Acetylcholine Receptor Binding Antibody

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Moris Campbell
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1 Acetylcholine Receptor Binding Antibody Order Name: ACETY BND Test Number: REV DATE:9/17/2008 Acetylcholine Receptor Binding Antibody RIA Preferred 1 ml (0.5) Serum Clot Activator (Red Top, No-Gel) Refrigerated Alternate 1 ml (0.5) Serum Clot Activator SST (Red/Gray or Tiger Top) Refrigerated Special SST Clot tubes acceptable, however it is best if collected in non-gel clot tubes. Specimen stability: Room Instructions: temperature: 2 hours; Refrigerated: 1 weeks; Frozen: 1 month. Testing Schedule: Sun-Sat Expected TAT: 4-5 Days Clinical Use: Used to aid in the differential diagnosis of myasthenia gravis-like muscle weakness, in differentiating between generalized MG and ocular MG, and in monitoring therapeutic response. Cpt Code(s): 83519

2 Acetylcholine Receptor Blocking Antibody Order Name: ACETY BLK Test Number: REV DATE:9/17/2008 Acetylcholine Receptor Blocking Antibody RIA Preferred 1 ml (0.5) Serum Clot Activator (Red Top, No-Gel) Refrigerated Alternate 1 ml (0.5) Serum Clot Activator SST (Red/Gray or Tiger Top) Refrigerated Special SST Clot tubes acceptable, however it is best if collected in non-gel clot tubes. Specimen stability: Room Instructions: temperature: 2 hours; Refrigerated: 1 weeks; Frozen: 1 month. Testing Schedule: Sun-Sat Expected TAT: 4-5 Days Clinical Use: Blocking antibodies are detected in approximately 50% of generalized myasthenia gravis patients and are detectable in the absence of binding antibodies in approximately 1% of myasthenia gravis patients. Cpt Code(s): 83519

3 Acetylcholine Receptor Modulating Antibody Order Name: ACETY MOD Test Number: REV DATE:9/17/2008 Acetylcholine Receptor Modulating Antibody RIA Preferred 1 ml (0.5) Serum Clot Activator (Red Top, No-Gel) Refrigerated Alternate 1 ml (0.5) Serum Clot Activator SST (Red/Gray or Tiger Top) Refrigerated Special SST Clot tubes acceptable, however it is best if collected in non-gel clot tubes. Specimen stability: Room Instructions: temperature: 2 hours; Refrigerated: 1 weeks; Frozen: 1 month. Testing Schedule: Sun-Sat Expected TAT: 4-5 Days Clinical Use: Confirming the diagnosis of myasthenia gravis. Modulating autoantibodies to AChR cause weakness by inhibiting or modulating binding to the receptors. Cpt Code(s): 83519

4 Actin (F-Actin) Smooth Muscle Antibody Order Name: ACTIN AB Test Number: REV DATE:9/30/2008 Actin (F-Actin) Smooth Muscle Antibody ELISA Preferred 1 ml (0.1) Serum Clot Activator SST (Red/Gray or Tiger Top) Refrigerated Special Specimen Stability: Room temperature: 8Hrs, Refrigerated: 2wks, Frozen: 1mo. Instructions: Testing Schedule: Tue-Sat Expected TAT: 3-4 Days Clinical Use: Actin is the major antigen to which smooth muscle antibodies react in autoimmune hepatitis. F-Actin IgG antibodies are found in 52-85% of patients with autoimmune hepatitis (AIH) or chronic active hepatitis and in 22% of patients with primary bilary cirrhosis (PBC). Anti-actin antibodies have been reported in 3-18% of sera from normal healthy controls. Notes: This is an ELISA based assay to purified F-actin. IgG antibodies to F-actin are present in approximately 75% of patients with AIH type 1, approximately 65% of patients with autoimmune cholangitis, approximately 30% of patients with primary biliary cirrhosis (PBS), and approximately 2% of healthy controls. High values are closely correlated with AIH type 1. Cpt Code(s): 83516

