Tests Catalogs

H. PYLORI BREATH TEST

LAB572

Collect

BreathTek UBT Kit (ARUP Supply #51124 ) available online through eSupply using ARUP Connect™ or contact ARUPClient Services at (800) 522-2787.

Patient Preparation

This test requires the adult patient (>17 years of age) to fast and abstain from smoking for 1 hour prior to test administration. The patient should not have taken antibiotics, proton pump inhibitors (e.g., Prilosec, Prevacid, Aciphex, Nexium), or bismuth preparations (e.g., Pepto-Bismol) within the previous 14 days. When used to monitor treatment, the test should be performed four weeks after cessation of definitive therapy. The patient should be informed that the Pranactin-Citric drink that will be administered contains phenylalanine. Phenylketonurics restrict dietary phenylalanine.

Specimen Preparation

1) Label breath collection bags with patient name, MRN, date and time of collection, and indicate Pre (blue) or Post (pink).
2) Collect the baseline (Pre) breath specimen according to the instructions in the BreathTek UBT kit.
3) After the allotted time, collect the Post breath specimen according to the instructions in the kit.

Unacceptable Conditions

Underinflated bags. Pediatric specimens

Storage/Transport Temperature

CRITICAL ROOM TEMPERATURE. Do not freeze.

Stability (from collection to initiation)

Ambient: 1 week; Refrigerated: Unacceptable; Frozen: Unacceptable

Remarks

For a valid result, the post breath specimen must be collected between 15 and 30 minutes after the patient drinks the Pranactin-Citric solution.

Notes

The post-dose sample must be collected between 15 and 30 minutes post-dose to prevent a false negative result.

Performed

Sun-Sat

Methodology

Qualitative Spectrophotometry

Reported

Within 4 days

Synonyms

  • Urea Breath Test
  • Breath Test
  • LAB572
  • HPYLORI BR

Additional Technical Information

Ordering Recommendations

Use to diagnose H. pylori infection in adults (>17 years of age). For children and adolescents, refer to Helicobacter pylori Breath Test, Pediatric (2010925).

Reference Interval

Negative

Interpretive Data

A negative result does not rule out the possibility of H. pylori infection. If clinical signs are suggestive of H. pylori infection, retest with a new specimen or an alternate method. Known causes of false negative results include:
1.  Use of antibiotics, proton pump inhibitors, and bismuth preparations during the preceding 2 weeks.
2.  Administration of the breath test less than 4 weeks after completion of definitive therapy to eradicate H. pylori.
3.  Premature or late collection of the post-dose specimen.

Known causes of false positive results include:
1. Patients with achlorhydria.
2. Rinsing the testing solution in the mouth, which can allow contact with urease-positive bacteria.
3. The presence of other gastric spiral organisms such as Helicobacter heilmanii.

CPT Codes

83013
Collection

LAB572

Collect

BreathTek UBT Kit (ARUP Supply #51124 ) available online through eSupply using ARUP Connect™ or contact ARUPClient Services at (800) 522-2787.

Patient Preparation

This test requires the adult patient (>17 years of age) to fast and abstain from smoking for 1 hour prior to test administration. The patient should not have taken antibiotics, proton pump inhibitors (e.g., Prilosec, Prevacid, Aciphex, Nexium), or bismuth preparations (e.g., Pepto-Bismol) within the previous 14 days. When used to monitor treatment, the test should be performed four weeks after cessation of definitive therapy. The patient should be informed that the Pranactin-Citric drink that will be administered contains phenylalanine. Phenylketonurics restrict dietary phenylalanine.

Specimen Preparation

1) Label breath collection bags with patient name, MRN, date and time of collection, and indicate Pre (blue) or Post (pink).
2) Collect the baseline (Pre) breath specimen according to the instructions in the BreathTek UBT kit.
3) After the allotted time, collect the Post breath specimen according to the instructions in the kit.

Unacceptable Conditions

Underinflated bags. Pediatric specimens

Storage/Transport Temperature

CRITICAL ROOM TEMPERATURE. Do not freeze.

Stability (from collection to initiation)

Ambient: 1 week; Refrigerated: Unacceptable; Frozen: Unacceptable

Remarks

For a valid result, the post breath specimen must be collected between 15 and 30 minutes after the patient drinks the Pranactin-Citric solution.

