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There are currently 25 names in this directory beginning with the letter C.

C002-IgE Penicillin V

Cadmium, Whole Blood

Cancer Antigen (CA) 125

Synonyms CA-125, Second Generation Assay Special Instructions Values obtained with different assay methodologies should not be used interchangeably in serial testing. It is recommended that only one assay method be used consistently to monitor a patient's course of therapy. This procedure does not provide serial monitoring; it is intended for one-time use only. If serial monitoring is required, please use the serial monitoring number 480061 to order. This test may exhibit interference when sample is collected from a person who is consuming a supplement with a high dose of biotin (also termed as vitamin B7 or B8, vitamin H, or coenzyme R). It is recommended to ask all patients who may be indicated for this test about biotin supplementation. Patients should be cautioned to stop biotin consumption at least 72 hours prior to the collection of a sample. Expected Turnaround Time Within 1 day Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Documents Sample Report Specimen Requirements Specimen Serum Volume 0.8 mL Minimum Volume 0.3 mL (Note: This volume does not allow for repeat testing.) Container Red-top tube or gel-barrier tube Collection If a red-top tube is used, transfer separated serum to a plastic transport tube. Storage Instructions Room temperature Stability Requirements Temperature Period Room temperature 14 days Refrigerated 14 days Frozen 14 days Freeze/thaw cycles Stable x3 Patient Preparation It is suggested that the assay not be performed until at least three weeks after the completion of primary chemotherapy and at least two months following abdominal surgery. Causes for Rejection Citrate plasma specimen; improper labeling Test Details Use The Elecsys CA 125 II assay is labeled "For in vitro diagnostic use" in the manufacturer's package insert.1 Limitations The measured CA 125 value of a patient's sample can vary depending on the test procedure used. The laboratory finding must, therefore, always contain a statement on the CA 125 assay method used. CA 125 values determined on patient samples by different test procedures cannot be directly compared with one another and could cause erroneous medical interpretations. As with all tests containing monoclonal mouse antibodies, erroneous findings may be obtained from samples taken from patients who have been treated with monoclonal mouse antibodies or have received them for diagnostic purposes.1 In rare cases, interference due to extremely high titers of antibody to streptavidin and ruthenium can occur. The test contains additives that minimize these effects.1 For diagnostic purposes, the results should always be assessed in conjunction with the patient's medical history, clinical examination, and other findings. Methodology Electrochemiluminescence immunoassay (ECLIA)

Cannabinoid (THC), Screen and Confirmation, Urine

Test Includes Cannabinoid (THC), qualitative, urine. Confirmation by MS is automatically performed on positive samples for additional charge. Special Instructions Chain-of-custody documentation is required for samples submitted for preëmployment, random employee testing, and forensic purposes. For other applications, use the standard request form. Please mark chain-of-custody test number on the request form. Expected Turnaround Time 1 - 4 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Specimen Requirements Specimen Urine Volume 20 mL Container Use plastic urine drug bottle and evidence tape or tamper-evident container for forensic specimen. Collection kits are available by request from the laboratory. Collection Urine temperature monitoring is recommended for samples to be tested for medicolegal purposes. Storage Instructions Maintain specimen at room temperature. If arrival at lab will extend beyond seven days, refrigerate. Stability Requirements Temperature Period Room temperature 14 days Refrigerated 14 days Frozen 14 days Test Details Use Detect and confirm the presence of cannabinoids Methodology Initial testing by immunoassay (IA); confirmation of positives by mass spectrometry (MS). Additional Information A positive test for cannabinoids indicates the presence of cannabinoid metabolites; 11-nor-9-carboxy-δ-9-THC is the major metabolite (carboxy THC) in urine but is not related to source, time of exposure, amount, or impairment. Unless the test is confirmed by MS, a positive result is presumptive and an unconfirmed test should not be used in workplace drug testing programs. Urine may contain carboxy THC for a week or 10 days after light or moderate use and as long as a month to six weeks after heavy use. Rapid storage of THC metabolites in body fat occurs after use. These substances are then released from storage sites slowly over time. A marijuana cigarette is made from the dried leaves of the plant, Cannabis sativa. The immediate effects of smoking marijuana include a faster heartbeat and pulse rate, bloodshot eyes, and a dry mouth and throat. The drug can impair or reduce short-term memory, alter sense of time, and reduce the ability to do things that require concentration, swift reactions and coördination, such as driving and operating machinery. Driving experiments show that marijuana affects a wide range of skills needed for safe driving. Thinking and reflexes are slowed, making it hard for drivers to respond to sudden unexpected events. Furthermore, a driver's ability to “track” through curves, brake quickly, and maintain speed and proper distance between vehicles is affected. Research shows that these skills are impaired for at least four to six hours after smoking a single marijuana cigarette. If a driver drinks alcohol along with using marijuana, the risks of an accident greatly increase.

Carcinoembryonic Antigen (CEA)

Special Instructions Values obtained with different assay methodologies should not be used interchangeably in serial testing. It is recommended that only one assay method be used consistently to monitor each patient's course of therapy. This procedure does not provide serial monitoring; it is intended for one-time use only. If serial monitoring is required, please order the serial monitoring test (480095). This test may exhibit interference when sample is collected from a person who is consuming a supplement with a high dose of biotin (also termed as vitamin B7 or B8, vitamin H, or coenzyme R). It is recommended to ask all patients who may be indicated for this test about biotin supplementation. Patients should be cautioned to stop biotin consumption at least 72 hours prior to the collection of a sample. Expected Turnaround Time Within 1 day Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Information Cancer Antigen (CA) 15-3 Related Documents For more information, please view the literature below. Thyroid Testing: Assessing Thyroid Disease in Your Patients Sample Report Specimen Requirements Specimen Serum Volume 0.8 mL Minimum Volume 0.3 mL (Note: This volume does not allow for repeat testing.) Container Red-top tube or gel-barrier tube Collection If a red-top tube is used, transfer separated serum to a plastic transport tube. Storage Instructions Refrigerate. Stability Requirements Temperature Period Room temperature 7 days Refrigerated 14 days Frozen 14 days Freeze/thaw cycles Stable x3 Causes for Rejection Citrate plasma specimen; improper labeling Test Details Use This assay is intended for the in vitro quantitative determination of carcinoembryonic antigen in human serum and plasma.1 The Elecsys CEA assay is further indicated for serial measurement of CEA to aid in the management of cancer patients. The main indication for CEA determinations is the follow-up and therapy-management of colorectal carcinoma. Limitations CEA determinations are not recommended for cancer screening in the general population. CEA concentrations within the normal range do not exclude the possible presence of a malignant disease. The measured CEA value of a patient's sample can vary depending on the test procedure used. CEA values determined on patient samples by different test procedures cannot be directly compared with one another and could be the cause of erroneous medical interpretations. As with all tests containing monoclonal mouse antibodies, erroneous findings may be obtained from samples taken from patients who have been treated with monoclonal mouse antibodies or have received them for diagnostic purposes.1 In rare cases, interference due to extremely high titers of antibody to streptavidin and ruthenium can occur. The test contains additives which minimize these effects.1 For diagnostic purposes, the results should always be assessed in conjunction with the patient's medical history, clinical examination, and other findings. Methodology Electrochemiluminescence immunoassay (ECLIA)

Carotene, β

Synonyms Beta Carotene Expected Turnaround Time 4 - 6 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Documents Sample Report Specimen Requirements Specimen Serum, protected from light Volume 0.7 mL Minimum Volume 0.4 mL Container Red-top tube or gel-barrier tube; amber plastic transport tube with amber top. (If amber tubes are unavailable, cover standard transport tube completely, top and bottom, with aluminum foil. Identify specimen with patient's name directly on the container and on the outside of the aluminum foil. Secure with tape.) For amber plastic transport tube and amber-top, order LabCorp N° 23598. Collection Specimen should be free from hemolysis. Protect from light. Transfer specimen to amber plastic transport tube. Storage Instructions Room temperature and protect from light. Stability Requirements Temperature Period Room temperature 14 days Refrigerated 14 days Frozen 14 days Freeze/thaw cycles Stable x3 Patient Preparation Patient should fast for 12 hours and abstain from alcohol for 24 hours prior to collection. For those who are younger than six months, draw prior to next feeding. Blood should be collected before breakfast in the morning and prior to any medication. Causes for Rejection Specimen not protected from light; hemolysis; sample type other than serum received Test Details Use Confirm the diagnosis of carotenoderma; detect fat malabsorption; depressed carotene levels may be found in cases of steatorrhea. Limitations High levels are useful to rule out steatorrhea but lower values lack specificity. There is poor sensitivity. High in the serum of those ingesting large amounts of vegetables. The gold standard for confirmation of a diagnosis of malabsorption remains fat measurement of a 72-hour stool specimen. Methodology High-pressure liquid chromatography (HPLC) Reference Interval 3−91 μg/dL Additional Information Vitamin A serum levels do not correlate well with liver stores. Carotenemia may be confused with jaundice. It is also reported high with some cases of diabetes mellitus, myxedema, chronic nephritis, nephrotic syndrome,1,2 liver disease, hypothyroidism, type I, IIA, and IIB hyperlipoproteinemia, and in a group of amenorrheic hypogonadotropic women.1 An inverse relationship between serum β-carotene and the risk of bronchogenic squamous cell carcinoma is reported.3 The highest carotene levels are found in the serum of faddists ingesting large amounts of vegetables.4 Oral leukoplakia responds well to β-carotene therapy.5 Low β-carotene levels are associated with oral contraceptives and smoking.6

