYROIDSTIMULATING HORMONE (TSH), SERUM Chemiluminescence

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: 0.34-5.60 ulU/ml

221

Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84443

THYROIDSTIMULATING IMMUNOGLOBULIN (TSI), SERUM In Vitro Bioassay Luciferase

Test Performed At: LabCorp

Specimen: 2 plain red top or 2 SST tube (minimum 3.0 ml serum). Centrifuge 30 minutes after draw. Refrigerate specimen.

Reference Values: <140% basal activity Analytic Time: 4 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 84445

THYROXINE See: “T4 (Thyroxine), Free, Serum" "T4 (Thyroxine), Total Only, Serum”

THYROXINE (T4 ), TOTAL OR FREE See: “T4 (Thyroxine), Free, Serum” “T4 (Thyroxine), Total Only, Serum”

THYROXINEBINDING GLOBULIN (TBG), FUNCTIONAL, SERUM Chemiluminescence

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 0.5 ml serum). Centrifuge 30 minutes after draw. Refrigerate.

Reference Values: 13-39 ug/ml Analytic Time: 1-3 days Day(s) Test Set Up: Sunday - Friday CPT Code(s): 84442

TIBC (TOTAL IRONBINDING CAPACITY) See: “Iron and Total Iron-Binding Capacity Serum”

222

TISSUE TRANSGLUTAMINASE ANTIBODIES, IGA EIA

Test Performed At: LabCorp

Specimen: 1 SST tube (minimum 0.5 ml serum). Refrigerate.

Reference Values: 0-3 U/ml Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 83516

TOBRAMYCIN, SERUM (PEAK OR TROUGH) Immunoassay

Test Performed At: LabCorp

Specimen: 1 plain red top tube for each (minimum 1.0 ml of serum for each). Refrigerate serum. The plain red top bube should NOT contain gel or silicone. Label specimens as either Peak or Trough. Serum for a peak level should be collected 30 minutes after completing infusion of intravenous dose or 60 minutes after an intramuscular or oral dose of tobramycin.

Note: Information concerning dosage, dosage schedule, and other antimicrobials given concurrehtly are required on request form for processing.

Reference Values: Therapeutic ranges Peak: 6-10 ug/ml Trough: 0.5-1.5 ug/ml Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 80200 Peak 80200 Trough

TOTAL ESTROGEN RIA

Test Performed At: LabCorp

Specimen: 2 SST tubes (minimum 3 ml serum). Refrigerate.

Reference Values: See report. Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 82672

TOTAL PROTEIN See: “Albumin/Globulin (A/G) Ratio, Serum” “Electrophoresis, Protein, Serum” “Electrophoresis, Protein, Urine” “Protein, Total, Serum”

223

TOXICOLOGY QUANTITATIVE SCREEN, DRUGS See: “Drug Screen, Plasma”

TOXOPLASMOSIS ANTIBODY See: "Toxoplasma Antibody IgG, IgM"

TOXOPLASMA ANTIBODY IGG & IGM, SERUM ELISA. If IgG is equivocal or positive, the IgM will be performed.

Test Performed At: LabCorp

Specimen: 1 plain red top tube or 1 SST tube (minimum 2.0 ml serum). Centrifuge 30 minutes after draw. Refrigerate.

NOTE: Indicate if oular toxoplasmosis is suspected.

Reference Values: See report. Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86777

TOXOPLASMA ANTIBODY, IGG & IGM, CSF ELISA

Test Performed At: LabCorp

Specimen: Minimum 0.5 ml spinal fluid. Refrigerate specimen.

Reference Values: Negative <0.9 ISR Analytic Time: 3-5 days Day(s) Test Set Up: Tuesday & Thursday CPT Code(s): 86777 86778

TPO (THYROID PEROXIDASE ANTIBODY) See: “Thyroid peroxidase antibodies, FIA”

TRACHOMATIS, CHLAMYDIA See: “Chlamydia by DNA Probe (GenProbe)” “Chlamydia pneumoniae Antibody Panel, Micro IFA” “Chlamydia Serology, Serum” “Culture, Chlamydia trachomatis”

TRANSFERRIN (IRON BINDING PROTEIN) See: “Transferrin, Serum”

TRANSFERRIN, SERUM

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Turbidimetric method

Test Performed At: Shore Health Laboratories

Specimen: 1 plain, red-top tube or 1 SST tube (minimum 2.0 ml of serum) from a fasting patient. Centrifuge 30 minutes after draw. Refrigerate.

Reference Values: Male: 180-329 mg/dl Female: 192-382 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84466

TRANSGROW® CULTURE See: “Culture, Transgrow®”

TRANSPEPTIDASE, GAMMAGLUTAMYL See: “Gamma-Glutamyltransferase (GGT), Serum”

TRAZODONE, SERUM/PLASMA HPLC Useful for assessment of treatment for depression.

Test Performed At: LabCorp (071688)

Specimen: 1 plain red top, 1 lavender (EDTA), or 1 green top (heparin) tube (minimum 2 ml serum or plasma) collected 12 hours after the last dose following a minimum of 5 days on trazodone. Refrigerate specimen. The plain red top should NOT contain gel or silicone.

NOTE: Hemolyzed samples cannot be accepted.

Reference Values: Therapeutic concentration: 800-1600 ng/ml Toxicity level not established for this test. Analytic Time: 3 days Day(s) Test Set Up: Tuesday & Thursday CPT Code(s): 82491

TRICHOMONAS SMEAR See: “Smear, Trichomonas” TRICHOMONAS VAGINALIS (NAAT)

Test Performed At: Shore Health Laboratories

Specimen: Female cervical specimens collected with a Gen-Probe Aptima® Unisex Swab Specimen Collection Kit. Female PAP specimens placed in Thin Prep PreservCyt Solution. Female vaginal specimens collected with an Aptima Vaginal Swab Specimen Collection Kit

Reference Values: Negative

Analytic Time: 1 day

Day(s) Test Set Up: Monday, Wednesday, Friday

CPT Code(s): 87661

225

TRICYCLIC ANTIDEPRESSANTS See: “Amitriptyline and Nortriptyline, Plasma” “Drug Screen, Plasma” “Drug Screen, Plasma and Urine” “Imipramine and Desipramine, Plasma” “Tricyclic Assay, Serum” "Nortriptyline, serum”

TRICYCLIC ASSAY, SERUM HPLC Includes amitriptyline, desipramine, imipramine, and nortriptyline.

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 lavender (EDTA) tube (minimum 2.0 ml serum or plasma) drawn 12 hours after last dose. The plain red top should NOT contain gel or silicone. Refrigerate specimen.

NOTE: The test is not suitable for monitoring therapeutic levels. Toxicity only.

Reference Values: See report. Analytic Time: 4 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 80101

TRIGLYCERIDES See: “Lipid Panel” “Triglycerides, Serum”

TRIGLYCERIDES, SERUM Spectrophotometry

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Draw specimen following an overnight (12-14 hour) fast. Patient must not consume any alcohol for 24 hours before the specimen is drawn. Centrifuge SST 30 minutes after draw. Refrigerate specimen. NOTE: Patient’s age and sex are required on request form for processing.

Reference Values: Adult: 30-149 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84478

TRIIODOTHYRONINE See: “T3 (Triiodothyronine), Free, Serum” “T3 (Triiodothyronine), Reverse, Serum” “T3 (Triiodothyronine), Total Only, Serum” “T3 (Triiodothyronine) Uptake, Serum”

226

TROPONIN, PLASMA OR SERUM Chemiluminescence

Test Performed At: Shore Health Laboratories

Specimen: Serum : 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate. Plasma: 1 green-top (heparin) tube (minimum 1.0 ml of serum). Refrigerate.

NOTE: 1. Indicate plasma or serum on request form. 2. Label specimen appropriately (plasma or serum).

Reference Values: < 0.5 ng/ml Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84470

TRYPTOPHAN, PLASMA HPLC

Test Performed At: LabCorp

Specimen: 2 green top (heparin) tubes (minimum 4 ml plasma). Centifruge immediately and FREEZE plasma.

NOTE: Patient should refrain from foods high in indole: avocado, banana, tomato, plum, walnut, pineapple, eggplant, tobacco, tea, and coffee 3 days prior to testing.

Reference Values: See report. Analytic Time: 5 days Day(s) Test Set Up: Sunday - Friday CPT Code(s): 82131

TSH (THYROIDSTIMULATING HORMONE) See: “Thyroid-Stimulating Hormone - Sensitive (S-TSH), Serum” “Thyroid-Stimulating Hormone (TSH), Serum”

TSH (THYROIDSTIMULATING HORMONE) FOR EACH TIMED SPECIMEN See: “Thyrotropin Releasing Hormone (TRH) Stimulation, Serum”

TULAREMIA ANTIBODY, SERUM Agglutination

Test Performed At: LabCorp

Specimen: 1 plain red top or SST tube (minimum 2.0 ml serum). Centrifuge, separate and freeze serum.

Reference Values: See report. Analytic Time: 3 days

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Day(s) Test Set Up: Monday - Friday CPT Code(s): 86668 x2

TYLENOL® (ACETAMINOPHEN) See: “Acetaminophen, Serum” “Drug Screen, Plasma”

TYPE AND Rh See: “Prenatal Profile” “Type, Blood” “Type and Screen, Blood"

TYPE, BLOOD Agglutination Hemagglutination

Test Performed At: Shore Health Laboratories

Specimen: 1 pink-top blood bank tube (minimum 5.0 ml of whole blood).

Reference Values: Descriptive report Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 86900 - ABO type 86901 - Rh type

TYPE AND SCREEN, BLOOD Agglutination Hemagglutination Antihuman Globulin Solid Phase

Test Performed At: Shore Health Laboratories

Specimen: 1 pink-top blood bank tube (minimum 5.0 ml of whole blood).

Reference Values: Antibody Screen: Negative If positive, antibody identification will be performed. Type and Rh: Descriptive report Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 86900 - ABO type 86870 - antibody identification 86850 - antibody screen 86905 - each red cell antigen typing 86901 - Rh type

TZANCK SMEAR See: “Smear, Tzanck”

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URATE CRYSTALS See: “Crystals, Body Fluids or Urine”

UREA NITROGEN See: “Renal Function Panel” “Urea Nitrogen, Serum” “Urea Nitrogen, Urine” "Basic Metabolic and Comprehensive Metabolic Panel"

UREA NITROGEN, SERUM Urease

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate.

Reference Values: Adult: 8-25 mg/dl Critical Value: Child: >70 mg/dl 20 yr old-Adult: >104 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84520

UREA NITROGEN, URINE Urease

Test Performed At: Shore Health Laboratories

Specimen: Submit an entire 12 or 24-hour urine collection in a urine container supplied by Shore Health Laboratories. Refrigerate specimen during and after collection. Send to Shore Health Laboratories as soon as possible after collection. NOTE: Follow guidelines in “Patient Instruction for 24-Hour Urine Collection” supplied by Shore Health Laboratories.

Reference Values: 7-20 g/24 hours or 4-10 gm/12 hr. collection Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84540 - urea nitrogen 81050 - urine timed measurement

229

URIC ACID See: “Uric Acid, Serum” “Uric Acid, Urine”

URIC ACID, SERUM Timed endpoint method

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 0.5 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate specimen.