Notes

The post-dose sample must be collected between 15 and 30 minutes post-dose to prevent a false negative result.
Ordering

Performed

Sun-Sat

Methodology

Qualitative Spectrophotometry

Reported

Within 4 days

Synonyms

  • Urea Breath Test
  • Breath Test
  • LAB572
  • HPYLORI BR

Additional Technical Information

Ordering Recommendations

Use to diagnose H. pylori infection in adults (>17 years of age). For children and adolescents, refer to Helicobacter pylori Breath Test, Pediatric (2010925).
Result Interpretation

Reference Interval

Negative

Interpretive Data

A negative result does not rule out the possibility of H. pylori infection. If clinical signs are suggestive of H. pylori infection, retest with a new specimen or an alternate method. Known causes of false negative results include:
1.  Use of antibiotics, proton pump inhibitors, and bismuth preparations during the preceding 2 weeks.
2.  Administration of the breath test less than 4 weeks after completion of definitive therapy to eradicate H. pylori.
3.  Premature or late collection of the post-dose specimen.

Known causes of false positive results include:
1. Patients with achlorhydria.
2. Rinsing the testing solution in the mouth, which can allow contact with urease-positive bacteria.
3. The presence of other gastric spiral organisms such as Helicobacter heilmanii.

Administrative

CPT Codes

83013

HAEMOPHILUS INFLUENZA B IGG AB

LAB1237

Collect

Serum separator tube. "Pre" and 30-day "post" Haemophilus influenzae b vaccination specimens should be submitted together for testing. "Post" specimen should be drawn 30 days after immunization and must be received within 60 days of "pre" specimen.

Specimen Preparation

Separate serum from cells ASAP or within 2 hours of collection. Transfer 1 mL serum to an ARUP Standard Transport Tube. (Min: 0.15 mL) Mark specimens clearly as "Pre-Vaccine" or "Post-Vaccine".

Unacceptable Conditions

Plasma or other body fluids. Contaminated, hemolyzed or, severely lipemic specimens.

Storage/Transport Temperature

Refrigerated.

Stability (from collection to initiation)

After separation from cells: Ambient: 48 hours; Refrigerated: 2 weeks; Frozen: 1 year (avoid repeated freeze/thaw cycles)

Performed

Sun-Sat

Methodology

Quantitative Multiplex Bead Assay

Reported

1-2 days

Synonyms

  • LAB1237
  • HIBE IGG

Ordering Recommendations

Evaluate the ability of a patient to produce antibody to a protein conjugated bacterial (H. influenza) vaccine to rule out antibody deficiency.

Reference Interval

< 1.0 µg/mL = Antibody concentration not protective.
≥ 1.0 µg/mL = Antibody to H. influenzae b detected. Suggestive of protection.

Interpretive Data

Responder status is determined according to the ratio of post-vaccination concentration to pre-vaccination concentration of Haemophilus influenza b antibody, IgG as follows:
1.  If the post-vaccination concentration is less than 3.0 µg/mL, the patient is considered to be a nonresponder.
2.  If the post-vaccination concentration is greater than or equal to 3.0 µg/mL, a patient with a ratio of greater than or equal to 4 is a good responder, a ratio of 2-4 is a weak responder, and a ratio of less than 2 is considered a nonresponder.

CPT Codes

86317
Collection

LAB1237

Collect

Serum separator tube. "Pre" and 30-day "post" Haemophilus influenzae b vaccination specimens should be submitted together for testing. "Post" specimen should be drawn 30 days after immunization and must be received within 60 days of "pre" specimen.

Specimen Preparation

Separate serum from cells ASAP or within 2 hours of collection. Transfer 1 mL serum to an ARUP Standard Transport Tube. (Min: 0.15 mL) Mark specimens clearly as "Pre-Vaccine" or "Post-Vaccine".

Unacceptable Conditions

Plasma or other body fluids. Contaminated, hemolyzed or, severely lipemic specimens.

Storage/Transport Temperature

Refrigerated.

Stability (from collection to initiation)

After separation from cells: Ambient: 48 hours; Refrigerated: 2 weeks; Frozen: 1 year (avoid repeated freeze/thaw cycles)
Ordering

Performed

Sun-Sat

Methodology

Quantitative Multiplex Bead Assay

Reported

1-2 days

Synonyms

  • LAB1237
  • HIBE IGG

Ordering Recommendations

Evaluate the ability of a patient to produce antibody to a protein conjugated bacterial (H. influenza) vaccine to rule out antibody deficiency.
Result Interpretation

Reference Interval

< 1.0 µg/mL = Antibody concentration not protective.
≥ 1.0 µg/mL = Antibody to H. influenzae b detected. Suggestive of protection.