5 Activated Protein C Resistance (APCR) Order Name: PROT C RES Test Number: REV DATE:9/9/2008 Activated Protein C Resistance (APCR) CLOT Preferred 2.7 ml Whole Blood Sodium Citrate 3.2% (Blue Top) Ambient whole blood or frozen aliquots Alternate 2.7 ml Double Spun Sterile, Capped Plastic Tube Ambient whole blood Plasma or frozen aliquots Special Please indicate anticoagulant therapy. Tubes must be filled to the proper level, no hemolysis. Improperly Instructions: filled tubes can give erroneous results. Whole blood must be transported to lab immediately. If sending citrated plasma aliquots, they must be double spun then aliquot 1. 5 ml plasma from each tube into individual plastic aliquot tubes and freeze. Do not pool aliquots together! Testing Schedule: Tues, Thurs Expected TAT: 3-5 Days Clinical Use: For the dermination of resistance to activated Protein C, caused by the Factor V (5) Leiden mutation. Cpt Code(s): 85307

6 BCR/ABL Gene Rearrangement, Quantitative PCR (t9,22)(philadelphia Chromosome) Test Number: Order Name: BCR GENE REV DATE:9/3/2008 BCR-ABL t(9;22) fusion ratio BCR-ABL:ABL Log Reduction ratio PCR PCR Preferred 2 ml (1.5) Whole Blood EDTA (Lavender Top) Room Temperature Special Keep as whole blood at room temperature, do not freeze. Instructions: Testing Schedule: Mon-Sat Expected TAT: 5 Days Clinical Use: The bcr/abl rearrangement is detected in 90 to 95% of CML, some acute lymphocytic leukemia (ALL), and, rarely, in acute myelogenous leukemia (AML). Diagnose chronic myelogenous leukemia (CML) in the presence or absence of Philadelphia chromosome. Determine prognosis & relapse. Also used to identify acute lymphocytic leukemia (ALL) patients who have a Philadelphia chromosome. Notes: The bcr/abl gene rearrangement is observed in CML, ALL, and AML. A negative result indicates fewer than 1 leukemic cell per 10,000 normal cells. This test detects only the bcr/abl translocation. It will not detect other translocations that may appear in the terminal phase of CML. Cpt Code(s): 83891; 83902x2; 83900; 83896x3; 83912

7 C1q Complement Component Order Name: C1Q QN Test Number: REV DATE:9/9/2008 C1q Complement Component RIA Preferred 1mL (0.1) Serum Clot Activator SST (Red/Gray or Tiger Top) Frozen Alternate 1mL (0.1) Plasma EDTA (Lavender Top) Frozen Special Best if specimen is kept refrigerated until frozen. Stability: Ambient 2 days; Refrigerated 2 weeks; Frozen 1 Instructions: month. Testing Schedule: Tues, Thur Expected TAT: 3-6 Days Clinical Use: The complement system is critical to the inflammatory response. C1q concentrations may be decreased in patients with acquired angioedema, immune complexed induced vasculitis, and concurrent low concentrations of C1 inhibitor, carcinoma, or lymphoma. Low levels of C1q indicate either increased consumption (catabolism) or decreased synthesis. Cpt Code(s): 86160

8 Cortisol, Free and Total, Serum or Plasma Order Name: CORT F & T Test Number: REV DATE:9/17/2008 Cortisol, Free and Total, Serum or Plasma LC/MS/ED Preferred 2 ml (0.7) Serum Clot Activator SST (Red/Gray or Tiger Top) Refrigerated Alternate 2 ml (0.7) Plasma EDTA (Lavender Top) Refrigerated Special Grossly hemolyzed specimens are unacceptable. Instructions: Testing Schedule: Sun, Wed Expected TAT: 4-7 Days Cpt Code(s): 82533; 82530

9 Cortisol, Free, 24-Hour Urine Order Name: CORT FR U Test Number: REV DATE:9/30/2008 Cortisol, Free, 24-Hour Urine TMS Preferred 5 ml (1) Urine, 24-hour 24 hour Urine Container Refrigerated Alternate 5 ml (1) Urine, Random Sterile Urine container Refrigerated Special Do Not Use Acid for Preservative! Instructions: Adequate refrigeration is the most important aspect of specimen preservation. Mark collection duration and total volume on transport tube and test request form. Stability: Ambient= 2 days; Refrigerated= 2 weeks; Frozen= 6 months. Testing Schedule: Sun-Sat Expected TAT: 2-3 Days Cpt Code(s): 82530

