Blood Group and Rh

CERNER / EPIC MNEMONIC: ABO; RH FEE; NEO ABO; RH FEE; CORD ABO; RH FEE
POE DESCRIPTION: ABO RH; NEO ABO; CORD ABO
CPT CODE: 86900; 86901
DAYS PERFORMED: Daily, 24 hours
TURNAROUND TIME: 1 hour
CONTAINER TYPE: Pink top tube
COLLECTION: Special Labeling Requirements: The content of each sample label must include the patient's full name and medical record number, the phlebotomist's initials, the date and time the sample was collected and, for non-LLT draws, the initials of a second medical professional who has confirmed that the sample came from the patient whose name is on the label; the computer label must have this same information plus an accession number and the tests ordered. NOTE:  LLT phlebotomists should write 'LLT' for the second set of initials.
SPECIMEN REQUIREMENTS: Red blood cells and plasma
MINIMUM VOLUME: 7 mL
TEST SYNONYM(S):ABO and Rh Type; Blood Type; Type and Rh

Bone Marrow Transplant Donor or Recipient

CERNER / EPIC MNEMONIC: ALLO DONOR; ALLO RECIP
POE DESCRIPTION: ALLO BONE MARROW DONOR; ALLO DONOR

ALLO BONE MARROW RECIPIENT; ALLO RECIP

CPT CODE: 86850; 86880; 86900; 86901
DAYS PERFORMED: Weekdays, 0700-1600; requires prior arrangement
TURNAROUND TIME: 48 hours
CONTAINER TYPE: One red top tube (clot), three pink or  lavender top top (EDTA) tubes
COLLECTION: Special Labeling Requirements: The initials of the person who collected the specimen and the date and time of collection MUST be noted on the specimen label.
SPECIMEN REQUIREMENTS: Blood
MINIMUM VOLUME: 28 mL (7 mL/tube)
ADDITIONAL INFORMATION: Infectious Disease Testing is sent out to a referral lab.

Blood Donation

B12, Vitamin

CERNER / EPIC MNEMONIC: B12
POE DESCRIPTION: VITAMIN B12
CPT CODE: 82607, 82746
DAYS PERFORMED:

Daily, 24 hours

TURNAROUND TIME:

8 hours

CONTAINER TYPE:

Red top tube or SSTTM tube

SPECIMEN REQUIREMENTS:

2.0 mL blood (1.0 mL serum)

REJECTION CRITERIA:

Hemolysis

MINIMUM VOLUME:

1.0 mL blood (0.5 mL serum)

REFERENCE RANGE: 210-920 pg/mL
METHODOLOGY:

Chemiluminescent

LAST UPDATED:

3-28-2013

TEST SYNONYM(S):B12; Cobalamin; Vitamin B12

Barbiturates, Qualitative, Urine

CERNER / EPIC MNEMONIC: U/DS
POE DESCRIPTION: URINE DRUG SCREEN; U/DS
CPT CODE: 80100 (x7)
TEST INFORMATION: Test includes amobarbital, butabarbital, butalbital, pentobarbital, phenobarbital, secobarbital and other barbiturates. Not orderable as separate test. Order Drug Screen, Urine
DAYS PERFORMED: Daily, 24 hours
TURNAROUND TIME: Routine: 4 hours; stat: 1 hour
SPECIAL INSTRUCTIONS: Do not use results for medicolegal purposes. For medicolegal purposes, specimens should be collected using chain-of-custody precautions and screening results should be confirmed using gas chromatography mass spectrometry. Chain-of-custody and confirmation are not part of the urine drug screen and are not provided by this laboratory.
CONTAINER TYPE: Sterile 80 mL specimen container
SPECIMEN REQUIREMENTS: 1.0 mL random urine
MINIMUM VOLUME: 0.5 mL random urine
REFERENCE RANGE: none detected
METHODOLOGY:

FPIA (Fluorescence Polarization Immunoassay)

Basic Metabolic Panel, Serum

CERNER / EPIC MNEMONIC: BMP
POE DESCRIPTION: BASIC METABOLIC PANEL; BMP
CPT CODE: 80048
TEST INFORMATION: Test includes sodium, potassium, chloride, carbon dioxide, glucose, calcium, urea nitrogen and creatinine
DAYS PERFORMED: Daily, 24 hours
TURNAROUND TIME: Routine: 8 hours; stat: 1 hour
CONTAINER TYPE:

SSTTM tube or green top (Heparin) microtainer for neonates

SPECIMEN REQUIREMENTS: Blood (serum)
MINIMUM VOLUME: 0.6 mL blood (0.3mL serum)
REFERENCE RANGE: See Table
CRITICAL VALUES: Sodium:  ≤ 120 mmol/L,  ≥ 160 mmol/L; potassium: < 2.5 mmol/L, > 6.5 mmol/L; calciuim < 5 mg/dl, > 13 mg/dl; glucose: 0-18 years, < 30 mg/dL
TEST SYNONYM(S):BMP

Benzodiazepines, Qualitative, Urine

CERNER / EPIC MNEMONIC: U/DS
POE DESCRIPTION: URINE DRUG SCREEN; U/DS
CPT CODE: 80100; 80100
TEST INFORMATION: Not orderable as separate test. Order Drug Screen, Urine.
DAYS PERFORMED: Daily, 24 hours
TURNAROUND TIME: Routine: 4 hours; stat: 1 hour
SPECIAL INSTRUCTIONS: Do not use results for medicolegal purposes. For medicolegal purposes, specimens should be collected using chain-of-custody precautions and screening results should be confirmed using gas chromatography/mass spectrometry. Chain-of-custody and confirmation are not part of the urine drug screen and are not provided by this laboratory.
CONTAINER TYPE: Sterile 80 mL specimen container
SPECIMEN REQUIREMENTS: 1.0 mL random urine
MINIMUM VOLUME: 0.5 mL random urine
REFERENCE RANGE: None detected
METHODOLOGY:

FPIA (Fluorescence Polarization Immuoassay)

Beta-2 Microglobulin

CERNER / EPIC MNEMONIC: B2 MICRO
POE DESCRIPTION: BETA 2 MICROGLOBULIN; B2 MICRO
DAYS PERFORMED:

Daily

TURNAROUND TIME:

8 hours

CONTAINER TYPE:

SST tube or Red top tube - 4 mL

SPECIMEN REQUIREMENTS: 4.0 mL blood (2.0 mL serum) 
REJECTION CRITERIA:

Excessive hemolysis, chylous serum

MINIMUM VOLUME: 2.0 mL blood (1.0 mL serum)
REFERENCE RANGE: Serum: <3.0 mg/L
METHODOLOGY:

Chemiluminescent

ADDITIONAL INFORMATION:

Measurement of ß2M is considered a sensitive means for diagnosing proximal tubular dysfunction.  It is reportedly the most reliable test for distinguishing upper from lower urinary tract infections, and a useful method for assessing the results of therapy and diagnosing recurrences of acute pyelonephritis using serial determinations.

LAST UPDATED:

6-6-2013

TEST SYNONYM(S):B2M, Serum; B2 Microglobulin

Beta-hCG, Tumor Marker

CERNER / EPIC MNEMONIC: BHCG
POE DESCRIPTION: BHCG TUMOR MARKER
CPT CODE: 86316
DAYS PERFORMED:

24 hours

TURNAROUND TIME:

8-24 hours

SPECIAL INSTRUCTIONS: Must indicate sex of patient on requisition.
CONTAINER TYPE:

SST tube or Red top tube - 4 mL

SPECIMEN REQUIREMENTS:

4 mL blood (2 mL serum)

MINIMUM VOLUME: 1.0 mL blood (0.3 mL serum)
REFERENCE RANGE: Male or non-pregnant female: <5 mIU/mL
METHODOLOGY:

Chemiluminescent Microparticle Immunoassay (CMIA)

TEST SYNONYM(S):Human Chorionic Gonadotropin, Beta Subunit; BHCG

Bilirubin Fractionation

CERNER / EPIC MNEMONIC: FBIL
POE DESCRIPTION: BILIRUBIN FRACTIONATION; BILI FRAC; FBIL
CPT CODE: 82247, 82248
TEST INFORMATION: This test is for patients >30 days. This test indicates a Total Bilirubin and a Direct Bilirubin.
DAYS PERFORMED: Specimen accepted daily, 24 hours
TURNAROUND TIME: Routine: 8 hours; stat: 1 hour
SPECIAL INSTRUCTIONS: Specimen must be protected from light and transported to the laboratory promptly.
CONTAINER TYPE:

SSTTM tube, Microtainer (Lithium heparin SST) tube

SPECIMEN REQUIREMENTS: Blood (serum)
MINIMUM VOLUME: 4 mL blood (2 mL serum)
REFERENCE RANGE: See Table
REFERENCE CHART:

Direct bilirubin 0.0-0.35 mg/dL (Adult) 

Total bilirubin 0.2-1.3 mg/dL

TEST SYNONYM(S):Conjugated (DBIL), and unconjugated (indirect) bilirubin; Calculated direct and delta bilirubin

Bilirubin, Neonatal

CERNER / EPIC MNEMONIC: NBIL
POE DESCRIPTION: BILIRUBIN NEONATAL; BILI NEONATAL
CPT CODE: 82247, 82248
TEST INFORMATION: Test includes: Direct Bilirubin, Total Bilirubin calculation. Patient must be <30 days old.
DAYS PERFORMED: Specimen accepted daily, 24 hours
TURNAROUND TIME: Routine 8 hours; Stat 1 hour
SPECIAL INSTRUCTIONS: Specimen must be protected from light and transported to the laboratory promptly.
CONTAINER TYPE:

Red top MicrotainerTM; green top (Heparin) tube for neonates

SPECIMEN REQUIREMENTS: Capillary blood (serum)
MINIMUM VOLUME: 0.4 mL blood, 0.2 mL serum
REFERENCE RANGE: See Table
REFERENCE CHART: Direct bilirubin 0.0-0.5 mg/dL (0 to 1 month)

Total bilirubin 0.6-11.1 mg/dL

CRITICAL VALUES:

Total bilirubin Newborn to 7 days:  ≥ 15 mg/dL

1 week to 1 month:  ≥ 20 mg/dL

TEST SYNONYM(S):Baby Bilirubin; Microbilirubin; Total Bilirubin, Neonatal

Bilirubin, Total Blood

CERNER / EPIC MNEMONIC: TBIL
POE DESCRIPTION: TOTAL BILIRUBIN; TBIL
CPT CODE: 82247
DAYS PERFORMED: Daily, 24 hours
TURNAROUND TIME: Routine: 8 hours; stat: 1 hour
CONTAINER TYPE:

SSTTM tube

SPECIMEN REQUIREMENTS: Blood (serum)
MINIMUM VOLUME: 0.4 mL blood (0.2 mL serum)
HANDLING INSTRUCTIONS: Specimen must be protected from light and transported to the laboratory promptly.
REFERENCE RANGE: 1 day to 1 month: 0.6-11.1 mg/dL; 1 month to adult: 0.2-1.3 mg/dL
CRITICAL VALUES:

Newborn to 7 days: > 15 mg/dL

1 week to 1 month: > 20 mg/dL

TEST SYNONYM(S):Total Bilirubin

Bilirubin, Total, Cerebrospinal Fluid

CERNER / EPIC MNEMONIC: C/TBIL
POE DESCRIPTION: CSF TOTAL BILIRUBIN
CPT CODE: 82247
DAYS PERFORMED: Specimen accepted daily, 24 hours
TURNAROUND TIME: 1 hour
CONTAINER TYPE:

CSF collection tubesRed top tube - 10 mLRed top tube - 4 mL

SPECIMEN REQUIREMENTS: Cerebrospinal fluid
MINIMUM VOLUME: 0.2 mL fluid
REFERENCE RANGE: None established
TEST SYNONYM(S):CSF Bilirubin

Blood Gases, Arterial

CERNER / EPIC MNEMONIC:

ABG

POE DESCRIPTION: ARTERIAL BLOOD GAS; ABG
CPT CODE: 82803
TEST INFORMATION: Test includes a measured pH, pO2, pCO2, and a calculated Bicarbonate, total CO2, O2 saturation and Base Excess
DAYS PERFORMED: Daily, 24 hours
TURNAROUND TIME: 15 minutes
SPECIAL INSTRUCTIONS: Requisition must indicate source (ie, arterial) and time sample is drawn. This test cannot be added onto an existing sample.
CONTAINER TYPE:

Heparinized syringe, heparinized capillary tube

SPECIMEN REQUIREMENTS: Whole blood, arterial
REJECTION CRITERIA: Include clotted sample, needle attached to the syringe, and air bubbles in the sample.
MINIMUM VOLUME: 0.3 mL
HANDLING INSTRUCTIONS: Deliver specimen immediately to the lab on ice.
REFERENCE RANGE:

See Table

CRITICAL VALUES:

≤ 7.2

TEST SYNONYM(S):ABG, Arterial Blood Gases, Gases

Blood Gases, Venous

CERNER / EPIC MNEMONIC:

VBG

POE DESCRIPTION: VENOUS BLOOD GASES; VBG
CPT CODE: 82803
TEST INFORMATION: Test includes measured pH, pO2, pCO2 and calculated Bicarbonate, total CO2, O2 saturation and Base Excess
DAYS PERFORMED: Specimen accepted daily, 24 hours
TURNAROUND TIME: 15 minutes
SPECIAL INSTRUCTIONS: Requisition must indicate source (ie, venous) and time sample is drawn. This test cannot be added onto an existing sample.
CONTAINER TYPE:

Heparinized syringe, heparinized capillary tube

SPECIMEN REQUIREMENTS: Whole blood, venous
REJECTION CRITERIA: Include clotted sample, needles still attached to the syringe, or air bubbles in the sample.