Celiac Antibodies tTG IgA, EMA IgA, Total IgA With Reflex to tTG IgG

Synonyms Endomysial Antibodies Tissue Transglutaminase (tTG) Antibodies Test Includes Endomysial antibody, IgA; tissue transglutaminase (tTG), IgA; total IgA; reflex to tissue transglutaminase (tTG), IgG Special Instructions Reflex testing for tissue transglutaminase (tTG) IgG antibodies is performed if total IgA is decreased. Expected Turnaround Time 2 - 6 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Documents For more information, please view the literature below. Celiac Disease Testing Services Sample Report Specimen Requirements Specimen Serum Volume 3 mL Minimum Volume 1 mL Container Red-top tube or gel-barrier tube Storage Instructions Room temperature Stability Requirements Temperature Period Room temperature 14 days Refrigerated 14 days Frozen 14 days Freeze/thaw cycles Stable x3 Causes for Rejection Hemolysis; lipemia; gross bacterial contamination Test Details Use Aid in the diagnosis of gluten-sensitive enteropathies Methodology Enzyme immunoassay (EIA); indirect immunofluorescence Additional Information Celiac disease is a gluten enteropathy occurring in both children and adults. The disease is probably underdiagnosed in that it may affect as much as 1% of the population in the US. The condition is characterized by a sensitivity to gluten (found in wheat, barley, and rye) that causes inflammation and atrophy of the villi of the small intestine, malabsorption, etc. This sensitivity to gluten may also be seen in dermatitis herpetiformis. Strict avoidance of gluten in the diet will control disease activity, and antibodies to serum markers will disappear with time.

Chlamydia trachomatis,Neisseria gonorrhoeae, and Trichomonas vaginalis, NAA

Synonyms Chlamydia/Gonococcus, PCR Trichomonas, PCR Expected Turnaround Time 3 - 4 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Information Trichomonas vaginalis, NAA Related Documents For more information, please view the literature below. LABupdate: Candida Species Identification by NAA Microbiology Specimen Collection and Transport Guide NuSwab℠: Smart Testing Has Arrived Patient Information: Chlamydia, Gonorrhea, and Trichomoniasis Protect Your Patients From the Consequences of Untreated Chlamydia, Gonorrhea, and Trichomonas: Easily Detected and Easily Treated Trichomonas vaginalis: Detect More Infections With Nucleic Acid Amplification Sample Report Specimen Requirements Specimen Vaginal, endocervical, or male urethral swab, first-void urine (patient should not have urinated for one hour prior to specimen collection), or cervical cells in liquid cytology vial. Volume One swab, 2 mL of a 20 mL to 30 mL urine collection, or entire liquid cytology vial Minimum Volume One swab, 2 mL of a 20 mL to 30 mL urine collection, or entire liquid cytology vial Container Gen-Probe® Aptima® swab or Aptima® urine specimen transport; ThinPrep® or SurePath™ liquid cytology vial Collection Vaginal swab collection: Care provider specimen: Collect vaginal fluid sample using the Gen-Probe® Aptima® Vaginal Swab Kit by contacting the swab to the lower third of the vaginal wall, rotating the swab for 10 to 30 seconds to absorb the fluid. Immediately place the swab into the transport tube and carefully break the swab shaft against the side of the tube. Tightly screw on the cap. Patient self-collection instructions: Partially open the package. Do not touch the soft tip or lay the swab down. If the soft tip is touched, the swab is laid down, or the swab is dropped, use a new Aptima® Vaginal Swab Specimen Collection Kit. Remove the swab. Carefully insert the swab into the vagina about 2" past the introitus and gently rotate the swab for 10 to 30 seconds, making sure the swab touches the walls of the vagina so that moisture is absorbed by the swab. Withdraw the swab without touching the skin. Immediately place the swab into the transport tube and carefully break the swab shaft against the side of the tube. Tightly screw on the cap. Endocervical swab: Remove excess mucus from the cervical os and surrounding mucosa using the cleaning swab (white shaft swab in the package with red printing). Discard this swab. Insert the specimen collection swab (blue shaft swab in the package with green printing) into the endocervical canal. Gently rotate the swab clockwise for 10 to 30 seconds in the endocervical canal to ensure adequate sampling. Withdraw the swab carefully; avoid contact with the vaginal mucosa. Remove the cap from the swab specimen transport tube and immediately place the specimen collection swab into the transport tube. Carefully break the swab shaft at the scoreline using care to avoid splashing of the contents. Recap the swab specimen transport tube tightly. Male urethral swab: The patient should not have urinated for at least one hour prior to specimen collection. Insert the specimen collection swab (blue shaft swab in the package with the green printing) 2 to 4 cm into the urethra. Gently rotate the swab clockwise for two to three seconds in the urethra to ensure adequate sampling. Withdraw the swab carefully. Remove the cap from the swab specimen transport tube and immediately place the specimen collection swab into the specimen transport tube. Carefully break the swab shaft at the scoreline using care to avoid splashing of contents. Recap the swab specimen transport tube tightly. Urine specimen: The patient should not have urinated for at least one hour prior to specimen collection. Direct patient to provide a first-catch urine (approximately 20 mL to 30 mL of the initial urine stream) into a urine collection cup free of any preservatives. Collection of larger volumes of urine may result in specimen dilution that may reduce test sensitivity; lesser volumes may not adequately rinse organisms into the specimen. Female patients should not cleanse the labial area prior to providing the specimen. Add urine to the Aptima® COMBO 2 urine collection device. The final volume must be between the two black lines on the device (about 2 mL). Storage Instructions Room temperature Causes for Rejection Specimen with incorrect patient identification; unlabeled specimen; inappropriate specimen transport conditions; specimens received after prolonged delay (usually >72 hours); specimen leaked in transit; specimen in expired transport or incorrect transport device; specimens with inappropriate source for test requested; specimen with fixative or additives; Aptima® urine transport >30 days from collection; Aptima® urine transport with incorrect specimen volume; 24 hours from collection; Aptima® swab transport >60 days from collection; Aptima® swab specimens with incorrect specimen volume; Aptima® swab specimen without a swab; cleaning swab (white-shaft swab) in Aptima® swab transport; any non−Gen-Probe® swab submitted in Aptima® transport device; wooden-shaft swab in transport device; transport device with multiple swabs; female urethral swab; bloody or grossly mucoid specimens; bacterial swabs; specimen in ProbeTec™ UPT transport; ProbeTec™ Q-swabs; UTM-RT Test Details Use Diagnosis of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis infections Methodology Nucleic acid amplification (NAA)

