MID
M AM
MERICA
A
CLLINICA
AL LAB
BORATTORIEES, LLC
C
Dirrectory of
o Service
es
Refference Guide
G
Pub
blished: December 21,, 2011
Mid America Clinical Labora
atories, LLC
r
reserv
ved
All rights
Mid America Clinical Labora
atories
ectory of Serrvices
Dire
2560 North Shadeland Aven
nue
N 46219-016
63
Indianapolis, IN
1
Table of Contents
About Mid America Clinical Laboratories, LLC ............................................................................................... 3
Mid America Clinical Laboratories’ Vision for the Future................................................................................................................................................3
Description of Laboratories ......................................................................................................................................................................................................3
Quality Assurance and Laboratory Accreditation .............................................................................................................................................................3
Client Response Center (CRC) ..................................................................................................................................................................................................4
Courier Services/Specimen Pick-up .......................................................................................................................................................................................4
Hospital Based Lab (HBL) Test Availability ...........................................................................................................................................................................5
Patient Service Center Network ..............................................................................................................................................................................................5
Professional Consultations ........................................................................................................................................................................................................6
Reference Ranges .........................................................................................................................................................................................................................6
Result Reporting ...........................................................................................................................................................................................................................6
Test Additions – After Submission of Specimen ................................................................................................................................................................6
Web Page ........................................................................................................................................................................................................................................6
MACL’s Directory of Services (DOS)........................................................................................................................................................................................6
Unlisted Tests/Tests Not Found In This Directory of Services .......................................................................................................................................6
General Specimen Collection Information ..................................................................................................... 8
Introduction ...................................................................................................................................................................................................................................8
Proper Labeling.............................................................................................................................................................................................................................8
Health and Safety Precautions .................................................................................................................................................................................................9
Unacceptable Specimens ..........................................................................................................................................................................................................9
Blood Collection ........................................................................................................................................................................................................................ 10
Urine Collection ......................................................................................................................................................................................................................... 12
Coagulation Specimen Collection and Handling ........................................................................................................................................................... 13
Microbiology Specimen Collection and Handling ....................................................................................... 14
Cytopathology Specimen Collection and Handling ..................................................................................... 22
Reflex Testing .................................................................................................................................................. 28
Client Information .......................................................................................................................................... 30
Account Management Team ................................................................................................................................................................................................. 30
Billing ............................................................................................................................................................................................................................................. 30
Ordering Supplies ..................................................................................................................................................................................................................... 31
Instructions for Packaging Specimens and Test Requisitions .................................................................................................................................... 32
Allergy Evaluations ......................................................................................................................................... 35
General Test Listings
Interpretive and Additional Information (from Quest Diagnostics, Inc.)
2
About Mid America Clinical Laboratories, LLC
Mid America Clinical Laboratories is an independent clinical laboratory jointly owned by the Community Hospital Network, St.
Vincent Hospitals and Health Services, Quest Diagnostics, Inc., and CoLab, LLC. Mid America Clinical Laboratories embraces, from its
founders, the concept of quality, service and excellence by working together.
Mid America Clinical Laboratories is customer-oriented, provides open and honest communication to engender trust and integrity
with all of its customers and works with its associates as team members. In addition, Mid America Clinical Laboratories recognizes
that it is an extension of its founders and will recognize their missions’ emphasis on efficiency, respect for the individual, simplicity
and quality improvement.
The primary objective of the partners in Mid America Clinical Laboratories (MACL) is to provide Indiana-based laboratory services to
physician practices throughout central and northern Indiana and to improve the efficiency of the individual hospital laboratories. It
is the mission of Mid America Clinical Laboratories to provide a full range of clinical laboratory services to patients and other
customers with an emphasis on high quality, efficiency and responsiveness.
Mid America Clinical Laboratories’ Vision for the Future
At Mid America Clinical Laboratories, we are striving to Be First in Customer Satisfaction Through Service,
Information and Innovation.
Each of our associates is committed to our Values:
• Commitment to Service
• Creativity
• Integrity
• Respect
• Quality
Description of Laboratories
The Hospital Based Laboratories (HBLs) provide transfusion services, chemistry, hematology, coagulation, urinalysis
and rapid microbiological tests when results are needed for the immediate treatment of the patient.
The Regional Laboratory performs routine testing when results are not required immediately. Most microbiology and
esoteric testing is performed in the Regional Laboratory because the technology precludes rapid turnaround (e.g.
bacterial cultures).
Three laboratory/patient service centers provide a limited STAT testing menu as well as specimen collection services.
Quality Assurance and Laboratory Accreditation
Board certified anatomic and clinical pathologists direct laboratory activities, providing supportive services in both the
medical and technical areas. Well trained and competent certified medical technologists, cytotechnologists and
technicians as well as a comprehensive and continuously monitored quality control program enable Mid America
Clinical Laboratories to provide precision and accuracy in its test results. Day to day quality and accuracy are assured
by internal and external proficiency testing programs.
Mid America Clinical Laboratories is accredited or approved to provide laboratory services by the following
organizations:
American Association of Blood Banks (AABB)
Centers for Medicare Services
Clinical Laboratory Improvement Amendment (CLIA)
College of American Pathologists (CAP)
Indiana State Department of Health
Medicaid
3
MID AMERICA CLINICAL LABORATORIES SERVICES
Client Response Center (CRC)
At Mid America Clinical Laboratories, we recognize that lab quality is defined by clinical quality and service quality. We
will continually strive to understand, respond to and meet the needs of our clients through functioning as a client
advocate, recognizing and responding to service opportunities and facilitating resolution.
We maintain a telephone call center staffed with courteous and knowledgeable associates, available to answer
questions and offer assistance in obtaining laboratory testing services. The MACL Client Response Center assists with
questions about our test menu or test results. CRC also helps with referrals to the appropriate Mid America employee
to assist with problem resolution and professional consultation.
The Client Response Center is staffed seven days a week and calls are answered 24 hours each day.
All customer inquires relative to specimen requirements, test results, test information, hard copy reports, etc., should
be directed to the Client Response Center at (317)803-1010 or (877)803-1010.
Courier Services/Specimen Pick-up
Courier service for specimen pick-up and supplies delivery at physician offices, clinics, hospitals and nursing homes is
available daily throughout our service area. Our couriers work on a schedule designed to meet our customers’ needs.
Calls for pick-ups and ordering supplies should be directed to (317)803-1020.
4
Hospital Based Lab (HBL) Test Availability
A limited menu of laboratory tests are available in all of the hospital-based facilities. STAT orders for these tests are
usually resulted within one hour or less of specimen receipt. The list is comprehensive, and not all tests are available at
every site.
Acetaminophen
Acetone
Albumin
Alcohol
Alkaline Phosphatase
ALT
Aminophylline
Ammonia
Amylase
AST
Basic Metabolic Panel
Bilirubin, Direct
Bilirubin, Neonatal
Bilirubin, Total
Blood Gas
BNP
Body Fluid, pH
BUN
Calcium
Carbon Monoxide
CBC w/o Diff
CBC with Diff
Cell Count, CSF
Cell Count, Joint Fluid
Chloride, Blood
CKMB
CO2
Comprehensive Metabolic
Panel
CPK
Creatinine
D-Dimer
Digoxin
Dilantin
Drug Screen, Urine
Electrolytes, Blood
Electrolytes, Urine
Factor VIII Activity
Factor IX Activity
Fetal Fibronectin
Fetal Hemoglobin (APT) Test
Fibrinogen
Gentamicin
Glucose, Blood
Glucose, CSF
Gram Stain
Group A Strep Screen, Rapid
HCG, Qualitative, Serum
HCG, Qualitative, Urine
HCG, Quantitative, Serum
Hepatic Panel
India Ink
Influenza A & B by EIA
Ionized Calcium
Lactic Acid, Blood
Lamellar Body Count
LDH
Lipase
Magnesium
O2 Saturation/Oxyhemoglobin
Occult Blood, Fecal
Occult Blood, Gastric
Phenobarbital
Phosphorous
Platelet Count
Platelet Function Test
Potassium, Blood
Potassium, Urine
Protime, PT
PTT, Partial Thromboplastin
Quantitative Dimer
Renal Panel
RSV by EIA
Salicylate
Sed Rate
Sodium, Blood
Sodium, Urine
Specific Gravity, Urine
Tegretol
Total Protein, Blood
Total Protein, CSF
Trichomonas Prep
Troponin I
Uric Acid, Blood
Urinalysis
Valproic Acid
Vancomycin
Methemoglobin
Mono Screen
WBC, Stool
Patient Service Center Network
Mid America Clinical Laboratories has a comprehensive network of Patient Service Centers (PSCs). Our PSCs provide
specimen collection services, including the following:
•
•
•
•
Routine phlebotomy (venipuncture)
Urine collections
Capillary sticks
Throat swabs
In addition to specimen collection, we have three laboratory service centers and our hospital-affiliated labs that also
provide a limited STAT test menu to support medically urgent situations.
Locations for PSCs are available by calling CRC at 317-803-1010 or on the internet at www.maclonline.com.
5
Patients must bring a Mid America Clinical Laboratories test requisition for service at our locations. The test requisition
must be completed with specific test order codes, all medically appropriate diagnosis codes as provided by the
physician, patient demographics and billing or insurance information.
Professional Consultations
Members of our staff are available for questions or medical and technical consultation. Our Client Response Center
Representatives can provide assistance in contacting the appropriate Mid America staff member for professional
consultation.
Reference Ranges
Reference ranges (normal ranges) for interpretation of results will be included on each patient test report. Because of
continuing improvements in methodology and expanding knowledge in clinical interpretation, reference ranges do
not remain static in a progressive laboratory. Each report will carry current reference ranges for the specific test.
Result Reporting
In accordance with regulations governing clinical laboratories and in order to maintain the confidentiality of records, it
is the policy of Mid America Clinical Laboratories to release test related information to only the person who ordered
the test or that person’s authorized representative.
Written reports are delivered electronically or by mail.
Alert (critical) results are flagged in the laboratory computer system when results exceed the verification range. All
alert and STAT values will be telephoned as soon as they are available, followed by written reports.
Turnaround times for STAT tests performed on site in the Hospital Based Labs will be one hour or less from time of
receipt in the lab. Turnaround times for routine tests performed on site at the Regional Laboratory will usually be 12
hours. Most microbiology and esoteric test results are available within 48 to 72 hours of specimen receipt.
Test Additions – After Submission of Specimen
The Client Response Center (CRC) can arrange for additional testing if sufficient specimen type and volume remains
after the initial tests have been completed. To request a test addition, contact CRC at 317-803-1010. We are required
by federal regulations to obtain written authorization for every test we perform. A hard copy request for written
confirmation will follow all verbal test requests. An employee authorized by the requesting client or physician must
sign this written confirmation.
Web Page
A wide variety of information about Mid America Clinical Laboratories is available at www.maclonline.com.
Information on lab test requirements, locations of our patient service centers, copies of our monthly newsletters, and
employment opportunities can be viewed.
MACL’s Directory of Services (DOS)
Mid America Clinical Laboratories’ Directory of Services (DOS) contains all the information needed to order and
procure testing services. The DOS is made available to all customers and prospective customers in a variety of
convenient, user-friendly formats, including our web page, on CD and in printed versions.
Unlisted Tests/Tests Not Found In This Directory of Services
We are continually developing new procedures. As a result, some tests may not be listed in this edition of the Mid
America Clinical Laboratories DOS. Additionally, certain procedures are no longer offered because they have become
obsolete. Contact the Client Response Center for information on tests not found in this DOS.
6
Mid America Clinical Laboratories will accept testing that is referred to other facilities as a convenience to our clients if
that laboratory is a testing partner of ours. A handling fee will be charged except as prohibited by law.
7
General Specimen Collection Information
Introduction
The quality of any laboratory test result is dependent on many variables. First, the patient must be properly
prepared so that the best possible specimen can be collected. Next, the actual collection of the specimen must be
completed. Then, the specimen should be properly processed, packaged and transported to the laboratory in a
timely manner and under environmental conditions that will not compromise the integrity of the specimen. After
all of these activities take place, a quality analysis can be performed. Specific specimen requirements for each test
are listed in the General Test Listing section of this directory. Specimen requirements include information such as
specimen volume, collection and transport containers as well as transport temperature. If additional information
is needed for the interpretation of the test results or there are specific instructions for patient preparation, they are
listed along with specimen requirements.
It is critical that an adequate specimen volume is submitted for analysis. The volume requested in this
directory will be enough for initial analysis, as well as any confirmatory tests that must be performed. If an
inadequate specimen is submitted, we may not be able to perform the initial test or required confirmatory
procedures. If repeat or confirmatory tests cannot be performed, the report will indicate that specimen quantity
submitted was “QNS” (Quantity Not Sufficient) for additional testing.
When serum or plasma is to be submitted for analysis, it is generally a good practice to collect a volume of blood
that is 2 to 2.5 times the volume of serum or plasma needed for the test. As an example, if 4 mL of serum or
plasma is needed for a test, collect 8 to 10 mL of blood.