Include clotted sample, needles still attached to the syringe, or air bubbles in the sample.

MINIMUM VOLUME: 0.3 mL
HANDLING INSTRUCTIONS: Deliver specimen immediately to the lab on ice.
REFERENCE RANGE: See table.
CRITICAL VALUES:

≤ 7.2

TEST SYNONYM(S):VBG; Venous Blood Gases

Body Fluids Cell Count and Differential

CERNER / EPIC MNEMONIC: F/P-D C-D (peritoneal dialysate); F/PCRD C-D (pericardial); F/SYN C-D (synovial)
POE DESCRIPTION: Pericardial fluid - CELL COUNT & DIFF PERICARDIAL; PERICARDIAL COUNT AND DIFF

Peritoneal fluid - CELL COUNT & DIFF PERITONEAL; FL PERITONEAL COUNT AND DIFF

Pleural fluid - CELL COUNT & DIFF PLEURAL; FL PLEURAL COUNT AND DIFF

Synovial fluid - CELL COUNT & DIFF SYNOVIAL; FL SYNOVIAL COUNT AND DIF

Miscellaneous - CELL COUNT AND DIFF MISC; FL MISC CELL COUNT & DIFF

CPT CODE: 89051
DAYS PERFORMED: Daily, 24 hours
TURNAROUND TIME: 8 hours
SPECIAL INSTRUCTIONS: Requisitions must state specific site aspirated.
CONTAINER TYPE: Lavender top (EDTA) tube, urine sample container
SPECIMEN REQUIREMENTS: Body fluid (eg, pleural fluid, synovial fluid, cyst fluid, paracentesis fluid, pericardial fluid, etc)
REJECTION CRITERIA: Sent to the laboratory with needle on syringe
MINIMUM VOLUME: 1 mL
HANDLING INSTRUCTIONS: Specimen should be brought directly to the laboratory after collection. Do not store.
REFERENCE RANGE:

Pleural fluid: clear and colorless to pale yellow; <1000 WBC/mm3; <25% polys; 0-RBC. Peritoneal fluid: clear and colorless to pale yellow; <500 WBC/mm3; <25% granulocytes; <100,000 RBC/mm3. Pericardial fluid: clear and colorless to pale yellow; <500 WBC/mm3; <25% polys; 0-RBC; synovial fluid: granulocytes <25% of nucleated cells; nucleated cell count <200/mm3.

LAST UPDATED:

11-22-2013

TEST SYNONYM(S):Extravascular Fluid Cell Count; Fluid Cell Count

Brushing Cytology

CPT CODE: 74013
DAYS PERFORMED: Mon-Fri, 0730-1700;
TURNAROUND TIME: 24-48 hours
SPECIAL INSTRUCTIONS: Specify the site brushed. If brushings are obtained from different sites, a separate fixative vial should be used for each site. Suspected infectious diseases should be specified.
CONTAINER TYPE: Cytolyt fixative vial
SPECIMEN REQUIREMENTS: Brush from lesion area
TEST SYNONYM(S):Cytology, Brushing

Biopsy Culture, Anaerobic

CERNER / EPIC MNEMONIC: C ANAEROBE
POE DESCRIPTION: C ANAEROBE; CU ANAEROBIC
CPT CODE: 87075
TEST INFORMATION: All biopsy specimens will be processed for routine anaerobic culture when an aerobic culture is requested. Test includes culture for anaerobic organisms. Other isolated organisms (i.e. aerobes, yeast, etc.) may be referred for identification and/or susceptibility testing if medically indicated AND a separate culture procedure has NOT yielded the same organism(s).
DAYS PERFORMED: Daily, 24 hours
TURNAROUND TIME: Cultures are examined every 48 hours. Preliminary reports are available after 48 hours. Culture reports of no growth will be issued after 5 days. Completion of culture reports may take 7-10 days after receipt of the specimen, depending upon the nature of the microorganisms isolated.
SPECIAL INSTRUCTIONS: Avoid exposure to atmospheric oxygen. Specimens should be transported as soon as possible. When transportation is delayed, leave at room temperature. Do NOT refrigerate. The specific anatomic site of the biopsy MUST be specified on the requisition with surface and/or deep or surgical biopsies delineated.
CONTAINER TYPE:

BBLTM Port-A-Cul Transport System; sealed sterile container

COLLECTION:

The specimen of choice is tissue or an aspirate, NOT a swab. Specimens are to be collected from a site prepared utilizing aseptic technique. Overlying and adjacent areas must be carefully prepared to eliminate surface (normal flora) anaerobes. Ideally, material obtained by needle aspiration through intact surface, which has been cleaned with antiseptic, is put directly into the BBLTM Port-A-Cul Transport System. Sampling of open lesions is enhanced by deep aspiration using a sterile plastic catheter. Curetting of the base of an open lesion is optimal. If irrigation is necessary, nonbacteriostatic sterile saline may be used. Pulmonary samples may be obtained by transtracheal percutaneous needle aspiration. When a syringe is used to obtain the specimen, all air should be expelled after which the sample should be injected into a BBLTM Port-A-Cul Transport System. Swabs should NOT be used due to the small volume of specimen obtainable by this method. Place tissue directly into the transport tube. Secure the lid tightly. Contamination with normal flora from skin or other body surfaces MUST be avoided since colonizing bacteria not involved in the infectious process may be introduced into the sample.

SPECIMEN REQUIREMENTS: Surgical tissue, biopsy material from normally sterile site appropriately obtained for anaerobic culture.
REJECTION CRITERIA: Inappropriate specimen container, insufficient specimen volume, refrigerated specimen. Specimens from sites which have anaerobic bacteria as normal flora will routinely be rejected.
MINIMUM VOLUME: 0.5-10 mL or a small piece of tissue
HANDLING INSTRUCTIONS: Avoid exposure to atmospheric oxygen. Specimen should be transported as soon as possible. When transportation is delayed, leave at room temperature. Do NOT refrigerate.
REFERENCE RANGE: No growth of anaerobic bacteria
LIMITATIONS OF TEST:

A specimen received in anaerobic transport devices is not suitable for routine fungal or mycobacterial cultures. If more than three anaerobic isolates are present, the Bacteroides fragilis group, and Clostridium perfringens will be the only isolates identified. Anaerobic susceptibility testing is NOT performed routinely. Should susceptibility testing be required, call the Clinical Microbiology laboratory at (312)942-5452.

METHODOLOGY: Conventional culture utilizing media specifically formulated for anaerobic isolation.
ADDITIONAL INFORMATION: The portion of the surgical specimen submitted to the Clinical Microbiology Laboratory should be aseptically separated from the portion submitted to the Pathology Department.
LAST UPDATED:

5-13-2014

TEST SYNONYM(S):Anaerobic Culture, Biopsy

Biopsy Culture, Fungus

CERNER / EPIC MNEMONIC: C FUNGUSSM
POE DESCRIPTION: C FUNGUSSM (NON-SKIN); CU FUNGUS W SMEAR (NON-SKIN)
CPT CODE: 87102 (culture); 87206 (smear)
TEST INFORMATION: Test includes a culture for fungi and performance of a direct fungal smear. All fungal isolates will be identified. Other isolated organisms (i.e. aerobes, etc.) may be referred for identification and/or susceptibility testing if medically indicated AND a separate culture procedure has NOT yielded the same organism(s).
DAYS PERFORMED: Daily, 24 hours.
TURNAROUND TIME: Smear results: same day if the specimen is received in the laboratory no later than 1400. Preliminary culture reports are available after 1 week or when a fungal isolate is detected. Cultures will be finalized after 4 weeks.
SPECIAL INSTRUCTIONS: The specific anatomic site of the biopsy MUST be specified on the order or requisition with surface and/or deep or surgical biopsies delineated.
CONTAINER TYPE: Sealed sterile container, no preservative; sterile Petri dish (available from the Clinical Microbiology Laboratory).
COLLECTION: Specimens are to be collected from a site prepared utilizing aseptic technique. Overlying and adjacent areas must be carefully prepared to eliminate surface organisms. Ideally, material is obtained by needle aspiration through intact surface, which has been cleaned with antiseptic, and injected into a sealed, sterile container. Sampling of open lesions is enhanced by deep aspiration using a sterile plastic catheter. If irrigation is necessary, nonbacteriostatic sterile saline may be used. Pulmonary samples may be obtained by transtracheal percutaneous needle aspiration. Optimal isolation of fungi from tissue is accomplished by processing as much tissue as possible.
SPECIMEN REQUIREMENTS: Surgical tissue, biopsy material
REJECTION CRITERIA: Inappropriate specimen container, insufficient specimen volume, refrigerated specimen, specimen received in a preservative.
MINIMUM VOLUME: As much as possible
HANDLING INSTRUCTIONS: Specimen should be transported as soon as possible. When transportation is delayed, leave at room temperature.
REFERENCE RANGE: No fungi isolated/observed.
METHODOLOGY: Fungal smear: calcofluor white stain. Culture: Conventional culture utilizing media specifically formulated for fungal isolation.
ADDITIONAL INFORMATION: The portion of the surgical specimen submitted to the Clinical Microbiology Laboratory should be aseptically separated from the portion submitted to the Pathology Department.
TEST SYNONYM(S):Fungus Culture, Biopsy

Biopsy Culture, Mycobacterium

CERNER / EPIC MNEMONIC: C AFBSM
POE DESCRIPTION: CU MYCOBACTERIUM W SMEAR; CU AFB AND SMEAR; C AFBSM
CPT CODE: 87015, 87116, 87206 (smear)
TEST INFORMATION:

Test includes culture and acid-fast stain (if specimen volume is adequate). Culture includes decontamination and concentration, if appropriate (i.e. specimen potentially contaminated with normal flora). If a mycobacterial species is isolated, the organism will be identified. Susceptibility testing will be performed depending upon the isolate identification. Other isolated organisms (i.e. aerobes, yeast, etc.) may be referred for identification and/or susceptibility testing if medically indicated AND a separate culture procedure has NOT yielded the same organism(s).