10 FIP1L1-PDGFRA Gene Rearrangement [del(4q12)] Order Name: FIP PDGFRA PCR Test Number: REV DATE:9/30/2008 FIP1L1-PDGFRA Gene Rearrangement [del(4q12)] PCR PCR Preferred 5 ml (2) Whole Blood EDTA (Lavender Top) Room Temperature Alternate 5 ml (2) Whole Blood EDTA (Lavender Top) Room Temperature Special Stability: Room temperature: 72hrs, Refrigerated: 72hrs, Frozen: Not Acceptable. Send specimen to RML main Instructions: lab ASAP. The specimen Must arrive at the reference lab within 72hrs of collection to be stabilized. Testing Schedule: Mon Expected TAT: 3-8 Days Clinical Use: This real-time quantitative RT-PCR (reverse transcription-polymerase chain reaction) for the amplification of FIP-PDGFRA fusion transcript generates by interstitial deletion of chromosome 4q12. It can also be used for monitoring the therapy of patients with this FIP-PDGFRA fusion transcript. Cpt Code(s): 83891, 83900, 83901x3, 83902x2, 83912

11 Heavy Metals Panel, 24-Hour Urine Order Name: METAL S U Test Number: REV DATE:9/23/2008 Heavy Metals Panel, 24-Hour Urine ICP/MS Preferred 7 ml Urine, 24-hour 24 Hour Urine Acid Washed Container Refrigerated Special Collect specimen in 24-hour acid washed urine container. To avoid contamination, do not measure 24-hour Instructions: volume. Do not pour off unless you have specific acid washed aliquot tubes. Send entire 24-hour acid washed urine container to main lab for processing. Patient should refrain from eating seafood, or taking mineral and herbal supplements for at least three days prior to specimen collection. Testing Schedule: Mon - Sat Expected TAT: 3 Days Clinical Use: Panel includes: Arsenic, Mercury, Lead, Creatinine. Cpt Code(s): 83015; 81050

12 Heavy Metals Panel, Random Urine Order Name: METAL U RA Test Number: REV DATE:9/23/2008 Heavy Metals Panel, Random Urine ICP/MS Preferred 10 ml (3.5) Urine, Random See Instructions Refrigerated Special Collect in an Acid Washed, Trace Element Free container. Patient should refrain from eating seafood at least Instructions: three days prior to specimen collection. Testing Schedule: Mon - Sat Expected TAT: 4 Days Clinical Use: Panel includes: Arsenic, Mercury, Lead, Creatinine. Cpt Code(s): 82175; 83825; 83655; 82570

13 HTLV I/II Antibody, EIA ( Positives Reflexed to Western Blot ) Test Number: Order Name: HTLV-I/II REV DATE:9/8/2008 HTLV I/II Antibody, EIA ( Positives Reflexed to Western Blot ) EIA Preferred 1 ml (0.5) Serum Clot Activator SST (Red/Gray or Tiger Top) Refrigerated Special Serum should be removed from cells promptly after collection and transferred to a plastic tube. Instructions: Testing Schedule: Tue-Fri Expected TAT: 2-3 Days Cpt Code(s): 86790; (if western blot is performed 86689)

14 Lead, Blood (Whole Blood) Order Name: LEAD Test Number: REV DATE:9/30/2008 Lead, Blood (Whole Blood) GC/MS Preferred 2 ml (1) Whole Blood EDTA (Royal Blue Top/Trace Element Free) Room Temperature Alternate 2 ml (1) EDTA Whole Blood Becton-Dickinson MicroGuard EDTA Pink-Top Room Temperature Special The best specimen for lead testing on children is EDTA whole blood. Whole blood should be collected in Instructions: royal blue-top (EDTA) evacuated tubes with negligible trace element levels. Pediatric use Becton-Dickinson MicroGuard Pink-Top. Testing Schedule: Sun-Thr Expected TAT: 4-5 Days Notes: The State will require that the patient have an EDTA whole blood specimen collected so that accurate numerical results are obtained. Cpt Code(s): 83655