Reference Values: Males: 4.8-8.7 mg/dl Females: 2.6-8.0 mg/dl Critical Value: Males and Females: > 13.0 mg/dl Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84550

URIC ACID, URINE Uricase

Test Performed At: Shore Health Laboratories

Specimen: Submit an entire 24-hour urine collection in a urine container supplied by Shore Health Laboratories. Refrigerate specimen during and after collection. Send to Shore Health Laboratories as soon as possible after collection. NOTE: Follow guidelines in “Patient Instructions for 24-Hour Urine Collection” supplied by Shore Health Laboratories.

Reference Values: 250-750 mg /24 hours Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 84560 - uric acid 81050 - urine timed measurement

URINALYSIS See: “Urinalysis, Chemical, Urine”

URINALYSIS, CHEMICAL, URINE Includes color, appearance, bilirubin, glucose, ketones, leukocyte esterase*, nitrite*, occult blood*, protein*, specific gravity, and urobilinogen.

(*A microscopic exam will automatically be done when any of these items are positive).

Test Performed At: Shore Health Laboratories

230

Specimen: 15 ml from a random urine collection in a urine sample cup supplied by Shore Health Laboratories. Refrigerate specimen.

Reference Values: See report Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 81002 - with microscopy 81001 - without microscopy

URINE CULTURE See: “Culture, Urine”

URINE (CYSTOBLADDER) CULTURE See: “Culture, Urine (Cysto-Bladder)”

VALIUM® (DIAZEPAM) See: “Diazepam and Nordiazepam, Serum” “Drug Screen, Plasma” “Drug Screen, Plasma and Urine”

VALPROIC ACID (DEPAKENE®), SERUM PETIA Immunoasaay

Test Performed At: Shore Health Laboratories

Specimen: Peak: 1 SST tube (minimum 0.5 ml of serum drawn as follows: Syrup dose : collect specimen 30-60 minutes after single dose for fasting patient. Capsule dose : collect specimen 2-8 hours after single dose for fasting patient. Enteric coated tablet : collect specimen 3-7 hours after ingestion. Centrifuge SST 30 minutes after draw. Refrigerate

Trough: 1 SST tube (minimum 0.5 ml of serum) drawn immediately prior to next dose. Centrifuge SST 30 minutes after draw. Refrigerate.

Reference Values: Therapeutic concentration: 50-100 ug/ml Critical Value: > 200 ug/ml Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 80164

VANCOMYCIN, SERUM PETIA Immunoassay

Test Performed At : Shore Health Laboratories

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Specimen: 1 plain red top tube (minimum 1 ml serum). A peak level specimen should be taken 30 minutes after complete infusion of intravenous dose or 60 minutes after an intramuscular or oral dose of vancomycin. Refrigerate.

References Values: Therapeutic ranges: Peak: 20-40 ug/ml Trough: 5-10 ug/ml Critical Value: Peak > 80 ug/ml Trough > 25 ug/ml Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 80202

VANILLYLMANDELIC ACID (VMA), URINE (24 HOUR OR RANDOM) HPLC. Includes Creatinine

Test Performed At: LabCorp

Specimen: Submit 10-30 ml from a 24 hour urine collection or random urine. Refrigerate specimen. The sensitivity of the test is greater on a 24 hour collection than on random specimens. Stable unpreserved for 5 days. Follow guidelines in “Patient Instructions for 24 hour Urine Collection” supplied by SHL.

NOTE: Amoxicillin interferes with the procedure; it should be discontinued at least 3 days prior to collection of specimen.

Reference Values: See report. Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 84585

VARICELLA (HERPES) ZOSTER CULTURE See: “Culture, viral”

VARICELLA ANTIBODY, IGG SERUM Enzyme-Linked Fluorescent Assay (ELFA)

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate . NOTE: Used to determine patient’s immunological experience with Varicella virus.

Reference Values: 0.00-0.59 Negative 0.60-0.89 Equivocal ≥ 0.90 Positive Analytic Time: 1 day Day(s) Test Set Up: Tuesday and Thursday CPT Code(s): 86787

VARICELLA ANTIBODY, IGG & IGM SERUM

Test Performed At: LabCorp

232

Specimen: 1 SST tube (minimum 2.0 ml of serum). Centrifuge SST 30 minutes after draw. Maintain at room temperature .

Reference Values: See report Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86787 x2

VARICELLAZOSTER VIRUS (VZV) See: “Varicella Serology, Serum” “Varicella-Zoster Virus (VZV) Detection by Polymerase Chain Reaction (PCR), Spinal Fluid”

VARICELLAZOSTER VIRUS (VZV) DTECTION BY POLYMERASE CHAIN REACTION (PCR), SPINAL FLUID

Test Performed At: LabCorp

Specimen: 0.5 ml spinal fluid in plain red top tube. Freeze specimen.

Reference Values: None detected Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 87798

VASOACTIVE INTESTINAL POLYPEPTIDE (VIP), PLASMA Radioimmunoassay (RIA)

Test Performed At: LabCorp

Specimen: Requires Trasylol collection kit. Follow instructions included in box. Prepared plasma sample to be sent frozen.

Reference Values: 23-63 pg/ml Analytic Time: 3 days Day(s) Test Set Up : Monday & Wednesday CPT Code(s): 84586

VIRAL CULTURE See: “Culture, Viral”

VIRAL SEROLOGY, SERUM (AND CSF) (EASTERN EQUINE ENCEPHALITIS, ST. LOUIS ENCEPHALITIS AND WEST NILE VIRUS ONLY) Agent Dependent Available for Eastern Equine Encephalitis, St. Louis Encephalitis, West Nile Virus and Rabies (serum only)

Test Performed At: Maryland State Health Department

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Specimen: Serum - 2 SST tube (minimum 4.0 ml of serum). Centrifuge SST 30 minutes after draw. Refrigerate. CSF – 1 plain red top tube (tightly sealed). Minimum 1.0 ml CSF

NOTE: 1. Acute and convalescent sera are needed to interpret the results. The convalescent serum should be obtained 2-3 weeks after onset. 2. Label serum specimen appropriately (acute or convalescent). 3. Type of viral agent is required on request form for processing. 4. No convalescent serum for Rabies is necessary.

Reference Values: Agent dependent For clinical illness, a fourfold rise in titer between acute and convalescent specimens indicates recent infection. Analytic Time: 21-28 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 86790

VISCOSITY, SERUM Kinematic Viscosity

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 1.0 ml serum). Centrifuge 30 minutes after draw. Refrigerate.

Reference Values: See report. Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 85810

VITAMIN A, SERUM (RETINOL) HPLC

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 lavender (EDTA) tube (minimum 1.5 ml serum or plasma). Protect from light . Refrigerate.

NOTE: Draw specimen following and overnight (12-14 hour) fast. Patient must not consume any alcohol for 24 hours before specimen is drawn.

Reference Values: See report. Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 84590

VITAMIN B1 (THIAMINE) (WHOLE BLOOD PERFERRED) HPLC

Test Performed At: LabCorp

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Specimen: 1 lavender top (EDTA) tube (minimum 1.0 ml plasma). Transfer plasma to amber plastic vial. FREEZE specimen . Protect specimen from light by wrapping in foil .

Reference Values: 4.0-20.0 ug/L Analytic Time: 3 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 84425

VITAMIN B 12 AND FOLATE, SERUM Chemiluminescence. Includes folate determination.

Test Performed At: Shore Health Laboratories

Specimen: 1 SST tube (minimum 1.0 ml of serum) from a fasting patient. Centrifuge SST 30 minutes after draw. Refrigerate . Protect specimen from light.

Reference Values: Vitamin B 12 : 180 - 914 pg/ml Folate: >3.6 ng/ml Analytic Time: 1 day Day(s) Test Set Up: Daily CPT Code(s): 82746 - Folate 82607 - Vitamin B 12

VITAMIN B12 BINDING CAPACITY, UNSATURATED (UBBC), SERUM Protein Binding Radioassay

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 SST tube (minimum 2.0 ml serum). Centrifuge 30 minutes after draw. Refrigerate specimen.

PRECAUTIONS: This test should not be requested on patients who have recently received radioisotopes therapeutically or diagnostically.

Reference Values: 725-2045 pg/ml Analytic Time: 5 days Day(s) Test Set Up: Tuesday & Thursday CPT Code(s): 82608

VITAMIN B6, PLASMA (PYRIDOXINE) Radioenzymatic Assay

Test Performed At: LabCorp

Specimen: 2 lavender top (EDTA) tube (minimum 2.0 ml plasma). Wrap in foil to protect from light or place in amber tube. Freeze plasma.

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Reference Values: See report. Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 84207

VITAMIN D, 1,25 DIHYDROXY, SERUM (CALCITRIOL) Cartridge Extraction and Radioreceptor Assay

Test Performed At: LabCorp

Specimen: 2 SST tubes (minimum 3.0 ml serum). Centrifuge SST 30 minutes after draw. Refrigerate. Protect specimen from light.

NOTE: Indicate if patient is on any of the following drugs: (1) Anticonvulsants, such as phenobarbital and dilantin, (2) Any vitamin D preparation, including vitamin D3, vitamin D2, 1,25-dihydroxy vitamin D3, or dihydrotachysterol.

Reference Values: 10-75 pg/ml Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 82652

VITAMIN D, 25 HYDROXY (FRAC) (D2 AND D3)

Test Performed At: LabCorp

Specimen: 2 SST tubes (minimum 2.0 ml serum). Freeze.

Reference Values: See report. Analytic Time: 3-5 days Day(s) Test Set Up: Daily CPT Code(s): 82306 x2

VITAMIN D, 25HYDROXY, SERUM TOTAL Radioimmunoassay

Test Performed At: Shore Health Laboratories

Specimen: 1 plain red top, 1 SST or 1 lavender (EDTA) tube (minimum 0.5 ml serum or plasma). Centrifuge 30 minutes after draw. Refrigerate.

Reference Values: See report. Analytic Time: 2 day Day(s) Test Set Up: Monday - Friday

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CPT Code(s): 82306

VITAMIN E, SERUM HPLC

Test Performed At: LabCorp

Specimen: 1 plain red top or 1 green top (heparin) tube (minimum 2.0 ml serum or plasma). Draw specimen following overnight(12-14 hour) fast. Patient must not consume any alcohol for 24 hours before the specimen is drawn. Place serum in amber tube and refrigerate. Protect specimen from exposure to light.

Reference Values: See report. Analytic Time: 2 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 84446

VOLATILES, TOX SCREEN STAT Gas Chromatography. Includes Ethanol, Methanol, Acetone, and Acetaldehyde.

Test Performed At: Quest Diagnostics / LabCorp

Specimen: 5 ml whole blood from a gray top tube. Send at room temperature. Prior to specimen collection, call Quest to arrange for a specimen pick up. Must submit a Quest requisition. See special procedure for phone numbers and process.

Reference Values: None detected Analytic Time: 4-6 hours Day(s) Test Set Up: Daily CPT Code(s): 84600

VOLATILES, TOX SCREEN – NON STAT

Test Performed At: LabCorp

Specimen: 2 grey top tubes unopened. Refrigerate. Reference Values: None detected Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 84600

VLDL (VERY LOW DENSITY LIPOPROTEIN) See: “Lipoprotein Profile, Serum”

WARFARIN, SERUM/PLASMA

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High-Pressure Liquid Chromatography (H PLC)

Test Performed At: LabCorp

Specimen: 1 red-top, 1 lavender (EDTA) or 1 green top (heparin) tube (minimum 2.0 ml serum or plasma). Do not use gel tubes. Separate and refrigerate.

