COMPONENT
Activated Partial Thromboplastin Time

SPECIMEN/STABILITY
Full Plasma Citrated Blue Tube
Room Temp.- 24 Hrs
Frozen (-20°C)- 2 weeks
Note: Specimen will be discarded after 7 days of storage.

COLLECTION NOTES
1. Draw blood into a buffered citrate collection tube (light blue top)filled to proper level. Do not overfill.
2. The blood-to-coagulant ratio should be 9:1; inadequate filling of the collection device will decrease this ratio and may lead to inaccurate results.
3. Invert gently to mix
4. Keep sample at room temperature.

CLINICAL UTILITY
This test measures the integrity of intrinsic and common pathway and monitoring heparin therapy.

REFERENCE RANGE
25.0 – 35.0 seconds

CRITICAL RESULTS
> 60.0 seconds

SCHEDULE
Sunday-Friday

REPORTED
Same day

See Alpha-Fetoprotein Tumor Marker, #197

COMPONENT
Albumin

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 days, Refrigerated – 30 Days
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
1 mL serum separated within 1 hr of collection; avoid hemolysis.

CLINICAL UTILITY
Serum Albumin is used for the diagnosis of numerous diseases. Elevated levels of Albumin could be a result of dehydration. Low levels of Albumin may be caused by kidney or liver disease, infection, or severe burns.

REFERENCE RANGE
M/F3.5 – 5.7 g/dL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Alkaline Phosphatase

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
1 mL serum separated within 1 hr of collection; avoid hemolysis.

CLINICAL UTILITY
Evaluate hepatobiliary disease, bone disease associated with increased osteoblastic activity, and possible metastatic disease; detect cirrhosis, alcoholism, primary and metastatic neoplasia in liver and bone, healing infarct of heart and lung, infectious mononucleosis and many other entities. Transient elevations may be found during healing of bone fractures and the third trimester of pregnancy. Bone growth in children accounts for their alkaline phosphatase elevation.

REFERENCE RANGE
34.0 – 104.0 U/L

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
TREE
Ash,White
Box Elder
Cottonwood, Eastern
Elm, White
Hickory, Shellbark
Oak, White

GRASS
Bermuda
Cocklebur
English Plantain
Lamb’s Quarters
Mugwort
Ragweed, Short
Sweet Vernal
Timothy

DUST
House
Mite (D farine)

DANDER
Dog
Cat

INSECT
Cockroach Mix

MOLD
Alternaria
Aspergillus
Cladosporium
Penicillum

FOOD
Almond
Corn
Egg, White
Garlic
Milk
Orange
Peanut
Potato
Rice
Shellfish Mix
Soybean
Wheat
Yeast, Baker’s

SPECIMEN/STABILITY
2 mL Serum; Serum Separator Tube (red-grey marble)
Refrigerated – 7 Day(s), Frozen – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COMPONENT
Alpha-Fetoprotein

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Refrigerated – 7 Day(s), Frozen – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Monitor the course of liver or testicular cancer, patient response to treatment, and disease recurrence. Alpha-fetoprotein (AFP) is elevated in the serum of more than 70% of patients with hepatocellular carcinoma (HCC) and 70% of patients with non-seminomatous testicular carcinoma.In non-seminomatous testicular carcinoma, tumor recurrence is often accompanied by a rise in AFP. THIS TEST SHOULD NOT BE USED FOR SCREENING NEURAL TUBE AND OTHER BIRTH DEFECTS.

REFERENCE RANGE
0.0 – 9.0 ng/mL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Alanine Transaminase (ALT)

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Avoid hemolysis. Avoid repeated freeze-thaw cycles.

CLINICAL UTILITY
Most commonly used and most prevalent in liver disease assessment. ALT = Alanine Aminotransferase. In comparison AST (aspartate amino transferase) is present to the same extent in heart, skeletal muscle, and liver. AST and ALT increase rapidly during the onset of viral jaundice and remain elevated for 1-2 weeks. In toxic hepatitis, ALT and AST are elevated, but LD (lactate dehydrogenase) is elevated to an even greater extent as a result of hepatic cell necrosis. ALT and AST serum activities are elevated in myocardial infarction, renal infarction, progressive muscular dystrophy, and numerous diseases that only secondarily affect the liver, such as Gaucher’s Disease, Niemann-Pick disease, infectious mononucleosis, myelocytic leukemia, diabetic ketacidosis, and hyperthyroidism.

REFERENCE RANGE
7.0 – 52.0 U/L

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Amylase

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Avoid hemolysis.

CLINICAL UTILITY
Amylases are enzymes that degrade complex carbohydrate molecules into smaller components. Amylase is produced by the exocrine pancreas and the salivary glands to aid in the digestion of starch. It is also found in the liver and in the lining of the fallopian tubes. Amylase is increased in serum and urine of patients suffering from pancreatitis. In acute pancreatitis a transient rise in serum amylase activity occurs within 2 to 12 hours of the onset; levels return to normal by the third or fourth day. The magnitude of elevation of serum enzyme activity is not related to the severity of pancreatic involvement; however, the greater the rise, the greater the probability of acute pancreatitis.

REFERENCE RANGE
29.0 – 103.0 U/L

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Antinuclear Antibodies

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Screening test for the detection of antibodies to nuclear antigens.Over 96% of patients with systemic lupus erythematosus (SLE) have values above 7.5 IU/mL.Less that 3-4% of healthy patients display ANA concentrations of 7.5 IU/mL or higer. For specific antibodies associated with SLE and other autoimmune diseases, Specialty offers ANALyzer without ANA.

REFERENCE RANGE
Negative

SCHEDULE
Monday-Saturday

REPORTED
Same day

COMPONENT
Apoliproprotein A1

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Refrigerated – 1 Month(s), Frozen – 1 Year
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Apolipoprotein A1 is the primary protein associated with HDL cholesterol. Like HDL cholesterol, increased concentrations are associated with reduced risk of cardiovascular disease.

REFERENCE RANGE
100 – 200 mg/dL

SCHEDULE
Monday-Saturday

REPORTED
Same day

COMPONENT
Apoliproprotein B

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Refrigerated – 1 Month(s), Frozen – 1 Year
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Apolipoprotein B (APO B) has been reported to be a powerful indicator of CAD. In some patients with CAD, APO B is elevated even in the presence of normal LDL cholesterol.

REFERENCE RANGE
50 – 155 mg/dL

SCHEDULE
Monday-Saturday

REPORTED
Same day

See Activated Partial Thromboplastin Time, #037.

COMPONENT
Aspartate Aminotransferase (AST)

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Avoid hemolysis. Avoid repeated freeze-thaw cycles.

CLINICAL UTILITY
Serum AST is one group of enzymes which catalyzes the interconversion of amino acids and keto acids by transfer of amino groups. Transaminases are widely distributed in body tissues with significant amounts found in the heart and liver. Lesser amounts are also found in skeletal muscles, kidneys, pancreas, spleen, lungs and brain. Injury to these tissues result in the release of the AST enzyme to general circulation.

