Test Directory - Understand Your Tests.

Zaleplon, Urine

Synonyms

Sonata®

Expected Turnaround Time

7 - 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.

Specimen Requirements

Specimen

Urine (random)

Volume

10 mL

Minimum Volume

2 mL

Container

Plastic urine container without preservative

Storage Instructions

Submission/transport (<3 days): Room temperature. For storage beyond three days, specimen should be refrigerated or frozen.

Causes for Rejection

Urine from preservative tube

Test Details

Use

Detect presence of zaleplon, a nonbenzodiazepine sedative-hypnotic

Methodology

Liquid chromatography/tandem mass spectrometry (LC/MS-MS)

ZAP-70 in B-CLL

Special Instructions

Draw specimen Monday through Thursday only after 12 noon EST. Specimen must be received at Integrated Oncology--Brentwood or Phoenix within 48 hours of collection. Please state date and time of collection on the test request form.

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.

Specimen Requirements

Specimen

Peripheral blood (preferred) or bone marrow

Volume

7 mL whole blood or 2 to 3 mL bone marrow

Container

Green-top (heparin) tube or lavender-top (EDTA) tube

Storage Instructions

Store and ship whole blood at room temperature. Ship bone marrow at room temperature.

Test Details

Methodology

Flow cytometry

Zika Virus, IgM, Serum

Special Instructions

Pregnancy status must be captured as part of the EUA and agreement with the CDC to offer the Zika virus IgM test. See the CDC website for updates to recommendations for Zika virus testing.

Expected Turnaround Time

2 - 5 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

Zika Virus Comprehensive Profile, NAA, Serum and Urine

Specimen Requirements

Specimen

Serum

Volume

2 mL

Minimum Volume

1 mL

Container

Gel-barrier tube is preferred. Red top tube is acceptable.

Collection

Usual phlebotomy collection. Spin as quickly as possible after clot formation, remove serum, and refrigerate.

Storage Instructions

Refrigerate

Stability Requirements

Temperature	Period
Room temperature	Unstable
Refrigerated	14 days
Frozen	14 days
Freeze/thaw cycles	Stable x3

Causes for Rejection

Specimen submitted at room temperature; overly hemolyzed specimen; lipemia; gross bacterial contamination; mislabeled specimen

Test Details

Use

Presumptive (not definitive) evidence of Zika virus infection

Limitations

Interpretation of Zika IgM results must account for the possibility of false-negative and false-positive results. False-negative results can arise from: a) Specimen collection conducted before IgM has reached detectable levels (typically around 4 days postonset of symptoms). b) Specimen collection conducted after IgM levels have decreased below detectable levels (typically around 12 weeks postonset of symptoms). c) Failure to follow the authorized assay procedures. The most common cause of false-positive results is cross-reactivity with IgM specific for other flaviviruses such as dengue virus. Only limited evaluation of cross-reactivity with flaviviruses or arboviruses has been conducted. No evaluation of cross-reactivity with rheumatoid factor has been conducted. Clinical data indicate cross-reactivity with antidengue virus antibodies is likely. Follow-up testing is necessary to rule out a false-positive result. Confirmation of the presence of anti-Zika IgM requires testing by CDC or a CDC-designated laboratory. The gold-standard method for confirmation of the presence of anti-Zika antibodies is the plaque reduction neutralization test (PRNT). Specimens are sent to CDC or a CDC designated State Laboratory for PRNT when results indicate the need based on the most recent algorithm(s). The CDC may refuse to accept specimens for PRNT that do not meet their epidemiologic criteria for PRNT testing. If this occurs you will be notified by the report. Follow up may occur from your state public health laboratory. All Zika testing should be conducted following the CDC-issued Zika laboratory guidance and testing algorithms: http://www.cdc.gov/zika/state-labs/index.html Negative results do not preclude infection with Zika virus and should not be used as the sole basis of a patient treatment/management decision. All results should be interpreted by a trained professional in conjunction with review of the patient's history and clinical signs and symptoms. This assay is for in vitro diagnostic use under FDA Emergency Use Authorization only and is limited to qualified laboratories. All specimens should be handled as if infectious. Proper biosafety precautions, including personal protective equipment, must be used when handling specimen materials. Proper collection, storage and transport of specimens are essential for correct results. Performance has only been established with the specimen types listed in the Intended Use. Other specimen types are not acceptable for use with this assay. It should be noted that as of April 2016, any patient whose sample yields positive PRNT results (ie, ≥10) for both Zika and dengue virus is now classified as having a flavivirus infection. This virus infection is only specified if one result is positive and the other negative. The former fourfold difference to identify the infection has been shown to be incorrect in a number of instances and has now been abandoned for Zika diagnosis only.