Reference Values: Therapeutic concentration: 1-10 mg/ml Analytic Time: 3 days Day(s) Test Set Up: Tuesday & Thursday CPT Code(s): 82491

WATERDIALYSIS UNIT CULTURE See: “Culture, Water-Dialysis Unit”

WBC, STOOL SMEAR (INCLUDING EOSINOPHILS Wright’s Stain

Test Performed At: Shore Health Laboratories

Specimen: A minimum of 15 g of stool collected in a gray cup or tightly covered container. Refrigerate. NOTE: Specimen must be tested within 24 hours of collection.

Reference Values: See Report Analytic Time: 1 day Day(s) Test Set Up: Daily

CPT Code(s): 87205

WESTERGREN SEDIMENTATION RATE See: “Sedimentation Rate (ESR), Serum”

WHOOPING COUGH See: "Bordetella pertussis Detection by Polymerase Chain Reaction (PCR)” “Culture, Bordetella pertussis”

XYLOCAINE® (LIDOCAINE) See: “Drug Screen, Plasma” “Drug Screen, Plasma and Urine” “Lidocaine, Serum”

XYLOSE (DXYLOSE), URINE Colorimetric. Performed on adults; not recommended for children.

Test Performed At: LabCorp

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Specimen: See p. 268 “D-xylose” for patient preparation. 5 hour collection of urine after D-xylose ingestion. Refrigerate.

NOTE: Patient’s age, dose, times of sampling, and 5 hour volume are required on request form for processing.

Reference Values: See report. Analytic Time: 2 days Day(s) Test Set Up: Wednesday CPT Code(s): 84620

YEAST CULTURE See: “Culture, Fungus”

ZINC PROTOPORPHYRIN (FEP, FREE ERYTHROCYTE PROTOPORPHYRIN) Hematofluorometry

Test Performed At: LabCorp

Specimen: 1 royal blue (EDTA) tube. Submit original tube at room temperature. Specimen cannot be frozen. Protect specimen from light .

NOTE: This test is not for workplace exposure. Reference Values: See report. Analytic Time: 1 day Day(s) Test Set Up: Monday - Friday CPT Code(s): 84202

ZINC, SERUM/PLASMA FAA/CP/MS

Test Performed At: LabCorp

Specimen: 1 red top or 1 royal blue top (EDTA) tube (minimum 2.0 ml serum or plasma). It is important that the specimen be obtained, processed, and transported according to instructions on p. 257, “Metals Analysis – Collection and Transport.”

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Reference Values: 70-150 ug/dl Analytic Time: 1-3 days Day(s) Test Set Up: Monday - Friday CPT Code(s): 84630

ZINC, URINE (RANDOM/24 HOUR) Inductively Coupled Plasma ((CP) Emission Spectroscopy

Test Performed At: LabCorp

Specimen: Submit 5 ml from a random or 24 hour urine collection in a urine container washed with acid. It is important that the specimen be obtained, processed, and transported according to instructions on p. 257, “Metals Analysis – Collection and Transport.” Send at room temperature. Follow guidelines in “Patient Instructions for 24 hour Urine Collection” supplied by SHL.

Reference Values: See report. Analytic Time: 3 days Day(s) Test Set Up: Tuesday - Friday CPT Code(s): 84630 82570

ZZP (ZINC PROTOPORPHYRIN) See: “Zinc Protoporphyrin (FEP, Free Erythrocyte Protoporphyrin”

SPECIAL INSTRUCTIONS

Allergens

Allergens — IgE Antibodies

IgE Antibody, Single Allergen, Serum This test is useful principally to confirm the allergen specificity in patients with clinically documented allergic disease. Therefore, requests for these tests should be made after a careful and comprehensive medical history is taken. Utilized in this way, a single allergen IgE antibody test is cost-effective. A positive result indicates with high predictive value that allergic signs and symptoms are caused by exposure to the allergen.

IgE Antibodies, MultiAllergen, Serum These panels are composed of three types as follows:

••• Geographic Area Panel

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These panels are especially useful in patients with allergies to inhalants. The panels are divided into geographic areas to assist in the selection of appropriate allergens. Seasonal recommendations are provided. ••• Other Allergen Panels Tests include other significant allergen groups. These are composed of molds, household, and epithelia groupings.

The multi-allergen IgE antibody test, combined with measurement of immunoglobulin E in serum, is a very sensitive first-order test for allergic disease. Positive results indicate a high probability of allergic disease induced by one or more allergens present in the multi-allergen panel. Negative results effectively rule out allergy except in rare cases of allergic disease induced by exposure to a single allergen.

Each of these panels may be ordered with or without concurrent measurement of immunoglobulin E.

Immunoglobulin E (IgE), Serum Measurement of the concentration of immunoglobulin E in serum is useful in the initial evaluation of patients suspected of having an allergic disease. Above-normal concentrations of immunoglobulin E in serum are strongly associated with allergic disease. However, some allergic individuals do not have above-normal concentrations. Measurement of serum immunoglobulin E along with the multi-allergen IgE antibody test offers greater sensitivity for the detection of allergic disease than either test alone.

Allergens Available for Single MOLDS

Alternaria tenuis Mucor racemosus Allergen IgE Antibody Testing Aspergillus fumigatus Penicilhium notatum Candida albicans Phoma betae Cladosporium herbarum Pityrosporum orbiculare For allergens not listed contact the Epicoccum purpuras Rhizopus nigricans laboratory Fusarium culmorum Stemphylium Helminthosporium halodes

GRASS FOODS

Almond Oat Common Reed Red Top (Bent) Bamboo Shoot Octopus Johnson Grass Rye, Cultivated Barley Orange Kentucky Blue (June) Sweet Vernal Beef Oysters Meadow Fescue Timothy Brazil Nut Pacific Squid Oat, Cultivated Wheat, Cultivated Buckwheat Pea Perennial Rye Carrot Peanut Orchard (Cocksfoot) Casein Pecan Nut Celery Pork WEEDS Chicken Meat Potato, White Chocolate Potato, Sweet Cocklebur Mugwort Chub Mackerel Rice (Sagebrush) Clam Rye Common Ragweed (Short) Ox-Eye Daisy Coconut Salmon Dandelion Pigweed Codfish Sardine-Pilchard English Plantain Russian Thistle Coffee Scallops False Ragweed Sheep Sorrel (Dock Yellow) Corn Sesame Seed Firebush (Kochia) Tobacco Crab Shrimp Giant Ragweed (Tall) Western Ragweed Egg White Soybean Goldenrod Wormwood Egg Yolk Strawberry (Sagebrush) Garlic Tomato Lamb’s Quarter Gluten Tuna Hazelnut Wheat Jack Mackerel-Scad Yeast Baker’s Lettuce Lobster EPIDERMALS OCCUPATIONAL Malt Milk Cat Dander/Epitheiuzn Tobacco Leaf Millet, Common Cow Epitheium Millet, Foxtail Dog Epitheium Millet, Japanese Horse Epithelium Mixed Feathers

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HOUSE DUST HYMENOPTERA VENOMS Beech Mesquite Birch Palm (Queen) House Dust (Greer) Cockroach Chestnut Pecan/Hickory House Dust (H/S) Honey Bee Cottonwood/Poplar Pine (Australian) Dermatophagoides Moth Douglas Fir Poplar Farinae Paper Wasp Elm (White) Olive Tree Dermatophagoides White Hornet Hazelnut Tree Spruce pteronyssinus Yellow Hornet Horse Chestnut Melaleuca Tree Blomia Iropicalis Yellow Jacket Linden Walnut Tree Maple (Box Elder) Sycamore Willow TREES

Alder Mountain Cedar Ash (White) Oak

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Amino Acid Disorders

Many abnormalities in the metabolism or the transport of amino acids can be detected by analysis of physiological fluids, urine, plasma, and spinal fluid for free amino acids. Free amino acids are found in urine or acid filtrates of protein-containing fluids.

Urine and plasma are used for the initial screen for inborn errors of metabolism. Both transport and metabolic errors can be detected by changes in the amino acid patterns observed. In many cases, metabolic errors are detected when the renal threshold of the amino acid or metabolite is exceeded; many intermediary metabolites exhibit low renal thresholds. Because groups of specific amino acids, i.e., the dibasic acids, lysine, ornithine, arginine, and cystine have common transport systems, detection of many disorders is also facilitated by evaluating the pattern of amino acids found in urine.

Many disorders of intermediary metabolism, especially the variants, are characterized by increased concentrations of a metabolite(s) only when the metabolic pathway is challenged by a substrate load, i.e., the characteristic metabolite(s) will not occur in excessive concentrations in plasma or urine unless the patient consumes protein or carbohydrate or is stressed. Stresses include dehydration, fever, or increase in dietary protein.

Reports will contain suggested diagnoses (when appropriate), confirmatory tests, and additional suggested laboratory tests. (Milne MD: Disorders of amino acid transport. Brit Med J 1:327-336, 1964; JB Stanbury, JB Wyngaarden, DS Fredrickson, et al [editors]: Part 3. Disorders of amino acid metabolism. In The Metabolic Basis of Inherited Disease. Fifth edition. New York, McGraw-Hill Book Company, 1983, pp 229-583)

243 Catecholamine Fractionation

A. Patient Preparation:

The patient must be prepared to minimize the influence of stress and other factors if clinically useful results are to be obtained. Epinephrine, epinephrine-like drugs, Aldomet®, and Inderal® interfere with the test procedure. (Inderal® has a physiologic effect even though it does not directly affect the test procedure.) These drugs should be discontinued 1 week prior to obtaining the sample. The patient must not use tobacco, drink coffee or tea, or eat anything for at least 4 hours before blood is drawn for the test. Preparation should also include the placement of an indwelling, heparinized intravenous catheter along with complete instructions and reassurance regarding the procedure. The patient should then rest for 30 minutes in the supine position in a quiet room before a specimen is obtained. At the end of these 30 minutes, withdraw 3.0 ml of blood to flush the heparin out of the catheter before obtaining the specimen.

B. Investigating for Pheochromocytoma or Evaluating Orthostatic (Postural) Hypotension:

For investigation of the possible presence of pheochromocytoma, one specimen drawn while the patient is supine will suffice. In some patients with pheochromocytoma, plasma catecholamines will be markedly elevated; in others, values may fall within the observed reference range. In this latter case, follow up with provocative tests or a 24-hour urine catecholamine determination would be indicated.

For evaluation of orthostatic (postural) hypotension, the patient should be instructed to sit up after the first specimen is collected and a second specimen is obtained after 15 minutes. Regardless of the baseline value (whether normal or low), failure of the catecholamines to increase after the patient has been sitting up suggests a dysfunction of the autonomic nervous system.

C. Specimens should be clearly labeled as supine or sitting. Plasma must be FROZEN within 15 minutes.

Urinary, Free Urinary fractionated catecholamines are performed on a 24-hour collection. In general, urinary specimens result in values more consistent than those obtained from plasma. The 24-hour collection tends to decrease transient elevations found in plasma samples from some patients.

Coagulation Studies

The physician interpreting results may be misled by abnormal results obtained in mishandled specimens.

To ensure the best possible specimen, follow collection requirements as closely as possible.