When an inappropriate specimen or unclear test requisition has been submitted, the ordering physician will
receive notification with instructions for resolving the problem. To prevent future delays, a report will be issued
with information regarding proper specimen submission.
Proper Labeling
1.
Test Orders
All laboratory specimens must be accompanied by a valid order. The order may be a manual or computer
requisition and must indicate the patient first and last name. It is recommended that the patient’s name on the
primary container exactly match that on the requisition. In addition, test orders, date and time of collection,
patient medical record number (for hospital registered patients), order number and ordering physician name must
be included. MACL clients are assigned a unique customer number which is preprinted on the test requisitions.
In general, specimens will not be accepted in the laboratory without an order, an ordering physician, and without
a patient name.
2.
Hospital Patients
The identification label must be completed and affixed to the primary container after the specimen has been
collected and before the specimen is taken from the patient’s room. The following information must be included
on the label:
a.
b.
c.
d.
e.
f.
g.
h.
I.
Patient’s name (no nicknames)
Hospital registration number
Medical Record number
Date and time collected
Patient’s room number
IS order number
Source of specimen, (other than blood).
Fi O2 for blood gas specimens
Initials of the person obtaining the specimen
8
3.
Outside Facilities/Clients
The specimen is labeled by the individual obtaining the specimen. The following must be included on the label:
a.
b.
c.
d.
Patient’s name, written exactly as it appears on the test requisition
Account number
Date and time collected
Source of specimen (other than blood). When submitting a specimen in a transfer tube, the specimen type
must be indicated on the transfer tube label (e.g., serum, plasma, urine).
Note:
When ordering tests in a series (e.g., growth-hormone stimulation, glucose tolerance, multiple-site renin
specimens);
1) Use one test requisition.
2) Label each specimen with the patient’s unique identifier, date and time of collection (if applicable),
site (if applicable) or other pertinent condition under which each specimen was collected.
3) Write the number of specimens on the test requisition.
4) Submit all specimens within a series together in one specimen bag.
Health and Safety Precautions
All specimens should be handled as if they are infectious. The greatest dangers to health care workers exposed to
blood and body fluids are the Human Immunodeficiency Virus (HIV) and the hepatitis viruses. The following safety
guidelines must be followed when preparing specimens for transport to Mid America Clinical Laboratories.
a.
Specimen container must be properly sealed. A leaking container not only compromises specimen integrity but
poses a health hazard for those handling the specimen. A leaking specimen can also contaminate the requisition
which is a safety hazard throughout the process.
b.
Specimens collected in syringes will not be accepted with the needle attached. The needle must be removed and
a syringe port attached.
c.
All specimens must be transported in a plastic ziplock bag as secondary containment. This protects anyone
handling the specimen in case of leakage or breakage.
d.
All specimens from outside facilities are transported in coolers with a fixed Biohazard label. This meets the
requirements of CFR 1910.1030. (G), “Individual containers of blood or other potentially infectious materials that
are placed in a labeled container during storage, transport, shipment, or disposal are exempted from the
(individual specimen) labeling requirement.”
e.
Clients have the responsibility to secure the specimen for transportation in a locked box. It is the customer’s
responsibility to report to local authorities any loss of or tampering with specimens occurring before pickup by
Mid America Clinical Laboratories.
Unacceptable Specimens
Specific instructions for storage and shipment of specimens for individual tests are listed under specimen
requirements in the alphabetical listing of laboratory tests.
Occasionally, blood specimens are contaminated with substances that interfere with accurate sample analysis:
1.
Hemolysis - Hemolysis occurs when the membrane surrounding red blood cells is
disrupted and hemoglobin and other intracellular components escape into the
serum or plasma. (This may occur with a difficult draw.)
9
Hemolyzed serum or plasma varies in color from faint pink to bright red, rather than the normal straw color. Even
a slight hemolysis will alter certain test results.
Grossly or moderately hemolyzed specimens may be rejected.
2.
Hyperbilirubinemia - Icteric serum or plasma varies in color from dark to bright
yellow, rather than the normal straw color. Icterus may affect certain test results.
Upon receipt of such specimens, we may request a new sample to assure results
of diagnostic value.
3.
Radioisotope interference - Diagnostic procedures or therapy involving
radioactive compounds may invalidate radioisotope assays. Obtain
specimens for anticipated radioisotope assays before administering isotopes to
the patient.
4.
Turbidity - Turbid, cloudy or milky serum (lipemic serum) may be
produced by the presence of fatty substances (lipids) in the blood. Bacterial
contamination may also cause cloudy serum. Moderately or grossly lipemic
specimens may alter certain test results.
A recent meal can produce transient lipemia. For the majority of tests performed on serum, plasma or whole
blood, a fasting specimen is preferred. Fasting is defined as no consumption of food or beverage, other than
water, for at least 8-12 hours before testing. The fasting specimen provides information that reflects the
physiological baseline of the patient. This information can easily be compared to information from tests obtained
at other times and provides a means for reliably monitoring a patient’s condition for the duration of their care.
Blood Collection
1.
Blood, Plasma
Plasma contains fibrinogen and other clotting factors when separated from the red cells. Evacuated tubes used to
collect plasma specimens contain an anticoagulant and frequently a preservative. The additive in the tube is
specified and correlates to the color of the tube stopper. Consult the individual test specimen requirement or Mid
America Clinical Laboratories’ tube collection chart to determine the correct additive/tube to use. Perform
venipuncture. Invert tube gently at least 8 times, 4 times for light blue tubes. If the plasma is removed from the
original vacutainer vial, the transfer tube and requisition must be labeled to indicate that the specimen is plasma.
2.
Blood, Serum
We recommend the use of serum separator collection tubes for most analyses. However, please check individual
specimen requirements for restrictions.
Perform venipuncture. Invert the tube gently at least five times.
Centrifugation Instructions:
3.
a.
Do not remove the stopper at any time. Allow the blood to clot in an upright position at least 30 minutes (but
not more than 60 minutes) before spinning. Do not centrifuge immediately after drawing blood.
b.
Centrifuge at greater than 3000 RPM for 10 minutes.
c.
Normally the specimen is transported to the laboratory in the original vacutainer.
Only transfer serum to a plastic vial when immediate freezing is necessary. Label the transferred specimen as
serum. Do not freeze the glass tubes.
Blood, Whole
10
Collect whole blood according to the instructions provided for the individual test. Thoroughly mix the blood
with the additives by gently inverting the tube at least ten times. Maintain the specimen at room
temperature before transporting to our laboratory unless instructed otherwise by the specimen requirements.
Never freeze whole blood unless specifically instructed by the specimen requirements.
4.
Common Blood Collection Tubes and Additives
HEMOGARD
CLOSURE
Plain Red
RUBBER
STOPPER
Plain Red
ADDITIVE
Light Blue
Light Blue
Sodium
Citrate.
0.105 M,
(3.2%)
Removes calcium
to prevent clotting.
Green
Green
Inhibits thrombin
formation to
prevent clotting.
Lavender
Lavender
Sodium
heparin,
lithium
heparin
EDTA
Pink
N/A
EDTA
Removes calcium
to prevent clotting.
Gold
Black/Red
Gel
separator/
clot
activator
Gray
Gray
Royal Blue
Royal Blue
Sodium
fluoride,
Potassium
oxalate
None
Clot activators
shorten the time
for clot formation.
The gel forms a
barrier between
cells and serum.
Inhibits glycolysis.
Removes calcium
to prevent clotting.
None
EDTA
Tan
Tan
EDTA
White
N/A
EDTA/Gel
ADDITIVE
FUNCTION
Contains no
anticoagulants and
no additives.
Removes calcium
to prevent clotting.
Contains no
anticoagulant.
CONSIDERATIONS
No additive. Clot
formation takes 30
minutes.
Tube should be full
and mixed well.
Blood to
anticoagulant ratio
very important (9:1).
Be careful of the type
of heparin that is
being used for what
type of testing.
Should be well mixed;
invert
6-8 times.
Should be well mixed;
invert
6-8 times.
Tubes should be
inverted 5 times to
expose the blood to
the activator.
Centrifuged after clot
formation is complete.
Should not be used
for other chemistries.
Chemically cleaned
and the rubber
stoppers contain low
levels of metals.
Removes calcium
to prevent clotting
Inhibits thrombin
formation to
prevent clotting.
Removes calcium
to prevent clotting.
The gel forms a
barrier between
the plasma and
cells.
11
Chemically cleaned
and the rubber
stoppers contain low
levels of metals.
N/A
LABORATORY
USE
Serum
chemistries,
serology,
body fluids,
therapeutic drug
monitoring.
Coagulation
studies, PT, APTT,
factor assay.
Plasma
chemistries.
Whole blood
hematology cell
counting, CBC.
Blood Bank tests
ONLY.
Most chemistry
testing and some
drug levels. Not
suitable for Blood
Bank testing.
Glucose testing,
glucose
tolerances,
alcohol levels
Toxicology, trace
metals.
Lead
Some Hepatitis
and HIV PCR
tests.
Urine Collection
1.
Urine, Chemistry
The normal composition of urine varies considerably during a 24 hour period. Most reference values are
based on analysis of the first urine voided in the morning. This specimen is preferred because it has a more
uniform volume and concentration, and its lower pH helps preserve the formed elements.
Urine for pregnancy testing should be a first morning voiding, or a random specimen with a specific gravity of
at least 1.010. Note the time of collection of the specimen on the test requisition form and on the label of the
container.
2.
Urine, Hematology (Urinalysis)
To reduce contamination, the specimen submitted for urinalysis should be a clean catch “midstream” sample.
Submit a first morning specimen whenever possible. Instructions for collecting a clean catch midstream
specimen are located on page 18-19.
3.
Urine, Cultures
See Microbiology Specimen Collection section for specific instructions (pages 18-19).
4.
Urine, 24-Hour Collection
Because proper collection of 24 hour urine specimens is essential for accurate test results, patients should be
carefully instructed in the correct procedure. Printed instructions for the patient are available from the
laboratory.
5.
a.
Unless the physician indicates otherwise, instruct the patient to maintain
the usual amount of liquid intake but to consume no alcoholic beverages.
b.
During the collection period, keep the 24 hour urine container in a refrigerator or cool place to prevent
growth of microorganisms and possible decomposition of urine constituents.
c.
Have the patient empty his/her bladder in the morning into the toilet (not to be included in the 24 hour
collection). Write the date and time of voiding on the container label.
d.
Collect the patient’s next voiding and add it as soon as possible to the 24
container.
e.
Add all subsequent voidings to the container as in Step d. The last sample
collected should be the first specimen voided the following morning at the same time as the previous
morning’s first voiding.
f.
The start and stop times, along with the total volume, must be recorded on the specimen container.
hour
Urine Drug Screens
Non-forensic screening for drugs of abuse occurs when a urine specimen is submitted without a forensic
chain of custody form. This testing is performed 24 hours a day in the Hospital Based Laboratories and is
resulted within one hour of specimen receipt. The method of testing is a qualitative detection of the major
metabolites of the drugs of abuse. The results are used for emergency medical/clinical diagnostic purposes
and can not be used to take legal or punitive action. For non-emergency medical/clinical diagnostic
purposes, a more comprehensive non-forensic screen for drugs of abuse is available.
12
Forensic testing requires a special collection kit containing a chain of custody form, security seals and
specimen collection container. Collection of these specimens are done by appointment in several of the Mid
America Clinical Laboratories Patient Service Centers. Call 317-803-1010 for locations. The patient must bring
a picture ID to confirm patient identification. Patients without proper identification will not be able to be
tested. Forensic testing must have a physician’s order, agreement with an employer, or a court order before
the laboratory can collect the specimen. The specimens are sent out to a reference laboratory for testing.
Note:
Forensic screening for drugs of abuse is not performed on an inpatient basis.
Coagulation Specimen Collection and Handling
For coagulation testing to be valid, critical attention must be paid to the collection and processing of these blood
samples. These instructions must be followed. Deviation from them will significantly alter the results.
1.
If a number of different tubes are to be collected from a patient, the order of the draw of the tubes is as
follows:
a.
Light blue top tubes*
b.
Serum tubes (gold, red/black, red)
c.
Green top tubes
d.
Lavender or pink top tubes
e.
Gray top tube
*In the event that only light blue top tubes are to be drawn, and a winged blood collection set is being
used, a red top tube must first be collected before drawing the blue top tube. This will fill the tubing’s dead
space to ensure maintenance of the proper blood-to-additive ratio.
2.
Venipuncture must be clean with no trauma. Hemolyzed samples are not acceptable.
3.
Mix sample gently by inverting the tube(s) 4 times immediately after filling.
4.
Deliver specimens to the laboratory within 30 minutes of collection.
5.
Tube must be properly filled. The correct ratio of blood to citrate is critical (9:1).
6.
Platelet function tests must not be drawn with a butterfly set or in “short draw” light blue top tubes.
13
Microbiology Specimen Collection and Handling
Introduction
The ability to assess the clinical significance of microbiology laboratory results is dependent upon proper
specimen collection, preservation and transport. There is a wide variety of microorganisms found on the body
naturally as “normal flora”. Specimen collection and preservation procedures are designed to avoid normal flora, if
possible, or to at least keep their numbers low. Mid America Clinical Laboratories has produced a color pictorial
“Microbiology Specimen Transport Guidelines” chart to assist in choosing the appropriate device.