DAYS PERFORMED: Daily, 24 hours.
TURNAROUND TIME: Smear results, 24 hours after receipt of the specimen in the laboratory. Preliminary reports are available after 1 week or when a mycobacterial isolate is detected. Negative cultures with negative smears will be issued after 8 weeks. Negative cultures with positive smears will be issued after 12 weeks. Completion of culture reports may require additional time when mycobacteria are isolated and/or susceptibility testing is performed.
SPECIAL INSTRUCTIONS: The specific anatomic site of the biopsy MUST be specified on the order or requisition with surface and/or deep or surgical biopsies delineated.
CONTAINER TYPE: Sealed sterile container, no preservative
COLLECTION: Specimens are to be collected from a site prepared utilizing aseptic technique. Overlying and adjacent areas must be carefully prepared to eliminate surface organisms. Ideally, material is obtained by needle aspiration through intact surface, which has been cleaned with antiseptic, and injected into a sealed, sterile container. Sampling of open lesions is enhanced by deep aspiration using a sterile plastic catheter. If irrigation is necessary, nonbacteriostatic sterile saline may be used. Pulmonary samples may be obtained by transtracheal percutaneous needle aspiration. Optimal isolation of mycobacteria from tissue is accomplished by processing as much tissue as possible.
SPECIMEN REQUIREMENTS: Surgical tissue, biopsy material from normally sterile site
REJECTION CRITERIA: Inappropriate specimen container, insufficient specimen volume, specimen received in a preservative. Only three specimens per body site with negative acid-fast smears will be processed. Subsequent specimens will be rejected. Specimens from known positive patients will be accepted only once a week for culture and smear per body site.
MINIMUM VOLUME: 0.5-10 mL or a small piece of tissue
HANDLING INSTRUCTIONS: Specimen should be transported as soon as possible. When transportation is delayed, refrigerate.
REFERENCE RANGE: No acid-fast bacilli observed on smear or isolated in culture.
LIMITATIONS OF TEST: A single negative smear does not rule out the presence of mycobacterial infection.
METHODOLOGY: Acid-fast smear: fluorochrome stain. Culture: inoculation of conventional culture media and a rapid medium for automated continuous analysis.

ADDITIONAL INFORMATION:

DNA probes may be incorporated to aid with more rapid identification of mycobacterial isolates. This will generate an additional charge(s). Susceptibility testing will be performed only on the first Mycobacterium isolate from each specimen type per patient. Additional susceptibilities may be performed after a period of 4 weeks for patients with suspected treatment failure. Susceptibility testing is performed routinely only for M. tuberculosis complex, Susceptibility testing for other Mycobacterium species is performed by special request only. The battery of drugs routinely tested will vary by isolate and/or physician request. Patients from whom M. tuberculosis is isolated in culture are reported to the City of Chicago Board of Health. This is mandated by law.

LAST UPDATED:

5-13-2014

TEST SYNONYM(S):AFB Culture, Biopsy; Biopsy AFB Culture; Mycobacterium Culture, Biopsy; TB Culture, Biopsy

Biopsy Culture, Routine

CERNER / EPIC MNEMONIC: C AERGS
POE DESCRIPTION: CU AEROBIC W GRAM STAIN; C AERGS
CPT CODE: 87205; 87071
TEST INFORMATION: The test includes a direct Gram stain, isolation and identification of microorganisms, and susceptibility testing, if appropriate. Other isolated organisms (i.e. anaerobes, yeast, etc.) may be referred for identification and/or susceptibility testing if medically indicated AND a separate culture procedure has NOT yielded the same organism(s).
DAYS PERFORMED: Daily, 24 hours
TURNAROUND TIME: Gram stain: 2 hours after receipt of the specimen in the laboratory. Preliminary culture reports are available after 24 hours. Culture reports of no growth will be issued after 72 hours. Completion of culture reports may take 3-5 days after receipt of the specimen when multiple isolates are found.
SPECIAL INSTRUCTIONS:

All biopsy/tissue specimens will routinely be cultured aerobically and anaerobically unless specifically indicated on the order or requisition that "No anaerobic culture needed." The specific anatomic site of the biopsy MUST be specified on the order or requisition with surface and/or deep or surgical biopsies delineated.

CONTAINER TYPE: Sealed sterile container, no preservative
COLLECTION: Specimens are to be collected from a site prepared utilizing aseptic technique. Overlying and adjacent areas must be carefully prepared to eliminate surface organisms. Ideally, material is obtained by needle aspiration through intact surface, which has been cleaned with antiseptic, and injected into a sealed, sterile container. Sampling of open lesions is enhanced by deep aspiration using a sterile plastic catheter. If irrigation is necessary, nonbacteriostatic sterile saline may be used. Pulmonary samples may be obtained by transtracheal percutaneous needle aspiration. Optimal isolation of microorganisms from tissue is accomplished by processing as much tissue as possible.
SPECIMEN REQUIREMENTS: Surgical tissue, biopsy material, etc.
REJECTION CRITERIA: Inappropriate specimen container, insufficient specimen volume, refrigerated specimen, specimen received in a preservative.
MINIMUM VOLUME: 0.5-5 mL or a small piece of tissue
HANDLING INSTRUCTIONS: Specimen should be transported as soon as possible. When transportation is delayed, leave at room temperature.
REFERENCE RANGE: No growth
LIMITATIONS OF TEST: A specimen with additional microbiologic procedures will be processed only if the specimen is of adequate quantity for all tests requested. A physician will be contacted to prioritize requested procedures when the specimen is of an inadequate quantity. The portion of the surgical specimen submitted for microbiologic analysis must be separated from the portion submitted to the Pathology Department utilizing sterile technique.
METHODOLOGY: Inoculation of conventional culture media.
LAST UPDATED:

5-19-2014

Blood Culture, Brucella

CERNER / EPIC MNEMONIC: C BLOOD
POE DESCRIPTION: CU BLOOD SET; C BLOOD
CPT CODE: 87040
TEST INFORMATION: The test includes the isolation and identification of microorganisms and susceptibility testing, when appropriate. Other isolated organisms (i.e. anaerobes, yeast, etc.) may be referred for identification and/or susceptibility testing if medically indicated AND a separate culture procedure has NOT yielded the same organism(s).
DAYS PERFORMED: Daily, 24 hours
TURNAROUND TIME:

14 days

SPECIAL INSTRUCTIONS: The order or requisition MUST state blood for Brucella Culture. Inform the Clinical Microbiology Laboratory of the specific request for Brucella Blood Culture such that the length of incubation of the culture media can be extended. The specific site of the specimen (i.e. arterial, CVP, etc.) MUST be specified on the requisition..
CONTAINER TYPE:

BacT/ALERT® SA (aerobic) and BacT/ALERT® SN(anaerobic)

COLLECTION: Blood cultures should be drawn prior to initiation of antimicrobial therapy. Follow the collection procedure for Blood Culture, Routine.
SPECIMEN REQUIREMENTS: Blood
REJECTION CRITERIA: Inappropriate specimen container, refrigerated specimen, improperly labeled bottles, insufficient specimen volume.
MINIMUM VOLUME:

0.1 mL (optimal volume for blood is 10 mL per bottle)

HANDLING INSTRUCTIONS: Blood cultures should be transported as soon as possible. When transportation is delayed, leave at room temperature. Do NOT refrigerate. Clients: incubate Bact/Alert bottles if transportation is delayed more than 4 hours.
REFERENCE RANGE: No growth
LIMITATIONS OF TEST: Blood cultures for Brucella are primarily useful in the early acute phase of the disease. Recovery of Brucella is limited by the relatively low level of bacteremia and the fastidious nature of the organism.
METHODOLOGY:

Automation (continuous monitoring)

ADDITIONAL INFORMATION:

Serologic testing of acute and convalescent blood specimens for Brucella antibodies may be useful when cultures are negative. The Clinical Microbiology Laboratory MUST be notified when Brucella is suspected so as to optimize the isolation of the organism and to prevent laboratory acquired infections.

LAST UPDATED:

5-19-2014

TEST SYNONYM(S):Brucella, Blood Culture; Culture for Brucella, Blood

Blood Culture, Fungus

CERNER / EPIC MNEMONIC: C FUNGUSBL
POE DESCRIPTION: CU FUNGUS BLOOD; C FUNGUSBL
CPT CODE: 87103
TEST INFORMATION: The test includes isolation and identification of any fungi isolated. Other isolated organisms (i.e. aerobes, etc.) may be referred for identification and/or susceptibility testing if medically indicated AND a separate culture procedure has NOT yielded the same organism(s).
DAYS PERFORMED: Daily, 24 hours
TURNAROUND TIME:

Preliminary culture reports are available after 1 week or when an isolate is detected. Cultures will be finalized after 4 weeks.

SPECIAL INSTRUCTIONS: Request test specifically. Not a component of a routine blood culture. The specific site of the specimen (i.e. arterial, swan ganz, etc.) MUST be specified on the order or requisition.
CONTAINER TYPE:

Inpatients:  BD Bactec Myco/F Lytic bottle (available from Clinical Microbiology, 312-942-5452)

COLLECTION: Swab the venipuncture site concentrically, starting at the center, with 4% chlorhexidine glucosate. After the disinfectant has dried, remove with an alcohol swab. The venipuncture site must not be palpated after preparation. Obtain 5 mL blood (adults)  1 mL (children). Inoculate the collection tube. Invert the tube 5-10 times to mix well. Blood cultures should be obtained prior to initiation of antifungal therapy. If more than one culture is ordered, the specimen should be obtained from separate venipuncture sites.  Disinfect the septum of the collection tube with alcohol. The time of collection must be indicated. Strict aseptic technique is essential.
SPECIMEN REQUIREMENTS: Blood
REJECTION CRITERIA: Inappropriate specimen container, specimen received more than 8 hours after collection, insufficient specimen volume, refrigerated specimen, clotted specimen.
MINIMUM VOLUME:

Adult: 3 mL; pediatric 1 mL (The optimal volume is 3 to 5 mL of blood)

HANDLING INSTRUCTIONS: Blood cultures should be transported as soon as possible. When transportation is delayed, leave at room temperature. Do NOT refrigerate.
REFERENCE RANGE: No fungi isolated; no growth
LIMITATIONS OF TEST: Routine blood cultures aer generally adequate for recovery of Candida spp. Fungal Blood Cultures are most effective in isolating Candida albicans and other yeasts. If other fungal species are suspected, a biopsy or bone marrow submitted for Fungus Culture should be considered.
METHODOLOGY:

Automation (continuous monitoring)

ADDITIONAL INFORMATION: If Malassezia furfur is suspected, this must be indicated on the order or the requisition. Bacterial isolates will be referred to the Blood Culture workstation for identification and susceptibility testing, when appropriate. An additional charge(s) will be incurred. Mycobacterial isolates will be referred to the Mycobacteriology laboratory for identification and susceptibility testing, when appropriate. An additional charge(s) will be incurred.
LAST UPDATED:

5-19-2014

TEST SYNONYM(S):Fungus Culture, Blood; Fungus, Blood Culture

Blood Culture, Mycobacterium

CERNER / EPIC MNEMONIC: C AFB BL
POE DESCRIPTION: CU MYCOBACTERIUM BLOOD; CU AFB BLOOD; CU ACID FAST BLOOD; C AFB BL
CPT CODE: 87116
TEST INFORMATION:

The test includes identification of any mycobacteria isolated, and susceptibility testing, if appropriate. Other isolated organisms (i.e. aerobes, yeast, etc.) may be referred for identification and/or susceptibility testing if medically indicated AND a separate culture procedure has NOT yielded the same organism(s).

DAYS PERFORMED: Daily, 24 hours
TURNAROUND TIME: Preliminary culture reports are available after 1 week or when a mycobacterial isolate is detected. Negative cultures will be finalized after 6 weeks. Completion of culture reports may require additional time when mycobacteria are isolated.
SPECIAL INSTRUCTIONS: Request test specifically. Not a component of a routine blood culture. The specific site of the specimen (i.e. arterial, swan ganz, etc.) MUST be specified on the order or requisition.
CONTAINER TYPE:

Inpatients:  BD Bactec Myco/F Lytic bottle (available from Clinical Microbiology, 312-942-5452)

COLLECTION:

Swab the venipuncture site concentrically, starting at the center, with 4% chlorhexidine glucosate. After the disinfectant has dried, remove with an alcohol swab. The venipuncture site must not be palpated after preparation. Obtain 5 mL blood (adults)  1 mL (children). Inoculate the collection tube. Invert the tube 5-10 times to mix well. Blood cultures should be obtained prior to initiation of antifungal therapy. If more than one culture is ordered, the specimen should be obtained from separate venipuncture sites.  Disinfect the septum of the collection tube with alcohol. The time of collection must be indicated. Strict aseptic technique is essential

SPECIMEN REQUIREMENTS: Blood
REJECTION CRITERIA: Inappropriate specimen container, specimen received more than 8 hours after collection, insufficient specimen volume, refrigerated specimen, clotted specimen.
MINIMUM VOLUME: 3 mL; 1 mL peds
HANDLING INSTRUCTIONS:

Specimen should be transported as soon as possible. When transportation is delayed, leave at room temperature. Do NOT refrigerate.