REFERENCE RANGE
13.0 – 39.0 U/L

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Beta-HCG, Total (Pregnancy)

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Avoid hemolysis. Avoid repeated freeze-thaw cycles.

CLINICAL UTILITY
Primarily used for the confirmation of pregnancy. Urine hCG tests usually suffice for diagnosis of normal pregnancy when it has progressed beyond the first week after the first missed period. However, qualitative serum pregnancy tests can detect pregnancy earlier, and quantitative serum tests have advantages for prognosis of early pregnancy. Detectable amounts of hCG (approx. 5 IU/L) are present 8 to 11 days after conception, which is the 3rd week of pregnancy as measured from the last menstrual period. The peak of immunological hCG start to decline at about 8 to 10 weeks and is about 100,000 IU/L/Subsequently concentrations of hCG start to decline slowly in urine and or abnormal intrauterine pregnancies. hCG levels can range from 0 to 200,000 IU/L with a geometric mean of about 1000 IU/L. In about 1% of patients with ectopic pregnancy, the hCG is undetectable using serum tests capable of measuring as little as little as 5 IU/L.

REFERENCE RANGE
Female: < 5.0 mIU/mL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Bicarbonate

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
To avoid loss of bicarbonate do NOT aliquot the specimen. Submit a spun SST for analysis.

CLINICAL UTILITY
Alterations of bicarbonate and carbon dioxide dissolved in plasma are characteristic of acid-base imbalance. Bicarbonate ions make up all but about 2 mmol/L of the total carbon dioxide of plasma. Total carbon dioxide in plasma is in physical solution, bound loosely to amine groups in proteins, as bicarbonate or other undissociated bicarbonates and carbonates as well as carbonic acid. When acid-base imbalance is suspected, evaluation of blood gases and pH is required to provide a definitive picture of the overall pattern of imbalances.

REFERENCE RANGE
21.0 – 31.0 mmol/L

CRITICAL RESULT
< 10 mmol/L > 40 mmol/L

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Bilirubin Direct

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
To avoid loss of Bilirubin wrap the specimen in aluminum foil. Submit a spun SST for analysis.

CLINICAL UTILITY
While total bilirubin provides a total amount of both conjugated (direct) and unconjugated (indirect) bilirubin, bilirubin fractionation provides more information concerning which form is primarily responsible for the increase. The most commonly occurring form of unconjugated bilrubinemia is seen in newborns. This is due to the premature breakdown of erythrocytes and ineffective erythropoiesis in the absence of any liver abnormality. In the genetic diseases Crigler Najjar syndrome and Gilbert’s syndrome, bilirubin cannot be conjugated at the normal rate, causing increases in unconjugated bilirubin. Conversely, plasma concentrations of conjugated bilirubin increase to abnormal values when any portion of the biliary tree becomes blocked or abnormally permeable, retarding the passage of bilirubin and all other components of bile.

REFERENCE RANGE
0.0 – 0.2 mg/dL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Bilirubin Total

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
To avoid loss of Bilirubin wrap the specimen in aluminum foil. Submit a spun SST for analysis.

CLINICAL UTILITY
Measurements of the level of bilirubin is used in the diagnosis and treatment of liver, hemolytic, hematologic, and metabolic disorders, including hepatitis and gallbladder obstruction. The assessment of direct biluirubin is helpful in the differentiation of hepatic disorder. The increase in total bilirubin associated with obstructive jaundice is primarily due to the direct (conjugated) fraction. Both direct and indirect bilirubins are increased in the serum with hepatitis. In the newborn patient with hemolytic jaundice and neonatal jaundice, the increase in the total bilirubin is primarily due to the indirect (unconjugated) bilirubin fraction. This jaundice may be caused by Rh, ABO, or other blood group incompatibilities, by hepatic immaturity, or by hereditary defects in bilirubin conjugation.

REFERENCE RANGE
0.3 – 1.0 mg/dL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Urea Nitrogen

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Avoid hemolysis. Avoid repeated freeze-thaw cycles.

CLINICAL UTILITY
Most commonly used and most prevalent in liver disease assessment. ALT = Alanine Aminotransferase. In comparison AST (aspartate amino transferase) is present to the sane extent in heart, skeletal muscle, and liver. AST and ALT increase rapidly during the onset of viral jaundice and remain elevated for 1-2 weeks.I n toxic hepatitis, ALT and AST are elevated, but LD (lactate dehydrogenase) is elevated to an even greater extent as a result of hepatic cell necrosis. ALT and AST serum activities are elevated in myocardial infarction, renal infarction, progressive muscular dystrophy, and numerous diseases that only secondarily affect the liver, such as Gaucher’s Disease, Niemann-Pick disease, infectious mononucleosis, myelocytic leukemia, diabetic ketacidosis, and hyperthyroidism.

REFERENCE RANGE
7.0 – 25.0 mg/dL

CRITICAL RESULT
> 90 mg/dL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
C-Reactive Protein High Sensitivity

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Lipemic, icteric, or hemolyzed samples are not suitable for analysis.

CLINICAL UTILITY
CRP is an acute reactant, which can be used as a general screening aid for inflammatory diseases, infections, and neoplastic diseases. In addition to its usual value as an acute phase reactant, CRP in large concentration (>5.0 mg/L) predicts progression of erosions in rheumatoid arthritis. Elevated serum CRP is characteristic of bacterial, but not viral, meningitis or meningoencephalitis. It may be useful in monitoring the clinical course of these illnesses. CRP concentrations characteristically return to normal after 7 days of appropriate treatment or bacterial meningitis if no complications develop.Serial monitoring of serum and CSF CRP concentrations may be useful clinically.

REFERENCE RANGE
< 1.0 mg/L

SCHEDULE
Monday-Saturday

REPORTED
Same day

COMPONENT
CA 125

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Monitor the course of ovarian cancer, patient response to treatment, and disease recurrence. Serum CA 125 concentrations are elevated in about 80% of women with carcinoma of the ovary, 26% of women with benign ovarian tumors and 66% of women with non-neoplastic conditions, but in only 3% of normal healthy women. CA 125 should not be used alone to diagnose or screen for cancer, but it is useful for monitoring patients with an established diagnosis of a gynecological malignancy that is associated with elevated CA 125 at diagnosis.

REFERENCE RANGE
0.6 – 35.0 U/mL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
CA 15-3

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Elevated serum CA 15-3 concentrations are found in 5% of stage I, 29% of stage II, 32% of stage III, and 95% of stage IV carcinoma of the breast. Most (96%) patients with a CA 15-3 increase of greater than 25% have disease progression. Most (nearly 100%) patients with a CA 15-3 decrease of greater than 50% are responding to treatment.

REFERENCE RANGE
1.0 – 25.0 U/mL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
CA 19-9

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Useful for monitoring gastrointestinal, pancreatic, liver, and colorectal malignancies.

REFERENCE RANGE
0.0 – 35.0 U/mL

SCHEDULE
Sunday-Saturday

REPORTED
Next day

COMPONENT
Calcium (Ionized)

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Use only SST for collection. Centrifuge after clotting. Do not remove stopper or expose to air. Ambient or refrigerated only. Frozen or aliquoted specimens are not acceptable.