Chlamydia/Gonococcus, NAA

Synonyms Chlamydia/Gonococcus, Amplicor® PCR Chlamydia/Gonococcus, Aptima® TMA Chlamydia/Gonococcus, LCR Test Includes Detection of Chlamydia trachomatis and Neisseria gonorrhoeae by nucleic acid amplification technology Special Instructions Submit one specimen per test requested. Specify the exact specimen source/origin (eg, endocervical). Indicate a specific test number on the test request form. Expected Turnaround Time 2 - 3 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Information Chlamydia trachomatis Culture Chlamydia/Gonococcus − Client-provided Aliquot DNA Probe Testing Virology Related Documents For more information, please view the literature below. LABupdate: Candida Species Identification by NAA Microbiology Specimen Collection and Transport Guide NuSwab℠: Smart Testing Has Arrived Protect Your Patients From the Consequences of Untreated Chlamydia, Gonorrhea, and Trichomonas: Easily Detected and Easily Treated The Most Accurate Results Come From the Best Specimens Trichomonas vaginalis: Detect More Infections With Nucleic Acid Amplification Sample Report Specimen Requirements Specimen Endocervical, vaginal, or male urethral swab; first-void urine (patient should not have urinated for one hour prior to specimen collection); or cervical cells in liquid cytology vial Volume One swab (endocervical, vaginal, or urethral), 2 mL of a 20 mL to 30 mL urine collection, or entire liquid cytology vial Minimum Volume One swab (endocervical, vaginal, or urethral), 2 mL of a 15 mL urine collection, or entire liquid cytology vial Container Gen-Probe® Aptima® swab or Aptima® urine specimen transport; ThinPrep® or SurePath™ liquid cytology vials Collection Option 1: Gen-Probe® Aptima® Endocervical, Male Urethral, or Vaginal Swab Endocervical swab: Remove excess mucus from the cervical os and surrounding mucosa using the cleaning swab (white-shaft swab in the package with red printing). Discard this swab. Insert the specimen collection swab (blue-shaft swab in the package with green printing) into the endocervical canal. Gently rotate the swab clockwise for 10 to 30 seconds in the endocervical canal to ensure adequate sampling. Withdraw the swab carefully; avoid contact with the vaginal mucosa. Remove the cap from the swab specimen transport tube and immediately place the specimen collection swab into the transport tube. Carefully break the swab shaft at the scoreline; use care to avoid splashing of the contents. Recap the swab specimen transport tube tightly. Male urethral swab: The patient should not have urinated for at least one hour prior to specimen collection. Insert the specimen collection swab (blue-shaft swab in the package with the green printing) 2 to 4 cm into the urethra. Gently rotate the swab clockwise for two to three seconds in the urethra to ensure adequate sampling. Withdraw the swab carefully. Remove the cap from the swab specimen transport tube and immediately place the specimen collection swab into the specimen transport tube. Carefully break the swab shaft at the scoreline; use care to avoid splashing of contents. Recap the swab specimen transport tube tightly. Vaginal swab: Care provider specimen: Collect vaginal fluid sample using the Gen-Probe® Aptima® vaginal swab kit by contacting the swab to the lower third of the vaginal wall and rotating the swab for 10 to 30 seconds to absorb fluid. Immediately place the swab into the transport tube and carefully break the swab shaft against the side of the tube. Tightly screw on the cap. Patient self-collection: Partially open the package of the Gen-Probe® Aptima® vaginal swab kit. Do not touch the soft tip or lay the swab down. If the soft tip is touched, the swab is laid down, or the swab is dropped, use a new Aptima® swab specimen collection kit. Remove the swab. Carefully insert the swab into the vagina about two inches past the introitus and gently rotate the swab for 10 to 30 seconds, making sure the swab touches the walls of the vagina so that moisture is absorbed by the swab. Withdraw the swab without touching the skin. Immediately place the swab into the transport tube, and carefully break the swab shaft against the side of the tube. Tightly screw on the cap. Option 2: Urine Specimen: The patient should not have urinated for at least one hour prior to specimen collection. Direct patient to provide a first-catch urine (approximately 20 to 30 mL of the initial urine stream) into a urine collection cup free of any preservatives. Collection of larger volumes of urine may result in specimen dilution that may reduce test sensitivity; lesser volumes may not adequately rinse organisms into the specimen. Female patients should not cleanse the labial area prior to providing the specimen. Add urine to the Aptima® Combo 2 urine collection device. The final volume must be between the two black lines on the device (about 2 mL). Option 3: Liquid-based Cytology Specimen ThinPrep® Vial − Broom or Brush/Spatula Broom-like collection technique: Obtain a sample from the cervix using a broom-like device by inserting the brush portion into the cervical os and then rotate the brush five times. Rinse the collection device in the PreservCyt® solution by pushing the brush into the bottom of the vial 10 times, forcing the bristles to bend apart to release the cervical material. As a final step, twirl the brush between the thumb and forefinger vigorously to further release cellular material. Discard the collection device. Tighten the cap on the ThinPrep® vial so that the torque line on the cap passes the torque line on the vial. Brush/spatula technique: Insert the brush into the endocervical canal until only the bottommost fibers are exposed. Slowly rotate the brush 1/4 to 1/2 turn in one direction. Do not over-rotate the brush. Then, rotate the brush in the PreservCyt® solution 10 times while pushing against the wall of the ThinPrep® vial. Swirl the brush vigorously to release additional material. Discard the brush. Obtain an adequate sample from the ectocervix using a plastic spatula. Swirl vigorously in the ThinPrep® vial 10 times and discard the spatula. Tighten the cap on the ThinPrep® container so that the torque line on the cap passes the torque line on the vial. SurePath™ Vial: When using the SurePath™ vial, the cervical broom must be used for specimen collection. Insert the broom into the cervical os and rotate five times. Place the broom head into the CytoRich™ preservative fluid in the SurePath™ collection vial. Tightly cap the vial. Storage Instructions Maintain specimen at room temperature or refrigerate (2°C to 30°C). Causes for Rejection Specimen with incorrect patient identification; unlabeled specimen; inappropriate specimen transport conditions; specimen leaked in transit; specimen in expired transport or incorrect transport device; specimens with inappropriate source for test requested; specimen with fixative or additives; APTIMA® urine transport >30 days from collection; APTIMA® urine transport with incorrect specimen volume; 72 hours from collection; APTIMA® swab transport >60 days from collection; APTIMA® swab specimens with incorrect specimen volume; APTIMA® swab specimen without a swab; cleaning swab (white-shaft swab) in APTIMA® swab transport; any non-Gen-Probe® swab submitted in APTIMA® transport device; wooden-shafted swab in transport device; transport device with multiple swabs; female urethral swab; bloody or grossly mucoid specimens; bacterial swabs; specimen in ProbeTec™ UPT transport; ProbeTec™ Q-swabs; BD ProbeTec™ ET male urethral swab; swab specimen in universal transport media or viral transport media Test Details Use Detect Chlamydia trachomatis and Neisseria gonorrhoeae Limitations Note: Specimens cannot be collected and used for Chlamydia/Neisseria and routine chemistry or urine culture. Chlamydia/Neisseria requires use of a first catch (the initial stream of urine that will wash organisms out of the urethra of men or women). Routine chemistry and bacterial or fungal culture require use of the clean catch midstream collection technique. Methodology Nucleic acid amplification (NAA)

Chlamydia/Gonococcus, NAA With Reflex to Trichomonas vaginalis, NAA

Expected Turnaround Time 2 - 4 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Documents Sample Report Specimen Requirements Specimen Vaginal, endocervical, or male urethral swab, first-void urine (patient should not have urinated for one hour prior to specimen collection), or cervical cells in liquid cytology vial. Volume One swab, 2 mL of a 20 mL to 30 mL urine collection, or entire liquid cytology vial Minimum Volume One swab, 2 mL of a 20 mL to 30 mL urine collection, or entire liquid cytology vial Container Gen-Probe® Aptima® swab or Aptima® urine specimen transport; Cytyc® ThinPrep® or TriPath SurePath™ liquid cytology vial Collection Vaginal swab collection: Care provider specimen: Collect vaginal fluid sample using the Gen-Probe® Aptima® Vaginal Swab Kit by contacting the swab to the lower third of the vaginal wall, rotating the swab for 10 to 30 seconds to absorb the fluid. Immediately place the swab into the transport tube and carefully break the swab shaft against the side of the tube. Tightly screw on the cap. Patient self-collection instructions: Partially open the package. Do not touch the soft tip or lay the swab down. If the soft tip is touched, the swab is laid down, or the swab is dropped, use a new Aptima® Vaginal Swab Specimen Collection Kit. Remove the swab. Carefully insert the swab into the vagina about 2" past the introitus and gently rotate the swab for 10 to 30 seconds, making sure the swab touches the walls of the vagina so that moisture is absorbed by the swab. Withdraw the swab without touching the skin. Immediately place the swab into the transport tube and carefully break the swab shaft against the side of the tube. Tightly screw on the cap. Endocervical swab: Remove excess mucus from the cervical os and surrounding mucosa using the cleaning swab (white-shaft swab in the package with red printing). Discard this swab. Insert the specimen collection swab (blue-shaft swab in the package with green printing) into the endocervical canal. Gently rotate the swab clockwise for 10 to 30 seconds in the endocervical canal to ensure adequate sampling. Withdraw the swab carefully; avoid contact with the vaginal mucosa. Remove the cap from the swab specimen transport tube and immediately place the specimen collection swab into the transport tube. Carefully break the swab shaft at the scoreline using care to avoid splashing of the contents. Recap the swab specimen transport tube tightly. Male urethral swab: The patient should not have urinated for at least one hour prior to specimen collection. Insert the specimen collection swab (blue-shaft swab in the package with the green printing) 2 to 4 cm into the urethra. Gently rotate the swab clockwise for two to three seconds in the urethra to ensure adequate sampling. Withdraw the swab carefully. Remove the cap from the swab specimen transport tube and immediately place the specimen collection swab into the specimen transport tube. Carefully break the swab shaft at the scoreline using care to avoid splashing of contents. Recap the swab specimen transport tube tightly. Urine specimen: The patient should not have urinated for at least one hour prior to specimen collection. Direct patient to provide a first-catch urine (approximately 20 mL to 30 mL of the initial urine stream) into a urine collection cup free of any preservatives. Collection of larger volumes of urine may result in specimen dilution that may reduce test sensitivity; lesser volumes may not adequately rinse organisms into the specimen. Female patients should not cleanse the labial area prior to providing the specimen. Add urine to the Aptima® COMBO 2 urine collection device. The final volume must be between the two black lines on the device (about 2 mL). Storage Instructions Room temperature Causes for Rejection Specimen with incorrect patient identification; unlabeled specimen; inappropriate specimen transport conditions; specimens received after prolonged delay (usually >72 hours); specimen leaked in transit; specimen in expired transport or incorrect transport device; specimens with inappropriate source for test requested; specimen with fixative or additives; Aptima® urine transport >30 days from collection; Aptima® urine transport with incorrect specimen volume; 24 hours from collection; Aptima® swab transport >60 days from collection; Aptima® swab specimens with incorrect specimen volume; Aptima® swab specimen without a swab; cleaning swab (white-shaft swab) in Aptima® swab transport; any non−Gen-Probe® swab submitted in Aptima® transport device; wooden-shaft swab in transport device; transport device with multiple swabs; female urethral swab; bloody or grossly mucoid specimens; bacterial swabs; specimen in ProbeTec™ UPT transport; ProbeTec™ Q-swabs; UTM-RT Test Details Use Diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae infection. If a positive result is obtained for either Chlamydia trachomatis or Neisseria gonorrhoeae, testing for Trichomonas vaginalis is performed. Limitations Note: Specimens cannot be collected and used for Chlamydia/Neisseria and routine chemistry or urine culture. Chlamydia/Neisseria requires use of a first catch (the initial stream of urine that will wash organisms out of the urethra of men or women). Routine chemistry and bacterial or fungal culture require use of the clean catch midstream collection technique. Methodology Nucleic acid amplification (NAA)