Sensitivities
Antimicrobic susceptibilities are performed as a reflex test on appropriate organisms, whether or not a
susceptibility is specifically requested. Susceptibility tests are not performed on normal flora, on isolates that have
predictable sensitivity patterns, such as beta hemolytic streptococci, or on anaerobes. Most isolates are held for
seven days and special requests can usually be accommodated. Please contact the Microbiology Department at
(317)803-0050 concerning these requests.
Specimen Site
When submitting a specimen, please be specific about the site of the specimen. Do not use terms such as
“wound”, “swab”, “fluid”, “tissue”, etc. For example, use the term “abdominal wound”. This gives the laboratory a
much better idea of appropriate methods to use to grow the organisms expected as normal and as pathogenic
from that area of the body.
Microbiology Reports
Reports are generated daily on routine cultures and weekly on fungus and acid-fast (AFB) cultures. Fungus
cultures are examined for four weeks and AFB cultures for six weeks before reporting as negative.
Unacceptable Specimens
Unacceptable specimens may result in test cancellation or delay. The following is a list of the most common
rejection criteria.
1.
Mislabeled or unlabeled specimen and/or test request form.
2.
Source not stated on test request form.
3.
Inappropriate specimen for culture requested (such as an anaerobic culture request
on a sputum specimen).
4.
Improper specimen container or transport media.
5.
Specimen too old (length of time varies with specimen source).
6.
Specimens received in expired transport containers.
7.
Urine contaminated with stool.
8.
Stool contaminated with urine.
9.
Diapers with absorbed stool.
10.
Viral cultures collected with calcium alginate or wooden shaft swabs.
14
11.
Tissue specimens in formalin.
12.
Urine transport tube not filled to minimum line.
Specimens for Anaerobic Culture
Specimens for anaerobic culture must be transported in a container appropriate for the preservation of anaerobes.
These transporters generally contain gel.
The following specimen types are not appropriate for anaerobic culture due either to the presence of normal
anaerobic flora or to the rarity of anaerobic infections from the specimen site.
1.
Boil, pustule, decubitus and other superficial wounds
2.
CSF
3.
Nose, throat swabs
4.
Sputum and bronchoscopic specimens (unless obtained by double lumen technique)
5.
Feces and rectal swabs, except for Clostridium difficile cultures
6.
Voided or catheterized urine
7.
Vagina, cervical, urethral swabs
As a general rule, aspirated fluid or tissue is preferable to a swab. Deep sites are the typical sites for recovery of
anaerobes.
Specimens for Viral Culture
1.
Always include source of specimen and, when appropriate, type of infection and/or
virus expected.
2.
Recovery of virus is improved if the specimen is collected in the acute stage of the illness.
3.
Viral, chlamydia, mycoplasma, ureaplasma transport media is available from the laboratory. M4 media is
useful for recovery of any of these organisms. M4RT media is acceptable for viral culturing and testing only.
4.
Collection of specimens for viral culture:
a.
Respiratory specimen
1) Viruses responsible for respiratory illness in a conscious patient may be
collected for viral culture simply with a throat swab. Swab the posterior region of the pharynx with a
sterile dacron swab. Do not use a calcium alginate or wooden shafted swab, which may be
inhibitory to certain viruses. Break the swab into a viral transport tube immediately after collection.
Cap the tube securely and label it. Place the tube in a plastic bag for transport to the laboratory.
2)
b.
For an RSV EIA test, nasal washings are preferred. Send nasal washings in a viral transport tube.
Urine specimen.
Collect a clean catch midstream (CCMS) or freshly catheterized urine into a sterile urine cup. Deliver the
specimen to the laboratory promptly or refrigerate until delivery.
c.
Skin lesion specimen.
15
The preferred specimen for skin lesion is an aspirate from a fresh lesion via a 26 or 27 gauge needle
attached to a tuberculin syringe. Expel the aspirated fluid immediately into a viral transport tube and cap
securely. Label the tube. If the lesion cannot be aspirated, apply a sterile dacron swab to the lesion and
rub vigorously. Break the swab into a viral transport tube and cap securely.
d.
Tissues or biopsies.
Collect fresh tissue from an appropriate site using sterile technique. Each specimen need not be more
than 1-2 cm. in diameter.
Place in viral transport media.
e.
Feces/rectal swab.
Collect feces in a clean container. Transfer sufficient feces to viral transport vial to make a 20-40%
suspension.
For rectal swab, insert swab(s) at least three centimeters into anal orifice. Rotate to ensure sufficient fecal
specimen on swab. Break swab tip(s) off into viral transport vial.
f.
Cerebrospinal fluid.
If less than 1 ml, send in CSF collection tube. If 1-2 ml, send in viral transport media.
g.
5.
Blood and serum
Except for cytomegalovirus and enteroviruses, blood and serum are usually not productive specimen
sources for the isolation of viruses. For isolation of cytomegalovirus from white blood cells (buffy coat),
submit fresh blood in heparin. Send 7 ml whole blood at room temperature. DO NOT REFRIGERATE. For
isolation of enteroviruses from serum (newborns and young children), collect one red-top tube of blood.
Separate serum and submit in a plastic screw capped vial.
Refrigerate specimens at 2-8º C (except CMV culture from buffy coat) immediately after collection. Do NOT
freeze.
16
VIROLOGY
Guidelines for Specimen and Test Selection
• For detailed instructions on specimen collection, see previous section.
• Refer to the General Test Listing section for test selection.
• Preferred specimen type listed below in bold type.
Disease or Syndrome Suspected Agents
Clinical Specimens
Cardiac
Pericarditis/Myocarditis
Myocarditis
Pleurodynia
Enterovirus, Influenza, Adenovirus, Parainfluenza, HSV, CMV
Enterovirus
Pericardial Fluid, Stool (only for Enterovirus), Throat
Swab (HSV)
Stool, Pleural Fluid, Throat Swab
Exanthema and Rashes
Chickenpox
Zoster (Shingles)
Herpes Simplex
Herpangina
Varicella-Zoster
Varicella-Zoster
Herpes Simplex Virus (HSV)
Echovirus, Coxsackie A
Vesicle Swab, Throat Swab
Vesicle Swab
Vesicle Swab
Vesicle Swab, Stool, Throat Swab
Adenovirus, Varicella-Zoster,
Chlamydia trachomatis
Adenovirus, HSV
Conjunctival Swab
Conjunctival Swab, Corneal Scraping
Rotavirus, Adenovirus 40/41,
Enterovirus
For Antigen Testing Only
Stool, Rectal Swab
Enterovirus, HSV, Mumps
Enterovirus, HSV, VaricellaZoster
CSF, Stool (only for Enterovirus), Throat Swab
CSF, Stool (only for Enterovirus), Throat Swab
Cytomegalovirus (CMV), HSV
HIV
CMV
HSV
Chlamydia trachomatis, CMV
Chlamydia trachomatis
Urine (only for CMV), Throat Swab, CSF, Orifice Swab
Blood (PCR testing only)
Urine, Throat Swab
Vesicle, Mouth, Eye, Throat or Ear Swab, CSF (if indicated)
Respiratory Aspirate, Nasopharyngeal or Throat Swab
Conjunctival Swab
Influenza, Parainfluenza
Adenovirus, Enterovirus,
Respiratory Syncytial Virus (RSV)
Nasopharyngeal (NP) Aspirate, NP Swab, Throat Washing
or Swab, Sputum, Bronchial Washing, Bronchoalveolar
Lavage
Sexually-Transmitted Diseases
Cervicitis
Epididymitis
Nongonococcal Urethritis
Pelvic Inflammatory Disease
Lymphogranuloma Venereum (LGV)
Perianal Infection
Herpes
Chlamydia trachomatis, HSV
Chlamydia trachomatis, HSV
Chlamydia trachomatis, HSV
Chlamydia trachomatis, HSV
Chlamydia trachomatis
Chlamydia trachomatis, HSV, CMV
HSV
Condyloma
Human Papillomavirus
Cervical Dysplasia and Carcinoma
Human Papillomavirus
Endocervical Swab, Genital Tissue (biopsy)
Urethral Swab
Urethral Swab, Genital Tissue (biopsy)
Endocervical Swab, Genital Tissue (biopsy)
Lymph Node Aspirate, Endocervical Swab, Lesion Swab
Perianal or Rectal Swab
Lesion Swab; Vesicular Fluid; for Asymptomatic Shedding
Endocervical Swab with a Vulvar Sweep
Endocervical Swab, Genital Tissue Biopsy
(For nucleic acid probe only)
Endocervical Swab, Genital Tissue Biopsy
Eye Infections
Conjunctivitis
Keratitis
Gastrointestinal
Diarrhea
Nervous System
Aseptic Meningitis
Encephalitis
Perinatal Infections
“Failure to Thrive”
Cytomegalic Inclusion Disease
Herpes
Pneumonitis
Conjunctivitis
Respiratory
Upper and Lower Respiratory
Infections (including Pharyngitis, Croup, Bronchiolitis,
Viral Pneumonia, and
Influenza)
17
Blood Culture Collection
1.
Labeling
Label all culture bottles with the patient’s name, date and collection time, phlebotomist’s initials, and
site of draw.
2.
Timing
We recommend the following guidelines for the timing of the collection of blood cultures and optimal
recovery of microorganisms present.
Before the use of systemic antimicrobials, obtain two separate sets of blood cultures. Most often, two
separate sets of blood cultures will suffice. More may be required to confirm certain suspected
diagnoses.
Systemic and Localized Infections
▪ Suspected acute sepsis, meningitis, osteomyelitis, arthritis, or acute, untreated bacterial pneumonia:
Obtain two sets of blood cultures.
▪ Fever of unknown origin: Initially, obtain two sets of blood cultures; 24-36 hours later obtain two
additional sets of blood cultures. Note: The yield beyond four sets of blood cultures is often
negligible.
▪ Suspected early typhoid fever or brucellosis: Owing to the low-grade bacteremia present in these
infections, obtain four sets of blood cultures (the same venipuncture site may be used) over a 24-36
hour period.
Infective Endocarditis
 Acute: Obtain three sets of blood cultures during the first 1-2 hours of evaluation.

Subacute: Obtain three sets of blood cultures on the first day (ideally 15 or more minutes apart, the
same venipuncture site may be used). If all three sets are negative, obtain two additional sets of
cultures.

Culture-negative endocarditis: Consult with the Medical Director, and/or local medical staff after
five negative sets of blood cultures. Special culture techniques may be advised.
3.
Blood Culture Bottles
Since these cultures are processed using special media and instrumentation, it is necessary to submit all
of these cultures in the Biomerieux aerobic (green) and anaerobic (orange) bottles supplied by Mid
America Clinical Laboratories. For children, use a Biomerieux pediatric bottle (yellow).
4.
Phlebotomy for Blood Cultures
After palpation, scrub the venipuncture site with 70% alcohol or a blood culture skin prep device for a
minimum of 30 seconds. Allow to air dry.
▪
Apply iodine/iodophor (1-2% tincture of iodine or 10% povidone-iodine) for 60 seconds in
concentric circles away from the venipuncture site covering an area 1 ½ - 2 inches in diameter. After
the puncture site has been decontaminated, do not touch.
▪
Decontaminate the diaphragm bottle tops by swabbing with 70% alcohol. Allow it to dry. Do not
use iodine on the diaphragm tops.
▪
Using a syringe and needle or a “butterfly” double needle collection system, perform venipuncture
and obtain 20 mL of blood (if an adult patient), 10 mL of blood (if a pediatric patient weighing 30-80
lbs.) and inoculate bottles as described below.
▪
Following venipuncture, remove iodophor that can irritate the skin of patients with 70% alcohol and
allow to evaporate.
▪
Do not overfill bottles. Greater than 12 mL in the adult bottles and greater than 5 mL in the pediatric
bottles constitute overfills.
18
5.
Blood Culture Volumes
Adult: Inoculate 10 mL each into Aerobic and Anaerobic bottles. If you cannot obtain 20 mL of blood,
divide as follows:
▪
Less than or equal to 8 mL: transfer entire amount to Aerobic bottle.
▪
Greater than 8 mL, but less than 20 mL: transfer 8-10 mL to Aerobic bottle and the remainder to
Anaerobic bottle.
Pediatric Patients weighing 30-80 lbs: If you cannot obtain 10 mL of blood, divide as follows:
▪
Less than or equal to 5 mL: transfer entire amount to a Peds bottle.
Throat Specimen Collection
1.
Have the patient sit in an upright position.
2.
Ask the patient where their throat hurts most. If the patient is a child that appears to be resistant, it may
be helpful to allow the child to sit on the adult’s lap and instruct the adult to restrain the child’s arms
from grabbing the swab.
3.
Instruct patient to open mouth and stick out their tongue.
4.
Use the tongue depressor to hold the tongue down.
5.