CLINICAL UTILITY
Evaluate nonbound calcium, calcium metabolism, physiologically active calcium fraction, hyperparathyroidism, ectopic hyperparathyroidism. Occasionally useful when hypercalcemia coexists with abnormal protein state such as myeloma. Useful in assessing active calcium fraction in hypoproteinemia and acidosis when calcium is low. Used in evaluation of PTH assay results.

REFERENCE RANGE
8.6 – 10.3 mg/dL

CRITICAL RESULT
< 7.0 mg/dL > 13.0 mg/dL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
CEA

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage

COLLECTION NOTES
Use only SST for collection. Centrifuge after clotting. Do not remove stopper or expose to air.

CLINICAL UTILITY
Carcinoembryonic antigen (CEA) monitors the course of adenocarcinoma of the lung, patient response to treatment, and disease recurrence. CEA has broad tumor specificity; CEA elevation is seen in cancers of the colon, rectum, stomach, breast, lung, pancreas, etc.

REFERENCE RANGE
0 – 3.0 ng/mL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

See Metabolic Panel Basic and Comprehensive, #11 and #12

COMPONENT
Chloride

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage

COLLECTION NOTES
Use only SST for collection. Centrifuge after clotting. Do not remove stopper or expose to air.

CLINICAL UTILITY
Serum chloride is the major extracellular anion and counter-balances the major cation, sodium, maintaining electrochemical neutrality of the body fluids. Two thirds of the total anion concentration in extracellular fluids is chloride and it is significantly involved in maintaining proper hydration and osmotic pressure. Movement of chloride ions across the red blood cell membrane is essential for the transport of bicarbonate ions in response to chaning concentrations of carbon dioxide. Chloride measurements aid in the diagnosis and treatment of electrolyte and metabolic disorders such as cystic fibrosis and diabetic acidosis.

REFERENCE RANGE
98.0 – 107.0 mmol/L

CRITICAL VALUE
< 80.0 mmol/L | > 115.0 mmol/L

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
REFERENCE RANGE
Triglycerides M/F: < 150.0 mg/dL Cholesterol, Total M/F: < 200.0 mg/dL HDL-C M: > 35.0 mg/dL F: > 45.0 mg/dL
LDL-C (calc) M/F: 0.0 – 130.0 mg/dL
Cholesterol/HDL-C Ratio M: 0.0 – 4.97 mg/dL F: 0.0 – 4.44 mg/dL
VLDL M/F: 0.0 – 38.0 mg/dL

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Patient should be fasting 10-16 hrs to collection of specimen. State patient’s age and gender on test requisition form.

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
REFERENCE RANGE
Critical Range
WBC M/F: 3.8 – 10.5 10^3/uL< 2.0 10^3/uL | >30.0 10^3/uL
RBC Total Count M: 4.2 – 5.8 10^6/uL< 2.0 10^6/uL | > 8.0 10^6/uL
F: 3.8 – 5.2 10^6/uL< 2.0 10^6/uL | > 8.0 10^6/uL
Hemoglobin M: 3.0 – 17.0 g/dL< 7.1 g/dL | > 21.9 g/dLF: 11.5 – 15.5 g/dL< 7.1 g/dL | > 21.9 g/dL
Hematocrit M: 13.0 – 17.0 g/dL< 7.1 g/dL | > 21.9 g/dLF: 11.5 – 15.5 g/dL< 7.1 g/dL | > 21.9 g/dL
MCV M: 80.0 – 94.0 fl
F: 80.0 – 90.0 fl
MCH M/F: 23.0 – 53.0 pg
MCHC M/F: 32.0 – 36.0 g/dL
RDW M/F: 11.5 – 15.5 %
Platelet Count M/F: 150.0 – 400 10^3uL 800 10^3uL
MPV M/F: 7.4 – 10.4 fl
Segmented Neutrophils % M/F: 40.0 – 75.0 %
Segmented Neutrophils # M/F: 1.80 – 7.40 10^3uL
Lymphocytes % M/F: 13.0 – 44.0 %
Lymphocytes # M/F: 1.0 – 3.0 10^3uL
Monocytes % M/F: 2.0 – 11.0 %
Monocytes # M/F: 0.0 – 0.9 10^3uL
Eosinophils % M/F: 0.0 – 6.0 %
Eosinophils # M/F: 0.0 – 0.5 10^3uL
Basophils % M/F: 0.0 – 2.0 %
Basophils # M/F:0.0 – 0.2 10^3uL
RBC Morphology

SPECIMEN/STABILITY
4 mL Whole Blood EDTA; Lavender Tube
Ambient – 14 Hour(s), Refrigerated – 24 Hour(s)

CLINICAL UTILITY
Evaluate anemia, leukemia, reaction to inflammation and infections, peripheral blood cellular characteristics.

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Cortisol

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage

COLLECTION NOTES
Acetic and boric acid are acceptable additives. Add 12.5 mL of 50% acetic acid or 5 g of boric acid at the start of a 24 hour collection. Measure the total volume, mix the specimen and transfer the aliquot to a clean, leak proof screw cap tube. Record the total volume on specimen container and requisition form.

CLINICAL UTILITY
Asses adrenal function; particularly useful in the diagnosis of Cushing syndrome. Recent data suggest that urinary free cortisol concentrations can be significantly altered in patients taking inhaled corticosteroids.

REFERENCE RANGE
6.7 – 22.6 ug/dL

SCHEDULE
Monday, Wednesday, Friday

REPORTED
Next day

COMPONENT
Creatinine

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Avoid hemolysis. Icteric samples are not acceptable.

CLINICAL UTILITY
Total creatine kinase is made up of the various isoenzyme components (CK-MM, CK-MB, and CK-BB). Increases in any one or more of these three isoenzymes will contribute to an increase in total creatine kinase. If total creatine kinase is elevated, consider running CK Isoenzymes to determine which component is elevated and also Troponin I, to rule out cardiac muscle injury, for clinical relevance of each isoenzymes.

REFERENCE RANGE
0.6 – 1.3 mg/dL

CRITICAL VALUE
> 10.0 mg/dL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Creatine Kinase Total

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Avoid hemolysis. Icteric samples are not acceptable.

CLINICAL UTILITY
Total creatine kinase is made up of the various isoenzyme components (CK-MM, CK-MB, and CK-BB). Increases in any one or more of these three isoenzymes will contribute to an increase in total creatine kinase. If total creatine kinase is elevated, consider running CK Isoenzymes to determine which component is elevated and also Troponin I, to rule out cardiac muscle injury, for clinical relevance of each isoenzymes.

REFERENCE RANGE
30.0 – 223.0 U/L

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Digoxin

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
The test to measure digoxin is ordered at the beginning of drug therapy to ensure correct dosage. Digoxin takes approximately one to two weeks to reach a steady level in the blood and in the target organ, the heart. A test done at that time will reflect more accurately whether a person is receiving the right amount of digoxin.