Chloride

Expected Turnaround Time Within 1 day Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Documents Sample Report Specimen Requirements Specimen Serum (preferred) or plasma Volume 1 mL Minimum Volume 0.5 mL Container Red-top tube, gel-barrier tube, or green-top (lithium heparin) tube Collection Separate serum or plasma from cells within 45 minutes of collection. Storage Instructions Maintain specimen at room temperature. Stability Requirements Temperature Period Room temperature 14 days Refrigerated 14 days Frozen 14 days Freeze/thaw cycles Stable x3 Causes for Rejection Improper labeling Test Details Use Evaluate electrolytes, acid-base balance, water balance. Chloride generally increases and decreases with plasma or serum sodium. Chloride is increased in dehydration, with ammonium chloride administration, with renal tubular acidosis (hyperchloremic metabolic acidosis) and with excessive infusion of normal saline. Differential diagnosis of acidemias and alkalemias. Chloride is higher in hyperparathyroidism than in some of the other causes of hypercalcemia, but a great deal of overlap exists. Chloride is decreased with overhydration, congestive failure, syndrome of inappropriate secretion of ADH, vomiting, gastric suction, chronic respiratory acidosis, Addison disease, salt-losing nephritis, burns, metabolic alkalosis, and in some instances of diuretic therapy. Methodology Ion-selective electrode (ISE) Reference Interval 96−106 mmol/L Additional Information Like other electrolytes, chloride cannot be interpreted without clinical knowledge of the patient. A diagnostic approach to the evaluation of hyperchloremic metabolic acidosis includes use of the urinary anion gap in conjunction with measurement of plasma potassium and urinary pH.1

Chloride, 24-Hour Urine

Special Instructions State 24-hour volume on the test request form. Expected Turnaround Time Within 1 day Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Information Urine Specimens Related Documents Sample Report Specimen Requirements Specimen Urine (24-hour) Volume 10 mL aliquot of entire collection Minimum Volume 0.5 mL aliquot Container Plastic urine container, no preservative Collection For a 24-hour collection, instruct patient to void at 8 AM (or 8 PM), and discard the specimen. Then collect all the urine including the final specimen voided at the end of the 24-hour collection period (ie, 8 AM [or 8 PM] the following day). Container must be labeled with patient's name and date and time collection started and finished. Storage Instructions Room temperature Stability Requirements Temperature Period Room temperature 14 days Refrigerated 14 days Frozen 14 days Freeze/thaw cycles Stable x3 Causes for Rejection Improper labeling Test Details Use Evaluate electrolyte composition of urine, acid-base balance studies. Distinguish whether or not a case of metabolic alkalosis is chloride-responsive (salt responsive). Sherman and Eisinger1,2 discuss bicarbonate excretion, blood volume, potassium depletion, and the differential diagnosis of metabolic alkalosis with loss of gastric juice (emesis, intubation) and after diuretics. Chloride depleted patients excrete urine with low chloride, 20 mmol/L. Such patients are chloride resistant. The finding of chloride resistant metabolic alkalosis may provide a stimulus to identify an ACTH or aldosterone producing neoplasm (eg, Cushing syndrome or Conn syndrome). In Bartter syndrome with metabolic alkalosis, there is usually increased urine chloride. The complex relationships of chronic pulmonary disease with metabolic alkalosis are mentioned by Sherman and Eisinger. Limitations Halogens other than chloride (bromide), which are also present in urine may erroneously elevate the chloride result. Isolated urine chloride, without urine sodium or potassium or without serum electrolytes, can provide misleading information. Discussion of electrolyte balance is beyond the scope of this manual (eg, effect of profound potassium depletion on impairment of chloride reabsorption). Fetal urinary electrolytes are an unreliable guide to evaluate fetal renal function.3 Methodology Colorimetric; ion-selective electrode (ISE) Reference Interval 110−250 mmol/24 hours Additional Information Urine chloride is often ordered with sodium and potassium as a timed urine. The urinary anion gap [Na+ − (Cl− + HCO3−)] or [(Na+ + K+) − (Cl−)] is useful in the initial evaluation of hyperchloremic metabolic acidosis.4

Cholinesterase

Synonyms Pseudocholinesterase Expected Turnaround Time 2 - 4 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Information Cholinesterase, Serum and RBC Related Documents Sample Report Specimen Requirements Specimen Serum Volume 0.5 mL Minimum Volume 0.2 mL Container Red-top tube or gel-barrier tube Collection Separate serum from cells immediately after clotting (30 minutes) and place in transport tube. Mark transport tube “serum”. Storage Instructions Room temperature Stability Requirements Temperature Period Room temperature 14 days Refrigerated 14 days Frozen 14 days Freeze/thaw cycles Stable x3 Causes for Rejection Whole blood specimen (a 20% to 25% increase can occur over a 24-hour period if serum is left on the clot); hemolysis Test Details Use Evaluate preoperative patients for succinylcholine (suxamethonium) anesthetic sensitivity, genetic or secondary to insecticide exposure, in appropriate circumstances. To prevent or evaluate prolonged anesthetic effect, prolonged apnea, after surgery. Very small amounts (0.04−0.06 mg/kg) of succinylcholine are needed to obtain 90% of neuromuscular blockade in patients with low levels of plasma cholinesterase activity.1 Monitor organophosphorous or carbamate insecticide poisoning, in which level is decreased; establish patient's baseline value before exposure. Indications include such pesticide exposure, especially with miosis, blurred vision, muscle weakness, twitching, and fasciculation, bradycardia, nausea, diarrhea, vomiting, salivation, sweating, pulmonary edema, arrhythmias, and convulsions. The value of assessing risk status in persons exposed to organophosphate insecticides on the basis of plasma or serum cholinesterase levels alone has been called into question.2 Are normal levels indicative of no exposure or of a genetic variant with or without exposure? There are interpretive problems with low or high values.2 Family studies may be done when an individual with a genetically abnormal type is documented by serum pseudocholinesterase deficiency and, ideally, confirmed by phenotyping. Limitations Serum cholinesterase may be decreased in patients on estrogens and oral contraceptives.3 Fluoride interferes. Pseudocholinesterase is low also in some instances of liver disease, including decompensated cirrhosis, hepatitis, metastatic carcinoma, CHF, and in malnutrition, but not sufficiently consistently enough to be a useful clinical test for such disorders. Genetic atypical enzyme does not explain every instance of prolonged postsurgical apnea. Red cell cholinesterase is more useful for chronic insecticide exposure. Carbamate-poisoned persons can appear to have near normal or normal levels of pseudocholinesterase. Methodology Spectrophotometry (Ellman) − kinetic Contraindications Not useful to evaluate for toxicity from chlorinated insecticides. Reference Interval • Male: − 1 day to 5 years: Not established − 6 to 17 years: 1396−3282 U/L − 18 to 70 years: 1801−3537 U/L − 71 years and older: 903−2964 U/L • Female: − 1 day to 1 year: Not established − 2 to 12 years: 1649−2940 U/L − 13 to 50 years: 1247−2978 U/L − 51 to 80 years: 1355−3299 U/L − 81 years and older: Not established Additional Information Two types of cholinesterase are found in blood: “true” cholinesterase (acetylcholinesterase) in red cells and “pseudocholinesterase” (acylcholine acylhydrolase) in serum (plasma). Low serum cholinesterase activity may relate to exposure to insecticides or to one of a number of variant genotypes. Dibucaine and fluoride numbers are useful to phenotype such homozygous and heterozygous individuals, who are genetically sensitive to succinylcholine. One patient in 1500 is susceptible to succinyldicholine anesthetic mishap. Evans and Wroe suggest that an enzyme level in serum below 2.5 standard deviations will pick up 90% of sensitive individuals using propionylthiocholine as substrate.4 Rather marked inhibition can be found without symptoms. Plasmapheresis has been noted to decrease the level of plasma cholinesterase. Patients with abnormally low cholinesterase activity after transfusion of blood or plasma will experience temporary augmentation of enzyme level.5 In estimating the duration of this enhanced activity, measures of plasma cholinesterase half-life have been utilized. The true half-life value has, however, been uncertain. A half-life value determined by measuring the rate of disappearance after intravenous injection of human cholinesterase has provided an average value of 11 days.6 A low level of activity of pseudocholinesterase has been demonstrated in cerebrospinal fluid, at about 1/20 to 1/100 the activity present in the corresponding plasma. With clinical conditions characterized by bleeding into the CSF, pseudocholinesterase activity increases to one-fourth to one-half that of plasma.7 Patients with a variety of carcinomas have been reported to accumulate an embryonic type of cholinesterase activity in their sera. Such novel cholinesterase activity was found only in the sera of patients undergoing antitumor therapy (eg, chemotherapy or radiation therapy and/or hormone therapy).8 Increase in acetylcholinesterase activity, notably, in an acetylcholinesterase:butyrylcholine esterase ratio (histochemical study, not as measured in serum) has provided discriminatory diagnostic value in some cases of Hirschsprung disease.9

