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REQUISITION AND ORDER/ENTRY
INFORMATION FOR IMMUNOGENETICS & TRANSPLANTATION
Procedures can be ordered using
form#151-222, available from Moore's Form Company "Immunogenetics &
Transplantation Test Request" or on Form# 151-858, "Miscellaneous Test Request"
A requisition must accompany all
samples.
| 1. Patient information: |
| -
Legal full name |
| - Sex |
| -
Date of Birth |
|
- Social Security Number (required for solid organ transplant recipients) |
| -
Medical Record Number |
| -
ICD-9 Code |
| -
Patient registration or bulk account number |
| 2. Date and time of sample collection |
| 3. Specimen source (i.e., peripheral blood,
bone marrow, etc.) |
| 4. Name and phone number of requesting
physician |
| 5. Test or testing protocol requested |
| 6. Address to which written laboratory report
should be sent |
| |
| Any referrals for HLA typing or histocompatibility
testing must additionally include: |
| a. Subject's status
(kidney recipient, related donor, etc.) |
| b. Relations to
prospective recipient, if applicable |
| c. Subject's racial
or ethnic background |
| d. Transplant date,
if known |
| The laboratory performs ABO Grouping in
conjunction with a Histocompatibility Workup, HLA Typing for Solid
|
| Organ and Bone Marrow Transplantation,
Lymphocytotoxic Antibody Screening and Crossmatching.
|
Molecular Genetics
|
The laboratory performs Chimerism
Testing for post transplant monitoring using STR (Short Tandem Repeats). |
Cell Surface Marker Analysis
| The laboratory performs Cell Surface Marker
Analysis (Immunophenotyping) by Flow Cytometry for |
| Lymphocyte Subset |
| Studies (i.e., T Cell Subsets, Leukemia/Lymphoma
Differential Diagnosis and monitoring of minimum |
| residual disease. |
Infectious Disease Serology
| The laboratory provides Serologic Testing for an
array of Viral Makers on a stat basis for Life Sharing (5-7 |
| hours) or on a routine basis (twice weekly) for
transplant related subjects only. Other patient samples should
be |
| referred to the Virology Lab. |
| Testing includes: Hepatitis B (HBsAg & HBcAb),
Hepatitis C (HCV Ab), HIV 1/2, HIV Antigen (p24 Ag),
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| CMV Ab(Total), HTLV I/ II, and RPR.
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