1. Patient should be fasting, if possible; for certain tests, the patient cannot be receiving anticoagulant medication (heparin or warfarin/Coumadin®). 2. Collect blood from the patient into light bluetop (sodium citrate) vacuum tubes (those used for prothrombin time/activated partial thromboplastin time containing 3.2% sodium citrate). The tubes must fill completely. A clean venipuncture is essential to avoid activation of coagulation by tissue thromboplastin. Samples containing fibrin clots will, in most cases, be rejected. 3. Please include the requested information (see individual test descriptions) as the testing and interpretations are dependent on clinical history in many of the more complex abnormalities. 4. Careful sample handling will most often ensure acceptable samples and valid results.

Pediatric Hemostasis References

1. Hathaway WE, Corrigan J: Report of Scientific and Standardization Subcommittee on Neonatal Hemostasis: normal coagulation data for fetuses and newborn infants. Thromb Haemost 65:323-325, 1991 2. Andrew M, Paes B, Milner R, et al: Development of the human coagulation system in the full term infant. Blood 70:165-1 72, 1987 3. Andrew M, Paes B, Milner R, et al: Development of the human coagulation system in the healthy premature infant. Blood 72:1651-1657, 1988 4. Andrew M, Vegh P, Johnston M, et al: Maturation of the hemostatic system during childhood. Blood 80:1998- 2005, 1992 5. Andrew M: The hemostatic system in the infant. In Hematology of Infancy and Childhood. Vol. 1. Fourth edition. Edited by DG Nathan, FA Oski. Philadelphia, PA, WB Saunders Company, 1993, pp 115-153 6. Hathaway WE, Bonnar J: Perinatal Coagulation. New York, NY, Grune and Stratton, 1978 7. Hathaway WE, Bonnar J: Hemostatic Disorders of the Pregnant Woman and Newborn Infant. New York, NY, Elsevier Science Publishing Company, 1987 8. MN Bern, FD Frigoletto Jr. (editors): Hematologic Disorders in Maternal-Fetal Medicine. New York, NY, Wiley-Liss, 1990 9. 5 Suzuki, WE Hathaway, J Bonnar, AH Sutor (editors): Perinatal Thrombosis and Hemostasis. Tokyo, Springer-Verlag, 1991 10. Hathaway WE, Manco-Johnson M: Disorders of coagulation and platelets in the neonate. In Hematology: Basic Principles and Practice. Edited by R Hoffman, EJ Benz Jr., SI Shattil, et al. New York, NY, Churchill Livingstone, 1991, pp 1409-1415 11. Corrigan JJ Jr: Normal hemostasis in the fetus and newborn: coagulation. In Fetal and Neonatal Physiology. Vol. 2. Edited by RA Polin, WW Fox. Philadelphia, PA, WB Saunders Company, 1992, pp 1368-1371

245

Biopsy Collection and Transport

A. Selection of biopsy sites:

1. Cutaneous immunofluorescence. a. Pemphigus and pemphigoid groups (including linear IgA bullous dermatosis and chronic bullous disease of childhood): Biopsy erythematous perilesional skin or mucosa. Avoid erosions, ulcers, and bullae while obtaining tissue adjacent to active lesions. Label as perilesional skin. b. Dermatitis herpetiformis: Biopsy normal appearing skin, 0.5-1.0 cm away from lesion. Label as perilesional skin. c. Lupus erythematosus: Involved areas of skin such as erythematous or active borders are preferred biopsy sites to confirm diagnosis of lupus erythematosus, either discoid or systemic. Label as involved skin. Uninvolved, nonexposed skin is the preferred site to exclude systemic lupus erythematosus. Should unexposed skin be desired, buttock or medial thigh is suggested. Label as uninvolved, nonexposed skin. Avoid ulcers, old lesions, and facial lesions, if possible. d. Mixed connective tissue disease: Biopsy as for lupus erythematosus except when sclerodermoid features are present. For sclerodermoid features, biopsy inflamed area. Label as involved or uninvolved, exposed or nonexposed skin. e. Vasculitis and urticaria: The erythematous or active border of a new lesion is preferred. Avoid old lesions and ulcers. Label as involved skin. If appropriate skin lesion is not present, diagnosis may sometimes be made from uninvolved skin. f. Porphyria cutanea tarda: Biopsy involved skin. Avoid old lesions and ulcers. Label as involved skin. g. Lichen planus: Biopsy involved skin. Avoid old lesions and ulcers. Label as involved skin. 2. Cutaneous leukocyte immunophenotype. a. Biopsy involved skin.

B. Choice of methods for fixation and transport of biopsy specimens:

1. Cutaneous immunofluorescence. Skin or mucosal specimens can be sent by using either the transport medium or the snap-frozen procedure. The practical value of using transport medium (supplied by Shore Health Laboratories) is recognized for direct immunofluorescence testing. However, we have found a loss in sensitivity of approximately 10% with the transport medium as compared with snap-frozen tissue. This may necessitate a repeat biopsy if the result seems to be false-negative. The assay cannot be performed on specimens fixed in formalin. 2. Cutaneous leukocyte immunophenotype. a. Biopsy involved skin. 1) This test is used to help differentiate benign from malignant lymphocytic infiltration of the skin as well as to help classify cutaneous lymphomas. For optimal interpretation, a formaldehyde-fixed H & E stained section is required. The test may be used in conjunction with molecular genetics studies for the most accurate assessment of malignancy. It may also be used to help differentiate CD1 positive from CD1 negative histiocytoses, such as X vs. non-X histiocytoses. 2) This test requires that the tissue be snap-frozen in liquid nitrogen and transported on dry ice. (Transportation of the tissue in transport medium is not adequate.) An accompanying permanent hematoxylin and eosin section of the tissue is optimal.

C. Transport medium method for cutaneous immunofluorescence specimens: Supplies and equipment needed — specimen vial containing medium (vials with transport medium are supplied by Shore Health Laboratories), forceps, and biopsy instruments. 1. Use a sharp 4-mm punch. If biopsy specimen is to be divided, use at least a 5-mm punch. An excisional biopsy may be needed. In dividing the specimen, cut with a very sharp razor blade. Do not squeeze or twist the specimen. Make a clean cut. Specimens larger than 5 mm in diameter should be divided for adequate fixation in transport medium. 2. Immediately drop specimen into provided vial of transport medium. Label vial, including patient’s name, identification number, biopsy site, and date. Seal tightly.

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3. Complete Chesapeake Pathology/Cytology Request Form. Interpretation of the results is facilitated by having available the following clinical data on the patient: age, sex, clinical diagnosis, biopsy site (anatomic), exposure of site to sun (exposed, unexposed), and relationship to lesional skin (perilesional, involved, uninvolved). 4. Mail in containers supplied by Shore Health Laboratories. Do not mail vials filled with transport medium on dry ice.

247

Hepatitis Clinical Interpretation Guide

Anti Anti HBs Anti Anti Anti HBV Anti Anti Anti HBc HBeAg HAV Interpretation Ag HBs HBc HBe DNA HD HAV HCV IgM IgM Early (presymptomatc) + +/ acute type B hepatitis

+ +/ + + +/ +/ +/ Acute type B hepatitis Recent hepatitis B + + +/ infection in "window" period Recovery from type B + + +/ +/ hepatitis Late recovery hepatitis +/ + B

+ +/ + +/ +/ +/ Chronic type B hepatitis

+ +/ + +/ +/ +/ + Chronic type D hepatitis Recent acute hepatitis + + A Recovery from hepatitis + A Late acute or chronic + hepatitis C Early acute type C hepatitis or non A, B, C, D hepatitis Hepatitis B vaccine + recipient

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Human Immunodeficiency Virus Clinical Interpretive Guide

Assay Results Interpretation Anti HIV 1/2 HIV 1 Anti HIV 2 HIV2 HIV1 p24 HIV 1 HIV 2 Infection EIA Western Blot EIA Western Infection Blot + + NT NT +/- Positive NT

+ - - NT - Negative Negative + - - NT + Positive Negative

+ - + - - Negative Negative

+ - + - + Positive Negative + - + I - Negative Inconclusive

+ - + I + Positive Inconclusive

+ - + + - Negative Positive + - + + + Positive Positive

+ I + - - Inconclusive Negative

+ I + - + Positive Negative + I + I - Inconclusive Inconclusive

+ I + I + Positive Inconclusive

+ I + + - Inconclusive Positive + I + + + Positive Positive

+ I - NT - Inconclusive Negative

+ I - NT + Positive Negative

Key

+ Positive NT Not Tested - Negative I Indeterminate

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IgG Subclasses Reference Values

(mg/dl)

Age IgG 1 IgG 2 IgG 3 IgG 4

0-1 year 194-842 23-300 19-85 0.5-78.0

2-3 years 315-945 38-225 17-68 1.0-54.0

4-5 years 308-945 61-345 10-122 2.0-112

6-7 years 288-918 44-375 16-85 0.4-98.0

8-9 years 432-1020 72-430 13-85 2.0-95.0

10-11 years 423-1080 78-355 17-173 2.0-115

12-13 years 342-1150 10-455 28-125 4.0-136

14-18 years 315-855 64-495 23-198 11-157

>18 years 382-929 241-700 22-178 4-86

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Lipids and Lipoproteins in Blood Plasma (Serum)

Lipoprotein Profile Significance Knowledge of certain features of patients’ blood lipoproteins should be useful to the physician. The following observations are significant:

1. An increased level of beta-low density lipoprotein (LDL) is a risk factor for atherosclerotic disease.

2. A high level of alpha-1 high density lipoprotein (alpha-1 HDL) may or may not reflect a healthy status. For a person who has no liver disease or chronic intoxication of any form, a high level of alpha-1 HDL probably is an indication of a healthy metabolic system and a relatively low risk for atherosclerotic disease. Otherwise, a high level (or increased concentration) of alpha-1 HDL may reflect the existence of an early stage of primary biliary cirrhosis or the existence of chronic hepatitis or of alcoholism or some other form of chronic intoxication.

3. High levels of a second form of HDL, alpha-2 HDL (Lp[a]HDL) have been observed in many cases; a favorable prognostic significance is not associated with this condition. Lp(a)HDL must be accounted for in interpreting values for total HDL and LDL. Values for Lp(a)HDL cholesterol in serum can be as high as 100 mg/dl. Recent information has shown that small increases in Lp(a)HDL are probably of no prognostic significance and that larger increases may be prognostically unfavorable in atherosclerotic disease. Depending on the method used, Lp(a)HDL cholesterol may be measured as a component of total HDL-cholesterol (ultracentrifugation methods) or total LDL-cholesterol (precipitation methods). Because Lp(a)HDL may be a significant component of either the LDL or HDL fraction, specimens containing increased Lp(a)HDL should be identified and the Lp(a)HDL should be quantified separately from alpha-i HDL and beta-LDL. Specimens that contain quantitatively significant concentrations of Lp(a)HDL can be identified most easily by electrophoresis of fractions prepared by ultracentrifugation.