REFERENCE RANGE: No mycobacteria isolated
METHODOLOGY: Lysis centrifugation followed by inoculation of conventional mycobacterial culture media, as well as a rapid medium for automated continuous analysis.
ADDITIONAL INFORMATION: Bacterial isolates will be referred to the Blood Culture workstation for identification and susceptibility testing, when appropriate. An additional charge(s) will be incurred. Fungal isolates will be referred to the Mycology laboratory for identification. An additional charge(s) will be incurred. Mycobacterial susceptibility testing is performed routinely only for M. tuberculosis complex, M. kansasii, M. chelonae complex, and M. fortuitum. Susceptibility testing for other Mycobacterium species is performed by special request only. Susceptibility testing will be performed only on the first Mycobacterium isolate from each specimen type per patient. Additional susceptibilities may be performed after a period of 4 weeks for patients with suspected treatment failure. The battery of drugs routinely tested will vary by isolate and/or physician request. Patients from whom M. tuberculosis is isolated are reported to the City of Chicago Board of Health. This is mandated by law.
LAST UPDATED:

5-19-2014

TEST SYNONYM(S):MAC Blood Culture; MAI Blood Culture; Mycobacterium Culture, Blood

Blood Culture, Routine

CERNER / EPIC MNEMONIC: C BLOOD
POE DESCRIPTION: CU BLOOD SET (PERIPHERAL); C BLOOD (PERIPHERAL)
CPT CODE: 87040
TEST INFORMATION: Used to isolate and identify potentially pathogenic aerobic and/or anaerobic microorganisms causing bacteremia and perform susceptibility testing, when appropriate; establish the diagnosis of endocarditis. Other isolated organisms (i.e. fungi and mycobacteria) may be referred for identification and/or susceptibility testing if medically indicated AND a separate culture procedure has NOT yielded the same organism(s).
DAYS PERFORMED: Daily, 24 hours
TURNAROUND TIME: Preliminary culture reports available after 24 hours or when an isolate is detected. Culture reports of no growth will be issued after 5 days.
SPECIAL INSTRUCTIONS: The specific site of the specimen (i.e. arterial, swan ganz, etc.) MUST be specified on the order or requisition.
CONTAINER TYPE: Blood: BacT/ALERT® SA (aerobic) and BacT/ALERT® SN(anaerobic)
COLLECTION:

Blood cultures should be obtained prior to the initiation of antimicrobial therapy. COLLECTION OF TWO BLOOD CULTURE SETS IS STRONGLY RECOMMENDED. The specimens should be drawn either at separate intervals, no less than 30 minutes apart, or from two separate sites.

Click here for detailed instructions for blood collection using a butterfly collection set.

Click here for detailed instructions for blood collection using a needle and syringe. 

SPECIMEN REQUIREMENTS: Blood or bone marrow aspiration
REJECTION CRITERIA: Improperly labeled bottles, expired bottles, refrigerated specimen, insufficient specimen volume, clotted specimen.
MINIMUM VOLUME: 0.1 mL blood per bottle, 0.1 mL bone marrow  OPTIMAL VOLUME FOR BLOOD IS 10 mL PER BOTTLE
HANDLING INSTRUCTIONS: Specimen should be transported as soon as possible. When transportation is delayed, leave at room temperature. Do NOT refrigerate. Clients: When transportation is delayed more than 4 hours, incubate at 35°C.
REFERENCE RANGE: No growth
LIMITATIONS OF TEST: Blood cultures from patients suspected of having Brucella or Leptospira MUST be requested as a special culture. Call the Clinical Microbiology laboratory at (312)942-5452 for special instructions for blood collection for these organisms. Yeast often are isolated from routine blood cultures. However, if yeast or other fungi are specifically suspected, a separate fungal blood culture should be drawn along with each of the routine blood specimens. See separate listing for proper collection of Blood Fungus Culture. If mycobacteria are suspected, a separate mycobacterial culture should be drawn along with each of the routine blood cultures. Refer to separate entry, Blood Mycobacterium Culture, for proper collection.
METHODOLOGY: Automation (continuous monitoring).
ADDITIONAL INFORMATION: It is NOT recommended to culture blood while antimicrobials are present unless verification of an agent`s efficacy is needed. To diagnose endocarditis, 3 sets of cultures may be required. Single blood culture sets are usually inappropriate and are contraindicated except for pediatric patients.
TEST SYNONYM(S):Culture, Blood; Culture, Bone Marrow

Body Fluid Culture, Anaerobic

CERNER / EPIC MNEMONIC: C ANAEROBE
POE DESCRIPTION: CU ANAEROBIC; C ANAEROBE
CPT CODE: 87075
TEST INFORMATION: Test includes culture for anaerobic organisms. Other isolated organisms (i.e. aerobes, yeast, etc.) may be referred for identification and/or susceptibility testing if medically indicated AND a separate culture procedure has NOT yielded the same organism(s).
DAYS PERFORMED: Daily, 24 hours
TURNAROUND TIME: Cultures are examined every 48 hours. Preliminary reports available after 48 hours. Culture reports of no growth will be issued after 5 days. Completion of culture reports may take 7-10 days after receipt of the specimen, depending upon the nature of the microorganisms isolated.
SPECIAL INSTRUCTIONS: Avoid exposure to atmospheric oxygen. Specimens should be transported as soon as possible. When transportation is delayed, leave at room temperature. Do NOT refrigerate. The specific anatomic site of the body fluid MUST be specified on the order or requisition.
CONTAINER TYPE:

BBLTM Port-A-Cul Transport System; Bact/Alert® SN (anaerobic) bottles; sealed sterile container

COLLECTION:

The specimen of choice is an aspirate, NOT a swab. Specimens are to be collected from a site prepared utilizing aseptic technique. Overlying and adjacent areas must be carefully prepared to eliminate surface (normal flora) anaerobes. Ideally, material obtained by needle aspiration through intact surface which has been cleaned with antiseptic, is put directly into either the BBLTM Port-A-Cul Transport System or 0.5-10 mL into the Bact/Alert® SN (anaerobic) bottles. If Bact/Alert® SN bottles are not directly inoculated, all air should be expelled from the syringe after which the specimen should be injected into the BBLTM Port-A-Cul Transport System or sealed sterile container. Swabs should be used as a last resort due to the small volume of specimen obtainable by this method. If a swab must be used, insert the swab containing the specimen about 1 cm from the bottom of the transport tube. Break off the swab shaft and secure the lid tightly. Contamination with normal flora from skin or other body surfaces MUST be avoided since colonizing bacteria not involved in the infectious process may be introduced into the sample.

SPECIMEN REQUIREMENTS: Aspirated body fluid, pleural, peritoneal, pericardial, synovial, and other normally sterile sites and fluids
REJECTION CRITERIA: Inappropriate specimen container, insufficient specimen volume, refrigerated specimen, gross contamination of specimen. Specimens from sites which have anaerobic bacteria as normal flora will routinely be rejected.
MINIMUM VOLUME: 0.5-10 mL; 0.5-10 mL per Bact/Alert® SN (anaerobic) bottles
HANDLING INSTRUCTIONS:

Avoid exposure to atmospheric oxygen. Specimen should be transported as soon as possible. When transportation is delayed, leave at room temperature. Do NOT refrigerate.

REFERENCE RANGE: No growth of anaerobic bacteria.
LIMITATIONS OF TEST:

A specimen received in anaerobic transport devices is not suitable for routine fungal or mycobacterial cultures. If more than three anaerobic isolates are present, the Bacteroides fragilis group, and Clostridium perfringens will be identified. Anaerobic susceptibility testing is not performed routinely. Should susceptibility testing be required, call the Clinical Microbiology laboratory at (312)942-5452.

METHODOLOGY: Conventional culture utilizing media specifically formulated for anaerobic isolation or automation (continuous monitoring) for Bact/Alert® SN bottles.
ADDITIONAL INFORMATION: The use of blood culture bottles for submission of the specimens has some limitations: quantitation unavailable, Gram stain unavailable unless a separate sample is submitted. Use of the bottles does however increase the sensitivity of the culture procedure and provides for automated continuous monitoring.
LAST UPDATED:

5-13-2014

TEST SYNONYM(S):Anaerobic Culture, Body Fluid

Body Fluid Culture, Fungus

CERNER / EPIC MNEMONIC: C FUNGUSSM; C FUNGUS (CSF only)
POE DESCRIPTION: CU FUNGUS W SMEAR (NON-SKIN); C FUNGUSSM

For CSF only: CU FUNGUS (NON-SKIN); C FUNGUS (NON-SKIN)

CPT CODE: 87102 (culture); 87206 (smear)
TEST INFORMATION: Test includes a culture for fungi and performance of a direct fungal smear. All fungal isolates will be identified. A Cryptococcal Antigen test will routinely be performed on all cerebrospinal specimens in lieu of a fungal smear if an adequate volume of sample is submitted. Other isolated organisms (i.e. aerobes, etc.) may be referred for identification and/or susceptibility testing if medically indicated AND a separate culture procedure has NOT yielded the same organism(s).
DAYS PERFORMED: Daily, 24 hours
TURNAROUND TIME: Smear results: same day if the specimen is received in the laboratory no later than 1400. Preliminary culture reports are available after 1 week or when an isolate is detected. Cultures will be finalized after 4 weeks.
SPECIAL INSTRUCTIONS: The specific anatomic site of the body fluid MUST be specified on the order or requisition.
CONTAINER TYPE: Sealed sterile container, no preservative; Copan Swab® II
COLLECTION: The specimen of choice is an aspirate, NOT a swab. Specimens are to be collected from a site prepared utilizing aseptic technique. Overlying and adjacent areas must be carefully prepared to eliminate surface (normal flora) organisms. Ideally, material obtained by needle aspiration through intact surface which has been cleaned with antiseptic, is put directly into a sealed, sterile container. Swabs should be used as a last resort due to the small volume of specimen obtainable by this method. If a swab must be used, use the Copan Swab® II collection device. Contamination with normal flora from skin or other body surfaces must be avoided since colonizing bacteria not involved in the infectious process may be introduced into the sample.
SPECIMEN REQUIREMENTS: Aspirated body fluid
REJECTION CRITERIA: Inappropriate specimen container, insufficient specimen volume, refrigerated specimen, specimen submitted in a preservative.
MINIMUM VOLUME: 0.5 mL
HANDLING INSTRUCTIONS: Specimen should be transported as soon as possible. When transportation is delayed, leave at room temperature.
REFERENCE RANGE: No fungi isolated/observed.
METHODOLOGY: Fungal smear: calcofluor white stain. Culture: Conventional culture utilizing media specifically formulated for fungal isolation.
TEST SYNONYM(S):Fungus Culture, Body Fluid

Body Fluid Culture, Mycobacterium

CERNER / EPIC MNEMONIC:

C AFBSM / C AFB for CSF

POE DESCRIPTION: CU MYCOBACTERIUM W SMEAR; CU AFB W SMEAR; C AFBSM
CPT CODE: 87116 (culture); 87206 (smear); 87015
TEST INFORMATION:

Test includes culture and acid-fast stain (if specimen volume is adequate). If a mycobacterial species is isolated, the organism will be identified. Susceptibility testing will be performed depending upon the isolate identification. Other isolated organisms (i.e. aerobes, yeast, etc.) may be referred for identification and/or susceptibility testing if medically indicated AND a separate culture procedure has NOT yielded the same organism(s).