Put the swab all the way to the back of the throat, rub in the area of the tonsils and behind them, making
sure to touch area the patient says hurts. Move the swab up and down. Touch any white patches in the
tonsillar area.
6.
Do not rub the roof of the mouth or the tongue.
7.
The swab must be saturated for accurate testing.
8.
Label the culturette with the patient information. Date, time and initial the specimen. Label the
specimen with the source of the collection (throat).
Urine Culture Collection
Submit specimens in urine culture transport tubes.
1.
Patient Collection Guidelines: Clean Catch Midstream (CCMS)
Females:
1. Wash hands using soap and water.
2. Open the collection cup. Do not touch the inside of the cup or the lid.
3. Spread the outer portion of the urinary area and hold apart for collection.
4. Use three wipes to clean the area.
5. Wipe one side, front to back, with first wipe.
6. Wipe other side, front to back, with second wipe.
7. Wipe the center, with third wipe.
8. Urinate into the toilet for a few seconds and stop.
9. Continue to urinate into the cup.
10. Replace the lid on the container. Screw the lid on tightly to prevent leakage.
11. Wash hands.
19
Males:
1. Wash hands using soap and water.
2. Using one of the antiseptic wipes, clean the end of the penis. Retract the foreskin if needed.
3. Repeat using second wipe.
4. Open the collection cup. Do not touch the inside of the cup or the lid.
5. Urinate into the toilet for a few seconds and stop.
6. Continue to urinate into the cup.
7. Replace the lid on the container. Screw the lid on tightly to prevent leakage.
8. Wash hands.
2.
Collection Guidelines: Indwelling Catheter.
Obtain the specimen with a needle and syringe. Select the puncture site 1-2 inches away from the
catheter tube entry point. Cleanse the area to be punctured with 70% alcohol. Aspirate exactly 5 mL of
urine with a sterile needle and syringe. Disinfect the rubber stopper and aseptically transfer the
specimen to the urine transport tube provided. Specimens obtained from the collection bag are not
suitable for analysis. Foley tips will not be accepted.
3.
Urine Culture Transport
Prevention of contamination by normal vaginal, perineal, and anterior urethral flora is the most
important consideration for collection of a clinically relevant urine specimen. (See guidelines above for
collection of a urine specimen.) Unpreserved urine is an excellent growth medium for most bacteria.
Unless urine is preserved during transport, bacteria may multiply, causing colony counts to be
erroneously high. The maintenance medium in the transport kit prevents rapid multiplication of bacteria
in the urine during shipment. Send urine for culture in a gray topped urine tube.
Instructions for use:
a.
Obtain the urine specimen.
b.
Open the pouch and remove the transfer device and tube.
c.
Submerge the straw of the transfer device to the bottom of the urine container. The container may
be tipped at an angle if the volume of urine is limited.
d.
Place the transport tube in the holder portion of the transfer device and push it down as far as it will
go, puncturing the stopper.
e.
Hold the tube and transfer device in position until the urine stops flowing into the tube.
f.
Remove the transport tube from the transfer device and shake the tube vigorously.
g.
Discard the transfer device and remaining cup of urine into appropriate biohazard
disposal containers.
Precaution: The transport tube must be filled to the minimum line indicated on the tube. A tube which
is not filled at least to this line is unacceptable for culture.
Sputum Specimen Collection
Collect by instructing the patient to remove dentures, rinse mouth, gargle with water and cough deeply,
expectorating into appropriate collection container. All specimens labeled “sputum” that are consistent with
saliva will be rejected. Rejection is based on observation of cells on a gram stained smear.
Stool Specimens
20
Specimens should be submitted in transport media suitable for the test(s) ordered. See individual test listing
and the “Microbiology Specimen Transport Guidelines” chart for specific requirements.
Wound Specimen Collection (wound, abscess, burn, exudate)
1.
The specimen of choice depends on the extent and character of the infection. An aspirate is always
preferred to a swab. A dry swab usually yields results of poor quality.
2.
The methods for collection of wound and other skin and tissue collections are as follows:
a.
Unruptured abscess:
Do not swab. Decontaminate the skin and aspirate contents with a syringe. If possible, submit a
portion of the abscess wall after draining the abscess. Submit the specimen in an anaerobic
transport container.
b.
Open lesions:
Remove as much of the superficial flora as possible by decontaminating the skin with skin
disinfectant. Remove exudate and sample the margin of the wound using a swab and firm pressure.
Do not request anaerobic culture on open, superficial lesions.
3.
Be as specific as possible in giving a specific anatomic source. “Wound”, “abscess” or “swab” is too
general.
4.
Transport the specimen to the lab as quickly as possible.
21
Cytopathology Specimen Collection and Handling
Specimen Collection and Handling
The essence of a successful Cytopathology program depends on both the physician and the laboratory. Obtaining
the patient’s medical history, and a properly fixed, adequate specimen is essential. A final report, using descriptive
Cytopathology terminology and an accurate interpretation are required to assure appropriate follow-up.
Cytopathology services are offered in partnership with Ameripath of Indiana.
Supplies
We strongly recommend the use of our collection materials (Cytopathology Test Requisitions, liquid-based collection
vials, slides, fixatives, endocervical brushes, brooms, spatulas and slide containers).
Ordering Information
Complete a Cytopathology test requisition including:
▪
Patient’s first and last name, social security number or unique identifier and date of birth
▪
Date of specimen collection
▪
Source of material submitted (cervical, endocervical, vaginal, or other gynecologic or non-gynecologic site)
▪
Submitting physician’s name, UPIN and telephone number
For GYN Specimens:
▪
Last menstrual period (LMP)
▪
Pertinent clinical information (pregnant, postpartum, hormone therapy, oral contraceptives, hysterectomy,
postmenopausal, pelvic radiation, etc.)
▪
History of abnormal cytology, gynecologic surgery, cryosurgery, high risk positive HPV
For Non-GYN Specimens:
▪
Source and specific site (left, right, quadrant, etc.)
▪
Nature of lesion (solid/cystic, mobile/fixed, functional/non-functional, etc.)
▪
Any other pertinent history (previous surgery, presence of other masses, previous abnormal findings)
▪
Mammographic, X-ray or other imaging findings
Specimen Identification
We cannot accept specimens that are not properly labeled per Clinical Laboratory Improvement Amendments of
1988 (CLIA) regulations.
▪
Label all slides on frosted end in pencil with patient’s first and last name or unique identifier.
▪
Label specimen containers (on the container wall, not the lid) with the patient’s first initial and full last name or
unique identifier and site(s) of specimen collected.
Unacceptable specimens*, with rare exception, will be rejected.
*Unacceptable Specimens are defined as:
▪
No patient identification on test requisition
22
▪
No patient identification on slide or specimen container (Labeling the slide holder only is not adequate
identification.)
▪
No account/physician number or name and none available
▪
Slides broken beyond repair
▪
Specimen leaked from container
▪
Mismatch between name of patient on specimen and name on test requisition
▪
Inappropriate or incomplete test requisition
▪
Syringe with needle attached
Specimen Collection Gynecologic
Patient Preparation
▪
Patient abstains from sexual intercourse for 48 hours prior to the examination
▪
Patient abstains from using vaginal medication, vaginal contraceptives, lubricants, or douches for 24-48 hours
prior to the examination
▪
The optimal time for a Pap test is mid-cycle. Menses may interfere with Pap test interpretation
Note:
DO NOT USE lubricant on the speculum. The speculum may be moistened with warm water if desired. The
use of lubricant may contribute to an increased incidence of unsatisfactory Pap tests. Lubricants may contain
ingredients known as “carbomers” or “carbopol polymers” that interfere with liquid-based Pap tests by
causing immiscible agglutination of cells.
Image Assisted ThinPrep® Pap Test/ThinPrep® Pap Test
Brush / Spatula Device
1.
Complete the test requisition.
2.
Record the patient’s first and last name or unique identifier on the vial.
3.
Obtain an adequate sampling from the ectocervix using a plastic spatula.
4.
Immediately rinse the spatula in the PreservCyt® Solution vial by swirling vigorously in the vial 10 times, forcibly
removing cells by scraping the spatula against the container if necessary. Discard the spatula. Do not let the
spatula sit in the vial.
5.
Obtain an adequate sampling from the endocervix using an endocervical brush device. Insert the brush into the
cervix until only the bottom-most fibers are exposed. Slowly rotate 180° clockwise. DO NOT OVER-ROTATE.
6.
Rinse the brush in the PreservCyt® Solution by rotating the device in the solution 10 times while pushing against
the PreservCyt® vial wall. Swirl the brush vigorously to further release material. If material is still visible on the
bristles, then scrape the bristles with the spatula staying within the fluid. Swirl the brush vigorously to further
release material. Discard the brush. Do not let the brush sit in the vial.
7.
Tighten the cap so that the torque line on the cap passes the torque line on the vial.
8.
Place the vial and requisition in a specimen bag for transport to the laboratory.
Broom-like Device
1.
Complete the test requisition.
2.
Record the patient’s first and last name or unique identifier on the vial.
23
3.
Obtain an adequate sampling from the cervix using a broom-like device. Insert the central bristles of the broom
into the endocervical canal deep enough to allow the shorter bristles to fully contact the ectocervix. Push gently,
and rotate the broom in a clockwise direction five times.
4.
Rinse the broom in the PreservCyt® Solution vial by pushing the broom into the bottom of the vial 10 times,
forcing the bristles apart. Swirl the broom vigorously to further release material. If material is still visible on the
bristles, then scrape the bristles against the vial staying within the fluid. Swirl the broom vigorously to further
release material. Discard the collection device. Do not let the broom sit in the vial.
5.
Tighten the cap so that the torque line on the cap passes the torque line on the vial.
6.
Place the vial and requisition in a specimen bag for transport to the laboratory.
Specimen Collection Non-Gynecologic
Fixatives:
Appropriate fixatives for non-gyn cytology specimens include:
▪
CytoLyt®
▪
95% ethyl alcohol
▪
Isopropyl or methyl alcohol may be used as a substitute if none of the above fixatives are available.
▪
Tissue Transport Media for possible flow cytometry analysis for lymphoma
Smear
(NOTE: Aspiration of cyst contents should be submitted as fluids, and not smears.)
1.
Complete test requisition.
2.
Write patient’s first and last name or unique identifier in pencil on frosted end of slide.
3.
Submit 2-6 slides of material from any source that can be evaluated cytologically.
4.
Immerse slides in 95% ethanol immediately after smearing.
5.
Transport in ethanol containing slide vials.
Fluid
1.
Complete test requisition
2.
Place fluid into 10 ml of CytoLyt®. Specimens greater than 10 mL should be fixed with a volume of fixative equal
to the volume of the specimen.
3.
Place fluid/fixative mixture in a tightly capped, leak-proof, labeled container (label the container wall, not the lid).
a.
Syringes are not acceptable specimen containers.
b.
Transportation of specimens with attached needles violates Department of Transportation Federal
regulations, 49CFR173.
Source
Submission Requirements
Breast Cyst Aspiration
Mix material with an equal volume of fixative (see Fixatives).
Breast Solid Mass Aspiration
See Fine Needle Aspiration Biopsy below.
Breast Secretion
(Nipple Discharge)
Drops of fluid from the nipple are smeared directly on clean glass
slides and immersed immediately in alcohol. Do not remove
the slides from the fixative. Send in alcohol transport container.
24
Bronchial Brushings
Roll brush(es) over clean, dry slide(s). Fix immediately with alcohol.
The brush(es) used to prepare bronchial brushing slides may be
swirled in a container of appropriate fixative to dislodge
additional specimen. Submit slides and liquid specimen together
with one test requisition.
Bronchial Washings
Mix with an equal volume of fixative or put specimen in at least 10 mL of
fixative if specimen is less than 10 mL volume.
Effusions
Mix material with an equal volume of fixative (see Fixatives).
Endometrial Washings
Mix material with an equal volume of fixative (see Fixatives).
Esophageal Brushings
Roll brushes over clean, dry slides. Immerse immediately in 95%
ethanol. The brush(es) used to prepare slides may be swirled in a
container of appropriate fixative to dislodge additional
specimen. Submit slides and liquid specimen together with one
test requisition.
Esophageal Washings
Mix material with an equal volume of fixative (see Fixatives).
Fine Needle Aspiration Biopsy,
(FNA) (Solid Lesion)
FNA Slide Technique – Preferred Method
1.
Label 6 glass slides with the patient’s first and last
name or unique identifier on the frosted end prior to starting
the procedure. Include the site, if there is room on the slide.
2.
If local anesthetic is used, infiltrate into the region, avoiding
possible contamination of the actual nodule.
3.
Attach a 23 or 25 gauge needle to a syringe.
4.
Insert needle into lesion.
5.
While applying negative pressure, move needle back and forth
traversing the entire lesion.
6.
Release negative pressure, then remove needle. Specimen
should not be drawn up into the barrel of the syringe. Pressure
should be released as fluid appears in the needle hub. The
cells and tissue fragments obtained from a solid lesion should
remain in the hub.
7.
After withdrawing the needle, eject one drop of specimen onto a
slide.
8.
Use another slide to smear the aspirated material.
9.