Cholinesterase, RBC

Synonyms Acetylcholinesterase, RBC Cholinesterase I Cholinesterase, Erythrocytic RBC Cholinesterase Red Cell Cholinesterase True Cholinesterase Expected Turnaround Time 2 - 4 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Information Cholinesterase, Plasma and RBC Cholinesterase, Serum and RBC Related Documents Sample Report Specimen Requirements Specimen Whole blood Volume 5 mL Minimum Volume 1 mL Container Lavender-top (EDTA) tube Storage Instructions Room temperature; do not separate. Stability Requirements Temperature Period Room temperature 14 days Refrigerated 14 days Frozen Unstable Freeze/thaw cycles Unstable Causes for Rejection Plasma specimen; anticoagulants other than EDTA; frozen whole blood received; hemolysis Test Details Use Erythrocyte cholinesterase is measured to diagnose organophosphate and carbamate toxicity and to detect atypical forms of the enzyme. Cholinesterase is irreversibly inhibited by organophosphate insecticides and reversibly inhibited by carbamate insecticides. Serum or plasma pseudocholinesterase is a better measure of acute toxicity, while erythrocyte levels are better for chronic exposure. (Serum level returns to normal prior to normalizing of red cell level). Limitations Values decrease as erythrocytes become senescent. Methodology Spectrophotometry (Ellman) − kinetic Reference Interval 5300−10,000 IU/L Additional Information The cholinesterase activity in human red cells is highly but not exclusively specific for acetylcholine. It is referred to as true or specific cholinesterase. Cholinesterase activity present in serum/plasma hydrolyses both choline and aliphatic esters, has a broader range of esterolytic activity, and is referred to as “pseudo-” or “nonspecific” cholinesterase. It hydrolyses acetylcholine only slowly. The systematic name for acetylcholinesterase is acetylcholine acetylhydrolase. Systematic name for cholinesterase (serum/plasma) is acylcholine acylhydrolase. The different nature of the cholinesterases was first described in 1940.1 The plasma enzyme is synthesized by the liver, the red cell enzyme during erythropoiesis. The enzyme is a large complex protein. There is evidence that it has a multiple subunit structure, four peptide chains that form two dimers. Because of the many constituent amino acids, many molecular variants are possible. The RBC level is increased in hemolytic states such as the thalassemias, spherocytosis, hemoglobin SS, and acquired hemolytic anemias. It is decreased in paroxysmal nocturnal hemoglobinuria and in relapse of megaloblastic anemia. (It returns to normal with therapy.) Potent inhibitors of cholinesterase may present important clinical toxicological problems. Systemic insecticides (eg, organophosphates or carbamates) are examples. Both RBC acetylcholinesterase and plasma cholinesterase are usually inhibited. The effect on the plasma enzyme is more marked, however, and serum levels are usually used in diagnosis and assessment of recovery. Recovery is best determined by looking for a plateau in erythrocyte cholinesterase activity. Toxic potency may vary, plasma versus red cell cholinesterase, such that in some cases, erythrocyte levels may be needed for diagnosis and/or monitoring. If there is suspicion that a decrease in cholinesterase activity may not relate to the inhibitor effect of an organophosphate, then red cell level of acetylcholinesterase should be obtained. If both serum and RBC levels are significantly decreased, findings are those of exogenous toxic effect.

Clonazepam

Synonyms Klonopin® Expected Turnaround Time 2 - 4 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Documents Sample Report Specimen Requirements Specimen Serum or plasma Volume 4 mL Minimum Volume 1.1 mL Container Red-top tube, lavender-top (EDTA) tube, or green-top (heparin) tube. Do not use a gel-barrier tube. The use of gel-barrier tubes is not recommended due to slow absorption of the drug by the gel. Depending on the specimen volume and storage time, the decrease in drug level due to absorption may be clinically significant. Collection Transfer separated serum or plasma to a plastic transport tube. Collect specimen immediately prior to next dose unless specified otherwise. Storage Instructions Refrigerate. Stability Requirements Temperature Period Room temperature 14 days Refrigerated 14 days Frozen 14 days Causes for Rejection Gel-barrier tube Test Details Use Evaluate toxicity; monitor therapeutic levels Limitations This test was developed and its performance characteristics determined by LabCorp. It has not been cleared or approved by the Food and Drug Administration. Methodology Liquid chromatography/tandem mass spectrometry (LC/MS-MS) Reference Interval Therapeutic: 20−70 ng/mL Critical Value Potentially toxic: >80 ng/mL Additional Information The drug is used in the treatment of petit mal variant (Lennox-Gastaut), akinetic seizures and myoclonic seizures. Serum peak levels occur approximately two hours after oral administration. The apparent half-life after a single oral dose is 20 to 40 hours. Active metabolites have longer half-lives than the parent drug. Half-lives are increased in the elderly. Therapeutic effect is not well correlated with serum levels. Effect of CNS depressants may be augmented by concomitant use of this agent. This drug is used as an anticonvulsant. It is useful in reducing tardive dyskinesia.1 Footnotes 1. Thaker GK, Nguyen JA, Strauss ME, Jacobson R, Kaup BA, Tamminga CA. Clonazepam treatment of tardive dyskinesia: A practical GABAmimetic strategy. Am J Psychiatry. 1990 Apr; 147(4):445-451. PubMed 1969244 References Drug Information Handbook. 24th ed. Hudson, OH: Wolters Kluwer Clinical Drug Information, Inc; 2015; 478-480.

Cobalt, Plasma

Synonyms Co, Plasma Expected Turnaround Time 2 - 4 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Information Cobalt, Urine Related Documents Sample Report Specimen Requirements Specimen Plasma Volume 2 mL Minimum Volume 0.6 mL Container Royal blue-top (EDTA) tube Collection Separate plasma immediately after the collection, and transfer to a certified metal-free plastic transport tube (PeopleSoft N° 111166) for shipment to the laboratory. Storage Instructions Maintain specimen at room temperature. Stability Requirements Temperature Period Room temperature 14 days Refrigerated 14 days Frozen 14 days Freeze/thaw cycles Stable x3 Causes for Rejection Certified metal-free plastic transport tube not submitted Test Details Use Monitor industrial exposure to cobalt Limitations This test was developed and its performance characteristics determined by LabCorp. It has not been cleared or approved by the Food and Drug Administration. Methodology Inductively-coupled plasma/mass spectrometry (ICP/MS) Reference Interval • Environmental exposure: <1.0 μg/L • Occupational exposure: BEI® (sampling time is end of shift at end of work week): 1.0 μg/L1 Additional Information Cobalt poisoning through chronic exposure may result in pulmonary fibrosis, cough, and dyspnea. Acute exposures are generally characterized by an allergic dermatitis.2 Cobalt is employed industrially in certain grades of steel and in tungsten carbide tools, and cobalt compounds are used as pigments in paints. In addition, cobalt is an essential element in man, supplied through dietary intake at an average of 280 μg/day. Although cobalt is found in the general environment, overexposure typically occurs in the industrial environment, primarily through the inhalation of cobalt dust and/or fumes. Cobalt exposure can also occur as a result of ingesting medications such as cobaltous chloride. Blood is the preferred specimen for measuring acute or recent exposure.