Interpretive Data

Responder status is determined according to the ratio of post-vaccination concentration to pre-vaccination concentration of Haemophilus influenza b antibody, IgG as follows:
1.  If the post-vaccination concentration is less than 3.0 µg/mL, the patient is considered to be a nonresponder.
2.  If the post-vaccination concentration is greater than or equal to 3.0 µg/mL, a patient with a ratio of greater than or equal to 4 is a good responder, a ratio of 2-4 is a weak responder, and a ratio of less than 2 is considered a nonresponder.

Administrative

CPT Codes

86317

HALOPERIDOL

LAB191

Collect

Plain red. Also acceptable: Lavender (K2 or K3EDTA) or pink (K2EDTA).

Patient Preparation

Timing of specimen collection: Pre-dose (trough) draw - At steady state concentration.

Specimen Preparation

Separate serum or plasma from cells within 2 hours of collection. Transfer 1 mL serum or plasma to an ARUP Standard Transport Tube. (Min: 0.5 mL)

Unacceptable Conditions

Whole blood. Gel separator tubes, light blue (citrate), or yellow (SPS or ACD solution).

Storage/Transport Temperature

Refrigerated.

Stability (from collection to initiation)

After separation from cells: Ambient: 4 hours; Refrigerated: 1 week; Frozen: 1 month (avoid repeated freeze/thaw cycles)

Performed

Mon, Wed, Fri

Methodology

Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Reported

1-5 days

Synonyms

  • Haldol
  • LAB191
  • HALO

Ordering Recommendations

Optimize drug therapy and monitor patient adherence.

Reference Interval

Effective November 18, 2013
Therapeutic Range:5.0-20.0 ng/mL
Toxic:Greater than 42 ng/mL

Interpretive Data

Adverse effects may include drowsiness, blurred vision, tardive dyskinesia, tachycardia, nausea and vomiting.

CPT Codes

80173
Collection

LAB191

Collect

Plain red. Also acceptable: Lavender (K2 or K3EDTA) or pink (K2EDTA).

Patient Preparation

Timing of specimen collection: Pre-dose (trough) draw - At steady state concentration.

Specimen Preparation

Separate serum or plasma from cells within 2 hours of collection. Transfer 1 mL serum or plasma to an ARUP Standard Transport Tube. (Min: 0.5 mL)

Unacceptable Conditions

Whole blood. Gel separator tubes, light blue (citrate), or yellow (SPS or ACD solution).

Storage/Transport Temperature

Refrigerated.

Stability (from collection to initiation)

After separation from cells: Ambient: 4 hours; Refrigerated: 1 week; Frozen: 1 month (avoid repeated freeze/thaw cycles)
Ordering

Performed

Mon, Wed, Fri

Methodology

Quantitative Liquid Chromatography-Tandem Mass Spectrometry

Reported

1-5 days

Synonyms

  • Haldol
  • LAB191
  • HALO

Ordering Recommendations

Optimize drug therapy and monitor patient adherence.
Result Interpretation

Reference Interval

Effective November 18, 2013
Therapeutic Range:5.0-20.0 ng/mL
Toxic:Greater than 42 ng/mL

Interpretive Data

Adverse effects may include drowsiness, blurred vision, tardive dyskinesia, tachycardia, nausea and vomiting.

Administrative

CPT Codes

80173

HANTAVIRUS ANTIBODIES IGG/IGM

LAB3482

Collect

Serum Separator Tube (SST).

Specimen Preparation

Transfer 1 mL serum to an ARUP Standard Transport Tube. (Min: 0.25 mL)

Storage/Transport Temperature

Refrigerated. Also acceptable: Room temperature or frozen.

Stability (from collection to initiation)

Ambient: 5 days; Refrigerated: 2 weeks; Frozen: 1 month

Performed

Varies

Methodology

Semi-Quantitative Enzyme-Linked Immunosorbent Assay

Reported

3-6 days

Synonyms

  • LAB3482
  • HANTAVIRUS

Ordering Recommendations

Use to detect hantavirus exposure.  Does not distinguish between Sin Nombre virus (cause of hantavirus pulmonary syndrome) and other hantaviruses (which cause hemorrhagic fever with renal syndrome).  For Sin Nombre virus-specific testing, contact your state health department.