Fix one of the pairs of slides immediately by immersion in 95%
alcohol.
10. Leave one slide to air dry and submit this slide labeled “air dried.”
11.
This procedure should be repeated 3-6 times, using a sterile
syringe and needle each time, until the lesion has been thoroughly sampled.
12.
If excess blood, fluid or cellular material is obtained with a needle
pass, the excess should be expressed into a container of
CytoLyt® or other cytology fixative. The container should be
labeled with the patient’s First Initial and Full Last Name or
unique identifier. The needle and syringe should be rinsed with
25
this same fixative. Submit the liquid specimen with the fixed and
air-dried slides using one test requisition.
Fine Needle Aspiration Biopsy,
(FNA) (Solid Lesion)
FNA Liquid-based Fixative Technique (Alternate Method)
1.
Label container of CytoLyt® or other cytology fixative with the
patient’s first and last name or unique identifier prior to
starting the procedure.
2.
If local anesthetic is used, avoid contaminating the site of the
nodule.
3.
Attach a 23 or 25 gauge needle to a syringe.
4.
Insert needle into lesion.
5.
While applying negative pressure, move needle back and forth
traversing the entire lesion.
6.
Release negative pressure, then remove needle. Specimen
should not be drawn up into the barrel of the syringe. Pressure
should be released as fluid appears in the needle hub. The
cells and tissue fragments obtained from a solid lesion should
remain in the hub.
7.
Eject specimen directly into container of CytoLyt® or other
cytology fixative. The container should be labeled with the
patient’s first and last name.
8.
Flush needle and syringe with fixative.
9.
This procedure can be repeated multiple times, using sterile
syringe and needle each time, until the lesion has been
thoroughly sampled adding material obtained with each
aspiration to the same container of fixative.
Gastric Brushings
Roll brush(es) over clean, dry slide(s). Fix immediately with alcohol.
In order to dislodge additional cells, swirl the brushes used to prepare
the slides in a container of fixative labeled with the patient’s first
and last name or unique identifier. Submit slides and
liquid specimen together with one test requisition.
Gastric Washings
Mix material with an equal volume of fixative (see Fixatives).
Lymph Node (Touch Prep)
Fix immediately in alcohol or air dry. Air-dried slides should be labeled
as such.
Paracentesis (Abdominal Fluid)
Mix material with an equal volume of fixative (see Fixatives).
Pericardial Fluid
Mix material with an equal volume of fixative (see Fixatives).
Pneumocystis jiroveci
(previously Pneumocystis
carinii)
Bronchoalveolar lavages are preferred specimens. Bronchial washing,
brushings or sputum may be submitted, but diagnostic yield is less.
Mix material with an equal volume of fixative (see Fixatives). Fix
submitted smears by immersing immediately in alcohol. Submit a
minimum of 2 slides. Use pencil to label frosted end of slide with
patient’s first and last name or unique identifier. Write
“Evaluate for Pneumocystis” on test requisition.
Skin (Viral) Lesions
Remove crust or dome from lesion. Scrape ulceration with a brush or
26
curette. Spread material on a slide. Fix slides immediately by
immersing in alcohol. Submit specimen in the alcohol container.
Sputum
Submit early morning deep-cough specimen prior to any food
ingestion. Have patient rinse mouth with plain water before sputum is
collected. Collect separate specimens on 3 consecutive mornings.
Do not pool specimens. Mix material with an equal volume of fixative.
Thoracentesis
(Pleural or Chest Fluid)
Mix material with an equal volume of fixative (see Fixatives).
Urine (Bladder/Kidney,
Voided)
Submit all specimens in an equal volume of fixative (see Fixatives).
Mark test requisition “Voided” or “Catheterized” as applicable.
Urine Collected at Home
1.
Provide patient with an appropriate volume of fixative (e.g., 50 mL
Of alcohol or pre-measured container of CytoLyt®).
2.
Instruct the patient to drink three (3) 8-oz. glasses of water before
bedtime.
3.
Have patient collect the second a.m. urine specimen and mix an
equal volume with the fixative. Do not submit a 24-hour urine
collection for cytologic evaluation.
For any additional questions about Non-Gyn collection, requisitions, supplies or test results, please call (317)275-8000.
27
Reflex Testing
Test Ordered
Adrenal Antibodies
TL Code
Result (Reflex Criteria)
4645
Positive
AFB Culture
4554
All orders, except CSF
AFB Stain
4503
All orders
Second or Confirmatory Test
Adrenal Antibody Titer
AFB stain, due to need for rapid
information
AFB culture, due to low sensitivity of
AFB stain
TL Code
36155%
4503
4554
Acetylcholinesterase Fetal Hemoglobin
%4929
36208
ANA Titer & Pattern
%36209
AFP, Amniotic Fluid
232
MoM >1.9
ANA Screen
249
1:40 or higher
Anaerobic Culture
4469
All Orders
Anticardiolipin Antibodies: IgA
4661
>22 or < 40 APL
anti ß2 Glycoprotein IgA
%59309
Anticardiolipin Antibodies: IgG
4662
>23 or < 40 GPL
anti ß2 Glycoprotein IgG & IgM
%59310
Anticardiolipin Antibodies: IgM
4663
>11 or < 40 MPL
anti ß2 Glycoprotein IgM & IgM
%59310
Anti-HCV
8472
Reactive with Low Signal/Cutoff Ratio
Antireticulin Antibody
37520
Positive
Aspirated or deep wound
specimen received for aerobic
culture
4550
All orders
As Ordered
Any Specimen Submitted
36560
Positive
Bronchial Alveolar Lavage (BAL)
Coccidioides Antibody IgG
Cryoglobulin
36562
Positive
None 4550
SEE DOS
All orders
Various
cultures
Pathogens isolated
Dilute Russell Viper Venom Test
(DRVVT)
59177
Abnormal
GC Chlamydia DNA Probe
Screening
6919
Positive
Gram Stain
497
CSF Specimen
Hepatitis B Surface Antigen
8472
Positive
Hepatitis B Core AB Total
CSF, Deep Wound, Respiratory
Cultures
Culture
501
Borderline or Positive
Hepatitis C as part of a
Needlestick Profile
None
Reactive with Low Signal/Cutoff Ratio
Hepatitis C Viral RNA,
Quantitative Real-Time PCR
35645
> 7,000,000 IU/mL
Homocysteine as part of a
Thrombotic Profile
31789
> 13.0
India Ink
59215
CSF Specimens
Gram Stain
RIBA
Antireticulin Antibody IgA Titer
Anaerobic culture
Cytology
Coccidioides AB Complement Fixation
Cyrocrit (calculation)
Gram stain, due to CAP requirements
497
8739
Not available as
a separate test
4469
Not available as
a separate test
906
Not available as
a separate test
497
Identifications and sensitivities for
appropriate pathogens isolated
None
Dilute Russell Viper Venom Test ratio
59178
Chlamydia DNA Probe Genital
GC DNA Probe Genital
8502
8501
Culture
4550
Confirmation
36204
Hepatitis B Core AB IgM
4848
Hepatitis C Viral RNA Qual PCR
34024
Extended Range
Not available as
a separate test
Methylene Tetrahydrofolate Reductase
677
36165
Fungus Culture
59250
Legionella culture, due to low sensitivity
of Legionella stain
None
Legionella Stain
None
All orders
Image assisted PAP with
expanded HPV
51183
ASCUS, ASC-H LSIL, HSIL
HPV-HR
31532
Liquid based PAP with expanded
HPV
51168
ASCUS, ASC-H LSIL, HSIL
HPV-HR
31532
Lyme Disease Ab Scrn
6646
Abnormal
Lyme Disease Antibogy IgG & IgM by
Western Blot
8593
Mitochondrial Ab
259
Positive
Mitochondrial Ab Titer
36205
Myocardial Ab
261
Positive
Myocardial AbTiter
36156
Parietal Cell Ab
262
Positive
Parietal Cell Ab Titer
%36207
28
Test Ordered
TL Code
Result (Reflex Criteria)
59180%
> 115
Platelet Function Test,
Epinephrine (PFT)
59149
> 192 seconds
Protein C Activity
1777
< 70
1779
< 50
PTT Lupus Anticoagulant (Within
a Profile)
59311
Greater than reference interval (>41.8
currently)
Q Fever Antibody (Includes
Phases I and II, IgG and IgM)
screen
37071
Positive
59360
Negative
Throat culture, due to low sensitivity of
rapid test
36125
Reactive
RPR Titer
Treponema Pallidum Antibodies
799
Reactive
RPR Titer
%36203
59151
No Sperm Seen
Fructose
%59342
Skeletal Muscle Ab
266
Positive
Striated Ab Titer
%36210
Smooth Muscle Ab
263
Positive
Smooth Muscle Ab Titer
681
All orders
36568
Positive
883
> 22.0
Platelet Function Adenosine
Diphosphate (Within a Profile)
Protein S Activity
Rapid Group A Strep Screen
RPR (Dx)
RPR (Monitor)
Semen Analysis
Stool for Ova and Parasites
Teichoic Acid Antibody
Thrombin Clotting Time (within a
profile)
Negative
Trichomonas Prep
7909
Urinalysis
3020
Urinalysis, Culture if Indicated
Urine Metabolic Screen and
Quantitative Organic Acids
von Willebrand Activity
Not available
as a separate
test
4459
Positive leukocyte esterase, nitrites,
hemoglobin, protein or other than clear
Nitrate positive or leukocyte esterase
positive,
WBC >5/hpf
Bacteria > trace
Yeast Present
Second or Confirmatory Test
Platelet aggregation
TL Code
59154
Platelet Function Adenosine
Diphosphate
%59180
Protein C Antigen
510.19
Protein S Antigen and Free S Antigen
STACLOT ™
Q Fever Antibody (includes Phases I
and II, IgG and IgM) titers
%51023
%51022
%51027
38506, 38510,
38508, 38512
394
%36203
4112
%36206
Permanent stain (Trichrome)
Not available as
a separate test
Teichoic Acid Antibody Titer
Not available as
a separate test
Thrombin Clotting Time with Protamine
Sulfate correction
Trichomonas Culture
%51014
3960
8563
Microscopic
395
Urine Culture
Positive
Not available as
a separate test
Urine Amino Acid Quantitation
< 50%
29
von Willebrand Antigen
%51024
Client Information
Account Management Team
As a client of Mid America Clinical Laboratories, a member of the Sales team of account representatives will be
assigned to help manage the services received from our laboratory.
The MACL account representative can be contacted directly or through the sales support team at our facility.
Billing
Several billing options are available to our clients. Client billing (billing to health care provider, physician or
group practice), patient billing (billing to the patient at a home address) or third party billing (billing to insurers
with whom MACL has a claims processing agreement) can be selected.
In order for us to bill third parties, we must be provided with the patient’s complete billing information including
the patient’s address and insurance information which may also include claims address, group or ID number. All
medically appropriate diagnosis ICD-9 codes are also necessary in order for us to bill a third party. A copy of the
patient’s insurance card should also accompany the order.
Field Name
Bill To
Patient Name
Date of Birth
Sex
Patient Social Security #
Patient Phone #
Name of Insured/Responsible
Party if Other Than Patient
Street Address of Insured
Medicare/Medicaid #
Relationship to Insured
Insurance Co. Name
Member/Insured ID #
Group #
Insurance Address
Employer Name/Employer #
Insured SS # If Not Pt.
ICD9 Diagnosis Code
Patient/Responsible Party
Signature
UPIN Referring Physician and/or
Payors
Fields the Physician Must Complete to Bill
Their Account
The Patient
Medicare/Medicaid
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Insurance
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Payers (including Medicare) are focusing on medical necessity guidelines. Many payers require laboratories to
include diagnoses (diagnosis, symptom, condition, complaint or problem) on every claim as documentation of
medical necessity. Our focus is specifically on Medicare’s medical necessity guidelines.
Diagnosis information must be furnished using the ICD-9-CM coding system. Centers for Medicare Services (CMS)
guidelines indicate that the ultimate responsibility for providing correct ICD-9 codes lies with the ordering
physician. All Medicare carriers have implemented Local Medical Review Policies that restrict the medical
conditions under which Medicare payment for certain tests will be made. These policies define the medical
conditions (diagnosis, symptom, condition, complaint or problem) or ICD-9 codes that establish the medical
necessity of certain tests under which payment will be made. If a limited coverage test is ordered in conjunction
30
with a diagnosis code that is not included in the Medicare carrier’s predetermined list of diagnoses, Medicare will
not pay for the test.
Based on these policies, we must have the most specific ICD-9 diagnosis codes, rather than a descriptive
diagnosis, for each test on each patient.
Any diagnosis information submitted on our claims must be furnished by the ordering physician or his or her
authorized staff, and must be consistent with the diagnosis information documented in the patient’s medical
records for that date of service.
If required diagnosis information (valid and specific ICD-9 codes) is missing or invalid on the test requisition, we
must generally contact the ordering physician or his or her authorized staff to obtain this required information.