REFERENCE RANGE
0.8 – 2.0 ng/mL

SCHEDULE
Monday, Wednesday, Friday

REPORTED
Next day

See Phenytoin, Free, #151

COMPONENT
Opiates
Cocaine Metabolites
Benzodiazepines
Cannabinoids
Amphetamines
Barbiturates
Methadone
Phencyclidine

SPECIMEN/STABILITY
1 mL Urine; Sterile Urine Container
Ambient – 7 Day(s), Frozen – 30 Day(s)

CLINICAL UTILITY
Screening for drug use

REFERENCE RANGE
Negative

SCHEDULE
Tuesday, Thursday, Saturday

REPORTED
Same day

COMPONENT
ESR

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Lipemic, icteric, or hemolyzed samples are not suitable for analysis.

CLINICAL UTILITY
ESR is an acute reactant, which can be used as a general screening aid for inflammatory diseases, infections, and neoplastic diseases. In addition to its usual value as an acute phase reactant, ESR in large concentration (>5.0 mg/L) predicts progression of erosions in rheumatoid arthritis. Elevated ESR is characteristic of bacterial, but not viral, meningitis or meningoencephalitis.It may be useful in monitoring the clinical course of these illnesses. ESR concentrations characteristically return to normal after 7 days of appropriate treatment or bacterial meningitis if no complications develop.

REFERENCE RANGE
M: 0.0 – 15.0 mm/Hour
F: 0.0 – 20.0 mm/Hour

SCHEDULE
Monday-Saturday

REPORTED
Same day

COMPONENT
Estradiol

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Assess hypothalamic and pituitary function; assess ovarian failure and follicular maturation. In males, E2 measurements may be helpful in the assessment of unexplained gynecomastia. In females, E2 measurements are frequently utilized to document hypoestrogenism in cases of delayed puberty, primary and secondary amenorrhea, and menopause. Monitor ovulation induction to stimulate follicle development in patients being treated for infertility. Serum estradiol levels are performed to correlate the number and maturity of the stimulated follicles and to avoid over stimulation.

REFERENCE RANGE
M: 7.63 – 42.6 pg/mL
F: 12.5 – 166.0 pg/mL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Ferritin

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Evaluate microcytic anemia, iron storage diseases, iron metabolism disease. Useful for the differential diagnosis of anemia of chronic disease (ACD) versus iron deficiency anemia.

REFERENCE RANGE
M: 23.9 – 336.2 ng/mL
F: 11.0 – 306.8 ng/mL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Folate

SPECIMEN/STABILITY
2 (1) mL Serum Separator Tube
Refrigerated – 48 Hour(s), Frozen – 2 Month(s)

CLINICAL UTILITY
Most useful when ordered with vitamin B12 and red cell folic acid; detect folate deficiency; monitor therapy with folate; evaluate megaloblastic and microcytic anemia. In mild folate and vitamin B12 deficiencies, serum folate and serum vitamin B12 can be normal. Homocysteine and methylmalonic acid are more sensitive indicators of mild deficiencies of these vitamins.

REFERENCE RANGE
> 6.59 ng/mL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Follicle-Stimulating Hormone

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Excessive Follicle-Stimulating Hormone (FSH) in hypogonadism indicated gonadal insufficiency. Pituitary function test, useful to distinguish primary gonadal failure from secondary (hypothalamic/pituitary) causes of menstrual disturbances and amenorrhea. Inadequate corpora lutea are related to low FSH levels. Useful in defining menstrual cycle phases in infertility evaluation of women and testicular dysfunction in men.

REFERENCE RANGE
M: 1.27 – 19.26 mIU/mL
F: 3.85 – 22.51 mIU/mL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Wheat IgE
Peanut IgE
Milk IgE
Shrimp IgE
Egg White IgE
Codfish IgE
Corn IgE
Sesame Seed IgE
Soybean IgE
Clam IgE
Walnut IgE
Scallop IgE

SPECIMEN/STABILITY
1 mL Serum; Serum Separator Tube (red-grey marble)
Refrigerated – 5 Day(s), Frozen – 3 Months(s)

CLINICAL UTILITY
Screening for allergens

REFERENCE RANGE
< 0.35 kUA/l

SCHEDULE
Tuesday, Thursday, Saturday

REPORTED
Same day

COMPONENT
Fructosamine

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Avoid Hemolysis

CLINICAL UTILITY
Because the Half-life of serum proteins (average 17 days) is shorter than that of hemoglobin (average 60 days), fructosamine measurements offer the advantage of monitoring glucose status over a shorter time frame (1-3 weeks) than glycated hemoglobin (6-8 weeks).Serum fructosamine has been shown to be more sensitive than glycated hemoglobin in detecting deterioration in diabetic control after discontinuing oral hypoglycemic drugs. The fructosamine assay may be run every 2-3 weeks to monitor short-term changed in diabetic control. In addition, the fructosamine concentration determined on a single random sample provides a simple and reliable assessment of glucose homeostasis.

REFERENCE RANGE
205.0 – 285.0 umol/L

SCHEDULE
Sunday-Saturday

REPORTED
Same day

See Follicle-Stimulating Hormone #139

COMPONENT
GGT

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Avoid hemolysis.Avoid repeated freeze-thaw cycles.

CLINICAL UTILITY
GGT is useful in the evaluation of obstructive liver diseases, being more organ specific than Alkaline Phosphatase (ALP). GGT is also elevated in chronic alcoholics, when other tests are normal. Disproportionate elevation of ALP and GGT indicates drug induced cholestasis. GGT is also increased during antiepileptic therapy.

REFERENCE RANGE
9.0 – 64.0 U/L

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Creatinine
Glomerular Filtration Rate(calculation)

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Glomerular Filtration Rate (GFR) is the index of kidney function.

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Glucose

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Serum glucose levels may be abnormally high (hyperglycemia) or abnormally low (hypoglycemia). Glucose measurements are used in the diagnosis and treatment of pancreatic islet cell carcinoma and of carbohydrate metabolism disorders such as diabetes mellitus, neonatal hypoglycemia and idiopathic hypoglycemia.

REFERENCE RANGE
55.0 – 100.0 mg/dL

CRITICAL VALUE
< 51.0 mg/dL | > 449.0 mg/dL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

See Hepatitis B Virus Antibodies; Antigens

See Hepatitis C Virus for antibody, antigen.

See C-Reactive Protein High Sensitivity, #1536.

COMPONENT
Hemoglobin A1c

SPECIMEN/STABILITY
0.5 mL Whole Blood EDTA; Lavender
Refrigerated – 7 Day(s)

CLINICAL UTILITY
Monitoring the long term blood glucose control in diabetic patients.

REFERENCE RANGE
> 5.7%

SCHEDULE
Monday-Saturday

REPORTED
Same day

COMPONENT
Albumin
Bilirubin Total
Bilirubin Direct
Alkaline Phosphatase
Aspartate Transaminase (AST)
Alanine Transaminase (ALT)
Total Protein

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Sample must be protected from light in foil-wrap or amber tube. 1 mL serum separated within 1 hr of collection; avoid hemolysis.