Cocaine Metabolite, Screen and Confirmation, Urine

Test Includes Cocaine metabolite. Confirmation by MS is automatically performed on positive samples at an additional charge. Special Instructions Chain- of-custody documentation is required for samples submitted for preëmployment, random employee testing, and forensic purposes. For other applications, use the standard request form. Please mark chain-of-custody test number on the request form. Expected Turnaround Time 1 - 4 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Specimen Requirements Specimen Urine Volume 20 mL Container Use plastic urine drug bottle and evidence tape or tamper-evident container for forensic specimen. Collection kits are available by request from the laboratory. Collection Urine temperature monitoring is recommended for samples to be tested for medicolegal purposes. Storage Instructions Maintain specimen at room temperature. If arrival extends beyond seven days, then refrigerate. Causes for Rejection Quantity not sufficient for analysis; improper specimen (serum, plasma, blood); incomplete chain-of-custody documentation; incomplete specimen identification; improper or missing tamper-evident seals Test Details Use Detect cocaine use Methodology Initial testing by immunoassay; confirmation of positives by mass spectrometry (MS). See drug profiles for multidrug testing. Additional Information Cocaine is a highly abused drug that is most frequently detected in the urine as the metabolite benzoylecgonine and usually as part of a multiclass drug profile. In preëmployment drug testing, the presence of cocaine (benzoylecgonine) should be confirmed by MS. Cocaine is a central nervous system stimulant. It usually appears as a fine crystal-like powder that is the hydrochloride or sulfate salt and, as such, is “snorted” (inhaled through the nose). When mixed with sodium bicarbonate and converted to free base, it appears as hard pieces called “crack,” which can be smoked. This is currently a very prevalent form of the drug. The effects of the drug begin within minutes and peak within 15 to 20 minutes. These effects include dilated pupils, as well as increased blood pressure, heart rate, breathing rate, and body temperature. The dangers of cocaine use vary, depending on how the drug is taken, the dose, and the individual. Some regular users report feelings of restlessness, irritability, anxiety, and sleeplessness. In some people, even low doses of cocaine may create psychological problems. People who use high doses of cocaine during a long period may become paranoid or experience what is called cocaine psychosis. This may include hallucinations of touch, sight, taste, and smell. Cocaine itself has a half-life of one to two hours while benzoylecgonine has an estimated half-life of seven to nine hours. Benzoylecgonine is detectable in urine within two to three hours and for a period of two to three days after a single use.

Complete Blood Count (CBC) With Differential

Test Includes Hematocrit; hemoglobin; mean corpuscular volume (MCV); mean corpuscular hemoglobin (MCH); mean corpuscular hemoglobin concentration (MCHC); red cell distribution width (RDW); percentage and absolute differential counts; platelet count (RBC); red cell count; white blood cell count (WBC) Expected Turnaround Time Within 1 day Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Documents Sample Report Specimen Requirements Specimen Whole blood Volume Fill tube to capacity. Minimum Volume 0.5 mL (500 μL for pediatric microtainer capillary tubes; fill tube to capacity.) Container Lavender-top (EDTA) tube Collection Invert tube 8 to 10 times immediately after tube is filled at the time of collection. Storage Instructions Maintain specimen at room temperature. Stability Requirements Temperature Period Room temperature 1 day Refrigerated 3 days Frozen Unstable Freeze/thaw cycles Unstable Causes for Rejection Hemolysis; clotted specimen; specimen drawn in any anticoagulant other than EDTA; specimen diluted or contaminated with IV fluid; tube not filled with minimum volume; improper labeling; transfer tubes with whole blood; specimen received with plasma removed (plasma is used for other testing) Test Details Use As a screening test to evaluate overall health; detect and/or identify a wide range of hematologic disorders; assist in managing medications/chemotherapeutic decisions Methodology Automated cell counter with mixed technologies Additional Information Assessments of stained smears are performed if results meet specific numeric and/or instrument flagging criteria. Smear review includes assessment of WBC cell populations, presence of WBC and/or RBC inclusions, RBC morphology, and platelet evaluation. Presence of one or more of the following may be indication for further investigation: hemoglobin 18 g/dL, MCV >100 fL, MCV 37%, WBC >20,000/mm3, WBC <2000/mm3, presence of sickle cells, spherocytes, Pappenheimer bodies, basophilic stippling, stomatocytes, schistocytes (fragmented RBCs), target cells, oval macrocytes, teardrop red blood cells, abnormal cell populations, nucleated red blood cells in other than the newborn, blood parasites (malarial or Babesia organisms or the possibility of parasitic organisms), hypersegmented neutrophils, agranular neutrophils, hyposegmented neutrophils (Pelger-Huët anomaly or pseudo-Pelger-Huët [pelgeroid] cells), mononuclear cells in which apparent nucleoli are prominent (blast-like cells), presence of metamyelocytes, myelocytes, promyelocytes, neutropenia, presence of plasma cells, peculiar atypical lymphocytes, significant increase or decrease in platelets or bizarre platelets. A six-part differential reported in some lab locations includes IG % and IG absolute counts. IG (immature granulocytes) includes metamyelocytes and myelocytes. It does not include bands or blast cells.1,2 Promyelocytes and blasts are reported separately to denote the degree of left shift. An elevated percentage of IG has not been found to be clinically significant as a sole clinical predictor of disease. IGs are associated with infections, a variety of inflammatory disorders, cytokine therapy, neoplasia, hemolysis, tissue damage, seizures, metabolic abnormalities, myeloproliferative neoplasms, and with the use of certain medications such as steroids.3 Pregnancy-associated leukocytosis may also show increased immature granulocytes without clinical significance. There is a significant increase of normoblastic erythropoiesis and, to a lesser extent, of granulopoiesis during pregnancy, which is associated with an increase in immature cells (shift to the left) of both erythropoietic and granulopoietic tissues. A possible physiologic explanation for the appearance of immature granulocytes in the peripheral blood of pregnant women, increased alkaline phosphate activity in granulocytes, and increased glycogen content of lymphocytes may be found in the excretion curves of hormones during pregnancy. There is a sharp rise in the fifth month then a decrease in the eighth month and a subsequent rise in the ninth month.4

Complete Blood Count (CBC) Without Differential

Synonyms Hemogram Test Includes Hematocrit; hemoglobin; MCH; MCHC; MCV; RDW; red blood cell count (RBC); platelet count; white blood cell count (WBC) Expected Turnaround Time Within 1 day Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Documents Sample Report Specimen Requirements Specimen Whole blood Volume Fill tube to capacity. Minimum Volume 0.5 mL (500 μL for pediatric microtainer capillary tubes; fill tube to capacity) Container Lavender-top (EDTA) tube Collection Invert tube 8 to 10 times immediately after tube is filled at the time of collection. Storage Instructions Maintain specimen at room temperature. Stability Requirements Temperature Period Room temperature 1 day Refrigerated 3 days Frozen Unstable Freeze/thaw cycles Unstable Causes for Rejection Hemolysis; tube not filled with minimum fill volume; specimen drawn in any anticoagulant other than EDTA; specimens diluted or contaminated with IV fluid; clotted specimen; improper labeling; transfer tubes with whole blood; lavender-top (EDTA) tubes received with plasma removed Test Details Use See comments in Complete Blood Count (CBC) With Differential [005009]. Methodology Automated cell counter

Cortisol, AM & PM

Special Instructions Submit two specimens on the same test request form (one collected in the AM and one in the PM as directed by the ordering physician). Print collection times and dates for both specimens on the individual tubes and in clinical information. This test may exhibit interference when sample is collected from a person who is consuming a supplement with a high dose of biotin (also termed as vitamin B7 or B8, vitamin H, or coenzyme R). It is recommended to ask all patients who may be indicated for this test about biotin supplementation. Patients should be cautioned to stop biotin consumption at least 72 hours prior to the collection of a sample. Expected Turnaround Time 1 - 2 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Information Cortisol Related Documents Sample Report Specimen Requirements Specimen Serum Volume 0.8 mL AM specimen and 0.8 mL PM specimen Minimum Volume 0.3 mL each (Note: This volume does not allow for repeat testing.) Container Red-top tube or gel-barrier tube Collection If a red-top tube is used, transfer separated serum to a plastic transport tube. Storage Instructions Room temperature. Stability Requirements Temperature Period Room temperature 14 days Refrigerated 14 days Frozen 14 days Freeze/thaw cycles Stable x3 Causes for Rejection Citrate plasma specimen; improper labeling Test Details Methodology Electrochemiluminescence immunoassay (ECLIA) Reference Interval AM: 6.2−19.4 μg/dL; PM: 2.3−11.9 μg/dL