CPT Codes

86790 x2
Collection

LAB3482

Collect

Serum Separator Tube (SST).

Specimen Preparation

Transfer 1 mL serum to an ARUP Standard Transport Tube. (Min: 0.25 mL)

Storage/Transport Temperature

Refrigerated. Also acceptable: Room temperature or frozen.

Stability (from collection to initiation)

Ambient: 5 days; Refrigerated: 2 weeks; Frozen: 1 month
Ordering

Performed

Varies

Methodology

Semi-Quantitative Enzyme-Linked Immunosorbent Assay

Reported

3-6 days

Synonyms

  • LAB3482
  • HANTAVIRUS

Ordering Recommendations

Use to detect hantavirus exposure.  Does not distinguish between Sin Nombre virus (cause of hantavirus pulmonary syndrome) and other hantaviruses (which cause hemorrhagic fever with renal syndrome).  For Sin Nombre virus-specific testing, contact your state health department.
Result Interpretation
Administrative

CPT Codes

86790 x2

HAPTOGLOBIN, SERUM

LAB89

HAPTO

Collect

One 4.5 mL Gold top tube with gel separator (SST).

Pediatric Collection

1.5 mL Blood.

Unacceptable Conditions

Sample not properly identified; incorrect container; insufficient sample volume.

Storage/Transport Temperature

Internal: Deliver to lab immediately.
Offsite: Centrifuge within 30 minutes of collection. Send at 2-8 degrees C.

Stability (from collection to initiation)

Ambient: Unacceptable; Refrigerated: 8 days; Frozen (-20 degrees C): 1 year.

Performed by

PCL Clinical Laboratory - Core

Performed

Daily

Methodology

Immunonturbidimetric

Reported

Daily

Synonyms

  • LAB89

Reference Interval

36.0-195.0 mg/dL

Performed by

PCL Clinical Laboratory - Core

CPT Codes

83010

Collection

LAB89

HAPTO

Collect

One 4.5 mL Gold top tube with gel separator (SST).

Pediatric Collection

1.5 mL Blood.

Unacceptable Conditions

Sample not properly identified; incorrect container; insufficient sample volume.

Storage/Transport Temperature

Internal: Deliver to lab immediately.
Offsite: Centrifuge within 30 minutes of collection. Send at 2-8 degrees C.

Stability (from collection to initiation)

Ambient: Unacceptable; Refrigerated: 8 days; Frozen (-20 degrees C): 1 year.

Performed by

PCL Clinical Laboratory - Core

Ordering

Performed

Daily

Methodology

Immunonturbidimetric

Reported

Daily

Synonyms

  • LAB89
Result Interpretation

Reference Interval

36.0-195.0 mg/dL

Performed by

PCL Clinical Laboratory - Core

Administrative

CPT Codes

83010

HEAVY METALS 4 SCREEN

LAB1019

Collect

Royal blue (K2EDTA or Na2EDTA).

Patient Preparation

Diet, medication, and nutritional supplements may introduce interfering substances.  Patients should be encouraged to discontinue nutritional supplements, vitamins, minerals, non-essential over-the-counter medications (upon the advice of their physician), and avoid shellfish and seafood for 48 to 72 hours.

Specimen Preparation

Transport 7 mL whole blood. (Min: 1.5 mL)

Unacceptable Conditions

Heparin anticoagulant. Frozen specimens.

Storage/Transport Temperature

Room temperature. Also acceptable: Refrigerated.

Stability (from collection to initiation)

Mercury is volatile; concentration may reduce after seven or more days of storage.  If the specimen is drawn and stored in the appropriate container, the arsenic, cadmium, and lead values do not change with time.

Remarks

Trace Elements requisition form may be required (ARUP form #32990).

Performed

Sun-Sat

Methodology

Quantitative Inductively Coupled Plasma-Mass Spectrometry

Reported

1-3 days

Synonyms

  • LAB1019
  • HMP4 B
  • Arsenic
  • AS blood level
  • Cadmium
  • Cd blood level
  • Heavy metals blood levels
  • Hg blood level
  • Lead
  • Mercury
  • Pb blood level

Ordering Recommendations

Useful in the assessment of recent exposure to arsenic, cadmium, mercury, and lead. For chronic exposure or the determination of arsenic species, refer to Heavy Metals Panel 4, Urine with Reflex to Arsenic Fractionation (0020572). For occupational exposure, consider Lead, Industrial Exposure Panel, Adults (0025016) and/or Cadmium Exposure Panel - OSHA (0025013).