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Hepatitis A Virus Antibodies

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Evaluate hepatitis A

REFERENCE RANGE
Nonreactive

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Hepatitis A Virus Antibodies
Hepatitis B Virus Core Total Antibodies
Hepatitis B Virus Surface Antibodies
Hepatitis B Virus Surface Antigen
Hepatitis C Virus Total

SPECIMEN/STABILITY
1.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
**All positive HBsAG results are confirmed by neutralization and can require up to 2 mL of additional specimen. Sample requirement must be met to prevent a QNS (Quantity Not Sufficient) result.

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Hepatitis B Virus Core Total Antibodies

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Used in the differential diagnosis of hepatitis B infection in conjunction with other serologic markers.

REFERENCE RANGE
Nonreactive

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Hepatitis B Virus Surface Antigens

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
**All positive HBsAG results are confirmed by neutralization and can require up to 2 mL of additional specimen. Sample requirement must be met to prevent a QNS (Quantity Not Sufficient) result.

CLINICAL UTILITY
Hepatitis B surface antigen is the earliest indicator of the presence of acute infection. Also indicative of chronic infection.

REFERENCE RANGE
Nonreactive

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Hepatitis B Virus Surface Antibodies

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Presence of hepatitis B surface antibody is an indicator of clinical recovery and subsequent immunity to hepatitis B virus. This test is useful for evaluation of possible immunity in individuals who are at increased risks for exposure to the hepatitis B, i.e, hemodialysis unit personnel, venipuncturists, etc. Evaluation of the need for hepatitis B immune globulin after needle stick injury. Evaluation of the need for hepatitis B vaccine, and to follow immune status after hepatitis B vaccine.

REFERENCE RANGE
< 8.5 mIU/mL

SCHEDULE
Sunday-Saturday

REPORTED
Next day

COMPONENT
Hepatitis C Virus Antibodies

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Confirmatory testing by RIBA is only recommended when the MEIA screen is ‘weekly positive’ (i.e. S/CO <10.0). RIBA results are reported as positive, indeterminate or negative in this assay. Patients with positive HCV antibodies by MEIA should be evaluated with a sensitive qualitative nucleic acid test for HCV RNA (Hepatitis C Virus RNA DetectR) to rule out active infection.

REFERENCE RANGE
Nonreactive

SCHEDULE
Tuesday-Saturday

REPORTED
Same day

See Hemoglobin A1c, #119

COMPONENT
Homocysteine

SPECIMEN/STABILITY
2 (1) mL Serum Separator Tube
Ambient – 48 Hour(s), Refrigerated – 14 Day(s), Frozen – 2 Month(s)

COLLECTION NOTES
Patient should be fasting for 12 hours overnight, prior to collection. Specimen (plasma or serum) must be centrifuged within one hour of collection. Longer storage of whole blood samples at room temperature has been found to increase Homocysteine concentration in the plasma. Serum values are expected to be higher than plasma values.Slightly higher Homocysteine values are observed in non-fasting patients.

CLINICAL UTILITY
Evaluate homocystinuria. Predictor of risk for ischemic stroke and myocardial infarction. Homocysteine is elevated in patients with cobalamin and/or folate deficiency, and is more sensitive than serum cobalamin and serum folate concentrations in diagnosing these vitamin deficiencies.

REFERENCE RANGE
4.0 – 15.4 umol/L

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
IgA Total

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Evaluate humoral immunity; monitor therapy in IgA myeloma.Selective IgA deficiency has an increased association with allergies, recurrent sinopulmonary infection, autoimmune disease, and the HLA A28, B14 or A1, B14 types. IgA deficiency accompanied by a deficiency of subclass IgG2 is associated with recurrent sinopulmonary infections.

REFERENCE RANGE
66.0 – 433.0 mg/dL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
IgE

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Immunoglobulin E (IgE) is firmly bound to mast cells and only trace amounts are normally present in serum. When antigen (allergen) cross-links two IgE molecules, the mast cell is stimulated to release histamine and other vasoactive amines.These vasoactive amines are responsible for the vascular permeability and smooth muscle contraction occurring in such allergic reactions as hay fever, asthma, urticaria, and eczema.

REFERENCE RANGE
1.31 – 165.3 IU/mL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
IgG Total

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Evaluate humoral immunity; monitor therapy in IgG myeloma; quantitate IgG; evaluate patients, especially children and those with lymphoma, with propensity to infections. In congenital hypogammaglobulinemia, the IgG is less than 200 mg/dL by 6 months of age. Acquired hypogammaglobulinemia may occur at any age and has IgG concentrations less than 500 mg/dL.IgG concentrations may also be decreased in combines cell-mediated and antibody immunodeficiencies.

REFERENCE RANGE
635.0 – 1741.0 mg/dL

SCHEDULE
Monday-Saturday

REPORTED
Same day

COMPONENT
IgM Total

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Evaluate humoral immunity; establish the diagnosis and monitor therapy in macroglobulinemia of Waldernstrom or plasma cell myeloma. IgM levels are used to evaluate likelihood of in utero infections or acuteness of infection.

REFERENCE RANGE
45.0 – 281.0 mg/dL

SCHEDULE
Monday-Saturday

REPORTED
Same day

COMPONENT
IgG Total
IgM Total
IgA Total

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Selective IgA deficiency characterized by IgA less than 5 mg/dL with other immunoglobulins normal or increased, is associated with allergies, recurrent sinopulmonary infection, autoimmune disease and HLA A28, B14 or A1.

SCHEDULE
Monday-Saturday

REPORTED
Same day

COMPONENT
Iron

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Avoid hemolysis. Separate serum/plasma from the clot within 1 hour after collection. Morning specimen preferred.

CLINICAL UTILITY
Aid in the evaluation of a number of conditions involving red cell production and destruction, iron metabolism, or iron transport.

REFERENCE RANGE
50.0 – 212.0 ug/dL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Iron
Iron Binding Capacity Total
% Saturation

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Avoid hemolysis. Separate serum/plasma from the clot within 1 hour after collection. Morning specimen preferred.

CLINICAL UTILITY
Increased total iron binding capacity is often seen in iron deficiency states, parental iron administration, pregnancy without iron supplements, and hepatitis or hepatic necrosis. Decreased concentrations are often seen in chronic disorders, kwashiorkor, chronic iron overloading, and malignancies.

REFERENCE RANGE
250.0 – 410.0 ug/dL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Iron
Iron Binding Capacity Total

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Avoid hemolysis. Separate serum/plasma from the clot within 1 hour after collection. Morning specimen preferred.

CLINICAL UTILITY
Increased total iron binding capacity is often seen in iron deficiency states, parental iron administration, pregnancy without iron supplements, and hepatitis or hepatic necrosis. Decreased concentrations are often seen in chronic disorders, kwashiorkor, chronic iron overloading, and malignancies.

REFERENCE RANGE
M: 20.0 – 50.0 %
F: 20.0 – 55.0 %

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Lactate Dehydrogenase

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Avoid hemolysis.