Methodology

IgM antibody capture ELISA

Additional Information

• This test has not been FDA cleared or approved; • This test has been authorized by FDA under an Emergency Use Authorization (EUA) for use by authorized laboratories; • This test has been authorized only for the diagnosis of Zika virus infection and not for any other viruses or pathogens; and • This test is only authorized for the duration of the declaration that circumstances exist justifying the authorization of the emergency use of in vitro diagnostic tests for detection of Zika virus and/or diagnosis of Zika virus infection under section 564(b)(1) of the Act, 21 U.S.C. § 360bbb-3(b)(1), unless the authorization is terminated or revoked sooner.

Zinc Protoporphyrin (ZPP)

Synonyms

ZPP

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

Specimen Requirements

Specimen

Whole blood

Volume

7 mL

Minimum Volume

0.2 mL

Container

Royal blue-top (EDTA) tube or tan-top lead-free tube; submit original tube.

Collection

Mix tube thoroughly to avoid clotting.

Storage Instructions

Room temperature. Stable for five days at room temperature or for seven days when refrigerated.

Causes for Rejection

Clotted specimen; frozen specimen; hemolyzed specimen; icteric specimen

Test Details

Limitations

Fluorescent substances in plasma may interfere with hematofluorometer results.² Skin contamination may lead to false elevations. Both this test and blood lead are needed for full evaluation.

Methodology

Fluorometry

Reference Interval

Environmental exposure: • ZPP, blood: Adults: 0−36 μg/dL; occupational exposure: BEI® (sampling time is after one month's exposure): <100 μg/dL¹

Additional Information

“Free” protoporphyrin is noncomplexed, nonheme protoporphyrin. Lead poisoning is also characterized by elevated plasma and urine δ-aminolevulinic acid and increased urinary coproporphyrin. Urinary porphobilinogen and uroporphyrin are normal to slightly increased.³ Free erythrocyte protoporphyrin is a sensitive test for lead toxicity or chronic exposure in adults. Erythrocyte protoporphyrin levels should not be used as a screening test for lead poisoning in children.⁴ The diagnosis of lead exposure or poisoning includes consideration of environmental exposure, as well as symptoms and abnormal erythrocyte protoporphyrin. This test is not to be used for workplace exposure to lead. If lead testing is required for workplace exposure to lead, please order test 010180. Increased lead absorption is reported in the presence of iron deficiency.

Zinc Protoporphyrin (ZPP), Workplace

Synonyms

Workplace ZPP
ZPP

Special Instructions

This test is for workplace monitoring. For nonworkplace monitoring, please order test 010170. Environmental and biological exposure indices (BEI) references will be listed on the report.¹ For workplace exposure to lead, please refer to the BEI. Levels above the environmental exposure range are not always indicative of lead poisoning. Note: This test is not intended for the evaluation of suspected porphyrias, including congenital erythropoietic porphyria. The Porphyrins, Evaluation, RBC test is intended for that purpose. This test is intended for the evaluation of suspected lead toxicity and iron deficiency anemia.

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

Specimen Requirements

Specimen

Whole blood

Volume

7 mL

Minimum Volume

0.2 mL

Container

Royal blue-top (EDTA) tube or tan-top lead-free tube; submit original tube.

Collection

Mix tube thoroughly to avoid clotting.

Storage Instructions

Room temperature. Stable for five days at room temperature or for seven days when refrigerated.

Causes for Rejection

Clotted specimen; frozen specimen; hemolyzed specimen; icteric specimen

Test Details

Use

Monitor chronic industrial exposure to lead

Limitations

Fluorescent substances in plasma may interfere with hematofluorometer results.² Skin contamination may lead to false elevations. Both this test and blood lead are needed for full evaluation.^3-5

Methodology

Fluorometry

Reference Interval

Occupational exposure: • ZPP, blood: Adults: 0−99 μg/dL: BEI® (sampling time is after one month's exposure)

Additional Information

"Free" protoporphyrin is noncomplexed, nonheme protoporphyrin. Lead poisoning is also characterized by elevated plasma and urine δ-aminolevulinic acid and increased urinary coproporphyrin. Urinary porphobilinogen and uroporphyrin are normal to slightly increased.³ Free erythrocyte protoporphyrin is a sensitive test for lead toxicity or chronic exposure in adults. Erythrocyte protoporphyrin levels should not be used as a screening test for lead poisoning in children.⁴ The diagnosis of lead exposure or poisoning includes consideration of environmental exposure, as well as symptoms and abnormal erythrocyte protoporphyrin. Increased lead absorption is reported in the presence of iron deficiency.⁵

Zinc, RBC

Synonyms

Zn RBC

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.