15 Liver-Kidney Microsome - 1 Antibody, IgG Order Name: LIV-KID AB Test Number: REV DATE:9/17/2008 Liver-Kidney Microsome - 1 Antibody, IgG ELISA Preferred 1 ml (0.5) Serum Clot Activator SST (Red/Gray or Tiger Top) Refrigerated Special Unacceptable Specimens: Hemolyzed, lipemic, contaminated, or heat-inactivated specimens. (Avoid repeated Instructions: freeze/thaw cycles). Stability after separation from cells: Ambient: 2 days; Refrigerated: 2 weeks; Frozen: 1 year. Testing Schedule: Sun, Tue, Thu Expected TAT: 2-5 Days Clinical Use: A positive result indicates the presence of IgG antibodies to recombinant human P450 2D6 and suggests the possibility of autoimmune hepatitis, type 2. A negative LKM-1 does not rule out the presence of autoimmune hepatitis, type 2. Cpt Code(s): 86376

16 Myasthenia Gravis Panel 2 Order Name: ACETY BBM Test Number: REV DATE:9/17/2008 Acetylcholine Receptor Binding Antibody Acetylcholine Receptor Blocking Antibody Acetylcholine Receptor Modulating Antibody RIA RIA RIA Preferred 2 ml (1.5) Serum Clot Activator (Red Top, No-Gel) Refrigerated Alternate 2 ml (1.5) Serum Clot Activator SST (Red/Gray or Tiger Top) Refrigerated Special SST Clot tubes acceptable, however it is best if collected in non-gel clot tubes. Specimen stability: Room Instructions: temperature: 2 hours; Refrigerated: 1 weeks; Frozen: 1 month. Testing Schedule: Sun-Sat Expected TAT: 4-6 Days Clinical Use: Myastenia Gravis is a neurological disorder characterized by a decrease in acetylcholine receptors. Patients exhibit skeletal muscle weakness and fatigability. Approximately 80% of patients with Myastenia Gravis, excluding ocular involvement only, have detectable acetylcholine receptor antibody. Cpt Code(s): 83519x3

17 Shiga Toxin types 1 and 2 Order Name: SHIGA TX Test Number: REV DATE:9/8/2008 Shiga Toxin type 1 Shiga Toxin type 2 IC IC Preferred See Instructions Stool, Random Parapak Refrigerated Special Stool should be placed in modified Cary-Blair Para-Pak Culture Media within 2 hours of collection and kept Instructions: refrigerated. (PARA-PAK C&S available from lab stores. ) Testing Schedule: Sun-Sat Expected TAT: 2-3 Days Notes: This test is a immunochromatographic rapid test for the qualitative detection of Shiga toxins 1 and 2 (also called Verotoxins) produced by E. coli in cultures derived from clinical stool specimens. This test used in conjunction with the patient's clinical symptoms and other laboratory tests to aid in the diagnosis of diseases caused by enterohemorrhagic E. coli (EHEC) infections. Cpt Code(s): 87015, 87899,

18 West Nile Antibodies IgG and IgM Order Name: WEST NILE Test Number: REV DATE:9/3/2008 West Nile Antibodies IgG West Nile Antibodies IgM EIA EIA Preferred 1 ml (0.5) Serum Clot Activator SST (Red/Gray or Tiger Top) Frozen Special Specimen is good refrigerated for 48 hours. If testing will be delayed longer than 48 hours, specimen should be Instructions: centrifuged, serum separated and frozen. Testing Schedule: Tue, Thr Expected TAT: 2-5 Days Clinical Use: West Nile Virus is a flavivirus recently associated with an outbreak of encephalitis in the Eastern United States. West Nile Virus IgM is usually detectable by the time symptoms appear, but IgG may not be detectable until day 4 or day 5 of illness. Antibodies induced by West Nile Virus infection show extensive crossreactivity with other flaviviruses, including Dengue Fever Virus and St. Louis Encephalitis Virus. Cpt Code(s): 86788, 86789

Anti-FceR (CU Index) Antibody

Anti-FceR (CU Index) Antibody Order Name: ANTI-FCER Test Number: 5587500 REV DATE:5/31/2007 Anti-FceR (CU Index) Antibody CU Index Preferred 2 ml (1mL) Serum Clot Activator SST (Red/Gray or Tiger Top)