CLINICAL UTILITY
Assessment of myocardial infarction, liver disease, pernicious and megaloblastic anemia, pulmonary embolus, malignancy, and muscular dystrophy.

REFERENCE RANGE
140.0 – 271.0 U/L

SCHEDULE
Sunday-Saturday

REPORTED
Same day

See Lactate Dehydrogenase

COMPONENT
LDL Direct

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Use only SST for collection. Centrifuge after clotting. Do not remove stopper or expose to air. Ambient or refrigerated only. Frozen or aliquoted specimens are not acceptable. Avoid hemolysis.

CLINICAL UTILITY
LDL cholesterol is a key factor in the pathogenesis of atherosclerosis and coronary artery diseases (CAD), while HDL cholesterol has often been observed to have a protective effect. Even within the normal range of total cholesterol concentrations, an increase in LDL cholesterol can produce an associated increased risk for CAD. LDL cholesterol binds to receptor sites on macrophages in blood vessel walls, inciting several changes to the blood vessel wall, which enhance atherosclerotic plaque development.

REFERENCE RANGE
0.0 – 100.0 mg/dL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Lipase

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Refrigerated – Several Weeks
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Grossly icteric specimens will be rejected.

REFERENCE RANGE
11.0 – 82.0 U/L

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Lithium

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Do not use serum separator tubes. Serum from red top tube without serum separator is acceptable. Do not use Lithium Heparin anticoagulant. The concentration of lithium in the serum varies with the time after the dose, therefore, blood for lithium determination (through values) should be collected at a standard time, preferably 8 – 12 hours after the last dose.

REFERENCE RANGE
0.6 – 1.2 mmol/L

CRITICAL VALUE
> 2.0 mmol/L

SCHEDULE
Sunday-Saturday

REPORTED

COMPONENT
Lyme IgG EIA
Lyme IgM EIA

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Refrigerated – 7 Day(s), Frozen – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Whole-cell sonicate (WCS) Borrelia burgdorferi antigens are utilized to measure both IgM and IgG antibody responses to B. burgdorferi in human serum, using an enzyme-immunoassay methodology (EIA).

CLINICAL UTILITY
Aid in the diagnosis of infection with the Lyme disease agent.

REFERENCE RANGE
< 0.8

SCHEDULE
Monday, Wednesday, Friday

REPORTED
Same day

COMPONENT
Magnesium

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Use fresh, nonhemolyzed fasting serum collected by standard venipuncture technique. Separate serum from the clot immediately to avoid false elevations due to elution of magnesium from the red cells. Hemolyzed specimens are unacceptable. Draw blood using a “clean stick” technique to avoid falsely increased values due to the admixture of blood with tissue fluid.

CLINICAL UTILITY
Magnesium is a cofactor for more than 300 enzymes in the body. It is an activator of many enzyme systems, is important in oxidation phosphorylation, glycolysis, cell replication, nucleotide metabolism, and protein biosynthesis. Reducing serum magnesium levels results in increased neuromuscular excitable because magnesium inhibits the entry of calcium into neurons.

REFERENCE RANGE
1.9 – 2.7 mg/dL

CRITICAL VALUE
< 0.8 mg/dL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Measles IgG Antibodies

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
The Presence of measles specific-IgM or –IgG antibodies would suggest previous immunization or exposure to the measles virus. In non-immunized individuals, the detection of measles specific-IgM antibodies would suggest an acute infection or when paired acute and convalescent specimens (two to three weeks apart) are evaluated with a 4-fold or greater rise in measles specific-IgG antibodies, an acute infection is suggested. An acute infection should be corroborated with clinical presentation. Please note that results from a single IgM assay should not be used as the sole determinate of an acute infection, as IgM test results may yield positive results and low levels of IgM antibody can persist for more than 12 months post infection. If an acute infection is indicated, submit an additional specimen in two or more weeks for IgM and IgG testing.

REFERENCE RANGE
< 0.9

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Sodium
Potassium
Chloride
Bicarbonate
Glucose
Urea Nitrogen
Creatinine
BUN/Creatinine Ratio
Calcium (Total)

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
To avoid loss of bicarbonate, do NOT aliquot the specimen. Submit a spun SST for analysis. The patient should fast 10 – 16 hours prior to collection of specimen. State patient’s age and gender on test requisition form. Avoid hemolysis and gross lipemia.

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Sodium
Potassium
Chloride
Bicarbonate
Glucose
Urea Nitrogen
Creatinine
Calcium (Total)
Total Protein
Albumin
Alkaline Phosphatase
Aspartate Transaminase (AST)
Alanine Transaminase (ALT)
Bilirubin Total
BUN/Creatinine Ratio
Globulin Total
A/G Ratio

SPECIMEN/STABILITY
1 mL Serum Separator Tube
Ambient – 24 Hour(s), Refrigerated – 72 Hour(s), Frozen – 2 Month(s)

COLLECTION NOTES
Sample must be protected from light in foil-wrap or amber tube. To avoid loss of bicarbonate do NOT aliquot the specimen. Submit a spun SST for analysis. The patient should fast 10 – 16 hours prior to collection of specimen. State patient’s age and gender on test requisition form.

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Microalbumin Urine

SPECIMEN/STABILITY
1 mL Urine; Sterilized Urine Container/Tube
Ambient – 5 Day(s), Refrigerated – 14 Day(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
After voided midstream urine collection is complete, mix the specimen and transfer a 10 mL aliquot of urine to a clean leakproof container with a screw cap. Transfer tubes are available from Enigma. Refrigerated specimen is preferred (store at 2-8 C). Ship within 24 hours of collection by overnight courier.

CLINICAL UTILITY
Microalbuminuria is used as an indicator of increased risk to develop renal disease in diabetics and as a predictor of morality due to cardiovascular disease.

REFERENCE RANGE
< 20.0 mg/L SCHEDULE Monday-Saturday REPORTED Same day

COMPONENT Measles IgG Antibodies Mumps IgG Antibodies Rubella IgG Antibodies SPECIMEN/STABILITY 0.5 mL Serum; Serum Separator Tube (red-grey marble) Ambient – 7 Day(s), Refrigerated – 1 Month(s) Note: Specimen will be discarded after 14 days of storage. SCHEDULE Sunday-Saturday REPORTED Same day

COMPONENT Mumps IgG Antibodies SPECIMEN/STABILITY 0.5 mL Serum; Serum Separator Tube (red-grey marble) Ambient – 7 Day(s), Refrigerated – 1 Month(s) Note: Specimen will be discarded after 14 days of storage. CLINICAL UTILITY The presence of mumps specific-IgG antibodies would suggest previous immunization or exposure to the mumps virus. In non-immunized individuals, when paired acute and convalescent specimens (two to three weeks apart) are evaluated with a 4-fold or greater rise in mumps specific-IgG antibodies, an acute infection is suggested and should be corroborated with clinical presentation. REFERENCE RANGE > 10.0 IU/mL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Parathyroid Hormone, Intact

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
PTH-Intact measures only the biological active hormone and provides a more precise assessment of parathyroid function in patients with renal disease and those with age-related diseases of glomerular filtration. Intact PTH contains 84 amino acids with biological activity residing in the N-terminal third of the molecule. Therefore, synthetic PTH containing the first 34 amino acids has full biological activity. An inverse relationship exists between PTH secretion and free calcium, since free calcium, since free calcium in blood and intracellular fluid is the primary physiological regulator of PTH secretion. PTH influences both calcium in blood and phosphate homeostasis through actions on bone, kidney, and (indirectly) on 1,25 hydroxyvitamin D, which stimulates the intestinal absorption of both calcium and phosphate. Generally less than 5 to 25% of total immunoreactive PTH is intact hormone. The remaining 75 to 95% is inactive midregion/carboxyl fragments. In hypercalcemia, secretion of these inactive forms persist. While secretion of intact hormone is greatly reduced or absent.