Reference Interval

Components
Reference Interval
Arsenic, Blood0.0-13.0 µg/L
Cadmium, Blood0.0-5.0 µg/L
Mercury, Whole Blood0-10 µg/L
Lead, Blood (Venous)0.0-4.9 µg/dL

Interpretive Data

Refer to report.

CPT Codes

82175; 82300; 83655; 83825
Collection

LAB1019

Collect

Royal blue (K2EDTA or Na2EDTA).

Patient Preparation

Diet, medication, and nutritional supplements may introduce interfering substances.  Patients should be encouraged to discontinue nutritional supplements, vitamins, minerals, non-essential over-the-counter medications (upon the advice of their physician), and avoid shellfish and seafood for 48 to 72 hours.

Specimen Preparation

Transport 7 mL whole blood. (Min: 1.5 mL)

Unacceptable Conditions

Heparin anticoagulant. Frozen specimens.

Storage/Transport Temperature

Room temperature. Also acceptable: Refrigerated.

Stability (from collection to initiation)

Mercury is volatile; concentration may reduce after seven or more days of storage.  If the specimen is drawn and stored in the appropriate container, the arsenic, cadmium, and lead values do not change with time.

Remarks

Trace Elements requisition form may be required (ARUP form #32990).
Ordering

Performed

Sun-Sat

Methodology

Quantitative Inductively Coupled Plasma-Mass Spectrometry

Reported

1-3 days

Synonyms

  • LAB1019
  • HMP4 B
  • Arsenic
  • AS blood level
  • Cadmium
  • Cd blood level
  • Heavy metals blood levels
  • Hg blood level
  • Lead
  • Mercury
  • Pb blood level

Ordering Recommendations

Useful in the assessment of recent exposure to arsenic, cadmium, mercury, and lead. For chronic exposure or the determination of arsenic species, refer to Heavy Metals Panel 4, Urine with Reflex to Arsenic Fractionation (0020572). For occupational exposure, consider Lead, Industrial Exposure Panel, Adults (0025016) and/or Cadmium Exposure Panel - OSHA (0025013).
Result Interpretation

Reference Interval

Components
Reference Interval
Arsenic, Blood0.0-13.0 µg/L
Cadmium, Blood0.0-5.0 µg/L
Mercury, Whole Blood0-10 µg/L
Lead, Blood (Venous)0.0-4.9 µg/dL

Interpretive Data

Refer to report.

Administrative

CPT Codes

82175; 82300; 83655; 83825

HEAVY METALS 4 SCREEN URINE W/REFLEX TO ARSENIC SPECIATION

LAB398

Collect

24-hour or random urine collection. Specimen must be collected in a plastic container and should be refrigerated during collection. ARUP studies indicate that refrigeration of urine alone, during and after collection, preserves specimens adequately if tested within 14 days of collection.

Patient Preparation

Diet, medication, and nutritional supplements may introduce interfering substances.  Patients should be encouraged to discontinue nutritional supplements, vitamins, minerals, non-essential over-the-counter medications (upon the advice of their physician), and avoid shellfish and seafood for 48 to 72 hours. High concentrations of iodine may interfere with elemental testing.  Abstinence from iodine-containing medications or contrast agents for at least 1 month prior to collecting specimens for elemental testing is recommended.

Specimen Preparation

Transfer 8 mL aliquot from a well-mixed collection to ARUP Trace Element-Free Transport Tubes (ARUP supply #43116). Available online through eSupply using ARUP Connect™ or contact ARUP Client Services at (800) 522-2787. (Min: 2 mL)

Unacceptable Conditions

Urine collected within 48 hours after administration of a gadolinium (Gd) containing contrast media (may occur with MRI studies). Acid preserved urine. Specimens contaminated with blood or fecal material. Specimen transported in non-trace element-free transport tube (with the exception of the original device).

Storage/Transport Temperature

Refrigerated. Also acceptable: Room temperature or frozen.

Stability (from collection to initiation)

Ambient: 1 week; Refrigerated: 2 weeks; Frozen: 1 year

Remarks

Trace Elements requisition form may be required (ARUP form #32990-Barcode; #32991-No Barcode). Record total volume and collection time interval on transport tube and on test request form.