4. Hypercholesterolemia apparently has been considered by many persons to be an expression of an increased concentration of beta-LDL, or type Ila hyperlipoproteinemia. In some patients, however, an increased or relatively high level of serum cholesterol reflects a high level of alpha-1 HDL. This interpretational problem is readily resolvable through simple quantitative testing involving ultracentrifugation or selective precipitation or a combination of these methods. In addition, hypercholesterolemia can be a reflection of the presence of “LP-X,” the abnormal lipoprotein complex associated with cholestasis, or of anomalous conditions characterized by increases of the less-well-known lipoproteins such as IDL, alpha-2 LDL (Lp[a]LDL), and alpha-2 HDL (Lp[a]HDL). Also hypercholesterolemia can reflect the presence of alpha-1 LDL, which is highly indicative of primary biliary cirrhosis. The basis of hypercholesterolemia in any single case can best be identified through the combination of electrophoretic screening and quantitative testing, with the method of quantitative testing being selected according to the forms of the LDLs and HDLs that are prominent in the electrophoregrams.

5. Identification of patients who have type III hyperlipoproteinemia may be helpful for the optimal management of their problem(s). A definitive analysis must include establishing the presence of an increased population of cholesterol-rich, very low density lipoprotein (VLDL) particles of sizes much smaller than the primary VLDL particles. Evaluation of the cholesterol/triglyceride ratio in the isolated total VLDL is a necessary step. Also, electrophoresis with molecular sieving in polyacrylamide gel can be a helpful test in establishing that a specimen contains a significant proportion of VLDL particles of small or intermediate size. In some cases, the presence of a mixture of VLDL particles of small, intermediate, and large sizes makes definitive evaluation possible only through analysis of the delipidized apolipoproteins F from isolated total VLDL.

6. Abnormalities in the serum lipoprotein profile can suggest various problems in metabolism, liver function, and renal function in addition to being reflections of problems primarily inherent in lipid transport.

7. For most patients, quantitative analysis of a single lipoprotein fraction is inadequate for evaluation of the status of the lipoprotein profile. The commonplace special attention focused on HDL cholesterol and on LDL cholesterol seems to be distracting attention from other significant components of the serum lipoproteins. Although the serum total cholesterol value and the alpha-1 HDL cholesterol value together can be adequate primary information for the evaluation of some specimens, in most cases, an adequate evaluation can be accomplished only with examination of the entire lipoprotein profile.

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8. An arithmetic estimation of LDL cholesterol (LDLC) has been promoted extensively as a practical measure. However, for 25% of 321 consecutive cases presented for lipoprotein analysis, the recommended arithmetic estimations of LDLC were in error by at least 20 mg/dl; in 12% of the 321 cases, the estimations were sufficiently in error to cause misinterpretations of the lipoprotein profiles and errors in the planning of patient management regimens. Clearly, the recommended arithmetic estimations are unreliable and can be misleading.

9. Lipoprotein Lp(a), first reported in 1963 by the Norwegian physician-investigator, Kare Berg, consists of an ordinary LDL particle combined with an additional protein. Like in ordinary LDL, the primary protein in the Lp(a) particle is apolipoprotein B1OO (molecular weight = approximately 512,000 D); the additional protein (molecular weight = 275,000-800,000 D), Lp(a)-specific protein, is highly similar to plasminogen. Also, like in ordinary LDL, most of the lipid is esterified cholesterol and phospholipids.

The Lp(a) particle has been referred to as “the most atherogenic lipoprotein.” Observations over the last three decades have indicated that Lp(a) increases cardiovascular risk twofold to threefold when its level in the blood plasma is above 30 mg/ dL; correspondingly, Lp(a) cholesterol would be above 10 mg/dl. Lp(a) concentrations of 15 mg or less per dL (Lp[aI cholesterol = 5 mg or less per dL) appear not to confer an increase of risk. Some recent observations have indicated that Lp(a)-associated cardiovascular risk is significant only when the concentration of the companion risk factor, LDL, is increased, also. One hypothesis is that while an increased concentration of ordinary LDL promotes the formation of atheroma, Lp(a) interferes with a normal preventive action of plasminogen.

Our Lipids and Lipoproteins Laboratory has recognized and reported increased Lp(a) in patients’ specimens since 1967, as a part of routine analysis of lipoprotein profiles. While the density of Lp(a) particles can be in either the LDL density range (1.01 9-1.063 mg/ml) or the HDL density range (1.063-1.21 mg/ml), in most cases, the blood of an individual contains only an LDL form (Lp[a]LDL) or an HDL form (Lp[aIHDL) and not both forms.

The compositional differences between Lp(a)LDL and Lp(a)HDL are not yet fully understood. Size of the Lp(a)-specific protein probably is one determinant; the size of Lp(a)-specific protein is quite varied in the population. The number of Lp(a)-specific protein molecules per lipoprotein particle is hypothetically a second determinant. Whether Lp(a)LDL and Lp(a)HDL differ as cardiovascular risk factors has not been determined.

Concentrations of Lp(a) particles in the blood can be expressed readily either as concentrations of Lp(a)- specific protein or as Lp(a) cholesterol. Accurate immunochemical measurement of Lp(a)-specific protein, however, is a problem. One complicating factor is a high level of homology with plasminogen. A second complicating factor is a variation of molecular composition in the population. Both factors, obviously, impact adversely the usual immunochemical type of approach to quantitation of a specific protein based on a unique and constant antigenicity. A third very significant problem is the issue of how to express the result of a quantitative test for Lp(a)-specific protein in meaningful terms. Because the molecular size of Lp(a)-specific protein varies over a broad range in the population (240,000-800,000 D), a test result primarily related to the number of molecules of Lp(a)-specific protein in a specimen cannot be expressed accurately or meaningfully in terms of mg protein/dL unless the molecular weight of the Lp(a)-specific protein in that specimen has been determined. A further complication is that the number of Lp(a)-specific protein molecules per Lp(a) particle may vary, and, therefore, the number of Lp(a)-specific protein molecules per Lp(a) particle must be determined in order for the quantitative protein test value to be used as an indicator of the size of the Lp(a) particle population. An additional related concern is that the degree of atherogenicity of the Lp(a) particle in any specific case might depend on the molecular size of the Lp(a)-specific protein and/or on the number of Lp(a)-specific protein molecules per particle. Clearly, a simple test of the quantity of Lp(a)-specific protein in a specimen does not exist, and the interpretation of quantitative data requires information on the molecular size of the Lp(a)-specific protein in that specimen and on the clustering of Lp(a)-specific protein molecules on the Lp(a) particles.

Alternatively, the cholesterol content of Lp(a) particles varies little, and Lp(a) cholesterol can be quantified readily. In many cases in our experience, we have observed Lp(a) cholesterol to be at levels of 25-50 mg/dl and in some cases to be above 100 mg/dl. Clearly, Lp(a) can contain significant proportions of the serum cholesterol. In such cases, knowledge of the concentration of Lp(a) and of the contribution of Lp(a)

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cholesterol to the serum total cholesterol should be helpful to physicians in their evaluation of cardiovascular risk levels.

Our Lipids and Lipoproteins Laboratory will continue to measure and report levels of Lp(a) in terms of cholesterol as a part of routine evaluations of lipoprotein profiles. In addition, the terms Lp(a), Lp(a)HDL, and Lp(a)LDL will replace in our reports the synonymous terms pre-beta-HDL, alpha-2 HDL, and alpha-2 LDL.

Lipoprotein analysis can provide practical information about a patient’s health. A definitive analysis must include preparative ultracentrifugation and quantitation of one or more components of each of the various individual lipoprotein fractions. Electrophoresis of the whole serum, of the isolated VLDLs, and of the LDLs and HDLs separate from the VLDLs provides an overview analysis to guide subsequent quantitative analyses; by electrophoresis of the serum and the fractions, the quantitatively significant components are revealed, and quantitative fractionation can be tailored accordingly. For example, if a specimen contains “LP- X” or Lp(a), special maneuvers can be applied to separate and quantify either fraction in terms of its lipid content or protein content. The testing of lipoprotein profiles in Mayo Medical Laboratories includes ultracentrifugation, selective precipitation, electrophoresis, electrophoresis with molecular sieving, quantitation of cholesterol and triglycerides in isolated lipoprotein fractions, and, in some cases, analysis of apolipoproteins.

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Cholesterol and Triglyceride Values in Serum Lipoprotein Fractions*

5th-95th Percentile Ranges by Age and Sex

Cholesterol

Age Females Males (yr) VLDL LDL HDL VLDL LDL HDL

6-11 3-20 60-150 (114) 34-65 3-20 60-140 (114) 30-70 12-14 3-25 60-150 (114) 30-65 3-25 60-140 (111) 30-65 15-19 3-25 60-150 (118) 33-65 3-30 60-140 (113) 30-60 20-29 3-35 60-160 (128) 34-75 5-45 60-175 (131) 30-65 30-39 3-35 70-170 (140) 35-80 5-60 70-190 (147) 30-70 40-49 3-35 80-190 (150) 35-80 5-60 70-205 (160) 30-70 >50 3-35 80-200 (164) 35-80 10-60 80-220 (170) 30-70

( ) Values in parentheses approximate the 75th percentile values for LDL cholesterol.

5th-95th Percentile Ranges by Age and Sex

Triglycerides

Age Females Males (yr) VLDL LDL HDL VLDL LDL HDL

6-7 10-60 10-25 5-15 5-60 10-25 5-15 8-11 5-85 10-25 5-15 5-60 10-25 5-15 12-14 5-85 10-25 5-15 5-90 10-25 5-15 15-19 5-85 10-25 5-15 5-105 10-25 5-15 20-29 5-90 10-30 5-15 5-155 10-30 5-20 30-39 5-90 10-40 5-15 5-155 10-40 5-20 40-49 5-90 10-40 5-15 5-155 10-50 5-20 >50 10-90 10-40 5-15 15-155 10-50 5-20

*The values are in mg/dl of serum and represent healthy persons at the mean ages of the age ranges shown

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Lipid Reference Values

The following set of values by percentiles has been determined at the Mayo Clinic for a defined population of healthy persons and with analytic systems that have been standardized for accuracy with the Lipid Standardization Laboratory of the Centers for Disease Control, Atlanta, GA. We recommend use of the 75th percentile values as upper limits for serum cholesterol and LDL cholesterol and the 95th percentile values for serum triglycerides and HDL cholesterol. Values are in mg/dl

Cholesterol (mg/dl) — Percentile Ranking by Age and Sex Females Age Percentiles (yr) 5 10 20 30 40 50 60 70 75 80 90 95

0-5 Not established 6-9 122 129 141 150 154 158 162 167 173 180 189 209 10-14 124 134 142 149 155 161 168 178 174 190 203 217 5-19 125 133 142 148 154 159 165 171 175 180 199 212 20-24 128 134 144 152 158 163 169 177 181 185 197 209 25-29 134 142 152 159 165 171 178 186 190 194 207 218 30-34 141 149 159 166 173 180 186 194 199 204 217 229 35-39 147 156 167 175 182 188 196 204 209 214 228 240 40-44 155 164 175 183 191 198 206 215 219 224 239 253 45-49 162 171 184 192 200 208 216 224 229 235 251 265 50-54 171 180 192 202 210 218 227 236 241 246 263 278 55-59 179 190 202 212 220 228 237 247 253 259 276 291 60-64 188 198 212 222 231 240 249 259 265 271 290 306 65-69 197 208 222 233 242 252 261 271 278 285 304 320 70-74 207 218 232 244 254 264 274 285 291 298 319 336 >74 217 229 244 256 266 277 287 299 306 313 334 352