REFERENCE RANGE
15.0 – 65.0 pg/mL

SCHEDULE
Sunday, Tuesday, Saturday

REPORTED
Same day

COMPONENT
Phenytoin Free

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Elimination half-life of Phenytoin is 7-42 hours, and steady-state levels are reached at 7-10 days after initiation of therapy.

REFERENCE RANGE
10.0 – 20.0 ug/mL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Phosphorus

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Use only SST for collection. Centrifuge after clotting. Do not remove stopper or expose to air. Ambient or refrigerated only. Frozen or aliquoted specimens are not acceptable.

CLINICAL UTILITY
Evaluate nonbound calcium, calcium metabolism, physiologically active calcium fraction, hyperparathyroidism, ectopic hyperparathyroidism. Occasionally useful when hypocalcaemia coexists with abnormal protein state such as myeloma. Useful in assessing active calcium fraction in hypoproteinemia and acidosis when calcium is low. Used in evaluation of PTH assay results.

REFERENCE RANGE
2.5 – 5.0 mg/dL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Potassium

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Do not allow serum/plasma to remain on the cells after centrifugation. Potassium from the red cells will diffuse into the serum, giving falsely elevated results. Gross lipemic specimens should be cleared by ultracentrifugation.

CLINICAL UTILITY
Potassium is the major intracellular cation. The concentration in erythrocytes is approximately 23 times the concentration in plasma. Decrease of extracellular potassium is characterized by muscle weakness, irritability, and paralysis; fast heart rates and specific conduction effects are apparent on electrocardiographic examination. Plasma potassium levels less than 3.0 mmol/L are associated with marked neuromuscular symptoms and evidence of a critical degree of intracellular depletion. Abnormally high extracellular potassium levels produce symptoms of mental confusion, weakness, numbness, and tingling of the extremities. The symptoms are apparently at potassium levels greater than 7.5 mmol/L; levels greater than 10.0 mmol/L are in most cases fatal.

REFERENCE RANGE
3.5 – 5.1 mmol/L

CRITICAL VALUE
< 3.0 mmol/L | > 5.9 mmol/L

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Prolactin

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Collect 3-4 hours after patient has awakened

CLINICAL UTILITY
First test for work-up of galactorrhea (inappropriate lactation). Pituitary function test useful in the detection of Prolactin secreting pituitary tumors (microadenomas, macroadenomas) with or without galactorrhea, with or without structural evidence of sellar enlargement. An adult female premenopausal patient having amenorrhea and galactorrhea is highly suspect of pituitary prolactinoma and is a candidate for radiologic evaluation of the pituitary as well as serum prolactin levels. Elevated Prolactin may be associated with corpus luteum insufficiency or anovulation. Sequelae of hyperprolactinemia include amenorrhea, anovulation, and decreased bone density. Prolactin greater than 200 ng/mL in a non-pregnant woman is suggestive of a pituitary microadenoma; milder degrees of hyperprolactinemia (20-200 ng/mL) suggest compression of the pituitary stalk by a macroadenoma.

REFERENCE RANGE
M: 2.64 – 13.13 ng/mL
F: 3.34 – 26.72 ng/mL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
REFERENCE RANGE
Protein Total 6.40 – 8.30 g/dL
Albumin 3.70 – 4.70 g/dL
Alpha 0.20 – 0.40 g/dL
Alpha 0.60 – 1.00 g/dL
Beta 0.60 – 1.00 g/dL
Gamma 0.60 – 1.40 g/dL
A/G Ratio 1.00 – 2.50 ratio
Protein Electrophoresis Interpretation

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Plasma and hemolyzed serum are not suitable for analysis. Split into 2 plastic tubes.

CLINICAL UTILITY
Evaluate serum protein, nutritional status; work up liver disease, including chronic active hepatitis; useful in the evaluation of myeloma, macroglobulinemia of Waldenstrom,, collagen diseases, and monoclonal gammopathies; evaluate inflammatory states; evaluate low back pain, arthritis,amyloidosis; evaluate lymphoma, leukemia, anemia.

SCHEDULE
Tuesday-Saturday

REPORTED
Same day

COMPONENT
Prothrombin Time
International Normalized Ratio

SPECIMEN/STABILITY
3 mL Plasma Citrated Blue Tube
Room Temp.- 4 Hrs
Refrigerated -16 Hrs

COLLECTION NOTES
Draw blood into a buffered citrate collection tube (light blue top) filled to proper level. Do not overfill. The blood-to-coagulant ratio should be 9:1; inadequate filling of the collection device will decrease this ratio and may lead to inaccurate results. Invert gently 6 times to mix. Refrigerate immediately.

CLINICAL UTILITY
This test measures the integrity of extrinsic and common pathway.

REFERENCE RANGE
10.2 – 12.0 seconds

CRITICAL VALUE
> 35.0 seconds

SCHEDULE
Monday-Saturday

REPORTED
Same day

COMPONENT
Prostate Specific Antigen

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
PSA is elevated in about 30% of all cases with nodular prostatic enlargement. If all malignant tissue is removed at the time of radical prostatectomy, PSA should decline to undetectable levels within 3 weeks of the operation. Recurrence should then be checked quarterly in the first year and then at intervals of 4-6 months in succeeding years.

REFERENCE RANGE
0.0 – 4.0 ng/mL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

See Parathyroid Hormone

COMPONENT
Rapid Plasma Reagin

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Because RPR is a non-treponemal test, it is useful for screening, monitoring treatment and detecting reinfection.

REFERENCE RANGE
Nonreactive

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Rheumatoid Factor

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Rheumatoid factor is essentially an IgM antibody that is directed toward IgG. Although it is a non-specific marker, it is associated with autoimmunity and rheumatoid arthritis. IgG antibodies may be altered to be recognized as “foreign,” resulting in an autoimmunity.

REFERENCE RANGE
< 14.0 IU/mL

SCHEDULE
Monday-Saturday

REPORTED
Same day

COMPONENT
Rubella IgG Antibodies

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Presence of Rubella IgG antibodies indicates current or past infection or vaccination. Acute infections can be serologically confirmed by a significant (2 to 4-fold) rise in Rubella IgG antibody titer in acute and convalescent (collected >7 days after acute specimen) samples, or by the presence of Rubella IgM antibodies.