DAYS PERFORMED: Daily
TURNAROUND TIME: Smear results: 24 hours after receipt of the specimen in the laboratory. Preliminary culture reports are available after 1 week or when a mycobacterial isolate is detected. Negative cultures with negative smears will be finalized after 8 weeks. Negative cultures with positive smears will be finalized after 12 weeks. Completion of culture reports may require additional time when mycobacteria are isolated and/or susceptibility testing is performed.
SPECIAL INSTRUCTIONS: The specific anatomic site of the body fluid MUST be specified on the order or requisition.
CONTAINER TYPE: Sealed sterile container, no preservative
COLLECTION: The specimen of choice is an aspirate, NOT a swab. Specimens are to be collected from a site prepared utilizing aseptic technique. Overlying and adjacent areas must be carefully prepared to eliminate surface (normal flora) organisms. Ideally, material obtained by needle aspiration through intact surface which has been cleaned with antiseptic, is put directly into a sealed, sterile container. Contamination with normal flora from skin or other body surfaces must be avoided since colonizing bacteria not involved in the infectious process may be introduced into the sample. Pulmonary samples may be obtained by transtracheal percutaneous needle aspiration.
SPECIMEN REQUIREMENTS: Aspirated body fluid. Because of the small number of mycobacteria present in most infected body fluids, submission of large volumes, ideally > 5 mL, will improve the sensitivity of culture. This is especially true for CSF specimens. A minimum volume of 10 mL is needed for CSF cultures.
REJECTION CRITERIA: Inappropriate specimen container, insufficient specimen volume, specimen received in a preservative. Only three specimens per body site with negative acid-fast smears will be processed. Subsequent specimens will be rejected. Specimens from known positive patients will be accepted only once a week for culture and smear per body site.
MINIMUM VOLUME: 0.5 mL; 1 mL for CSF culture; 10 mL preferred.
HANDLING INSTRUCTIONS: Specimen should be transported as soon as possible. When transportation is delayed, refrigerate.
REFERENCE RANGE: No acid-fast bacilli observed on smear or isolated in culture.
LIMITATIONS OF TEST: A single negative smear does not rule out the presence of mycobacterial infection.
METHODOLOGY:

Due to low sensitivity AFB smears not performed on CSF specimen. Culture: inoculation of conventional culture media and a rapid medium for automated continuous analysis.

 

 

ADDITIONAL INFORMATION:

DNA probes may be incorporated to aid with more rapid identification of mycobacterial isolates. This will generate an additional charge(s). Susceptibility testing will be performed only on the first Mycobacterium isolate from each specimen type per patient. Additional susceptibilities may be performed after a period of 4 weeks for patients with suspected treatment failure. Susceptibility testing is performed routinely only for M. tuberculosis complex.  Susceptibility testing for other Mycobacterium species is performed by special request only. The battery of drugs routinely tested will vary by isolate and/or physician request. Patients from whom M. tuberculosis is isolated in culture are reported to the City of Chicago Board of Health. This is mandated by law.

LAST UPDATED:

5-13-2014

TEST SYNONYM(S):AFB Culture, Body Fluid; Body Fluid AFB Culture; Body Fluid Culture, TB; Mycobacterium Culture, Body Fluid; TB Culture, Body Fluid

Body Fluid Culture, Routine

CERNER / EPIC MNEMONIC: C FLUID; C FLUIDGS
POE DESCRIPTION: CU FLUID AND GRAM STAIN; C FLUIDGS

CU FLUID; FLUID CULTURE

CPT CODE: 87071 (culture); 87205 (Gram stain)
TEST INFORMATION: Test includes a direct Gram stain, isolation and identification of microorganisms, and susceptibility testing, if appropriate. Other isolated organisms (i.e. fungi, mycobacteria) may be referred for identification and/or susceptibility testing if medically indicated AND a separate culture procedure has NOT yielded the same organism(s).
DAYS PERFORMED: Daily, 24 hours
TURNAROUND TIME:

Gram stain: 1 hour for CSF after receipt of the specimen in the laboratory. Preliminary culture reports available after 24 hours. Culture reports of no growth will be issued after 72 hours. Completion of culture reports may take 3-4 days after receipt of the specimen when multiple isolates are found.

SPECIAL INSTRUCTIONS:

The specific anatomic site of the body fluid MUST be specified on the order or the requisition.  All sterile body fluids (except CSF) cultured aerobically and anaerobically unless specifically indicated on the order or requisition that "no anaerobic culture needed."

CONTAINER TYPE:

Sealed sterile container; BacT/ALERT® SA (aerobic) and BacT/ALERT® SN(anaerobic); red top Vacutainer® tube

COLLECTION: The specimen of choice is an aspirate, NOT a swab. Specimens are to be collected from a site prepared utilizing aseptic technique. Overlying and adjacent areas must be carefully prepared to eliminate surface (normal flora) organisms. Ideally, material obtained by needle aspiration through intact surface which has been cleaned with antiseptic, is put directly into a sealed, sterile container. Swabs should be used as a last resort due to the small volume of specimen obtainable by this method. If a swab must be used, use the Copan Swab® II collection device. Contamination with normal flora from skin or other body surfaces must be avoided since colonizing bacteria not involved in the infectious process may be introduced into the sample. Pulmonary samples may be obtained by transtracheal percutaneous needle aspiration.
SPECIMEN REQUIREMENTS: Aseptically aspirated body fluid
REJECTION CRITERIA: Inappropriate specimen container, insufficient specimen volume, gross contamination of specimen, refrigerated specimen.
MINIMUM VOLUME: 1 mL sealed sterile container, 0.5 mL per Bact/Alert bottle
HANDLING INSTRUCTIONS:

Specimen should be transported as soon as possible. When transportation is delayed, leave at room temperature. Do NOT refrigerate.

REFERENCE RANGE: No growth
LIMITATIONS OF TEST:

The use of blood culture bottles for submission of the specimen has some limitations: quantitation unavailable, Gram stain unavailable unless a separate sample is submitted. Use of the blood culture bottles does however increase the sensitivity of the culture procedure.

METHODOLOGY: Inoculation of conventional culture media; automation (continuous monitoring) for Bact/Alert blood culture media.
LAST UPDATED:

5-19-2014

Bone Marrow Culture, Fungus

CERNER / EPIC MNEMONIC: C FUNGUSSM
POE DESCRIPTION: CU FUNGUS W SMEAR (NON-SKIN); C FUNGUSSM (NON-SKIN)
CPT CODE: 87102, 87206
TEST INFORMATION: Test includes a culture for fungi and performance of a direct fungal smear. All fungal isolates will be identified. Other isolated organisms (i.e. aerobes, mycobacteria) may be referred for identification and/or susceptibility testing if medically indicated AND a separate culture procedure has NOT yielded the same organism(s).
DAYS PERFORMED: Daily, 24 hours
TURNAROUND TIME: Smear results: same day if the specimen is received in the laboratory no later than 1400. Preliminary culture reports are available after 1 week or when an isolate is detected. Cultures will be finalized after 4 weeks.
SPECIAL INSTRUCTIONS: The specific anatomic site of the specimen MUST be specified on the order or requisition.
CONTAINER TYPE: Yellow top SPS Vacutainer® tube
COLLECTION: Specimens are to be collected from a site prepared utilizing aseptic technique. Overlying and adjacent areas must be carefully prepared to eliminate surface organisms. Material obtained by needle aspiration through intact surface, which has been cleaned with antiseptic, is injected into the yellow top SPS Vacutainer® tube. Invert the tube 5-10 times to mix well.
SPECIMEN REQUIREMENTS: Bone marrow
REJECTION CRITERIA: Inappropriate specimen container, insufficient specimen volume, refrigerated specimen.
MINIMUM VOLUME: 1 mL
HANDLING INSTRUCTIONS: Specimen should be transported as soon as possible. When transportation is delayed, leave at room temperature. Do NOT refrigerate.
REFERENCE RANGE: No fungi isolated/observed.
METHODOLOGY: Fungal smear: calcofluor white stain. Culture: Conventional culture utilizing media specifically formulated for fungal isolation.
ADDITIONAL INFORMATION: Fungal blood cultures are most effective in isolating Candida albicans and other yeasts.
TEST SYNONYM(S):Fungus Culture, Bone Marrow

Bone Marrow Culture, Mycobacterium

CERNER / EPIC MNEMONIC:

C AFB BL

POE DESCRIPTION: CU MYCOBACTERIUM W SMEAR; CU AFB W SMEAR; C AFBSM
CPT CODE:

87116 (culture)

TEST INFORMATION:

Culture only, no acid fast stain (if specimen volume is adequate). If a mycobacterial species is isolated, the organism will be identified. Susceptibility testing will be performed depending upon the isolate identification. Other isolated organisms (i.e. aerobes, fungi) may be referred for identification and/or susceptibility testing if medically indicated AND a separate culture procedure has NOT yielded the same organism(s).

DAYS PERFORMED: Daily
TURNAROUND TIME:

Preliminary culture reports are available after 1 week or when a mycobacterial isolate is detected. Negative cultures will be finalized after 8 weeks. Completion of culture reports may require additional time when mycobacteria are isolated and/or susceptibility testing is performed.

CONTAINER TYPE:

Bactec Myco/F Lytic bottle (available from Clinical Microbiology, 312-942-5452)

COLLECTION:

Specimens are to be collected from a site prepared utilizing aseptic technique. Material obtained by needle aspiration, is injected into the bottle. Invert the tube 5-10 times to mix well.

SPECIMEN REQUIREMENTS: Bone marrow
REJECTION CRITERIA:

Inappropriate specimen container, insufficient specimen volume, refrigerated specimen.

MINIMUM VOLUME: 0.5 mL
HANDLING INSTRUCTIONS: Specimen should be transported as soon as possible. When transportation is delayed, leave at room temperature. Do NOT refrigerate.
REFERENCE RANGE:

No acid-fast bacilli isolated.

METHODOLOGY:

Culture:  Automated continuous analysis

ADDITIONAL INFORMATION:

DNA probes may be incorporated to aid with more rapid identification of mycobacterial isolates. This will generate an additional charge(s). Susceptibility testing will be performed only on the first Mycobacterium isolate from each specimen type per patient. Additional susceptibilities may be performed after a period of 4 weeks for patients with suspected treatment failure. Susceptibility testing is performed routinely only for M. tuberculosis complex.  Susceptibility testing for other Mycobacterium species is performed by special request only. The battery of drugs routinely tested will vary by isolate and/or physician request. Patients from whom M. tuberculosis is isolated in culture are reported to the City of Chicago Board of Health. This is mandated by law.

LAST UPDATED:

5-13-2014

TEST SYNONYM(S):AFB Culture, Bone Marrow; Mycobacterium Culture, Bone Marrow; TB Culture, Bone Marrow

Bordetella pertussis PCR

CERNER / EPIC MNEMONIC:

BPERT PCR

POE DESCRIPTION: MICROBIOLOGY REFERRAL
CPT CODE:

87798 - No Fee

TEST INFORMATION:

Test includes PCR and detection of Bordetella Pertusis DNA.

DAYS PERFORMED: Monday-Friday, 0700-1400
SPECIAL INSTRUCTIONS: Requisition must specify Bordetella pertussis and/or B. parapertussis.  The specific anatomic site of the specimen MUST be specified on the order or requisition.
CONTAINER TYPE:

Sealed sterile container

COLLECTION:

Shape the flexible swab into the contour of the nares and into the nasopharynx. Pass the swab gently through the nose. Leave the swab in place near the septum and floor of nose for 15-30 seconds. Rotate and remove. Insert the swab into sterile container. Nasopharyngeal washings or aspirate acceptable. Submit to the Clinical Microbiology laboratory IMMEDIATELY.

SPECIMEN REQUIREMENTS: Calgiswab® nasopharyngeal (NP) swab; nasopharyngeal washings (sealed sterile container).
REJECTION CRITERIA:

Swab specimen submitted in viral transport medium; insufficient quantity.

MINIMUM VOLUME: One NP swab; 1 mL washings/aspirate
HANDLING INSTRUCTIONS: When transportation MUST be delayed, leave at room temperature.
REFERENCE RANGE:

No B. pertussis DNA detected

LIMITATIONS OF TEST:

PCR test does not differentiate live organisms from dead.