Notes

If total arsenic concentration is between 35-2000 ug/L, then Arsenic, Fractionated, will be added to determine the proportion of organic, inorganic, and methylated forms. Additional charges apply.

Performed

Sun-Sat

Methodology

Quantitative Inductively Coupled Plasma-Mass Spectrometry

Reported

1-4 days

Synonyms

  • LAB398
  • HMP4 U
  • Arsenic (As)
  • As
  • Cadmium (Cd)
  • Cd
  • Hg
  • Lead (Pb)
  • Mercury (Hg)
  • Metals Screen
  • Pb
  • Toxicology Quantitative Screen, Metals

Ordering Recommendations

Useful in the assessment of acute and chronic exposure to arsenic, cadmium, mercury, and lead. The preferred test for the assessment of lead exposure is Lead, Blood (Venous) (0020098). For occupational exposure, consider Lead, Industrial Exposure Panel, Adults (0025016) and/or Cadmium Exposure Panel - OSHA (0025013).

Reference Interval

Effective May 18, 2015
Components
Reference Interval
Arsenic Urine - per volume0-35.0 µg/L (based on Biological Exposure Index)
Arsenic Urine - per 24h0-50.0 µg/d
Arsenic, Urine - ratio to CRTLess than 30 ug/gCRT
Arsenic, Fractionated, Urine
Components
Reference Interval
Arsenic, OrganicRefer to report
Arsenic, InorganicRefer to report
Arsenic, MethylatedRefer to report

Lead, Urine - ratio to CRTLess than 5 ug/gCRT
Lead, Urine - per 24h0-31 µg/d
Lead, Urine - per volume0-23 µg/L
Mercury, Urine - per 24h0-15 µg/d
Mercury, Urine - per volume0-10 µg/L
Mercury, Urine - ratio to CRTLess than or equal to 35 µg/gCRT
Creatinine, Urine - per 24h
AgeMaleFemale
3-8 years140-700 mg/d140-700 mg/d
9-12 years300-1300 mg/d300-1300 mg/d
13-17 years500-2300 mg/d400-1600 mg/d
18-50 years1000-2500 mg/d700-1600 mg/d
51-80 years800-2100 mg/d500-1400 mg/d
81 years and older600-2000 mg/d400-1300 mg/d

Cadmium, Urine
Components
Reference Interval
Cadmium, Urine - per volumeRefer to report
Cadmium, Urine - per 24hRefer to report
Cadmium, Urine - ratio to CRTRefer to report
Creatinine, Urine - per 24hRefer to report


Interpretive Data

Urine cadmium levels can be used to assess cadmium body burden. In chronic exposures, the kidneys are the primary target organ. Symptoms associated with cadmium toxicity vary based upon route of exposure and may include tubular proteinuria, fever, headache, dyspnea, chest pain, conjunctivitis, rhinitis, sore throat and cough. Ingestion of cadmium in high concentration may cause vomiting, diarrhea, salivation, cramps, and abdominal pain.

Urinary mercury levels predominantly reflect acute or chronic elemental or inorganic mercury exposure. Urine concentrations in unexposed individuals are typically less than 10 µg/L. 24 hour urine concentrations of 30 to 100 µg/L may be associated with subclinical neuropsychiatric symptoms and tremor while concentrations greater than 100 µg/L can be associated with overt neuropsychiatric disturbances and tremors. Urine mercury levels may be useful in monitoring chelation therapy.

The ACGIH Biological Exposure Index (BEI) for arsenic in urine is 35 µg/L. The ACGIH BEI is based on the sum of inorganic and methylated species. For specimens with a total arsenic concentration between 35-2000 µg/L, fractionation is automatically performed to determine the proportions of inorganic, methylated and organic species.  It may be appropriate to request fractionation for specimens with a total arsenic greater than 30 µg/gCRT despite a total arsenic concentration less than 35 µg/L. If low-level chronic poisoning is suspected, the µg/gCRT ratio may be a more sensitive indicator of arsenic exposure than the total arsenic concentration.

CPT Codes

82175; 83655; 83825; 82300; if reflexed, add 82175
Collection

LAB398

Collect

24-hour or random urine collection. Specimen must be collected in a plastic container and should be refrigerated during collection. ARUP studies indicate that refrigeration of urine alone, during and after collection, preserves specimens adequately if tested within 14 days of collection.