When this happens, it is not unusual for patients to receive unnecessary and often confusing correspondence
from Medicare, their insurance companies, our laboratory, and the physician’s office pertaining to medical
necessity/diagnosis information. Providing all medically appropriate and specific ICD-9 diagnosis codes on ALL
test requisitions that accompany the specimen to our laboratory (including electronically submitted requisitions)
can help to:
▪ Prevent inconvenience for patients
▪ Reduce payment delays from insurance companies
▪ Prevent the inconvenience of having us contact the ordering physician’s office
Medicare will only pay for services that are determined to be reasonable and necessary under section 1862(a)(1)
of the Medicare Law. If Medicare determines that a particular service, although it would otherwise be covered, is
not reasonable and necessary under the Medicare Program Standards, Medicare will deny payment for that
service. These tests may be identified as “limited coverage” under the National Coverage Determinations or Local
National Coverage Determinations, may have frequency limits, or may be performed using a test kit that is not
currently approved by the Food and Drug Administration. By signing a valid Advance Beneficiary Notice (ABN),
the patient or responsible party is confirming agreement to assume financial responsibility for payment of these
tests.
The following information must be marked and/or indicated for the ABN to be valid:
•
•
•
•
Name of the test indicated
Date of Service
Option Box 1 or Option Box 2 checked. The Option box 1 indicates that the patient would like to receive
the laboratory test and they understand that Medicare may or may not cover the test and the patient
may be liable for the bill. Option box 2 indicates that the patient has declined the laboratory testing
service.
Patient’s Signature (patient must sign prior to receiving the service)
CPT Codes (Current Procedure Terminology Codes)
All requests for CPT codes are accompanied by the following CPT code disclaimer:
The CPT codes provided are based on AMA guidelines and are for informational purposes only. CPT
coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the
payer being billed.
It is the client’s responsibility to determine the appropriate coding when a client is billing a third party payor for
services performed by MACL.
Ordering Supplies
Certain supplies necessary to collect and submit specimens for analysis by MACL are provided to customers as
part of our testing services. Type and quantity of items must correlate to the tests submitted to MACL for testing.
31
Ordering supplies can be done from the Internet. Go to www.maclonline.com and select “Try our new online
client supply request system” at the bottom of the screen. Follow the instructions. Supplies can also still be
ordered by calling 317-803-1010 and selecting option 4.
Instructions for Packaging Specimens and Test Requisitions
1.
Complete the “Patient Information” and “Insurance Information” sections and check (√) which party will be
responsible for payment in the “Bill To” section of the test requisition. Enter the ICD-9 diagnosis codes that
reflect the patient’s diagnoses and provide medical justification for the tests ordered.
2.
Collect the specimen(s) in proper transport container. (Refer to the test detail section of the Directory of
Services for more information.) Ensure that all specimen container caps and lids are properly tightened to
prevent leakage.
3.
Fold the top copy (original) of the test requisition in half widthwise (top to bottom) with the patient’s name
and bar code facing out. Retain the second copy for your files.
4.
The specimen bag has two pouches. Place the specimen(s) in the rear pouch with the zip lock. Place the
requisition in the front pouch with the bar code facing out.
5.
Frozen specimens must be placed in a separate specimen bag along with a separate requisition. Frozen
specimens cannot be split for other tests.
Proper Specimen Packing Helps Expedite Your Order.
32
1
1
1
1
1
1
3
1
2
1
1
4
2
2
8
5
6
7
2
2
2
2
9
2
2
2
1
2
1
3
3
3
3
33
Test Requisition Definitions
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Bar Code Section
Contains the pre-assigned client and requisition numbers.
Client Number
Identifies your MACL client identification number.
Requisition Number
Identifies the specific patient order.
Client Address Section
Client name, address and phone appear here.
Date Collected
Indicate date specimen is collected.
Time
Indicate the collection time. Circle AM or PM.
Total vol/hrs
Indicate the total volume (ML) of specimen and the hours
of collection (HR).
Fasting
Indicate by checking the box if fasting is applicable for
this patient.
U.P.I.N. Referring Physician and/or Payers
Indicate the name of referring physician here. If the order
is billed to Medicare, it must also indicate the physician’s
U.P.I.N. number. This area may contain a combination of
UPINs, Referring Physicians or Payers. When completing a
Generic Test Requisition, every field on the sample
requirement section must be completed or testing may
be delayed.
Call/Fax Results
Check the box if results are to be called or faxed. Include
the appropriate number(s), starting with the area code.
Duplicate Report
Fill in the complete name and address of physician(s) to
receive duplicate report, or fill in an established client
number, preceded by the # sign. Incomplete information
will cause delays in test results reporting.
Bill to Box
In the Bill To box, check the box which indicates the type
of billing requested: doctor’s office, insurance, patient.
Patient Name
Print last name and first name.
Date of Birth
Date of Birth—Month, Day, Year (MM DD YEAR).
Sex
Indicate M-Male F-Female
Patient Social Security Number
Indicate the patient’s social security number.
Office/Patient ID Number
Indicate any patient ID to be printed on the report or
client bill.
Patient Phone Number
Indicate the patient’s phone number, starting with area
code.
Name of Responsible Party, if Other Than Patient
Indicate the responsible party if other than the patient.
Indicate last name, first name, and middle initial.
Patient or Responsible Party Address
Indicate the address of the patient or responsible party.
Include the street address, apartment number (key
number, if applicable), city, state and zip.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34
Relationship to Insured
Indicate the relationship to insured by checking one of
the following boxes? Self Spouse Dependent
Insurance Company Name
Indicate the name of the insurance company and
insurance plan or product.
Member/Insured ID Number
Indicate the member or subscriber number as it is listed
on the insurance card.
Group Number
Indicate the group number as it is listed on the insurance
card.
Insurance Address
Indicate the insurance company’s address as it is listed on
the insurance card. If there is more than one listed on the
card, use the claims office address.
Employer Name
Indicate the patient’s or responsible party’s employer’s
name and employer ID number.
Insured Social Security Number
Indicate insured social security number, if not the patient.
Insured Birth Date
Date of Birth—Month, Day, Year (MMDDYEAR)
ICD-9 Diagnosis Code(s)
Indicate all applicable codes in the boxes provided. Do
not include descriptive diagnosis. ICD-9 codes are for
billing purposes only and will not be considered as clinical
history in the evaluation of Pap Smears.
Advance Beneficiary Notice (ABN)
Medicare will only pay for services that it determines to be
reasonable and necessary under section 1862(a)(1) of the
Medicare Law. If Medicare determines that a particular
service, although it would otherwise be covered, is not
reasonable and necessary under the Medicare Program
Standards, Medicare will deny payment for that service.
By signing an ABN, the patient or responsible party is
confirming agreement to assume financial responsibility
for payment of these tests. Tests identified on
requisitions with an “@” are likely to be denied payment if
the diagnosis does not meet the reimbursement rules.
Those tests identified with “&” are likely to be denied
because the test is non-FDA approved/experimental.
Tests designated with “F” are likely to be denied for
payment because Medicare will pay for screening with
these tests but only once every twelve months. Tests
marked with “B” have both diagnosis and frequencyrelated coverage limitations.
Additional Tests
Indicate all MACL Order Codes for additional tests
required that are not preprinted on the Test Requisition;
and/or indicate “STAT” if STAT testing is required.
(Note: Additional fees will be assessed for this expedited
service.)
Physician Signature
Physician signature required for Medicaid billing in
specific states.
Standing Order Information
Need: Start date, stop date and frequency.
Allergy Evaluations
Individual Allergens
Preferred Specimen: 1 mL serum from a red-top tube for 1-4 allergens tested, and at least 2 mL serum for each 5-10
allergens tested.
Allergen Specific IgE Interpretation of Results
Specific IgE Class
0
1
2
3
4
5
6
kU/L
< 0.35
0.35-0.70
0.71-3.50
3.51-17.5
17.6-50
51-100
> 100
Level of Allergen Specific IgE Antibody
Absent/Undetectable
Low Level
Moderate Level
High Level
Very High Level
Very High Level
Very High Level
The individual allergens, represented with their Pharmacia CAP System® code in the following Tables may be ordered
on an individual basis. These Tables are listed alphabetically by allergen.
Alphabetical by Allergen
Table 1
Animals
Cat epithelia
Chicken feathers
Cow dander
Dog dander
Dog epithelia
Duck feathers
Goat epithelia
Goose feathers
Guinea Pig epithelia
Hamster epithelia
Horse dander
Mouse epithelia
Mouse serum proteins
Mouse urine proteins
Parrot/Parakeet droppings
Parrot/Parakeet feathers
Parrot/Parakeet serum proteins
Pigeon droppings
Rabbit epithelia
Rat
Rat epithelia
Rat serum proteins
Rat urine proteins
Sheep epithelia
Swine epithelia
Pharmacia
Code
e1
e85
e4
e5
e2
e86
e80
e70
e6
e84
e3
e71
e76
e72
e77
e78
379
e7
e82
e87
e73
e75
e74
e81
e83
Test
Code
2601
2651
2604
2605
2602
2664
2656
2661
2606
2652
2603
2657
6744
2658
2663
2662
2679
2607
2654
2538
2659
6778
2660
2655
2653
Alphabetical by Allergen
Table 2
Biologics & Occupational
Castor bean
Cotton seed
Green coffee bean
Insulin, bovine
Insulin, human
Insulin, porcine
Ispaghula (psyllium)
Latex
Silk
Sunflower seed
Wild silk
Pharmacia
Code
k71
k83
k70
c71
c73
c70
k72
k82
k74
k84
k73
Test
Code
2751
23862
2752
2755
2760
2754
2753
8927
2758
23864
2757
Pharmacia
Code
f202820
f762851
f492849
f237
f261
Test
Code
Table 3
Food
Almond
Alpha-lactalbumin
Apple
Apricot
Asparagus
35
2563
2626
Avocado
Banana
Barley
Basil
Beef
Beta-lactoglobin
Black Pepper
Blackberry
Alphabetical by Allergen
f968928
f928926
f6
f269
f272827
f772852
f280
f211
Honey
Kiwi fruit
Lamb
Lemon
Lentils
Lettuce
Lime
Lobster
Mackerel
Malt
2806
2564
2561
2630
f247
f84
f88
f208
f235
f215
f306
f80
f206
f102
8930
2884
2888
2708
3010
2862
2709
2855
2713
2863
Table 3 (Continued)
Food
Blue mussel
Blueberry
Brazil nut
Broccoli
Buckwheat
Cabbage
Carrot
Casein
Cashew nut
Cauliflower
Celery
Cheddar cheese
Cheese, mold type
Cherry
Chestnut
Chicken meat
Chili Pepper
Cinnamon
Clam
Cocoa
Coconut
Codfish
Coffee
Corn
Crab
Cucumber
Egg Mix
Egg white
Egg yolk
Eggplant
Garlic
Ginger
Gluten
Goat Milk
Grape
Grapefruit
Green bean
Green Pepper
Halibut
Hazel nut
Pharmacia
Code
f372837
f288
f182818
f260
f112811
f216
f312831
f782853
f202
f291
f852860
f812858
f822859
f242
f299
f832857
f279
f220
f207
f932875
f362836
f3
f221
f8
f23
f244
f245
f1
f75
f262
f47
f270
f79
f30
f259
f209
f315
f263
f303
f17
Alphabetical by Allergen
Test
Code
Table 3 (Continued)
2568
Food
Mandarin
Mango fruit
Melons
Milk
Milk, boiled
Mushroom
Mustard
Nutmeg
Oat
Onion
Orange
Oregano
Oyster
Papaya
Paprika
Parsley
Passion fruit
Pea
Peach
Peanut
Pear
Pecan
Pine nut
Pistachio
Plum
Poppy seed
Pork
Potato
Rabbit
Rice
Rye
Salmon
Scallops
Sesame seed
Shrimp
Soybean
Spinach
2631
2632
2608
2635
2609
2636
2610
2637
8929
2803
2915
2808
2823
2639
2919
2801
2856
2642
2847
2644
2854
2922
2675
2923
2680
2931
2998
2817
36
Pharmacia
Code
f302
f91
f87
f2
f231
f212
f89
f282
f7
f48
f33
f283
f290
f293
f218
f86
f29
f12
f95
f13
f94
f201
f253
f203
f255
f224
f26
f35
f213
f9
f5
f41
f38
f10
f24
f14
f214
Test
Cod
2714
23860
2887
2802
3044
8931
2889
2718
2807
2848
2833
3045
8932
2720
3047
2861
2724
2812
8405
2813
8884
2864
2725
2726
2728
3050
2826
2835
2730
2809
2805
2841
273
2810
2824
2814
3054
Squid
Strawberry
Sweet Potato
Swordfish
Tea
Tomato
Trout
Tuna
Vanilla
Walnut
Wheat
White bean
Yeast
f258
f44
f54
f312
f222
f25
f204
f40
f234
f256
f4
f15
f45
2745
2844
2555
3055
6805
2825
3063
2840
3244
3489
2804
2815
2845
Table 6
Test
Code
2317
2302
2311
2371
2307
3490
2314
2312
2315
2310
Alphabetical by Allergen
Pharmacia
House Dust Mites
Code
Dermatophagoides farinae
d2
Dermatophagoides pteronyssinus
d1
Glycyphagus domesticus
d73
Lepidoglyphus destructor (Storage mite)
d71
Test
Code
2722
2721
2727
2723
Alphabetical by Allergen
Table 4
Pharmacia
Grasses
Code
Bahia grass (paspalum notatum)
g17
Bermuda grass (nodon dactylon)
g2
Brome grass (Bromus inemis)
gil
Canary grass (Phalaris canariensis)
g71
Common reed (Phragmites communis)
g7
Corn grass
g202
Cultivated oat pollen (Avena sativa)
g14
Cultivated rye grass (Secale cereale)
g12
Cultivated wheat pollen (Tritica sativa)
g15
Johnson grass (Sorghum halepense)
g10
June grass (Kentucky Blue)
(Poa pratensis) g8
2308
Meadow fescue (Festuca elation)
g4
Meadow foxtail (Alopecurus pratensis)
g16
Orchard grass (cocksfoot)
(Dactylis glomerata)
g3
Perennial rye grass (Latium perenne)
g5
Red top grass (Bent grass)
(Agrostis alba)
g9
Salt grass (Distichlis species)
g100
Sweet vernal grass
(Anthoxanthum odoratum)
g1
Timothy grass (Phleum pratense)
g6
Velvet grass (Holcus lanatus)
g13
Wild rye (Secale species)
g70
Table 7
Insects
Bloodworm
Cockroach
Green Nimitti midge
Honeybee
Imported fire ant
Mosquito
Paper wasp
White-faced hornet
Yellow hornet
Yellow jacket
2304
2316
2303
2305
Pharmacia
Code
h1
h2
Test
Code
2738
2736
2737
2731
2739
2740
2734
2732
2733
2733
Pharmacia
Code
m6
m3
m12
6647
3301
m208
m5
Test
Code
2706
2703
6634
Table 8
Molds
Alternaria alternata
Aspergillus fumigatus
Aureobasidium pullulans (Pullularia)
Botrytis cinerea m7
C. acremonium m20
C. globosum
Candida albicans
Caldosporium herbarum
(Hormodendrum)
Cum/aira lunata
Epicoccum purpurascens
Fusarium moniliforme
Helminthosporium halodes
Mucor racemosus
Pityrosporum orbiculare
Penicillum notatum
2309
2350
2301
2306
2313
2370
Table 5
House Dust
House dust (Greer)
House dust (Hollister-Stier)
Pharmacia
Code
i73
i6
i72
i1
i70
i71
i4
i2
i5
i3
Test
Code
2711
2712
37
m2
m16
m14
m9
m8
m4
m70
m1
3415
2705
2702
6680
6692
6696
6711
2704
3403
2701
Phoma betae
Rhizopus nigricans
Stemphylium botyrosum
T. rubum
Trichoderma viride
m10
m11
m10
m205
m15
6770
6781
6799
3406
6809
Table 10
Pharmacia
Weeds
Code
Cocklebur (Xanthum pennsylvanicum)
w13
Common ragweed (short)
(Ambrosia elation)
w1
Dandelion (Taraxacum vulgare)
w8
English plantain (Plantago lanceolata)
w9
False ragweed (Franseria acanthicarpa)
w4
Firebush (Kochia scoparia)
w17
Giant ragweed (tall) (Ambrosia trifida)
w3
Goldenrod (Solidago virgaurea)
w12
Lamb’s-quarters (goosefoot;
Chenopodium album)
w10
Mugwort (sagebrush) (Artemisia vulgaris)
w6
Nettle (Urtria dioica)
w20
Oxeye daisy
(Chrysanthemum leucanthum)
w7
Rough marsh elder (Iva)
w16
Rough pigweed (Amaranthus retroflexus)
w14
Russian thistle (prickly saltwort;
Salsola kal.)