Creatine

Special Instructions State the patient's sex on the test request form. Expected Turnaround Time 4 - 6 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Documents Sample Report Specimen Requirements Specimen Serum, frozen Volume 1 mL Minimum Volume 0.5 mL Container Red-top tube Collection Separate serum from red cells. To avoid delays in turnaround time when requesting multiple tests on frozen samples, please submit separate frozen specimens for each test requested. Storage Instructions Freeze Causes for Rejection Hemolysis; specimen not frozen Test Details Use Serum creatine levels may be significantly increased in amyotrophic lateral sclerosis, dermatomyositis, myasthenia gravis, starvation, muscular dystrophies, and trauma. Creatine synthesis is stimulated by methyltestosterone and may also be increased in hyperthyroidism, diabetic acidosis, and puerperium. Methodology Enzymatic (creatinase)/spectrophotometry Reference Interval See table. Age (y) Range (mg/dL) 0−1 0.1−1.4 2−5 0.6−1.4 6−9 0.5−1.3 10−13 0.2−1.1 14−17 0.0−0.8 Female: >17 0.1−1.0 Male: >17 0.0−0.7 Additional Information Creatine is transported from the sites of synthesis (kidney, liver, pancreas) via the circulatory system to muscle and brain tissue where it is phosphorylated to phosphocreatine. Phosphocreatine and creatine are rapidly interconverted during muscle contraction. Approximately 1% to 2% of free creatine in muscle is converted to creatinine daily.

Crohn's Disease Prognostic Profile

Synonyms Glycominds IBDX Test Includes Antichitobioside carbohydrate antibodies (ACCA); antilaminaribioside carbohydrate antibodies (ALCA); antimannobioside carbohydrate antibodies (AMCA); anti-Saccharomyces cerevisiae antibodies (ASCA) Expected Turnaround Time 3 - 7 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Information Inflammatory Bowel Disease (IBD) Expanded Profile Inflammatory Bowel Disease (IBD) Profile Related Documents For more information, please view the literature below. Bowel Disorders Evaluation Rule-out Cascade: Applying Exclusionary Criteria to Assist Diagnosis Sample Report Specimen Requirements Specimen Serum Volume 1 mL Minimum Volume 0.2 mL Container Red-top tube or gel-barrier tube Storage Instructions Refrigerate Causes for Rejection Hemolysis; lipemia; heat-treated specimen; gross bacterial contamination Test Details Use Prognostic aid for use in the clinical management of patients who have been diagnosed with Crohn's disease. Limitations The absence of antibody reactivity in this panel, although associated with increased incidence of a more benign course, does not preclude the future development of more complicated disease or need for surgery.1 Methodology Enzyme immunoassay (EIA) Additional Information The presence and increasing titer of these antibodies has been shown to correlate with a more complicated disease course (strictures or fistulas) or the need for surgery. The antibodies included in the panel are ASCA (anti-Saccharomyces cerevisiae antibodies), ALCA (antilaminaribioside carbohydrate antibodies), ACCA (antichitobioside carbohydrate antibodies), and AMCA (antimannobioside carbohydrate antibodies).1-3 Numerous studies of CD have demonstrated an association between ileal disease and the presence of ASCA,1-7 ACCA,1 ALCA,1,3 and AMCA.3 Among these antibodies, the association with localization to the small intestine increased with the number of positive antibodies and with the concentration of individual antibodies.1-3,6,8 A more aggressive or complicated disease course in CD (as indicated by stricturing or perforation of the intestine or need of surgery), has also been associated with the presence of ASCA,1-3,5,7 ALCA,1-3 ACCA,1,2 and AMCA.1,2 Among these antibodies, the association with complicated disease behavior or surgery increased with the number and concentration of antibodies.1,2,6,8

Cyclic Citrullinated Peptide (CCP) Antibodies, IgA, IgG, ELISA

Synonyms Anti-CCP Anti-citrullinated protein antibodies (ACPA) Expected Turnaround Time 1 - 3 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Documents For more information, please view the literature below. Rheumatoid Arthritis Testing with Better Performance Flyer Rheumatoid Arthritis Brochure Sample Report Specimen Requirements Specimen Serum Volume 1 mL Minimum Volume 0.3 mL Container Red-top tube or gel-barrier tube Collection Following collection, serum should be separated from the clot. Storage Instructions Room temperature Stability Requirements Temperature Period Room temperature 7 days Refrigerated 14 days Frozen 14 days Freeze/thaw cycles Stable x3 Causes for Rejection Hemolysis; lipemia; gross bacterial contamination; addition of azide or other preservative; heat inactivation Test Details Use The presence of CCP antibodies, when considered in conjunction with other laboratory and clinical findings, is an aid in the diagnosis of rheumatoid arthritis (RA). Approximately 70% of RA patients are positive for anti-CCP IgG, while only 2% of random blood donors and control subjects are positive. Methodology Enzyme-linked immunosorbent assay (ELISA)

Cytochrome P450 2D6/2C19 Genotyping

Synonyms DME Genotyping Expected Turnaround Time 6 - 10 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Documents Sample Report Specimen Requirements Specimen Whole blood Volume 7 mL Minimum Volume 3 mL Container Lavender-top (EDTA) tube or yellow-top (ACD) tube Storage Instructions Maintain specimen at room temperature or refrigerate at 4°C. Causes for Rejection Frozen specimen; clotted whole blood; hemolysis; quantity not sufficient for analysis; improper container Test Details Use The xTAG® CYP2D6 Kit v3 is a qualitative genotyping assay, which can be used as an aid to clinicians in determining therapeutic strategy for the therapeutics that are metabolized by the CYP2D6 gene product. CYP2D6 is involved in the metabolism of more than 65 commonly used drugs including β-blockers, antipsychotics, antidepressants, analgesics, and antiarrythmics. The CYP2D6 gene is highly polymorphic. Many alleles of 2D6 encode enzymes that have reduced or no function compared to the wild-type enzyme. Individuals can also have gene rearrangements with more than two copies of the CYP2D6 gene (gene duplication) or absence of both copies (gene deletion). Depending on the combination of alleles in an individual, drug-metabolizing phenotypes associated with the CYP2D6 enzyme can vary. The XTAG® CYP2C19 Kit v3 is a qualitative genotyping assay, which can be used as an aid to clinicians in determining therapeutic stattegy for the therapeutics that are metabolized by the CYP2C19 gene product. CYP2C19 is involved in the metabolism of drugs including clopidogrel, anticonvulsants, diazepam, omeprazole, tricyclic antidepressants and proton pump inhibitors. The CYP2C19 gene is highly polymorphic. Many alleles of CYP2C19 encode enzymes that have non-functional, decreased or increased enzyme activity compared to wild-type. Depending on the combination of alleles in an individual, drug-metabolizing phenotypes associated with the CYP2C19 enzyme can vary. Limitations These kits are not indicated for stand-alone diagnostic purposes. These tests are not intended to be used to predict drug response or non-response. Only alleles listed will be identified by these products. Other CYP2D6 or CYP2C19 alleles, which are rare, or were unknown at the time of release of these products, will not be identified by these products. These other alleles may result in either a *1 call, a no-call, or a call of a genetically related allele included in these kits. The physiological effect of phenotype depends on individual clinical profile. The co-administration of drugs metabolized, or other drugs that can act as inducers or inhibitors, also affects the drug metabolizing phenotype. Methodology This assay utilizes the Luminex xTAG® CYP2D6 Kit v3 US-IVD and the Luminex xTAG® CYP2C19 Kit v3 US-IVD. The xTAG® CYP2D6 Kit v3 is a device used to simultaneously detect and identify a panel of nucleotide varients found within the highly polymorphic CYP2D6 gene located on chromosome 22 from genomic DNA extracted from EDTA and citrate anticoagulated whole blood samples. This kit can also identify gene rearrangements associated with the deletion (*5) and duplication genotypes. The xTAG® CYP2D6 Kit v3 incorporates multiplex Polymerase Chain Reaction (PCR) and multiplex Allele Specific Primer Extension (ASPE) with Luminex's proprietary Universal Tag sorting system on the Luminex® 100/200™ xMAP® platform. Alleles detected by the xTAG® CYP2D6 Kit v3: *1, *2, *3, *4, *5, *6, *7, *8, *9, *10, *11, *15, *17, *29, *35, *41, and DUP (duplication). The *1 allele is the most common allele in all ethnicities. The xTAG® CYP2C19 Kit v3 is an in vitro diagnostic test used to simultaneously detect and identify a panel of nucleotide variants found within the highly polymorphic CYP450 2C19 gene, located on chromosome 10q24, from genomic DNA extracted from EDTA or citrated anticoagulated whole blood samples. The xTAG® CYP2C19 Kit v3 incorporates mutiplex Polymerase Chain Reaction (PCR) and multiplex Allele Specific Primer Extension (ASPE) with a proprietary universal array sorting system on the Luminex® platform. Alleles detected by xTAG® CYP2C19 Kit v3: *1, *2, *3, *17. The wild-type (WT) allele, CYP2C19 *1, is the most common variant. Additional Information The combination of alleles contributes to the individual's phenotype. Drug-metabolizing phenotypes have been classified into groups, from the lowest level of metabolism to the highest level of metabolism: poor metabolizers (PMs), intermediate metabolizers (IMs), normal/extensive metabolizers (NMs/EMs), rapid metabolizers (RMs), and Ultra-rapid extesive metabolizers (UMs). Variations in enzyme activity can lead to a variety of problems in clinical practice. PMs develop a higher serum concentration of drug, which may lead to increased risk of concentration-dependent side effects. They may also experience drug toxicity or other adverse drug reactions, or prolonged therapeutic effect because of impaired clearance of drug. If a drug is administered as a pro-drug that requires biotransformation to an active form, PMs may experience inadequate therapeutic effect if the drug does not reach the therapeutic dose. IMs may experience some of these same problems to a lesser extent. For UMs, rapid metabolism of the drug may lead to inadequate drug efficacy and therapeutic failure, because the drug may not reach the therapeutic serum concentration. For pro-drugs, UMs may be at higher risk of adverse drug reactions and side effects. References Caudle KE, Dunnenberger HM, Freimuth RR, et al. Standardizing terms for clinical pharmacogenetic test results: consensus terms from the Clinical Pharmacogenetics Implimentation Consortium (CPIC). Genet Med. 2017 Feb;19(2):215-223. PubMed 27441996 Shimada T, Yamazaki H, Mimura M, Inui Y, Guengerich FP. Interindividual variations in human liver cytochrome P-450 enzymes involved in the oxidation of drugs, carcinogens and toxic chemicals: studies with liver microsomes of 30 Japanese and 30 Caucasians. J Pharmacol Exp Ther. 1994 Jul;270(1):414-423. PubMed 8035341 Wilkinson GR. Drug metabolism and variability among patients in drug response. N Engl J Med. 2005 May 26;352(21):2211-2221. PubMed 15917386 xTAG® CYP2D6 Kit v3 US-IVD [package insert]. Luminex; MLD-030-KPI-001 Rev G; 2018. xTAG® CYP2C19 Kit v3 US-IVD [package insert]. Luminex; MLD-046-KPI-001 Rev E; 2018. LOINC® Map Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC 511905 Cytochrome P450 2D6/2C19 504202 2D6 Genotype: 40425-1 511905 Cytochrome P450 2D6/2C19 504376 Interpretation: 72880-8 511905 Cytochrome P450 2D6/2C19 504377 CYP2D6 Information: 49549-9 511905 Cytochrome P450 2D6/2C19 504631 Director Review: 69426-5 511905 Cytochrome P450 2D6/2C19 504204 2C19 Genotype: 57132-3 511905 Cytochrome P450 2D6/2C19 504205 2C19 Metabolic Activity: 79714-2 511905 Cytochrome P450 2D6/2C19 504433 Interpretation: 72879-0 511905 Cytochrome P450 2D6/2C19 504434 CYP2C19 Information: 49549-9 511905 Cytochrome P450 2D6/2C19 504632 Director Review: 69426-5 511905 Cytochrome P450 2D6/2C19 000000 MGRM Informed Consent Review N/A