METHODOLOGY:

PCR

REFERRAL LABORATORY:

Commercial

LAST UPDATED:

6-2-2014

TEST SYNONYM(S):Whooping cough; Bordetella parapertussis PCR

Bronchial Aspirate Culture, Fungus

CERNER / EPIC MNEMONIC: C FUNGUSSM
POE DESCRIPTION: CU FUNGUS W SMEAR (NON-SKIN); C FUNGUSSM (NON-SKIN)
CPT CODE: 87102 (culture); 87206 (smear)
TEST INFORMATION: Test includes a culture for fungi and performance of a direct fungal smear. All fungal isolates will be identified. Other isolated organisms (i.e. aerobes, mycobacteria) may be referred for identification and/or susceptibility testing if medically indicated AND a separate culture procedure has NOT yielded the same organism(s).
DAYS PERFORMED: Daily, 24 hours
TURNAROUND TIME: Smear results: same day if the specimen is received in the laboratory no later than 1400. Preliminary culture reports are available after 1 week or when a fungal isolate is detected. Cultures will be finalized after 4 weeks.
SPECIAL INSTRUCTIONS: The specific anatomic site of the specimen MUST be specified on the order or requisition.
CONTAINER TYPE: Sealed sterile container, no preservative; sterile sputum container; sterile Leuken`s tube
COLLECTION: Specimens are to be collected from a site prepared utilizing aseptic technique. Non-bacteriostatic sterile saline should be used when obtaining washings and/or lavage specimens. Material obtained by needle aspiration (transbronchial lung biopsy) is injected into a sealed sterile container.
SPECIMEN REQUIREMENTS: Bronchial aspirate, bronchial biopsy, bronchial brush, endotracheal aspirate, transtracheal aspirate, tracheal aspirate
REJECTION CRITERIA: Inappropriate specimen container, insufficient specimen volume, specimen received in a preservative.
MINIMUM VOLUME: 1 mL or a piece of tissue
HANDLING INSTRUCTIONS: Specimen should be transported as soon as possible. When transportation is delayed, leave at room temperature. Do NOT refrigerate.
REFERENCE RANGE: No fungi observed/isolated.
LIMITATIONS OF TEST: Anesthetic solutions used during the bronchoscopy procedure may inhibit growth of organisms. Bronchial brushes MUST be transported to the laboratory IMMEDIATELY to eliminate dessication of the specimen. Specimens collected via bronchoscopy are contaminated with normal oral flora.
METHODOLOGY: Fungal smear: calcofluor white stain. Culture: Conventional culture utilizing media specifically formulated for fungal isolation.
ADDITIONAL INFORMATION: Please notify the Clinical Microbiology Laboratory (312-942-5452) if Histoplasma capsulatum, Blastomyces dermatitidis, or Coccidioides immitis is suspected. These pathogens are highly infectious when propagated in vitro and have been transmitted to exposed laboratory workers.
TEST SYNONYM(S):Fungus Culture, Bronchial Aspirate

Bronchial Aspirate Culture, Mycobacterium

CERNER / EPIC MNEMONIC: C AFBSM
POE DESCRIPTION: CU MYCOBACTERIUM W SMEAR; CU AFB W SMEAR; C AFBSM

CPT CODE: 87117 (culture); 87206 (smear)
CDM NUMBER: 3451029; 3451025
TEST INFORMATION: The test includes culture and acid-fast stain (if specimen volume is adequate). Culture includes decontamination and concentration followed by inoculation of specific mycobacterial conventional media and a rapid medium for automated analysis. If a mycobacterial species is isolated, the organism will be definitely identified. Susceptibility testing will be performed depending on the isolate identification. Other isolated organisms (i.e. aerobes, fungi) may be referred for identification and/or susceptibility testing if medically indicated AND a separate culture procedure has NOT yielded the same organism(s).
DAYS PERFORMED: Daily
TURNAROUND TIME: Smear results: 24 hours after receipt of the specimen in the laboratory. Preliminary culture reports are available after 1 week or when a mycobacterial isolate is detected. Negative cultures with negative smears will be finalized after 8 weeks. Negative cultures with positive smears will be finalized after 12 weeks. Completion of culture reports may require additional time when mycobacteria are isolated and susceptibility testing is performed.
SPECIAL INSTRUCTIONS: The specific anatomic site of the specimen MUST be specified on the order or requisition.
CONTAINER TYPE: Sterile sputum container; sterile Leuken`s tube; sealed sterile container, no preservative
COLLECTION: Specimens are to be collected from a site prepared utilizing aseptic technique. Non-bacteriostatic sterile saline should be used when obtaining washings and/or lavage specimens. Material obtained by needle aspiration (transbronchial lung biopsy) is injected into a sealed sterile container.
SPECIMEN REQUIREMENTS: Bronchial aspirate, bronchial biopsy, bronchial brush
REJECTION CRITERIA:

Inappropriate specimen container, insufficient specimen volume, specimen received in a preservative. Specimens from known positive patients will be accepted only once a week for culture and smear per body site.

MINIMUM VOLUME: 5 mL or a piece of tissue
HANDLING INSTRUCTIONS:

Specimen should be transported as soon as possible. When transportation is delayed, refrigerate.

REFERENCE RANGE: No acid-fast bacilli observed on smear or isolated in culture
LIMITATIONS OF TEST: A single negative smear does not rule out the presence of mycobacterial infection. Anesthetic solutions used during the bronchoscopy procedure may inhibit growth of organisms. Bronchial brushes MUST be transported to the laboratory IMMEDIATELY to eliminate desiccation of the specimen. Specimens collected via bronchoscopy are contaminated with normal oral flora.
METHODOLOGY: Acid-fast smear: fluorochrome stain. Culture: inoculation of conventional culture media and a rapid medium for automated continuous analysis.
ADDITIONAL INFORMATION:

DNA probes may be incorporated to aid with more rapid identification of mycobacterial isolates. This will generate an additional charge(s). Susceptibility testing will be performed only on the first Mycobacterium isolate from each specimen type per patient. Additional susceptibilities may be performed after a period of 4 weeks for patients with suspected treatment failure. Susceptibility testing is performed routinely only for M. tuberculosis complex.  Susceptibility testing for other Mycobacterium species is performed by special request only. The battery of drugs routinely tested will vary by isolate and/or physician request. Patients from whom M. tuberculosis is isolated in culture are reported to the City of Chicago Board of Health. This is mandated by law.

LAST UPDATED:

5-13-2014

TEST SYNONYM(S):Bronchial Aspirate AFB Culture; Bronchial Aspirate TB Culture; Lower Respiratory Mycobacterium Culture; Mycobacterium Culture; Bronchial Aspirate

Bronchial Aspirate Culture, Routine

CERNER / EPIC MNEMONIC: C SPUTUMGS
POE DESCRIPTION: SPUTUM OR LEUKENS W GRAM STAIN; CU SPUTUM AND GS; C SPUTUMGS
CPT CODE: 87071 (culture); 87025 (smear)
TEST INFORMATION: Test includes a direct Gram stain, isolation and identification of potential pathogens, and susceptibility testing, if appropriate. Other isolated organisms (i.e. fungi, mycobacteria) may be referred for identification and/or susceptibility testing if medically indicated AND a separate culture procedure has NOT yielded the same organism(s).
DAYS PERFORMED: Daily, 24 hours
TURNAROUND TIME:

Preliminary culture reports are available after 24-48 hours. Cultures with no growth or normal flora only will be finalized after 48 hours. Completion of culture reports may take 3-4 days after receipt of the specimen when multiple isolates are found.

SPECIAL INSTRUCTIONS: The specific anatomic site of the specimen MUST be specified on the order or requisition. Order or requisition must also state Cystic Fibrosis protocol, when appropriate, for cystic fibrosis patients.
CONTAINER TYPE: Sealed sterile container, no preservative; sterile sputum container; sterile Leuken`s tube
COLLECTION: Specimens are to be collected from a site prepared utilizing aseptic technique. Non-bacteriostatic sterile saline should be used when obtaining washings and/or lavage specimens. Material obtained by needle aspiration (transbronchial lung biopsy) is injected into a sealed sterile container.
SPECIMEN REQUIREMENTS: Bronchial aspirate, bronchial biopsy, bronchial brush, endotracheal aspirate, tracheal aspirate, transtracheal aspirate
REJECTION CRITERIA: Inappropriate specimen container, insufficient specimen volume, specimen submitted in a preservative.
MINIMUM VOLUME: 2-10 mL or a piece of tissue
HANDLING INSTRUCTIONS: Specimen should be transported as soon as possible. When transportation is delayed, leave at room temperature. Do NOT refrigerate.
REFERENCE RANGE: No growth or normal respiratory flora only
LIMITATIONS OF TEST: Anesthetic solutions used during the bronchoscopy procedure may inhibit growth of organisms. Bronchial brushes MUST be transported to the laboratory IMMEDIATELY to eliminate desiccation of the specimen. Specimens collected via bronchoscopy are contaminated with normal oral flora. Postbronchoscopy expectorated specimens may provide a better yield of organisms than those obtained during the bronchoscopy procedure.
METHODOLOGY: Inoculation of conventional culture media.
ADDITIONAL INFORMATION: Presence of normal respiratory flora will be reported. Normal flora includes alpha and nonhemolytic streptococci, saprophytic Neisseria species, coagulase-negative staphylococci, Micrococcus species, and diphtheroids. Bronchial specimens are not screened for specimen acceptability by means of a sputum screen.
LAST UPDATED:

5-19-2014

TEST SYNONYM(S):Lower Respiratory Culture Aspirate

Brucella Antibody Panel

CERNER / EPIC MNEMONIC:

BRUCELLA

POE DESCRIPTION: MICROBIOLOGY REFERRAL
CPT CODE: 86622 (x2)
TEST INFORMATION: Test includes antibody titers to Brucella abortus.
DAYS PERFORMED: Monday-Friday, 0700-1400
TURNAROUND TIME: 2-5 days
SPECIAL INSTRUCTIONS: Acute and convalescent specimens should be submitted with the convalescent specimen submitted 2-3 weeks after the acute. It is the requesting physician`s responsibility to see that both acute and convalescent specimens are obtained.
CONTAINER TYPE:

Red top Vacutainer® tube or SSTTM tube, sterile container with no preservative for CSF

SPECIMEN REQUIREMENTS:

Blood (serum), CSF

REJECTION CRITERIA: Inappropriate specimen container, insufficient specimen volume.
MINIMUM VOLUME:

5 mL blood (1 mL serum) or 1 mL CSF

HANDLING INSTRUCTIONS: Specimen should be transported as soon as possible. When transportation is delayed, refrigerate.
REFERENCE RANGE:

Serum:  < .80

CSF   :  < .50

LIMITATIONS OF TEST: Cross reactions can occur with other Brucella species, Yersinia enterocolitica serotype 9, Francisella tularensis, and Vibrio cholerae. Brucella abortus antigen detects infection also caused by B. suis and B. melitensis, but not B. canis.
METHODOLOGY:

ELISA

REFERRAL LABORATORY: Commercial Laboratory
ADDITIONAL INFORMATION:

Antibody titers are measured against Brucella abortus ONLY. Brucellosis antibody appears during the second week in acute cases and peaks in 3-6 weeks. Acute disease is manifested by the presence of specific IgM and increasing amounts of IgG antibodies. Elevated concentrations of Brucella specific IgG are seen in patients with chronic brucellosis.