Specimen Requirements

Specimen

Red blood cells (RBCs)

Volume

1 mL

Minimum Volume

0.125 mL

Container

Royal blue-top (EDTA) tube

Collection

Centrifuge tube within 45 minutes of collection and separate plasma from cells. Discard the plasma. Using the original collection tube, submit only the RBCs to the laboratory.

Storage Instructions

Room temperature

Stability Requirements

Temperature	Period
Room temperature	14 days
Refrigerated	14 days

Causes for Rejection

Plasma or serum submitted

Test Details

Use

Zinc is an essential trace element. Subnormal levels are associated with alcoholic cirrhosis, cystic fibrosis, myocardial infarction, acute and chronic infections. High levels may be due to industrial exposure.

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

822−1571 μg/dL

Zinc, Urine

Synonyms

Zn, Urine

Test Includes

Creatinine, urine; zinc, urine; zinc:creatinine ratio; zinc, urine (24-hour)

Special Instructions

If 24-hour urine is submitted, then request form must state 24-hour collection volume. Do not use preservative. Preservatives used for routine analysis may contain mercuric oxide (ie, Stabilur), which interferes with all metal testing. If both urinalysis and metal testing are ordered, please submit a separate urine specimen (containing no additive) for the metal testing.

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

Specimen Requirements

Specimen

Urine (24-hour or random)

Volume

5 mL

Minimum Volume

1.7 mL

Container

Plastic urine container, no preservative

Collection

Optional protocol: Instruct the patient to void at 8 AM and discard the specimen. Then collect all urine including the final specimen voided at the end of the 24-hour collection period (ie, 8 AM the next morning). Screw the lid on securely.

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

Test Details

Use

Evaluate zinc exposure; evaluate low serum zinc levels; evaluate compliance in oral zinc therapy of Wilson disease.² Low urine zinc levels in the presence of depressed serum zinc tends to confirm zinc deficiency.

Limitations

Zinc deficiency is usually accompanied by decreased urine zinc excretion. Zinc deficiency, however, may be in part due to excess urine losses, especially in cirrhosis, hemolytic anemias, sickle cell disease, alcoholism, diabetes, or chronic renal diseases. 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: 100−900 μg/g creatinine,¹ 150−1200 μg/24 hours

Additional Information

Zinc poisoning through inhalation of zinc oxide fumes or dust often produces symptoms of respiratory tract irritation, chest pain and cough, fatigue, headache, nausea, fever, and muscle pain.³ Zinc is utilized as an alloying agent in brass and other metals, as well as in metal plating. Zinc chloride is often produced in the chemical smoke generators that are employed in industry. Zinc chloride is also used in soldering fluxes and wood preservatives.

Ziprasidone, Serum or Plasma

Synonyms

Geodon®

Expected Turnaround Time

5 - 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.

Specimen Requirements

Specimen

Serum or heparinized plasma

Volume

2 mL

Minimum Volume

0.5 mL

Container

Red-top tube or green-top (heparin) tube. Gel-barrier tubes are not recommended.

Collection

Serum or plasma should be separated from cells within two hours of venipuncture. Submit serum or plasma in a plastic transport tube.

Storage Instructions

Maintain specimen at room temperature; stable for three days. Stable refrigerated for 14 days

Patient Preparation

Trough levels are most reproducible.

Causes for Rejection

Gel-barrier tubes

Test Details

Use

Therapeutic drug management

Methodology

Liquid chromatography/tandem mass spectrometry (LC/MS-MS)

ZnT8 Antibodies

Synonyms

Zinc Transporter 8 Autoantibodies

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.

Specimen Requirements

Specimen

Serum (preferred) or plasma (heparin)

Volume

0.5 mL

Minimum Volume

0.2 mL (Note: This volume does not allow for repeat testing.)