Cholesterol (mg/dl) — Percentile Ranking by Age and Sex Males Age Percentiles (yr) 5 10 20 30 40 50 60 70 75 80 90 95

0-5 Not established 6-9 126 133 141 146 151 156 162 168 172 176 187 191 10-14 130 135 145 152 157 162 167 174 179 185 196 204 15-19 114 117 130 139 145 151 156 162 167 173 190 198 20-24 128 135 145 153 160 166 173 181 185 190 204 216 25-29 140 148 159 168 175 182 189 197 202 208 222 236 30-34 150 160 170 178 187 194 202 211 216 222 238 250 35-39 156 166 179 187 196 203 212 221 226 232 250 264 40-44 162 172 185 195 203 211 220 229 235 241 258 274 45-49 166 176 190 200 208 217 226 236 242 248 264 280 50-54 170 180 193 204 213 221 230 240 246 252 270 286 55-59 173 183 196 207 216 225 234 244 250 256 275 291 60-64 175 185 198 209 218 228 237 247 253 259 278 295 65-69 176 186 200 211 220 229 239 249 255 262 280 298 70-74 177 188 202 212 221 230 240 250 256 263 282 299 >74 178 190 202 213 223 231 241 251 257 264 282 300

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Triglycerides (mg/dl) - Percentile Ranking by Age and Sex Females Age Percentiles (yr) 5 10 20 30 40 50 60 70 80 90 95

0-5 Not established 6-9 34 39 45 50 53 56 59 62 66 70 76 10-14 33 37 44 51 56 63 68 77 90 100 121 15-19 33 36 42 47 52 57 62 67 77 88 122 20-24 32 36 43 47 52 56 61 67 75 86 97 25-29 33 38 44 49 54 59 64 70 78 89 100 30-34 35 41 46 52 57 62 67 74 81 94 106 35-39 38 42 49 55 60 65 71 77 86 99 110 40-44 40 44 52 57 63 68 74 81 89 104 117 45-49 41 46 54 60 66 71 78 85 94 108 122 50-54 43 49 56 63 69 75 81 89 98 113 128 55-59 45 52 59 66 72 78 85 93 103 119 134 60-64 47 54 62 69 76 82 89 97 106 125 140 65-69 50 56 65 72 79 86 93 102 113 130 147 70-74 52 59 68 76 83 90 98 107 118 137 154 >74 54 62 72 79 87 95 103 112 124 143 162

Triglycerides (mg/dl) - Percentile Ranking by Age and Sex Males Age Percentiles (yr) 5 10 20 30 40 50 60 70 80 90 95

0-5 Not established 6-9 27 32 37 42 46 50 55 60 68 87 102 10-14 30 33 40 46 51 56 61 66 74 92 103 15-19 31 33 39 46 53 62 69 78 90 107 124 20-24 34 41 48 56 62 69 77 86 98 118 137 25-29 40 46 56 64 72 80 88 98 113 136 157 30-34 43 51 62 70 78 87 97 109 124 148 171 35-39 45 54 65 74 83 92 102 114 130 157 182 40-44 48 56 67 77 86 96 106 119 135 162 189 45-49 50 57 69 79 88 98 109 121 138 166 193 50-54 50 58 70 80 89 99 110 123 140 169 195 55-59 51 59 71 81 90 100 111 124 142 170 197 60-64 51 59 71 81 91 101 111 125 142 170 198 65-69 51 59 71 81 91 101 112 126 143 171 199 70-74 51 59 71 82 91 101 112 126 143 172 199 >74 51 60 71 82 91 101 112 126 144 172 199

Serum cholesterol and triglycerides are dependent on age and sex. The 75th percentile values are proposed as guidelines for significant hypercholesterolemia and the 95th percentile for significant triglyceridemia. This should not be construed to imply that values below these percentiles are without risk in the development of atherosclerosis, particularly coronary artery disease. The risk of coronary artery disease apparently is present at lower lipid levels and increases stepwise with increments in serum lipid values.

The predictive value of blood lipid concentrations diminishes with increasing age. Hypertension and cigarette smoking augment the cardiac risk attendant on hyperlipidemia.

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It is recommended that persons <60 years of age have serum lipid profiles evaluated (serum cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides). If two or more of these evaluations have been performed over several successive years and indicate no evidence for hyperlipidemia, further reevaluations every 4-5 years should be adequate. Because the age of onset of some of the hyperlipoproteinemias is not entirely known, we recommend that persons under 50 years of age have a recheck of the lipid screen every 4-5 years. This is particularly true in the age group of 20-49 years.

Analysis of the serum lipoproteins may be of use if the lipids are abnormal (outside the 75th percentile for cholesterols or beyond the 95th percentile for triglycerides). Once a lipoprotein analysis has been obtained, routine repetition of lipoprotein analysis is not necessary; however, reevaluation of the lipoproteins would be appropriate after a clinically significant change in either the serum cholesterol or triglyceride concentration.

The National Cholesterol Education Program of the National Heart, Lung, and Blood Institute has announced guidelines for identification and treatment of hyperlipidemia. Those guidelines are not related to age or sex and consist of the following points:

Serum cholesterol (SC) mg/dL

Desirable level <200 Marginally high risk 200-239 High risk >240

Recommended follow-up:

SC <200 Retest within 5 years SC = 200-239 and no CHD and no more Improve diet and retest annually

than one CHD risk factor — including maleness SC = 200-239 and two or more Action based on lipoprotein profile with additional CHD risk factors special attention to LDL cholesterol SC >240 Medication indicated

LDL cholesterol (LDLC) mg/dl

Desirable level <130 Marginally high risk 130-159 High risk >160

Recommended follow-up: Initiation Level Minimal Goal mg/dl mg/dl

Diet management: Without CHD and without more >160 <160 than one risk factor With CHD or two other risk >130 <130 factors

Medication regimen: Without CHD and without more >190 <160 than one risk factor With CHD or two other risk >160 <130 factors

CHD = coronary heart disease; LDL = low density lipoproteins

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“Other risk factors” include male sex, family history of CHD, cigarette smoking, hypertension, HDL cholesterol level below 35 mg/dl, diabetes mellitus, history of cerebrovascular or occlusive peripheral vascular disease, and obesity equal to 30% or more overweight (Arch Int Med 148:36, 1988).

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Metals Analysis — Collection and Transport

When multiple blood samples are scheduled for collection from one patient, the trace metal specimens should be collected first; once the phlebotomy needle has punctured another rubber stopper, it is contaminated and should not be used for trace metal specimen collection.

Always use an alcohol swab to cleanse the venipuncture site. Avoid iodine-containing disinfectants. Use only stainless steel phlebotomy needles.

Blood specimens

Specimens for serum testing should be collected in the Trace Element Blood Collection Tube, navy blue top. Allow the specimen to clot for 30 minutes; then centrifuge the specimen to separate serum from the cellular fraction. Remove the stopper and carefully pour the serum into a metal-free, transfer vial, avoiding transfer of the cellular components of blood. DO NOT insert a pipet into the serum to accomplish transfer, and DO NOT ream the sample with a wooden stick to assist with serum transfer. Place the cap on the vial tightly, attach a specimen label, and send specimen to the laboratory at refrigerated or frozen temperature.

Specimens for whole blood testing should be collected in a Trace Element Blood Collection Tube, navy blue top, containing EDTA as an anticoagulant. Leave the specimen in the tube, attach an identification label, and send the specimen to the laboratory at cool temperature.

Urine specimens

We urge the use of acid-washed plastic containers for specimen collection and transport. Acid stabilized specimen collection is essential for accurate analysis of calcium, magnesium, and oxalate. If the urine pH is >4, some of these elements will be lost in the urine sediment such that at the time of aliquot separation, some of the sediment will be unhomogeneously divided.

DO NOT collect urine specimens in the environment in which exposure is most likely to occur. It is important that dust from clothing not contribute to the specimen contents.

DO NOT collect urine in metal-based containers such as metal urinals or pans.

Tips to Control Contamination

1. Keep patient specimen area clean and free of dust. 2. It is best to use the metal free blood tubes. 3. DO NOT touch specimen with utensils unless they have been acid-washed. 4. Dialysis patients on heparin may form an uncoagulated serum when centrifuging. Pour off serum as soon as possible, invert the clotted tube, and repeat centrifugation step to separate cellular fraction if more serum is needed. 5. DO NOT leave serum on cells more than 60 minutes. Centrifuge and pour serum into metal-free vial.

References 1Moody JR, Lindstrom RM: Selection and cleaning of plastic containers for storage of trace element samples. Anal Chem 49:2264-2267, 1977 2Lecomte R, Paradis P, Monar 5, et al: Trace element contamination in blood-collecting devices. IntJ NucI Med Biol 6:207-211, 1979 3Handy RW: Zn contamination in vacutainer tubes. Clin Chem 25:197-198, 1979 4Ericson SP, McHalsky ML, Rabinow BE, et al: Sampling and analysis techniques for monitoring serum for trace elements. Clin Chem 32:1 350-1 356, 1986 5Nixon DE, Moyer TP, Squillace DP, McCarthy IT: Determination of serum nickel by graphite furnace atomic absorption spectrometry with Zeeman-effect background correction: values in a normal population and a population undergoing dialysis. Analyst 114:1671-1674, 1989

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Microbiology Specimen Guide for Viral and Mycoplasma Specimens*

Infective Agent Isolation Source Culture Specimen

Adenovirus Biopsy, conjunctival swab, Multi microbe  transport rectum, sputum, stool, or throat medium

Cytomegalovirus Urine (first voided a.m. Sterile container specimen)

Enterovirus (Coxsackie A, B, Biopsy, rectum, spinal fluid, Multi microbe  transport ECHO, polio) stool, throat, urine, or vagina stool cup -stool

Herpes simplex virus Scrapings from infected lesion Swab in Multi microbe  or vesicular fluid transport media

Herpes (varicella) zoster virus Scrapings from infected lesion Swab in Multi microbe  or vesicular fluid transport media

Influenza virus Biopsy, stool, or naso-pharyngeal Swab in Influenza viral transport medium

Mumps virus Biopsy, spinal fluid, stool, Swab in Multi microbe  throat, or or urine transport medium

Mycoplasma Throat Swab in Multi microbe  transport medium

Parainfluenza virus Biopsy, stool, or throat Swab in Multi microbe  Medium

Reovirus Rectum, stool, or throat Swab in Multi microbe  Medium

Rubeola Biopsy, conjunctival swab, Swab in Multi microbe  sputum, spinal fluid, throat, or medium urine

*Refrigerate specimen after collection and forward promptly in appropriate transport as noted above.

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Parathyroid Hormone Assays

Measurement of parathyroid hormone (PTH) plays an important role in the laboratory evaluation of various primary and secondary disorders of calcium metabolism. A large array of analytical methods are available for measuring PTH, including radioimmunoassays, immunoradiometric assays (ICMA), and bioassays. There are considerable differences among these. Because of the superior performance and reliability of the ICMA, the C-terminal radioimmunoassay and the N-terminal bioassay have been discontinued. Selection of the appropriate method of analysis and accurate interpretation of the results require knowledge of both the analytic method and the clinical situation. This often is a problem for both the clinician and the laboratorian.