LAST UPDATED:

5-19-2014

Bone Marrow Aspirate and Biopsy

CERNER / EPIC MNEMONIC: BMA; BMBX;
TEST INFORMATION: Test includes H&E stain, Wright's stain, and iron stain
DAYS PERFORMED: Mon-Fri, 0800-1530; for emergencies also available stat Mon-Fri, 1530-0900 and 24 hours on weekends by contacting Hematology fellow 'on call.' Stat requests must be accompanied by a stat Hematology consult except for extenuating circumstances negotiated with the Diagnostic Bone Marrow Laboratory on an individual basis, technologists will not be available to perform or assist with bone marrows in the O.R. When applicable, arrangements for such must be made 24 hours in advance.
TURNAROUND TIME: 2-3 working days
SPECIAL INSTRUCTIONS: For adult patients schedule procedure with the Diagnostic Bone Marrow Clinic, 563-2348. Aspirates on pediatric patients are performed by pediatric hematology/oncology, 942-8114.The test must be ordered in the patient chart. Include requests for cultures, flow cytometry, cytogenetics, molecular studies, or other procedures indicated. Clinical history must be stated. Patient must have current CBC, platelet, PT and PTT results available. Patients with platelet counts <20,000/mm3 or abnormal PT and PTT results must be cleared with a Hematology attending physician. If premedication of patient is desired, the laboratory should be notified at the time the test is scheduled.
CONTAINER TYPE: Slides prepared by laboratory technologist, biopsy placed in fixative by technologist
COLLECTION: Test performed by Hematology fellow or resident physician.
SPECIMEN REQUIREMENTS: Bone marrow aspirate and/or biopsy
REJECTION CRITERIA: Order not written on patient's chart; CBC, platelet, PT, or PTT results not available or are abnormal beyond proscribed limits.
MINIMUM VOLUME: >1 cm core of bone marrow from biopsy; 2-5 mL aspirate
REFERENCE RANGE: Preliminary and final results interpreted by Hematopathologist. Phone Surgical Pathology, 942-5260 for results.
LIMITATIONS OF TEST: Aspirates containing insufficient numbers of cells may not be representative of the marrow.
ADDITIONAL INFORMATION: Written consent for a bone marrow aspirate is not required. The attending physician will explain the procedure to the patient and obtain verbal consent prior to scheduling the test with the laboratory.

Patient should lie on site for 20-30 minutes and keep site dry for 24 hours.

Evaluate bone marrow cellularity, morphology, and iron stores; may assist in diagnosis of elevated blood cell counts, cytopenias, leukemias, dysplasia, staging of lymphomas and diagnosis of certain infections (MAI, histoplasmosis, etc); marrow culture occasionally may assist in diagnosis of infection. For staging of lymphomas, for diagnosis of infections, and for evaluation of metastases, biopsy has higher yield than aspirate alone. In general, in an otherwise healthy patient, ferritin level measurement in conjunction with the serum iron, TIBC, and peripheral smear evaluation can replace bone marrow exam when the only indication for marrow exam is evaluation of iron stores.

Patient's platelet count must be > 20,000/mm3 and INR <1.5 except upon approval by a Hematology attending physician.

TEST SYNONYM(S):Bone Marrow; Bone Marrow Biopsy

Blood Donation

CERNER / EPIC MNEMONIC: (not orderable on LIS)
CPT CODE: 86999
DAYS PERFORMED: Mon-Fri, 0800-2000; Sat, 0800-1600; Sun, 1100-1900
TURNAROUND TIME: 1 hour for donations; 3 working days till available for transfusion
SPECIMEN REQUIREMENTS: Blood
MINIMUM VOLUME: 450 mL
TEST SYNONYM(S):Autologous Blood; Directed Donor Blood; Phlebotomy

Blood Gases, Venous - Cord Blood

CERNER / EPIC MNEMONIC: VBG-C
POE DESCRIPTION: VBG CORD, VENOUS BLOOD GASES (CORD), CORD VBG
CPT CODE: 82803
TEST INFORMATION: Test includes measured pH, p02, pC02 and calculated Bicarbonate, total C02, 02 saturation and Base Excess.
DAYS PERFORMED: Specimen accepted daily, 24 hours
TURNAROUND TIME: 15 minutes
SPECIAL INSTRUCTIONS: Requisition must indicate source (ie, venous) and time sample id drawn.
CONTAINER TYPE: Heparinized syringe
SPECIMEN REQUIREMENTS: Cord blood, venous
REJECTION CRITERIA: Include clotted sample, needles still attached to the syringe, or air bubbles in the sample.
MINIMUM VOLUME: 0.3 mL
HANDLING INSTRUCTIONS: Deliver specimen immediately to the lab on ice.
REFERENCE RANGE: Reference ranges not established for cord samples.
TEST SYNONYM(S):Cord Blood Gases, Venous

Blood Gases, Arterial - Cord Blood

CERNER / EPIC MNEMONIC: ABG-C
POE DESCRIPTION: ABG CORD, ARTERIAL BLOOD GAS (CORD), CORD ABG
CPT CODE: 82803
TEST INFORMATION: Test includes measured pH, p02, pC02 and calculated Bicarbonate, total C02, 02 saturation and Base Excess
DAYS PERFORMED: Specimen accepted daily, 24 hours
TURNAROUND TIME: 15 minutes
SPECIAL INSTRUCTIONS: Requisition must include source (ie, arterial) and time sample is drawn.
CONTAINER TYPE: Heparinized syringe
SPECIMEN REQUIREMENTS: Cord blood, arterial
REJECTION CRITERIA: Include clotted sample, needles still attached to the syringe, or air bubbles in the syringe.
MINIMUM VOLUME: 0.3 mL
HANDLING INSTRUCTIONS: Deliver specimen immediately to the lab on ice.
REFERENCE RANGE: Reference ranges not established for cord samples.
TEST SYNONYM(S):Cord Blood Gas, Arterial

Beta-2 Transferrin

CERNER / EPIC MNEMONIC: BETA2 TRF
POE DESCRIPTION: BETA-2 TRANSFERRIN
CPT CODE:

86335-90

TEST INFORMATION: Used for detection of cerebrospinal fluid leakage in ear or nasal fluid.
TURNAROUND TIME: 5 days
SPECIAL INSTRUCTIONS: Direct collections may be done with a pipette, syringe, test tube or microcollection device. Samples absorbed into an absorbent material MUST be expressed from the absorbent material and placed into a microcollection container.
CONTAINER TYPE: If liquid, tightly sealed container
SPECIMEN REQUIREMENTS: 0.5 mL Fluid; Collected specimen may be in a serous liquid form, or may have been absorbed into an absorbent material such as cotton swabs, gauze sponges, cotton balls, etc.
MINIMUM VOLUME:

0.1 mL Fluid

HANDLING INSTRUCTIONS: Deliver to Core Laboratory as soon as possible.
REFERENCE RANGE:

See Specialty Labs - Search Test Code S48873

REFERENCE CHART: Tau-transferrin, Asialo-transferrin

Bilirubin, Amniotic Fluid

CERNER / EPIC MNEMONIC: SPEC SCAN
POE DESCRIPTION: FL AMNIOTIC SPECTROPHOTOM
CPT CODE: 82143-90
TURNAROUND TIME: 4-6 hours
SPECIAL INSTRUCTIONS: State gestational age on requisition.
CONTAINER TYPE: Brown plastic tubes for amnios
SPECIMEN REQUIREMENTS: 7 mL amniotic fluid
MINIMUM VOLUME: 2 mL
HANDLING INSTRUCTIONS: Keep specimen on ice; protect from light. Transport to the laboratory immediately.  Do not process specimen in any manner.

REFERENCE RANGE:

See Quest Diagnostics - Search Test Code 289

Varies with week of gestation. A rise in optical density at 450 nm >0.15 at 34 weeks gestation suggests erythroblastosis fetalis. Liley's zone: I: minimal or no involvement, II: moderate involvement, III: severe involvement.

TEST SYNONYM(S):Amniotic Fluid Spectral Scan; Liley's Zone Analysis; OD 450

BMT Profile (52)

CERNER / EPIC MNEMONIC: Order individually
POE DESCRIPTION: BONE MARROW TRANSPLANT PROFILE (52)
CPT CODE: 85025; 80053; 83615; 83735; 84100; 84550
TEST INFORMATION:

Test includes CBC, CMP, LDH, MG, PO4, URIC.

DAYS PERFORMED: Daily, 24 hours.
TURNAROUND TIME: Routine: 8 hours; Stat 1 hour
CONTAINER TYPE:

Red top tube or SSTTM tube AND Lavender top

SPECIMEN REQUIREMENTS: Blood (serum and plasma)
MINIMUM VOLUME: 0.6 mL serum, 1.5 mL whole blood for CBC
TEST SYNONYM(S):BMT Panel

Blood Culture, Catheter

CERNER / EPIC MNEMONIC: C BLOODLN
POE DESCRIPTION: CU BLOOD SET (CATHETER); C BLOOD (CATHETER)
CPT CODE: 87040
TEST INFORMATION:

Used to isolate and identify potentially pathogenic aerobic and/or anaerobic microorganisms causing bacteremia and perform susceptibility testing, when appropriate; establish the diagnosis of endocarditis. Other isolated organisms (i.e. fungi and mycobacteria) may be referred for identification and/or susceptibility testing if medically indicated AND a separate culture procedure has NOT yielded the same organism(s).

DAYS PERFORMED:

Daily, 24 hours

TURNAROUND TIME: Preliminary culture reports available after 24 hours or when an isolate is detected. Culture reports of no growth will be issued after 5 days.
SPECIAL INSTRUCTIONS: The specific site of the specimen (i.e. arterial, swan ganz, etc.) MUST be specified on the order or requisition.
CONTAINER TYPE:

Blood: BacT/ALERT SA (aerobic) and BacT/ALERT SN(anaerobic)

COLLECTION:

Blood cultures should be obtained prior to the initiation of antimicrobial therapy. COLLECTION OF TWO BLOOD CULTURE SETS IS STRONGLY RECOMMENDED. Specimen to be collected via catheter.

Click here for detailed instructions for blood collection using a needle and syringe.

SPECIMEN REQUIREMENTS:

Blood

REJECTION CRITERIA:

Improperly labeled bottles, expired bottles, refrigerated specimen, insufficient specimen volume, clotted specimen

MINIMUM VOLUME:

0.1 mL blood per bottle (optimal volume for blood is 10 mL per bottle)

HANDLING INSTRUCTIONS:

Specimen should be transported as soon as possible.  When transportation is delayed, leave at room temperature. Do NOT refrigerate.

REFERENCE RANGE: No growth
LIMITATIONS OF TEST: Blood cultures from patients suspected of having Brucella or Leptospira MUST be requested as a special culture. Call the Clinical Microbiology laboratory at (312)942-5452 for special instructions for blood collection for these organisms. Candida species are usually isolated from routine blood cultures. However, if fastidious yeast such as Histoplasma capsulatum or Malasezzia furfur or mold are specifically suspected, a separate fungal blood culture should be drawn along with each of the routine blood specimens. See separate listing for proper collection of Blood Fungus Culture. If mycobacteria are suspected, a separate mycobacterial culture should be drawn along with each of the routine blood cultures. Refer to separate entry, Blood Mycobacterium Culture, for proper collection.
METHODOLOGY: Automation (continuous monitoring).
ADDITIONAL INFORMATION:

It is NOT recommended to culture blood while antimicrobials are present unless verification of an agent''s efficacy is needed. To diagnose endocarditis, 3 sets of cultures may be required. Single blood culture sets are usually inappropriate and are contraindicated except for pediatric patients.

LAST UPDATED:

5-19-2014

TEST SYNONYM(S):Blood Culture - Drawn from line

Beta 2 Glycoprotein I Antibodies, IgA, IgG, IgM

CERNER / EPIC MNEMONIC: B2 GLYP AB
POE DESCRIPTION: B2 GLYP AB
CPT CODE: 86146 (x3)
TEST INFORMATION:

Included as part of the Antiphospholipid Profile

TURNAROUND TIME: 5-7 working days
CONTAINER TYPE:

Red top tube or SSTTM tube

COLLECTION: Blood, serum
SPECIMEN REQUIREMENTS: 3.0 mL blood (1.0 serum )
MINIMUM VOLUME: 1.5 mL blood (0.6 mL serum)
REFERENCE RANGE: See Specialty Labs - Search Test Code 1083

Bone Specific Alkaline Phosphatase

CERNER / EPIC MNEMONIC: AP-BONE
POE DESCRIPTION: Bone Specific Alk Phos
CPT CODE: 84075-90
CDM NUMBER: 3181371
TURNAROUND TIME: 5-7 working days
CONTAINER TYPE:

Red top tube or SST TM  tube

SPECIMEN REQUIREMENTS: 2.0 mL blood (1.0 mL serum)
MINIMUM VOLUME: 1.0 mL blood (0.5 mL serum)
REFERENCE RANGE: See Specialty Labs - Search Test Code 3974
METHODOLOGY: Immunoradiometric Assay
TEST SYNONYM(S):Alkaline Phosphatase-Bone Specific

Bile Acids, fractionated, blood

CERNER / EPIC MNEMONIC:

BILE ACIDS

POE DESCRIPTION:

Bile Acids, fractionated

CPT CODE:

83789-90

TEST INFORMATION:

Test includes cholic, deoxycholic, chenodeoxycholic and total bile acids.