w11
Scale (Atriplex)
w15
Sheep sorrel (dock; Rumex acetosella)
w18
Alphabetical by Allergen
Table 9
Pharmacia
Trees
Code
Acacia (Acacia species)
t19
Alder (Alnus incana)
t2
Australian pine (Casuarina equisetifolia)
t73
Beech (Fagus grandifolia)
t5
Birch (Betula verrucosa)
t3
Chestnut
t206
Test
Code
2519
2502
2554
2505
2503
3417
Alphabetical by Allergen
Table 9 (Continued)
Pharmacia
Trees
Code
Cottonwood (Populus deltoides)
t14
Douglas fir
t207
Elm (Ulmus americana)
t8
Eucalyptus (Eucalyptus species)
t18
Hazel nut (Corylus avellana)
t4
Italian cypress (Cupressus sempervirens)
t23
Maple (box elder; Acer negundo)
t1
Melaleuca (Melaleuca species)
t21
Mesquite (Prospus juliflora)
t20
Mountain cedar (Juniperus sabinoides)
t6
Oak (Quercus alba)
t7
Olive (Olea europa)
t9
Pecan/Hickory (Carya species, pecan)
t22
Pine
t213
Privet
t210
Queen palm
(Arecastrum romanzoffianum)
t72
Spruce
t201
Sweet gum
t211
Sycamore (Plantanus acerfolia)
tt11
Walnut (Juglans californica)
t10
White ash (Fraxinus americana)
t15
White mulberry (Morus species)
t70
White pine (Pinus strobus)
t16
Willow (Salixnigra)
t12
Test
Code
2514
3319
2508
2518
2504
2523
2501
2521
2520
2506
2507
2509
2522
3423
3326
Test
Code
2413
2401
2408
2409
2404
2417
2403
2412
2410
2406
2420
2407
2416
2414
2411
2415
2418
Table 10
Weeds
Western ragweed
(Ambrosia psilostachya)
Wormwood (sagebrush)
(Artemisia absinthium)
Pharmacia
Code
Test
Code
w2
2402
w5
2405
Table 11
Other Allergen
Ascaris
Echinococcus
Seminal Fluid
2556
3426
3328
2511
2510
2515
2570
2516
2512
38
Pharmacia
Code
p1
p2
o70
Test
Code
2741
2742
2770
Allergy Evaluations
Allergy Profiles for Inhalant and Food Allergens
A total of 19 regional allergy profiles have been developed based upon the regional prevalence of allergens, taking into
account the relative abundance and antigenicity for each seasonal allergen. Each Regional Respiratory Allergy Profile consists
of from 14-21 of the most prevalent tree, grass, and weed allergens specific to that region, in addition to the most prevalent
allergens common to all regions. All Regional Respiratory Allergy Profiles include a Total IgE test. Testing is performed by the
Pharmacia Diagnosis ImmunoCAP®1 Specific IgE blood test, which utilizes a fluoroenzyme immunoassay (non-RAST1)
procedure that is more accurate than either RAST. This results in a high degree of diagnostic efficiency in the detection of
atopic individuals relative to inhalant and food allergens. Submission requirements: 2 mL serum-plastic vial.
Table 1.
Regional Respiratory Allergy Profiles for Inhalant Allergens
Test
(Profile I: CT, MA, ME, NH, NJ, PA, RI, VT)
(Profile II: DC, DE, MD, NC, VA)
Prevalent Test Allergens
Test
Code
d1
d2
e1
e5
g3
i6
m2
m3
m6
t1
t3
t7
t8
t15
w1
w10
Dermatophagoides pteronyssinus
Dermatophagoides farinae
Cat epithelia
Dog dander
Orchard grass (cocksfoot; Dactylis glomerata)
Cockroach
Cladosporium herbarum (Hormodendrum)
Aspergillus fumagatus
Alternaria alternata (a mold)
Maple (box elder; Acer negindo)
Birch (Betula verrucosa)
Oak (Quercus alba)
Elm (ulmus americana)
White ash (Fraxinum americana)
Common ragweed (short; Ambrosia elation)
Lamb’s-quarters (goosefoot; Chenopodium album)
10643
d1
d2
e1
e5
g2
g8
g10
i6
m2
m3
m6
t1
t7
t8
t22
w1
w10
Dermatophagoides pteronyssinus
Dermatophagoides farinae
Cat epithelia
Dog dander
Bermuda grass (Cynodon dactylon)
June grass (Kentucky blue; Poa prentesis)
Johnson grass (Sorghum halepense)
Cockroach
Cladosporium herbarum (Hormodendrum)
Aspergillus fumigatus
Alternaria alternata (a mold)
Maple (box elder; Acer negindo)
Oak (Quercus alba)
Elm (Ulmus americana)
Pecan/Hickory (Carya species, pecan)
Common ragweed (short; Ambrosia elation)
Lamg’s-quarters (goosefoot; Chenopodium album)
10644
39
Allergy Evaluations
Table 1.
Regional Respiratory Allergy Profiles for Inhalant Allergens (Continued)
Test
(Profile III: GA, northern F4 SC)
(Profile IV: FL, south of Orlando)
(Profile V: IN, KY, OH, TN, WV)
Prevalent Test Allergens
Test
Code
d1
d2
e1
e5
g2
g8
g10
g17
i6
m1
m2
m3
m6
t7
t8
t22
w1
w14
Dermatophagoides pteronyssinus
Dermatophagoides farinae
Cat epithelia
Dog dander
Bermuda grass (Cynodon dactylon)
June grass (Kentucky blue; Poa prentesis)
Johnson grass (Sorghum halepense)
Bahia grass (asoakyn bitatyn)
Cockroach
Penicillum notatum
Cladosporium herbarum (Hormodendrum)
Aspergillus fumigatus
Alternaria alternata (a mold)
Oak (Quercus alba)
Elm (Ulmus americana)
Pecan/Hickory (Carya species, pecan)
Common ragweed (short; Ambrosia elation)
Rough pigweed (Amaranthus retroflexus)
10285
d1
d2
e1
e5
g2
g17
i6
m1
m2
m3
m6
t7
t22
t73
w1
w14
Dermatophagoides pteronyssinus
Dermatophagoides farinae
Cat epithelia
Dog dander
Bermuda grass (Cynodon dactylon)
Bahia grass (asoakyn bitatyn)
Cockroach
Penicillum notatum
Cladosporium herbarum (Hormodendrum)
Aspergillus fumigatus
Alternaria alternata (a mold)
Oak (Quercus alba)
Pecan/Hickory (Carya species, pecan)
Australian pine (Casuarina equisetifolia)
Common ragweed (short; Ambrosia elation)
Rough pigweed (Amaranthus retroflexus)
10286
d1
d2
e1
e5
g2
g8
g10
i6
m2
m3
m6
t7
t8
t10
t22
w1
w10
Dermatophagoides pteronyssinus
Dermatophagoides farinae
Cat epithelia
Dog dander
Bermuda grass (Cynodon dactylon)
June grass (Kentucky blue; Poa prentesis)
Johnson grass (Sorghum halepense)
Cockroach
Cladosporium herbarum (Hormodendrum)
Aspergillus fumigatus
Alternaria alternata (a mold)
Oak (Quercus alba)
Elm (Ulmus americana)
Walnut (Juglans californica)
Pecan/Hickory (Carya species, pecan)
Common ragweed (short; Ambrosia elation)
Lamb’s-quarters (goosefoot; Chenopodium album)
10647
40
Allergy Evaluations
Table 1.
Regional Respiratory Allergy Profiles for Inhalant Allergens (Continued)
Test
(Profile VI: AL, AR, LA, MS)
(Profile VII: MI, MN, WI)
(Profile VIII: IA, IL, MO)
Prevalent Test Allergens
Test
Code
d1
d2
e1
e5
g2
g8
g10
i6
m1
m2
m3
m6
t7
t8
t10
t22
w1
w16
Dermatophagoides pteronyssinus
Dermatophagoides farinae
Cat epithelia
Dog dander
Bermuda grass (Cynodon dactylon)
June grass (Kentucky blue; Poa prentesis)
Johnson grass (Sorghum halepense)
Cockroach
Penicillum notatum
Cladosporium herbarum (Hormodendrum)
Aspergillus fumigatus
Alternaria alternata (a mold)
Oak (Quercus alba)
Elm (Ulmus americana)
Walnut (Juglans californica)
Pecan/Hickory (Carya species, pecan)
Common ragweed (short; Ambrosia elation)
Rough marsh elder (Iva)
10647
d1
d2
e1
e5
g3
g9
m2
m3
i6
m6
t1
t3
t7
t8
w1
w16
Dermatophagoides pteronyssinus
Dermatophagoides farinae
Cat epithelia
Dog dander
Orchard grass (cocksfoot; Dactylis glomerata)
Red top grass (Bent grass; Agrostis alba)
Cladosporium herbarum (Hormodendrum)
Aspergillus fumigatus
Cockroach
Alternaria alternata (a mold)
Maple (box elder; Acer negundo)
Birch (Betula verrucosa)
Oak (Quercus alba)
Elm (Ulmus americana)
Common ragweed (short; Ambrosia elation)
Rough marsh elder (Iva)
10648
d1
d2
e1
e5
g3
g8
i6
m2
m3
m6
t1
t3
t7
t8
w1
w16
Dermatophagoides pteronyssinus
Dermatophagoides farinae
Cat epithelia
Dog dander
Orchard grass (cocksfoot; Dactylis glomerata)
June grass (Kentudky Blue; Poa pratensis)
Cockroach
Cladosporium herbarum (Hormodendrum)
Aspergillus fumigatus
Alternaria alternata (a mold)
Maple (box elder; Acer negundo)
Birch (Betula verrucosa)
Oak (Quercus alba)
Elm (Ulmus americana)
Common ragweed (short; Ambrosia elation)
Rough marsh elder (Iva)
41
Allergy Evaluations
Table 1.