PTH Metabolism

PTH is produced and secreted by the four parathyroid glands located along the posterior aspect of the thyroid gland. The hormone is first synthesized as a 1 15-amino acid precursor (pre-pro-PTH). This form is cleaved to pro- PTH and then to the 84-amino acid “whole” PTH. The precursor forms generally remain within the cells of the parathyroid gland. After the whole PTH is secreted, it undergoes further cleavage and metabolism to form carboxyl- terminal fragments (PTH-C; amino acids 53-84); amino-terminal fragments (PTH-N; amino acids 1-34); and mid- molecule fragments (PTH-M; amino acids 44-68). Only those portions of the molecule that carry the amino-terminus (i.e., the whole molecule and PTH-N) are biologically active.

The active forms have half-lives of approximately 5 minutes. The inactive PTH-C fragments, which normally make up more than 90% of the total circulating PTH, are cleared by the kidney and have a longer half-life, 30-40 minutes. As the renal function deteriorates, clearance of PTH-C decreases significantly to a half-life of 24-36 hours. As a result, patients with renal failure may have strikingly high PTH-C values, even in the absence of parathyroid disease.

The serum calcium level regulates PTH secretion via negative feedback. Decreased calcium level stimulates PTH release which increases renal tubular reabsorption of calcium, decreases renal tubular reabsorption of phosphorus, enhances osteoclastic bone resorption and mobilization of calcium from bone, and increases renal synthesis of 1 ,25-dihydroxy vitamin D which, in turn, increases intestinal absorption of calcium.

Parathyroid Disorders

The four main disorders affecting calcium metabolism are: 1) primary hyperparathyroidism (PHPT), 2) secondary hyperparathyroidism, 3) hypercalcemia of malignancy, and 4) hypoparathyroidism. PHPT is the most common cause of hypercalcemia in asymptomatic, nonhospitalized patients. In PHPT, one or more glands secrete excess PTH. The cause may be a carcinoma, a benign tumor (adenoma), or diffuse hyperplasia with independent PTH production and loss of negative feedback control.

In patients with renal failure and persistently low calcium levels, the parathyroid glands may undergo hyperplasia in an attempt to bring the calcium level to normal. Autonomously functioning adenomas also may develop with time. As is the case with primary hyperparathyroidism, surgical removal of the adenomatous tissue often is necessary to prevent the serious consequences of hyperparathyroidism, including kidney stones and bone disease. With renal failure, various bone diseases not related to hyperparathyroidism (e.g., osteomalacia and aluminum toxicity) may develop. Determination of PTH level often is necessary to identify the type of bone disease present in these patients.

Hypercalcemia of malignancy is the most common cause of hypercalcemia in hospitalized patients. In these cases, the high calcium level is not due to excess PTH. In fact, PTH level may be suppressed in an attempt to lower the calcium level. Various malignancies may result in hypercalcemia by several different mechanisms. In multiple myeloma and some cases of bony metastasis, the local erosive effects result in bone destruction and release of calcium into the peripheral blood. With other tumors, notably squamous cell carcinoma of the lung, breast cancer, and prostate cancer, the tumor may secrete substances that have PTH-like activity. Recently, such a substance was identified and named PTH-related peptide (PTHrP). It is a 141-amino acid fragment with significant homology

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with the first 13 amino acids of the amino-terminal fragment of PTH. PTHrP promotes calcium resorption from bone and decreases calcium excretion by the kidney.

Hypoparathyroidism results from absence (usually as a result of surgical removal) or hypofunction of the parathyroid glands. In these cases, PTH and calcium levels are low.

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Pediatric Literature References

1. Altman PL, Katz DD: Human Health and Disease, Bethesda, MD, Federation of American Societies for Experimental Biology, 1977

2. Meites S: Pediatric Clinical Chemistry: A Survey of Reference (Normal Values, Methods, and Instrumentation, with Commentary). Washington, DC, American Association for Clinical Chemistry, 1981

3. DG Nathan, FA Oski (editors): Hematology of Infancy and Childhood. Philadelphia, PA, WB Saunders Company, 1981

4. Stalker HP, Holland NH, Kotchen JM, Kotchen TA: Plasma renin activity in healthy children. I Pediatr 89:256- 258, 1976

5. Loeuille G-A, Racadot A, Vasseur P, Vandewalle B: Etude des taux Sanguins et Urinaires d’Aldosterone chez le Nouveau Ne, le Nourrisson et 1’Enfant Normal. Pediatrie 36:335-344, 1981

6. Ducharme JR, Forest MG, De Peretti E, et al: Plasma adrenal and gonadal sex steroids in human pubertal development. J Clin Endocrinol Metab 42:468-476, 1975

7. Hicks JM, Boeckx RL: Pediatric Clinical Chemistry, Philadelphia. PA, WB Saunders Company, 1984

8. Davis J, Andelman 5: Urinary delta-aminolevulinic acid (ALA) levels in lead poisoning. Arch Environ Health 15:53-59, 1967

9. Allison DI, Walker A, Smith QT: Urinary hydroxyproline: creatinine ratio of normal humans at various ages. Clin Chim Acta 14:729-734, 1966

10. Meites 5: Pediatric Clinical Chemistry Reference (Normal) Values. Third edition. Washington, DC, American Association for Clinical Chemistry, 1989

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Porphyrinogens. Porphyrins, and Porphyrias

The porphyrias are emotionally distressful and potentially lethal disorders that are evidenced prominently with neurologic and dermatologic expressions. Congenital erythropoietic porphyria (CEP) is evidenced in infancy, but the porphyrias of other types have been evidenced almost entirely in adulthood in most cases and only rarely during childhood.

Acute Intermittent Porphyria (AlP), Coproporphyria (CP), and Variegate Porphyria (VP) are three of the more prevalent forms of porphyria. Acute episodes are characteristic of all three of these forms and most frequently include mild to severe abdominal pain and psychiatric distress ranging from depression to psychosis. The episodes of abdominal pain may be so severe as to indicate a need for immediate surgical exploration and intervention. Whether mild or severe, in most cases of AlP and CP the recurring abdominal discomfort has been the unnerving factor that has caused patients to seek examination. Additional episodic characteristics of lesser frequencies include hypertension, paresthesias, fever, and seizures.

AlP, CP, and VP can cause episodes of neuromuscular weakness that can progress quickly to paraparesis and whole-body paralysis with life-threatening respiratory paralysis; onset of neuromuscular weakness is clearly a signal for expeditious establishment of a diagnosis and prompt medical intervention. Expression of AlP does not include skin problems, but 20-30% of known cases of CP and most, if not all, cases of VP are photosensitive and/or have increased physical fragility of the skin, increased sensitivity to chemical contact, and increased susceptibility to “neurodermatitis.” Hypertrichosis and regional alopecia may occur in the more severely expressed cases of CP and VP. The dermopathy resulting from the photosensitivity of CP and VP includes erythema, urticaria, and blistering and vesicular lesions.

During acute episodes of AlP, CP, and VP, the production and urinary excretion of delta-aminolevulinic acid (5- ALA) and porphobilinogen (Pbg) are increased; therefore, quantitation of urinary 5-ALA and Pbg during suspected acute episode is helpful. AlP can be diagnosed in either the acute state or latent state by quantitation of 5-ALA dehydratase and Pbg deaminase (uroporphyrinogen I synthase) activities in erythrocytes. CP and VP can be detected by analysis of the fecal porphyrins: coproporphyrin excretion is increased in CP, and both fecal coproporphyrins and protoporphyrins are increased in VP. Diminished activity of Cpg oxidase in hepatocytes is definitive for a diagnosis of CP, and diminished activity in ervthrocvtes is strongly indicative.

Acute attacks of Acute Intermittent Porphyria. Hereditary Coproporphyria and Variegate Porphyria usually are provoked by medications (barbiturates and antibacterials are among the best known offenders); various other commonplace substances that are suspect include household or industrial chemicals, agricultural pesticides, industrial chemical wastes, garden chemicals, and chemicals used in hobby crafts — such as mineral pigments used in ceramics work and degreasing solvents used in automotive and other mechanical repair work.

Congenital Erythropoietic Porphyria is readily recognizable in early life by photosensitivity and voiding of pink, wine- red, or dark urine. Diminished activity of uroporphyrinogen III synthase (co-synthase) in erythrocytes is definitive evidence for a diagnosis.

Porphyria Cutanea Tarda is characterized by photosensitivity and increased urinary excretion of uroporphyrinogen, uroporphyrin, and the heptacarboxylporphyrinogen and porphyrin. It is potentiated by a partial deficiency of uroporphyrinogen decarboxylase, and it is provoked into a metabolically active form by factors such as excessive storage of iron and chronic abuse of alcohol.

Protoporphyria is relatively mild but potentiates the victim for acute solar urticaria and chronic solar eczema. The chemical features include increased erythrocyte protoporphyrin and greatly increased fecal excretion of protoporphyrin.

Intoxication Porphyria can be caused by a variety of toxic substances; probably most of the recognized cases have been caused by ingestion of lead. Heavy metals, halogenated aromatic hydrocarbons, and drugs can suppress enzymes involved in porphyrinogen metabolism, leading to the accumulation of intermediates. Enzymes known to be suppressible by toxic substances include aminolevulinic acid dehydratase, porphobilinogen deaminase,

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uroporphyrinogen decarboxylase, and ferrochelatase. Other porphyrinogen-related enzymes probably can be suppressed, also. Usually, intoxication porphyria results in increased erythrocyte protoporphyrin, increased urinary excretion of & ALA and of porphobilinogen, and increased fecal excretion of protoporphyrin. In addition, increased urinary excretion of porphyrinogens and porphyrins can occur. Coproporphyrinuria has been observed in many cases of intoxication with industrial chemicals and waste byproducts. Also, intoxication porphyria can mimic porphyria cutanea tarda in terms of both clinical signs and increased urinary excretion of uroporphyrin and heptacarboxylporphyrin; this form of intoxication porphyria occurs when the toxin interferes with the production of or function of uroporphyrinogen decarboxylase.

Expression of the porphyrias in symptoms and pathology is provoked by environmental stresses and/or physiologic factors that biochemically impact the characteristic diminished enzyme activities of the heme-forming system. The needs for avoidance of provocative environmental factors and for minimizing risks for potentially lethal acute episodes mandate the identification of persons with porphyriagenic genes — persons with active porphyria and persons with latent traits not yet provoked into symptomatic or pathologic status (mainly first degree relatives of persons with diagnosed porphyria).

The following table should be helpful for categorizing patients as a preliminary to the selection of appropriate diagnostic tests.

Prevalence Among Type Porphyric Persons Dermopathy Neuropathy Other Indicators

RBC &-ALA dehydra- Very rare None Mild to severe Intermittent fever, tase deficiency (ADP) hypertension

Acute intermittent porphyria (AlP) RBC Pbg deaminase Among most None Mild to severe Intermittent fever, deficiency prevalent hypertension

Congenital erythro- Very rare Very severe, Possibly Pink, red, or violet poietic Porphyria (CEP) mutilating; evidence urine staining in infancy diapers

Porphyria cutanea tarda Among most Mild to severe Not usually Siderosis (PCT) prevalent

Coproporphyria (CP) Among most 20-30% of cases; Mild to severe Intermittent fever, prevalent mild to severe hypertension

Variegate porphyria (VP) Among most Present in 75-80% Mild to severe Intermittent fever, prevalent of all cases hypertension

Protoporphyria (PP) Quite rare Mild to severe Not usually Abnormal liver function tests; gallstones

Intoxication porphyria Among most In some cases, Usually Variable; intermittent (IP) prevalent not in others fever, hypertension

The porphyrinogens of series III are precursors to heme, and the isomeric porphyrinogens of series I are metabolic byproducts with no known physiologic function. The porphyrins are by-products formed by nonenzymic oxidations of the porphyrinogens. The following table is a guide for the ordering of tests to establish diagnoses of porphyrias and to establish the specific type of any individual case.