TURNAROUND TIME:

5-7 working days

CONTAINER TYPE:

SSTTM tube or red top

SPECIMEN REQUIREMENTS:

3.0 mL blood 1.0 mL serum)

MINIMUM VOLUME:

1.0 mL blood (0.2 mL serum)

REFERENCE RANGE:

See Specialty Labs - Search Test Code S49102

METHODOLOGY:

Tandem mass spectrometry

TEST SYNONYM(S):Bile salts

B-type Natriuretic Peptide

CERNER / EPIC MNEMONIC:

BNP

POE DESCRIPTION:

B-type Natriuretic Peptide

CPT CODE:

83520-90

CDM NUMBER:

3181386

TURNAROUND TIME:

Routine: 4 hours; STAT: 1 hour

SPECIAL INSTRUCTIONS:

This test cannot be added onto an existing sample more than 24 hours old.

CONTAINER TYPE: Lavender top (K2 EDTA) tube - 3 mL  (Plastic tube only)
SPECIMEN REQUIREMENTS:

3.0 mL EDTA whole blood (1.5 mL EDTA plasma)

REJECTION CRITERIA:

Gross hemolysis

MINIMUM VOLUME:

1 mL EDTA whole blood (0.3 mL EDTA plasma)

REFERENCE RANGE:

0-100 pg/mL

METHODOLOGY:

Chemiluminescent Microparticle Immunoassay (CMIA)

ADDITIONAL INFORMATION: BNP results < 100 pg/mL are seen in healthy patients. BNP is markedly increased in chronic and acute congestive heart failure patients and correlates with disease severity.
TEST SYNONYM(S):BNP, Brain Natriuretic Peptide, Natriuretic Peptide

B2 Microglobulin, Urine

CERNER / EPIC MNEMONIC:

RU/B2 MICR

POE DESCRIPTION:

Urine B2 Microglobulin Random

CPT CODE:

82232-90

TURNAROUND TIME:

5-7 working days

CONTAINER TYPE:

Random urine container

COLLECTION:

Random urine

SPECIMEN REQUIREMENTS:

4 mL random urine

MINIMUM VOLUME:

1 mL random urine

REFERENCE RANGE:

See Specialty Labs - Search Test Code 3143U

TEST SYNONYM(S):Urine B2 Microglobulin

Brazil nut (IgE) Rast Allergen

CERNER / EPIC MNEMONIC:

BRAZILNUT

POE DESCRIPTION:

Brazil Nut Allergen

CPT CODE:

86003-90

TURNAROUND TIME:

5-7 working days

CONTAINER TYPE:

SSTTM tube or red top

SPECIMEN REQUIREMENTS:

2.0 mL blood (1.0 mL serum)

MINIMUM VOLUME:

1.0 mL blood (0.3 mL serum)

REFERENCE RANGE:

See Specialty Labs - Search Test Code F18

Bacterial Vaginosis Screen

CERNER / EPIC MNEMONIC:

BV SCREEN

POE DESCRIPTION:

BV SCREEN

CPT CODE:

87205

TEST INFORMATION:

The Bacterial vaginosis screen utilizes a standardized scoring system (Nugent''''s) for the interpretation of Gram-stained vaginal smears to aid in the diagnosis of bacterial vaginosis.  Test has a sensitivity of 89.1% and specificity of 83.1%.

DAYS PERFORMED:

Daily, 24 hours

TURNAROUND TIME:

2 hours

CONTAINER TYPE:

culturette or sterile cup

COLLECTION:

swab of vaginal wall or discharge

SPECIMEN REQUIREMENTS:

specimen must be from vagina

REJECTION CRITERIA:

specimens other than vaginal secretions

MINIMUM VOLUME:

1 culturette

HANDLING INSTRUCTIONS:

room temperature  24 hours

REFERENCE RANGE:

0-3 normal,  4-6 altered vaginal flora, 7-10 bacterial vaginosis

LIMITATIONS OF TEST:

Interpretation of test has not been validated on pre-menarcheal girls or post-menopausal women

METHODOLOGY:

Gram stain using the Nugent Scoring system

ADDITIONAL INFORMATION:

Nugent score = 4 -6  indicates altered vaginal flora which frequently represents a transitional stage.  If signs and/or symptoms persist, repeat testing may be warranted.

Nugent score = 7 - 10 is indicative of Bacterial vaginosis

Quantity of wbc yeast and clue cells reported.

LAST UPDATED:

6-3-2014

TEST SYNONYM(S):vaginosis screen, non-specific vaginitis, anaerobic vaginosis, Gardnerella vaginalis vaginitis screen

Bilirubin, Total Fluid

CERNER / EPIC MNEMONIC:

F/TBIL

POE DESCRIPTION:

FLUID BILIRUBIN TOTAL

CPT CODE:

82247

DAYS PERFORMED:

Specimen accepted daily, 24 hours

TURNAROUND TIME:

1 hour

SPECIAL INSTRUCTIONS:

Must specify fluid type on the requisition.

CONTAINER TYPE:

Red top tube - 10 mLRed top tube - 4 mLSterile 80 mL specimen container

SPECIMEN REQUIREMENTS:

Body fluid

MINIMUM VOLUME:

0.2 mL

REFERENCE RANGE:

None established

TEST SYNONYM(S):Fluid Bilirubin, total

Beta-Hydroxybutyrate, Serum (Sendout)

CERNER / EPIC MNEMONIC:

BOH-KETOS

POE DESCRIPTION:

Beta-hydroxybutyrate

CPT CODE:

82010-90

TEST INFORMATION:

See Specialty Labs - Search Test Code S51561

TURNAROUND TIME:

one week

CONTAINER TYPE:

SSTTM tube

SPECIMEN REQUIREMENTS:

3 mL blood (1.0 mL serum

MINIMUM VOLUME:

1 mL blood (0.3 mL serum)

Biotinidinase

CERNER / EPIC MNEMONIC:

BIOTINID

POE DESCRIPTION:

Biotinidase

CPT CODE:

82261-90

TURNAROUND TIME:

one week

CONTAINER TYPE:

SSTTM tube

SPECIMEN REQUIREMENTS:

4.0 mL blood (2.0 mL serum)

MINIMUM VOLUME:

1.0 mL blood (0.5 mL serum)

REFERENCE RANGE:

See Specialty Labs - Search Test Code S40690

B-Raf V600E Mutation Detection by SSP-PCR

CERNER / EPIC MNEMONIC:

BRAFPCR

CPT CODE:

83891, 83898, 83894, 83903, 83912

CDM NUMBER:

3391019, 3391013, 3391006, 3391021, 3391014

DAYS PERFORMED:

Mon-Thur., 0900-1600; Fri., 0900-1200

TURNAROUND TIME:

7-10 days

SPECIAL INSTRUCTIONS:

Specimens must be accompanied by a Specialty Tests requisition form

CONTAINER TYPE:

Fixed tissue block, or thin sections

SPECIMEN REQUIREMENTS:

2-3 ml bone marrow, 3-5 ml peripheral blood

REJECTION CRITERIA:

Unlabeled or mixed specimens, specimens mixed with more than 60% normal cells

MINIMUM VOLUME:

4 mm2 tumor tissue (5 micron sections); at least 40% tumor cells    

HANDLING INSTRUCTIONS:

Hold at room temperature, deliver to 1188 Jelke within 24 hours

REFERENCE RANGE:

Mutation detected/not detected

LIMITATIONS OF TEST:

Only detects the B-raf V600E mutation

METHODOLOGY:

Sequence specific PCR

ADDITIONAL INFORMATION:

May be used before K-Ras testing

Bilirubin, direct

CERNER / EPIC MNEMONIC:

DBIL

CPT CODE:

82248

DAYS PERFORMED:

Specimen accepted daily, 24 hours

TURNAROUND TIME:

Routine: 8 hours; stat: 1 hour

SPECIAL INSTRUCTIONS:

Specimen must be protected from light and transported to the laboratory promptly.

CONTAINER TYPE:

SST tube or Microtainer (Lithium heparin SST) tube

SPECIMEN REQUIREMENTS:

Blood

MINIMUM VOLUME:

0.4 mL blood (0.2 mL serm)

REFERENCE RANGE:

0 - 1 month: 0.0 - 0.6 mg/dL

1 month - adult: 0.0 - 0.4 mg/dL

LAST UPDATED:

3-25-2013

TEST SYNONYM(S):Conjugated Bilirubin, DBIL

Blastomyces Dermatitidis Quantitative Antigen EIA

CERNER / EPIC MNEMONIC:

BLASTO AG

CPT CODE:

87449

CDM NUMBER:

3181502

TEST INFORMATION:

Intended use is as an aid in diagnosis of  blastomycosis or to monitor therapy.

DAYS PERFORMED:

Test performed  Monday - Thursday only.

TURNAROUND TIME:

2 - 7 days

CONTAINER TYPE:

Sealed sterile urine container (no preservative); red top Vacutainer tube or SST tube; sealed sterile cerebrospinal fluid collection tube; sealed sterile sputum or Leuken's container.

SPECIMEN REQUIREMENTS:

Urine, serum separated from the clot, plasma separated from the red cell layer, CSF, bronchial, or other sterile body fluid

REJECTION CRITERIA:

Inadequate specimen volume, particulate matter or viscosity that would not allow the specimen to be pipetted.

MINIMUM VOLUME:

2.0 mL

HANDLING INSTRUCTIONS:

Store in refrigerator if not sent the same day as obtained.

REFERENCE RANGE:

Negative = None Detected, Low Positive = Below the Limit of Quantification,  Low Positive = 0.20-1.99 ng/ml, Moderate Positive = 2.00-14.70 ng/ml, High Positive = Above the Limit of Quantification

LIMITATIONS OF TEST:

Cross-reactions occur in histoplasmosis, paracoccidioidomycosis, penicilliosis, coccidioidomycosis and rarely in aspergillosis and possibly in sporotrichosis.  Sputolysin and NaOH treatment degrade the analyte detected in the assay.  Negative results do not exclude blastomycosis: testing both urine and serum offers the highest sensitivity.

METHODOLOGY:

Quantitative sandwich enzyme immunoassay (EIA)

REFERRAL LABORATORY:

Commercial Laboratory

LAST UPDATED:

5-19-2014

Banana (IGE) Rast Allergen

CERNER / EPIC MNEMONIC:

BANANA

CPT CODE:

86003-90

TURNAROUND TIME:

5-7 working days

CONTAINER TYPE:

SST or Red top

SPECIMEN REQUIREMENTS:

2.0 mL blood (1.0 mL serum)

MINIMUM VOLUME:

1.0 mL blood (0.5 mL serum)

REFERENCE RANGE:

See Specialty Labs - Search Test Code F92

LAST UPDATED:

7-10-2013

Bartonella Hensalae Antibodies (IGG, IGM) with Reflex to Titer

CERNER / EPIC MNEMONIC:

BART HENAB

CPT CODE:

86611X2

TEST INFORMATION:

Infection with Bartonella henselae has been associated with cat scratch disease, bacillary angiomatosis,peliosis hepatis, and bacteremia. If  Bartonella  henselae screen is positive, an IgG and/or IgM titer will be performed at an additional charge.

TURNAROUND TIME:

3-7 DAYS

CONTAINER TYPE:

Red Top or SST tube

SPECIMEN REQUIREMENTS:

Blood  (Serum)

MINIMUM VOLUME:

5 mL blood (1 mL serum)

HANDLING INSTRUCTIONS:

Specimen should be transported as soon as possible. When transportation is delayed, refrigerate.

REFERENCE RANGE:

Negative, Refer to Quest Test Code 37671

METHODOLOGY:

Immunofluorescence Assay (IFA)

REFERRAL LABORATORY:

Quest Diagnostics

LAST UPDATED:

9-11-2013

TEST SYNONYM(S):Cat scratch disease antibodies