Cytomegalovirus (CMV) Culture

Synonyms CMV Culture Culture, Cytomegalovirus (CMV) Test Includes Shell vial or equivalent multiwell plate and conventional culture. Shell vial cultures are stained at 48 hours and four days after receipt. Cultures positive by shell vial are reported as final; cultures negative by shell vial are continued for a total of three weeks. CPT coding for microbiology and virology procedures often cannot be determined before the culture is performed. Requests with only a written order and no test number indicated will be processed according to Default Testing for Virology. This culture is for the isolation of cytomegalovirus; other viral agents will not be routinely detected. If a virus other than the one specified for this virus-specific culture is recovered, identification will be made and an additional charge will apply. The client will not be telephoned to approve this charge. Special Instructions If reflex test is performed, additional charges/CPT code(s) may apply. Submit one specimen per test requested. Specify the exact specimen source/origin (eg, genital lesion). Indicate a specific test number on the test request form. Check expiration date of transport; do not use expired devices. Expected Turnaround Time 8 - 14 days Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary. Related Information Viral Culture, Rapid, Cytomegalovirus (CMV) Virology Related Documents Sample Report Specimen Requirements Specimen Blood, urine, buffy coat, throat, bronchoalveolar lavage (BAL), bronchial washings, cervical, semen, biopsy sources, or bone marrow Volume 10 to 14 mL blood or 4 mL urine Container Two green-top (heparin) tubes; sterile leakproof urine container; viral, Chlamydia, or Mycoplasma culture transport provided by LabCorp, or other appropriate transport medium (throat, cervical, semen, biopsy sources) Collection Bronchoalveolar lavage: Submit 10 to 50 mL fluid in sterile leakproof container and refrigerate. Urine: A first morning clean catch urine should be submitted in a sterile screw-cap container. Refrigerate immediately and ship at 4°C. Do not freeze. Blood/buffy coat/bone marrow: Collect two green-top (heparin) tubes. Transport at room temperature as soon as possible. Do not freeze. Other: Collect a viral transport for throat, cervical, semen, and biopsy sources. Refrigerate immediately and ship at 4°C. Do not freeze. Storage Instructions Do not freeze. Maintain blood at room temperature; other specimen sources should be refrigerated. Causes for Rejection Bacterial swab specimen; specimen received in grossly leaking transport container; dry specimen; specimens submitted in fixative or additive; specimen received in expired transport media or incorrect transport device; inappropriate specimen transport conditions; specimen received after prolonged delay in transport (usually more than 72 hours); specimen stored or transported at room temperature; specimen received frozen; wooden shaft swab in transport device; unlabeled specimen or name discrepancy between specimen and request label Test Details Use Aid in the diagnosis of disease caused by CMV (eg, viral infections, pneumonia, and organ transplant-related disease) Methodology Conventional tissue culture and shell vial cell cultures; FA confirmation Additional Information CMV infections are common and are often asymptomatic, but can be severe and life-threatening in immunocompromised patients including organ recipients and AIDS patients. CMV is the most frequent cause of congenital viral infections in humans and occurs in about 1% of all newborns. Approximately 90% have no clinical symptoms at birth. Ten percent to 20% of these infants will develop complications before school age. Congenital infection may occur as a result of either primary or recurrent maternal infection. Serology for the detection of cytomegalovirus is available.

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COMMON LAB TESTS

Complete Blood Count

This test, also known as a CBC, is the most common blood test performed. It measures the types and numbers of cells in the blood, including red and white blood cells and platelets. This test is used to determine general health status, screen for disorders and evaluate nutritional status. It can help evaluate symptoms such as weakness, fatigue and bruising, and can help diagnose conditions such as anemia, leukemia, malaria and infection.

Prothrombin Time
Also known as PT and Pro Time, this test measures how long it takes blood to clot. This coagulation test measures the presence and activity of five different blood clotting factors. This test can screen for bleeding abnormalities, and may also be used to monitor medication treatments that prevent the formation of blood clots.

Basic Metabolic Panel
This test measures glucose, sodium, potassium, calcium, chloride, carbon dioxide, blood urea nitrogen and creatinine which can help determine blood sugar level, electrolyte and fluid balance as well as kidney function. The Basic Metabolic Panel can help your doctor monitor the effects of medications you are taking, such as high blood pressure medicines, can help diagnose certain conditions, or can be part of a routine health screening. You may need to fast for up to 12 hours before this test.

Comprehensive Metabolic Panel
This test combines the Basic Metabolic Panel with six more tests for a more comprehensive evaluation of metabolic functions, with a focus on organ systems.

Lipid Panel
The lipid panel is a group of tests used to evaluate cardiac risk. It includes cholesterol and triglyceride levels.

Liver Panel
The liver panel is a combination of tests used to assess liver function and establish the possible presence of liver tumors.

Thyroid Stimulating Hormone
This test screens and monitors the function of the thyroid.

Hemoglobin A1C
This test is used to diagnose and monitor diabetes.

Urinalysis
Often the first lab test performed, this is a general screening test used to check for early signs of disease. It may also be used to monitor diabetes or kidney disease.

Cultures
Cultures are used to test for diagnosis and treatment of infections. Illnesses such as urinary tract infections, pneumonia, strep throat, MRSA and meningitis can be detected and tested for appropriate antibiotic treatment.

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