Container

Red-top tube, gel-barrier tube, or green-top (heparin) tube

Collection

Serum or plasma must be separated from cells within 45 minutes of venipuncture. Transfer separated serum or plasma to a plastic transport tube. 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. Stable at room temperature, refrigerated, or frozen for seven days. Freeze/thaw cycles: stable x6

Causes for Rejection

Gross hemolysis; lipemic specimen; EDTA plasma

Test Details

Use

Detects zinc transporter 8 autoantibodies (ZnT8), an autoimmune diabetes marker that is instrumental in the diagnosis of new-onset type 1 diabetes

Methodology

Enzyme-linked immunosorbent assay (ELISA)

Zolpidem, Serum or Plasma

Synonyms

Ambien®
Edluar®
Intermezzo®

Expected Turnaround Time

7 - 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.

Specimen Requirements

Specimen

Serum or plasma

Volume

3 mL

Minimum Volume

0.6 mL

Container

Red-top tube or green-top (heparin) tube. Gel-barrier tubes are not recommended.

Collection

Serum or plasma should be separated from cells within two hours of venipuncture. Submit serum or plasma in a plastic transport tube.

Storage Instructions

Submission/transport (<3 days): Room temperature. For storage beyond three days, specimen should be refrigerated or frozen. Specimen is stable for three days at room temperature, for three days refrigerated, and for two weeks frozen.

Causes for Rejection

Gel-barrier tubes

Test Details

Use

Therapeutic drug management

Methodology

Liquid chromatography/tandem mass spectrometry (LC/MS-MS)

Reference Interval

Expected hypnotic zolpidem concentrations in patients taking recommended daily dosages: up to 250 ng/mL.

Zonisamide, Serum or Plasma

Synonyms

Zonegran®

Special Instructions

Refrigerate at 2°C to 8°C if specimen is not tested immediately.

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.

Specimen Requirements

Specimen

Serum or plasma

Volume

1.2 mL

Minimum Volume

0.4 mL (Note: This volume does not allow for repeat testing.)

Container

Red-top tube or lavender-top (EDTA) 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

Separated serum from cells within 45 minutes of collection and transfer to a plastic transport tube. Separate plasma immediately and transfer to a plastic transport tube for shipment to the laboratory. Trough: Immediately prior to next dose. Steady-state levels are reached within 5 to 15 days in patients on zonisamide monotherapy.

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

Gel-barrier tube; hemolysis; nonseparated serum or plasma specimen

Test Details

Use

Monitor drug levels for optimal therapy

Limitations

Zonisamide is contraindicated in patients who have demonstrated hypersensitivity to sulfonamides or zonisamide. Consideration should be given to discontinuing zonisamide in patients who develop an otherwise unexplained rash. If the drug is discontinued, patients should be observed frequently. 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

10.0−40.0 μg/mL

Additional Information

Zonisamide is an antiepileptic drug belonging to the sulfonamide class and is chemically unrelated to other antiepileptic drugs. While the exact mechanism of action is unknown, anticonvulsant activity may be mediated by action at sodium and calcium channels. This action may result in stabilizing neuronal membranes and suppressing neuronal hypersynchronizations.¹ Preliminary studies on smaller population groups has indicated possible other uses for zonisamide in intractable neuropathic pain syndromes² and refractory migraine headaches.³ Zonisamide is excreted primarily in urine as the parent drug and glucuronide of the metabolite 2-sulfamoylacetyl phenol. Metabolism of zonisamide is mediated by the P450 isozyme CYP3A4 and to a lesser extent by CYP2D6.⁴ The drug was rapidly absorbed orally following 200−400 mg doses in volunteers. Peak plasma concentrations were 2−5 μg/mL and occurred in two to six hours. Food does not effect the overall bioavailability, but delays time to maximum concentration until four to six hours. Zonisamide extensively binds to erythrocytes, resulting in an eightfold higher concentration in red blood cells than in plasma. The pharmacokinetics of zonisamide are dose proportional in the range of 200−400 mg.¹ Time to steady state is from 5 to 15 days with an elimination half-life of 63 to 69 hours in volunteers receiving no other medication.⁴ The half-life, however, is reduced by the co-medicated P450 inducers phenytoin and carbamazepine. The half-life of zonisamide is reduced to a mean of 27.1 hours when the former is co-administered and to a mean of 36.4 hours with co-administration of the latter.⁵

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