REFERENCE RANGE
< 9.0 IU/mL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Sodium

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Sodium measurements aid in the diagnosis and treatment of aldosteronism, diabetes insipidus, adrenal hypertension, Addison’s disease, dehydration, inappropriate antidiuretic hormone secretion, or other diseases involving electrolyte imbalance.

REFERENCE RANGE
136.0 – 145.0 mmol/L

CRITICAL VALUE
< 125.0 mmol/L | > 155.0 mmol/L

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Testosterone

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Refrigerated – 7 Day(s), Frozen – 6 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Reliable indicator of LH secretion and Leydig cell function; evaluate gonadal and adrenal function; helpful in the diagnosis of hyprogonadism in males and hirsutism and virilization in females. Total testosterone includes free testosterone, weakly bound testosterone (bound to albumin), and tightly bound testosterone (bound to SHBG or sex hormone binding globulin).

REFERENCE RANGE
M: 175 – 781 ng/dL
F: 10 – 75 ng/dL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
T3
Free T4
TSH

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Free thyroxine (Free T4) is used to evaluate thyroid function independent of binding protein status. T4 and T3 circulate in the blood as equilibrium mixtures of free and protein-bound hormones. Changes in concentration or affinity of TBG or other transport proteins profoundly affect the total hormone concentration in serum. The free hormone is independent of these binding protein variations and remains almost constant.

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
TSH

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Differential diagnosis of primary hypothyroidism and hyperthyroidism from normal; differential diagnosis of primary hypothyroidism from secondary and tertiary hypothyroidism; thyroid function test (TSH is high in primary hypothyroidism, low in hyperthyroidism); evaluate hypothyroid patients receiving replacement doses of various thyroid hormone preparations; detect hypopituitarism; follow up on low T4 newborn screen results.

REFERENCE RANGE
0.34 – 5.60 uUI/mL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Thyroxine, (T4) Free

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Free Thyroxine (Free T4) is used to evaluate thyroid function independent of binding protein status. T4 and T3 circulate in the blood as equilibrium mixtures of free and protein-bound hormones. Changes in concentration or affinity of TBG or other transport proteins profoundly affect the total hormone concentration in serum. The free hormone is independent of these binding protein variations and remains almost constant.

REFERENCE RANGE
0.61 – 1.12 ng/dL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Total Protein

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
The total serum protein level is the sum of all circulating proteins that are major components of blood. Serum total protein measurements are adjunct in the diagnosis and follow-up of a variety of diseases involving the liver, kidney, or bone marrow as well as other metabolic or nutritional disorders. The measurement of total protein in peritoneal and pleural fluid may be useful in differentiating between transudates and exudates. An elevated total protein level in synovial fluid confirms the presence of an inflammatory process.

REFERENCE RANGE
6.0 – 8.3 g/dL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Transferrin

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Differential diagnosis of anemia; monitor its effectiveness of treatment for anemia.

REFERENCE RANGE
203.0 – 362.0 mg/dL

SCHEDULE
Monday-Saturday

REPORTED
Same day

COMPONENT
Triglycerides

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Patient should be fasting 12 – 16 hours prior to collection of specimen. Avoid hemolysis.

CLINICAL UTILITY
In human nutrition, triglycerides are the most prevalent glycerol esters (fatty acid derivatives covalently linked to glycerol). They constitute 95% of tissue storage fat. After digestion, triglycerides are resynthesized in the epithelial cells and combines with cholesterol and apolipoproteins to form chylomicrons. A single cholesterol and triglyceride value more than 20% below the suggested age and sex-adjusted upper reference limits virtually eliminates a diagnosis of hyperlipoproteinemia in lipoprotein disorders. Increased triglyceride levels contribute to overall obesity and increase both atherosclerosis and risk for myocardial infarction due to arterial deposition of plaque.

REFERENCE RANGE
< 150 mg/dL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Triiodothyronine (T3)

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Thyroid function test, particularly useful in the diagnosis of T3 thyrotoxicosis and confirmation of hyperthyroidism. Needed in patients with clinical evidence of hyperthyroidism, in whom thyroid profile is normal or borderline.

REFERENCE RANGE
0.87 – 1.78 ng/dL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

See (Thyroid-Stimulating Hormone)

COMPONENT
Uric Acid

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Avoid hemolysis. Avoid repeated freeze-thaw cycles

REFERENCE RANGE
M: 4.4 – 7.6 mg/dL
F: 2.3 – 6.6 mg/dL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
REFERENCE RANGE
Color yellow
Clarity clear
Glucose neg
Bilirubin neg
Ketones neg
Specific Gravity 1.003 – 1.029
Blood neg
PH 5.0 – 8.0
Protein neg
Urobilinogen 0.0 – 1.0 mg/dL
Nitrogen neg
Leokocytes neg Leu/uL

SPECIMEN/STABILITY
20-50 mL Urine Container or Tube
Refrigerated – 72 hour(s),

COLLECTION NOTES
Collect a freshly voided random urine sample and pour approximately 20-50mL into a properly labeled urine container or tube. Label should have patient name and requisition ID number.

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Valproic Acid

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Serum separator tubes are not acceptable; use polypropylene tubes and ship on cold pack by overnight courier. Collect at trough concentration, i.e. within 30 minutes of next dose.

REFERENCE RANGE
50.0 – 100.0 ug/mL

CRITICAL VALUE
> 150.0 ug/mL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Folate
Vitamin B12

SPECIMEN/STABILITY
1 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
In mild folate and vitamin B12 deficiencies, serum folate and serum vitamin B12 can be normal. Homocysteine and methylmalonic acid are more sensitive indicators of mild deficiencies of these vitamins.

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Vitamin B12

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

CLINICAL UTILITY
Useful in detection of B12 deficiency as in pernicious anemia; diagnosis folic acid deficiency; evaluate hypersegmentation of granulocyte nuclei; follow up MCV > 100; diagnosis microcytic anemia; diagnosis megaloblastic anemia; evaluate alcoholism, prenatal care; evaluate malabsorption, neurological disorders, or the elevation of B12 as seen in liver cell damage or myeloid leukemia. In mild folate and vitamin B12 deficiencies, serum folate and serum vitamin B12 can be normal. Homocysteine and methylmalonic acid are more sensitive indicators of mild deficiencies of these vitamins.

REFERENCE RANGE
180.0 – 914.0 pg/mL

SCHEDULE
Sunday-Saturday

REPORTED
Same day

COMPONENT
Vitamin D (25-hydroxy)

SPECIMEN/STABILITY
0.5 mL Serum; Serum Separator Tube (red-grey marble)
Ambient – 7 Day(s), Refrigerated – 1 Month(s)
Note: Specimen will be discarded after 14 days of storage.

COLLECTION NOTES
Refrigerated 48hr; otherwise freeze serum.

CLINICAL UTILITY
Rule out vitamin D deficiency as cause of bone disease; differential diagnosis of hypercalcemia.

REFERENCE RANGE
30.0 – 100.0 ng/mL

SCHEDULE
Tuesday and Thursday

REPORTED
Same day