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Suspected Porphyria Recommended Tests

Acute intermittent porphyria (AlP) Erythrocyte porphobilinogen deaminase (uroporphyrinogen I synthase) and erythrocyte 5-ALA dehydratase; during acute episodes urine Pbg, 5-ALA, porphyrins

Congenital erythropoietic porphyria (CEP) Urine porphyrins by HPLC, erythrocyte porphyrins with fractionation by HPLC, and uroporphyrinogen III cosynthase in RBCs

Porphyria cutanea tarda (PCT) Urine porphyrins; uroporphyrinogen decarboxylase in RBCs

Coproporphyria (CP) Fecal porphyrins; urine Pbg, 5-ALA, porphyrins; coproporphyri nogen oxidase (erythrocyte porphobilinogen deaminase and 5- ALA dehydratase may be necessary to differentiate from AlP)

Variegate porphyria (VP) Fecal porphyrins; urine Pbg, 5-ALA, porphyrins; (erythrocyte porphobilinogen deaminase and 5-ALA dehydratase may be necessary to differentiate from AlP)

Protoporphyria (PP) Urine, fecal, and erythrocyte porphyrins with fractionation by HPLC

Intoxication porphyria (IP) * Erythrocyte porphyrins; urinary 5-ALA, Pbg, porphyrins; fecal porphyrins; 5-ALA dehydratase, Pbg deaminase, and/or uroporphyrinogen decarboxylase in RBCs may be necessary

(Pbg, porphobilinogen; 5-ALA, delta-aminolevulinic acid)

*In some cases, the quantitation of erythrocyte zinc protoporphyrin should be included to distinguish intoxication porphyria from protoporphyria.

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Renin Aldosterone Studies

Preparation for Renin — Aldosterone Studies

A. Renin-Angiotensin-Aldosterone System: 1. Renin is secreted by the juxtaglomerular cells of the kidneys in response to changes in plasma volume. An increase in renin normally produces an increase in aldosterone through angiotensin intermediates. Renin’s physiological effects are manifested mainly through its changes on aldosterone production. Aldosterone is produced by the adrenal glands and fluctuates normally with changes in renin levels. With aldosterone-producing tumors, the serum aldosterone level is elevated even though renin may be suppressed. Aldosterone production results in retention of sodium and excretion of potassium.

B. Usual Laboratory Test Findings in Renin Aldosterone Disorders: 1. Renal disease, such as unilateral renal artery stenosis, results in elevated renin and aldosterone levels. Renal venous catheterization may be helpful. A positive test is a renal venous renin ratio (affected/normal) >1 .5. 2. Primary aldosteronism is manifested by low renin and elevated aldosterone levels. The aldosterone level will not be suppressed by a high salt intake, whereas in normals it will. An elevated urinary aldosterone excretion rate and increased levels of serum aldosterone associated with low plasma renin activity is presumptive evidence for primary aldosteronism.

C. Preparation of Patient for Plasma Renin Activity Determination: 1. The traditional method is to discontinue all substances known to affect the renin angiotensin system and to then rapidly induce extracellular volume contraction by means of a low sodium diet and diuretic administration. Paradoxically, chronic volume contraction tends to lessen renin secretion. Recently, it has been shown that it is possible to stimulate renin secretion and assist in lateralization by means of converting enzyme inhibitors. a. Volume contraction protocols: Intake of all diuretic drugs, antihypertensive drugs (other than guanethidine [Ismelin®], which for some reason does not alter renin secretion), cyclic progestational agents, estrogens, and licorice should be terminated. The patient should be on a normal sodium diet.

(1) Three-day diet preparation: (a) For 3 days prior to the test, the patient should limit sodium intake to 20 mEq/day (see p. 266, “Diet for Renin Test [20 mEq of Sodium]”). (b) Administer chlorothiazide 0.5 g b.i.d. for 3 days.

(2) Acute (furosemide) preparation: (a) Administer furosemide 50 mg orally the night before and 40 mg the morning of the test.

b. Angiotensin converting enzyme inhibition protocol: It has been shown that acute administration of drugs which block the action of angiotensin converting enzyme will enhance renin lateralization. Surprisingly, the effect is not seen if three drugs are given chronically. An advantage of this protocol is that the inhibiting effects of other drugs can be eliminated and it is unnecessary to allow a washout period to pass. Captopril (Capoten® — Squibb) is available as a converting enzyme inhibitor. Reports of renal toxicity by a variety of mechanisms are known. It would appear, however, that a single dose for testing purposes is relatively innocuous.

(1) Administer captopril 25 mg by mouth 30 minutes prior to the procedure. Caution should be taken to guard against orthostatic hypotension.

D. Preparation of Patient and Samples for Primary Aldosteronism Study: 1. Primary testing

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a. No salt depletion is necessary. b. Collect a 24-hour urine for aldosterone starting at 10 a.m. c. At 10 a.m. the next day, draw a peripheral blood sample for plasma renin and serum aldosterone assays. The patient should be in an upright position when sample is drawn. 2. Confirmatory testing In primary aldosteronism, the plasma renin activity is suppressed. To confirm that the plasma renin activity is suppressed, a sodium depleted renin test should be performed. Deplete the patient of sodium by administering 40 mg of furosemide at 6 p.m. and at 10 p.m. the day before the test and at 7 a.m. on the day of the test. The patient should be upright for 3 hours before the blood specimen is obtained. Patients with angina or cerebrovascular insufficiency should not have a furosemide stimulation test. For alternative stimulated renin test, the patient should follow a 20-mEq sodium diet for 3 days and take 0.5 g of chlorothiazide twice daily.

Diet for Renin Test (20 mEq of Sodium) FOODS MAY BE DELETED FROM THIS DIET BUT NO FOODS MAY BE ADDED.

Important Information for the Physician: This diet is quite stringent and should be given for 3 days only and under circumstances such that the patient’s condition and activity can be carefully supervised. In most instances, it is best to hospitalize the patient because, with this diet, patients who do not have primary aldosteronism are likely to become hypovolemic and may suffer from orthostatic hypotension of varying degrees.

General Instructions: 1. Eat only foods included in meal plan. 2. Use standard measuring cups and spoons to measure all portions. 3. Use 1/4 pound of beefsteak or ground beef (raw weight) unsalted for noon meal and 1/4 pound chicken (raw weight) unsalted for evening meal. 4. Vegetables allowed are asparagus, green or wax beans, cabbage, cauliflower, lettuce, and tomatoes, unsalted. 5. Bread and butter must be unsalted. 6. Use only the measured amount of coffee. Only distilled water may be taken between meals. 7. All food must be prepared without salt; do not use salt at the table.

Breakfast: 1 cup orange juice 1 egg, poached, boiled, or fried in unsalted fat 2 slices unsalted toast 1 shredded wheat biscuit or 2/3 cup unsalted cooked cereal 1/2 cup half & half or milk 1 cup (measuring cup) coffee Sugar, jam or jelly, and unsalted butter as desired

Noon Meal: 1/2 cup unsalted tomato juice 1/4 pound ground beef or beef steak (raw weight) unsalted; may be broiled or fried with unsalted fat 1/2 cup unsalted potato 1/2 cup unsalted green beans or other allowed vegetable 1 serving fruit 1 cup (measuring cup) coffee Sugar, jam or jelly, and unsalted butter as desired

Evening Meal: 1/4 pound chicken (unsalted); may be baked, broiled, or fried in unsalted fat 1/2 cup unsalted potato 1 slice unsalted bread Lettuce salad (vinegar & oil dressing) 1/2 cup unsalted green beans or other allowed vegetable 1 serving fruit 1 cup (measuring cup) coffee Sugar, jam or jelly, and unsalted butter as desired

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Stool Collections

A. Containers and Transport:

Special containers for the collection and processing of fecal specimens are supplied by Shore Health Laboratories.

Please check the specific test listing for preferred transport temperature.

B. Container Label and Required Information:

1. Each container has a label affixed.

2. At the time the container is given to the patient, please: a. Fill in the patient name b. Review the test to be done and specimen requirements with the patient • Collection duration • Diet requirements • Collection and storage of the specimen until it is returned to you • One aliquot container should be provided for a random collection • Provide patient with information on how to obtain additional containers from you should that be necessary c. Instruct patient not to fill any container more than 3/4 full (to the indicated line on the label)

3. At the time the patient returns the container to you, complete the following information on the label: a. Duration of collection should have the appropriate box checked. If timed duration is other than those listed, please list it on the line provided following Other ______b. Indicate if the entire collection is contained in one container or in multiple containers. Indicate total number of containers sent.

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DXylose 5 HR URINE

Patient Preparation and Sample Collection

Patient must fast a minimum of 8 hours prior to administration of d-xylose (25 gm d-xylose). Pediatric patients (younger than 9 years of age) should fast only 4 hours. No restriction on water. Weigh patient for proper dosage of d-xylose. Weight based dosage of d-xylose for oral administration: 0.5 g/kg body weight up to a maximum of 25 grams of d-xylose. Dissolve in water 10% (w/v) with a maximum of 250 ml. Patient should drink 8 oz (250 ml) of water after d-xylose administration and another 8 oz after 1 hour. Patient must remain in supine position for duration of the test except during urine collection. Patient should refrain from foods rich in pentose (fruits, preserves, and grains) for a 24 hour period prior to the test. Record total 5 hour urine volume and send aliquot. Record total volume on request form.

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PSA (PROSTATE SPEC AG), SCREEN NORMAL RANGE

Ages Normal Range

0 – 60 Days 0 – 2.0 2 – 60 Months 0 – 2.0 5 – 40 Years 0 – 2.0 41 Years 0 – 2.1 42 Years 0 – 2.2 43-44 Years 0 – 2.3 45 Years 0 – 2.4 46 Years 0 – 2.5 47- 48 Years 0 – 2.6 49 Years 0 – 2.7 50 Years 0 – 2.8 51 Years 0 – 2.9 52 Years 0 – 3.0 53 Years 0 – 3.1 54 Years 0 – 3.2 55 Years 0 – 3.3 56 Years 0 – 3.4 57 Years 0 – 3.5 58 Years 0 – 3.6 59 Years 0 – 3.7 60 Years 0 – 3.8 61 Years 0 – 4.0 62 Years 0 – 4.1 63 Years 0 – 4.2 64 Years 0 – 4.4 65 Years 0 – 4.5 66 Years 0 – 4.6 67 Years 0 – 4.8 68 Years 0 – 4.9 69 Years 0 – 5.1 70 Years 0 – 5.3 71 Years 0 – 5.4 72 Years 0 – 5.6 73 Years 0 – 5.8 74 Years 0 – 6.0 75 Years 0 – 6.2 76 Years 0 – 6.4 77 Years 0 – 6.6 78 Years 0 – 6.8 79 Years 0 – 7.0 80 – 199 Years 0 – 7.2

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INDEX

No main index - tests are listed alphabetically.

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APPENDIX

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