Regional Respiratory Allergy Profiles for Inhalant Allergens (Continued)
Test
Prevalent Test Allergens
d1
d2
e1
e5
g2
g9
i6
m2
m3
m6
t1
t7
t8
t14
w1
w11
w16
w17
Dermatophagoides pteronyssinus
Dermatophagoides farinae
Cat epithelia
Dog dander
Bermuda grass (Cynodon dactylon)
Red top grass (Bent grass; Agrostis alba)
Cockroach
Cladosporium herbarum (Hormodendrum)
Aspergillus fumigatus
Alternaria alternata (a mold)
Maple (box elder; Acer negundo)
Oak (Quercus alba)
Elm (Ulmus americana)
Cottonwood (Populus deltoids)
Common ragweed (short; Ambrosia elation)
Russian thistle (prickly saltwort; Salsola kali)
Rough marsh elder (Iva)
Firebush (Kochia scoparia)
(Profile X: OK, TX)
d1
d2
e1
e5
g2
g8
g10
i6
m2
m3
m6
t6
t7
t8
t10
w1
w16
Dermatophagoides pteronyssinus
Dermatophagoides farinae
Cat epithelia
Dog dander
Bermuda grass (Cynodon dactylon)
June grass (Kentucky Blue; Poa pratensis)
Johnson grass (Sorghum halepense)
Cockroach
Cladosporium herbarum (Hormodendrum)
Aspergillus fumigatus
Alternaria alternata (a mold)
Mountain cedar (Juniperus sabinoides)
Oak (Quercus alba)
Elm (Ulmus americana)
Walnut (Juglans californica)
Common ragweed (short; Ambrosia elatior)
Rough marsh elder (Iva)
(Profile XI: AZ (mountains), CO, ID
(mountains), MT, NM, UT, WY)
d1
d2
e1
e5
g2
g9
i6
m2
m3
m6
t1
t2
t6
t7
t8
t14
w11
w17
Dermatophagoides pteronyssinus
Dermatophagoides farinae
Cat epithelia
Dog dander
Bermuda grass (Cynodon dactylon)
Red top grass (Bent grass; Agrostis alba)
Cockroach
Cladosporium herbarum (Hormodendrum)
Aspergillus fumigatus
Alternaria alternata (a mold)
Maple (box elder; Acer negundo)
Alder (Alnus incana)
Mountain cedar (Juniperus sabinoides)
Oak (Quercus alba)
Elm (Ulmus americana)
Cottonwood (Populus deltoids)
Russian thistle (prickly saltwort; Salsola kali)
Firebush (Kochia scoparia)
(Profile IX: KS, NE, ND, SD)
42
Test
Code
10650
10653
Allergy Evaluations
Table 1.
Regional Respiratory Allergy Profiles for Inhalant Allergens (Continued)
Test
(Profile XII: AZ (south), CA (southeast desert)
(Profile XIII: CA, southern coast)
Prevalent Test Allergens
Test
Code
d1
d2
e1
35
g2
g5
i6
m2
m3
m6
t6
t9
t14
t15
t20
w11
w14
w15
Dermatophagoides pteronyssinus
Dermatophagoides farinae
Cat epithelia
Dog dander
Bermuda grass (Cynodon dactylon)
Perennial rye grass (Lolium perenne)
Cockroach
Cladosporium herbarum (Hormodendrum)
Aspergillus fumigatus
Alternaria alternata (a mold)
Mountain cedar (Juniperus sabinoides)
Olive (Olea europa)
Cottonwood (Populus deltoides)
White ash (Fraxinus americana)
Mesquite (Prospus juliflora)
Russian thistle (prickly saltwort; Salsola kali)
Rough Pigweed (Amaranthus retroflexus)
Scale (Atriplex)
10654
d1
d2
e1
e5
g2
g11
g14
i6
m2
m3
m6
t1
t7
t9
t10
t11
t17
w4
w11
w14
w15
Dermatophagoides pteronyssinus
Dermatophagoides farinae
Cat epithelia
Dog dander
Bermuda grass (Cynodon dactylon)
Brome grass (Bromus inermis)
Cultivated oat pollen (Avena sativa)
Cockroach
Cladosporium herbarum (Hormodendrum)
Aspergillus fumigatus
Alternaria alternata (a mold)
Maple (box elder; Acer negundo)
Oak (Quercus alba)
Olive (Olea eruopa)
Walnut (Juglans californica)
Sycamore (Plantanus acerfolia)
Japanese cedar
False ragweed (Franseria acanthicarpa)
Russian thistle (prickly saltwort; Salsola kali)
Rough Pigweed (Amaranthus retroflexus)
Scale (Atriplex)
10655
43
Allergy Evaluations
Table 1.
Regional Respiratory Allergy Profiles for Inhalant Allergens (Continued)
Test
(Profile XIV: CA, central valley)
(Profile XV: ID (south), NV)
Prevalent Test Allergens
d1
d2
e1
e5
g2
g9
g14
i6
m2
m3
m6
t1
t2
t7
t9
t10
t17
w6
w10
w14
w15
Dermatophagoides pteronyssinus
Dermatophagoides farinae
Cat epithelia
Dog dander
Bermuda grass (Cynodon dactylon)
Red top grass (Bent grass; Argostis alba)
Cultivated oat pollen (Avena sativa)
Cockroach
Cladosporium herbarum (Hormodendrum)
Aspergillus fumigatus
Alternaria alternata (a mold)
Maple (box elder; Acer negundo)
Alder (Alnus incana)
Oak (Quercus alba)
Olive (Olea eruopa)
Walnut (Juglans californica)
Japanese cedar
Mugwort (sagebrush; Artemisia vulgaris)
Lamb’s-quarter’s (goosefoot; Chenopodium album)
Rough pigweed (Amaranthus retroflexus)
Scale (Atriplex)
d1
d2
e1
e5
g2
g9
i6
m2
m3
m6
t1
t2
t3
t9
t14
t70
w6
w11
w14
Dermatophagoides pteronyssinus
Dermatophagoides farinae
Cat epithelia
Dog dander
Bermuda grass (Cynodon dactylon)
Red top grass (Bent grass; Argostis alba)
Cockroach
Cladosporium herbarum (Hormodendrum)
Aspergillus fumigatus
Alternaria alternata (a mold)
Maple (box elder; Acer negundo)
Alder (Alnus incana)
Birch (Betula verrucosa)
Olive (Olea eruopa)
Cottonwood (Populus deltoides)
Mulberry
Mugwort (sagebrush; Artemisia vulgaris)
Russian thistle (prickly saltwort; Salsola kali)
Rough pigweed (Amaranthus retroflexus)
44
Test
Code
10668
Allergy Evaluations
Table 1.
Regional Respiratory Allergy Profiles for Inhalant Allergens (Continued)
Test
(Profile XVI: OR, WA (central and east)
(Profile XVII: CA (northwest), OR (west), WA)
(Profile XVIII: Alaska)
Prevalent Test Allergens
Test
Code
d1
d2
e1
e5
g9
i6
m2
m3
m6
t1
t2
t3
t7
t14
w6
w11
w14
Dermatophagoides pteronyssinus
Dermatophagoides farinae
Cat epithelia
Dog dander
Red top grass (Bent grass; Argostis alba)
Cockroach
Cladosporium herbarum (Hormodendrum)
Aspergillus fumigatus
Alternaria alternata (a mold)
Maple (box elder; Acer negundo)
Alder (Alnus incana)
Birch (Betula verrucosa)
Oak (Quercus alba)
Cottonwood (Populus deltoides)
Mugwort (sagebrush; Artemisia vulgaris)
Russian thistle (prickly saltwort; Salsola kali)
Rough pigweed (Amaranthus retroflexus)
10657
d1
d2
e1
e5
g6
i6
m2
m3
m6
t1
t2
t3
t7
t10
w2
w11
w14
Dermatophagoides pteronyssinus
Dermatophagoides farinae
Cat epithelia
Dog dander
Timothy grass (Phleum pretense)
Cockroach
Cladosporium herbarum (Hormodendrum)
Aspergillus fumigatus
Alternaria alternata (a mold)
Maple (box elder; Acer negundo)
Alder (Alnus incana)
Birch (Betula verrucosa)
Oak (Quercus alba)
Walnut (Juglans californica)
Western ragweed (Ambrosia psilostachya)
Russian thistle (prickly saltwort; Salsola kali)
Rough pigweed (Amaranthus retroflexus)
10658
d1
d2
e1
e5
g11
g71
i6
m2
m3
m6
t2
t3
t14
w14
Dermatophagoides pteronyssinus
Dermatophagoides farinae
Cat epithelia
Dog dander
Brome grass (Bromus inermis)
Canary grass (Phalaris canariensis)
Cockroach
Cladosporium herbarum (Hormodendrum)
Indoor mold (Aspergillus fumigatus)
Outdoor mold (Alternaria alternate)
Alder (Alnus incana)
Common silver birch
Cottonwood (Populus deltoides)
Rough pigweed (Amaranthus retroflexus)
45
Allergy Evaluations
Table 1.
Regional Respiratory Allergy Profiles for Inhalant Allergens (Continued)
Test
(Profile XIX: Puerto Rico)
Table 2.
Puerto Rico
Dermatophagoides pteronyssinus
Dermatophagoides farinae
Cat epithelia
Dog dander
Bermuda grass (Cynodon dactylon)
Bahia grass (Paspalum notatum)
Cockroach
Penicillum notatum (a mold)
Cladosporium herbarum (Hormodendrum)
Aspergillus fumigatus
Alternaria alternata (a mold)
Oak (Quercus alba)
Eucalyptus (Eucalyptus species)
Pecan/Hickory (Carya species, pecan)
Queen palm (Arecastrum romanzoffianum)
Australian pine (Casuarina equisetifolia)
English plantain (Plantago lanceolata)
Rough pigweed (Amaranthus retroflexus)
Wall pellitory
Test
Code
38828
Childhood Allergy (Food and Environmental) Profile
States
50 States
d1
d2
e1
e5
g2
g17
i6
m1
m2
m3
m6
t7
t18
t22
t72
t73
w9
w14
w19
Prevalent Test Allergens
Test
Prevalent Test Allergens
d2
e1
e5
f1
f2
f3
f13
f14
f4
i6
m6
Dermatophagoides farinae
Cat epithelia
Dog dander
Egg white
Milk
Codfish
Peanut
Soybean
Wheat
Cockroach
Outdoor mold (Alternaria alternate)
d1
e1
e5
f1
f2
f8
f13
f14
f4
i6
m6
Total IgE
Dermatophagoides farinae
Cat epithelia
Dog dander
Egg white
Milk
Corn
Peanut
Soybean
Wheat
Cockroach
Outdoor mold (Alternaria alternate)
Total IgE
46
Test
Code
10659
Allergy Evaluations
Table 3.
Food Allergy Profile, Adult
States
Test
f1
f2
f3
f4
f8
f13
f14
f24
f207
f256
f338
50 States
Prevalent Test Allergens
Egg white
Milk
Codfish
Wheat
Corn
Peanut
Soybean
Shrimp
Calm
Walnut
Scallop
Test
Code
10715
Additional Allergy Panels
Submission Requirements: Each of these panels, consisting of 5 allergens, may be determined from 2 mL Serum – Plastic vial.
Mold Group #11 (Test Code 7911)
m2
Cladosporium herbarum
m3
Aspergillus fumigatus
m4
Mucor racemosus
m5
Candida albicans
m6
Alternaria tenuis
Vegetable Group #16 (Test Code 7916)
f8
Corn
f12
Pea
f15
White bean
f31
Carrot
f35
Potato
Animal Group #1s (Test Code 7912)
e3
Horse dander
e4
Cow dander
e7
Pigeon droppings
e70
Goose feathers
e85
Chicken feathers
Salad Group #17 (Test Code 7917)
f25
Tomato
f33
Orange
f85
Celery
f86
Parsley
f215
Lettuce
Stinging Insect Group #13 (Test Code 7913)
i1
Honeybee
i2
White-faced hornet
i3
Yellow jacket
i4
Paper wasp
i5
Yellow hornet
Nut Mix Group #18 (7918)
f10
Sesame seed
f13
Peanut
f20
Almond
f36
Coconut
f201
Pecan
Cereal Group #15 (Test Code 7915)
f5
Rye
f6
Barley
f9
Rice
f11
Buckwheat
f79
Gluten
NOTE:
Seafood Group #19 (Test Code 7919)
f3
Codfish
f23
Crab
f24
Shrimp
f40
Tuna
f80
Lobster
A substitution will be made only when an individual allergen is unavailable.
47
This page intentionally left blank
48