Patient Preparation

Diet, medication, and nutritional supplements may introduce interfering substances.  Patients should be encouraged to discontinue nutritional supplements, vitamins, minerals, non-essential over-the-counter medications (upon the advice of their physician), and avoid shellfish and seafood for 48 to 72 hours. High concentrations of iodine may interfere with elemental testing.  Abstinence from iodine-containing medications or contrast agents for at least 1 month prior to collecting specimens for elemental testing is recommended.

Specimen Preparation

Transfer 8 mL aliquot from a well-mixed collection to ARUP Trace Element-Free Transport Tubes (ARUP supply #43116). Available online through eSupply using ARUP Connect™ or contact ARUP Client Services at (800) 522-2787. (Min: 2 mL)

Unacceptable Conditions

Urine collected within 48 hours after administration of a gadolinium (Gd) containing contrast media (may occur with MRI studies). Acid preserved urine. Specimens contaminated with blood or fecal material. Specimen transported in non-trace element-free transport tube (with the exception of the original device).

Storage/Transport Temperature

Refrigerated. Also acceptable: Room temperature or frozen.

Stability (from collection to initiation)

Ambient: 1 week; Refrigerated: 2 weeks; Frozen: 1 year

Remarks

Trace Elements requisition form may be required (ARUP form #32990-Barcode; #32991-No Barcode). Record total volume and collection time interval on transport tube and on test request form.

Notes

If total arsenic concentration is between 35-2000 ug/L, then Arsenic, Fractionated, will be added to determine the proportion of organic, inorganic, and methylated forms. Additional charges apply.
Ordering

Performed

Sun-Sat

Methodology

Quantitative Inductively Coupled Plasma-Mass Spectrometry

Reported

1-4 days

Synonyms

  • LAB398
  • HMP4 U
  • Arsenic (As)
  • As
  • Cadmium (Cd)
  • Cd
  • Hg
  • Lead (Pb)
  • Mercury (Hg)
  • Metals Screen
  • Pb
  • Toxicology Quantitative Screen, Metals

Ordering Recommendations

Useful in the assessment of acute and chronic exposure to arsenic, cadmium, mercury, and lead. The preferred test for the assessment of lead exposure is Lead, Blood (Venous) (0020098). For occupational exposure, consider Lead, Industrial Exposure Panel, Adults (0025016) and/or Cadmium Exposure Panel - OSHA (0025013).
Result Interpretation

Reference Interval

Effective May 18, 2015
Components
Reference Interval
Arsenic Urine - per volume0-35.0 µg/L (based on Biological Exposure Index)
Arsenic Urine - per 24h0-50.0 µg/d
Arsenic, Urine - ratio to CRTLess than 30 ug/gCRT
Arsenic, Fractionated, Urine
Components
Reference Interval
Arsenic, OrganicRefer to report
Arsenic, InorganicRefer to report
Arsenic, MethylatedRefer to report

Lead, Urine - ratio to CRTLess than 5 ug/gCRT
Lead, Urine - per 24h0-31 µg/d
Lead, Urine - per volume0-23 µg/L
Mercury, Urine - per 24h0-15 µg/d
Mercury, Urine - per volume0-10 µg/L
Mercury, Urine - ratio to CRTLess than or equal to 35 µg/gCRT
Creatinine, Urine - per 24h
AgeMaleFemale
3-8 years140-700 mg/d140-700 mg/d
9-12 years300-1300 mg/d300-1300 mg/d
13-17 years500-2300 mg/d400-1600 mg/d
18-50 years1000-2500 mg/d700-1600 mg/d
51-80 years800-2100 mg/d500-1400 mg/d
81 years and older600-2000 mg/d400-1300 mg/d

Cadmium, Urine
Components
Reference Interval
Cadmium, Urine - per volumeRefer to report
Cadmium, Urine - per 24hRefer to report
Cadmium, Urine - ratio to CRTRefer to report
Creatinine, Urine - per 24hRefer to report


Interpretive Data

Urine cadmium levels can be used to assess cadmium body burden. In chronic exposures, the kidneys are the primary target organ. Symptoms associated with cadmium toxicity vary based upon route of exposure and may include tubular proteinuria, fever, headache, dyspnea, chest pain, conjunctivitis, rhinitis, sore throat and cough. Ingestion of cadmium in high concentration may cause vomiting, diarrhea, salivation, cramps, and abdominal pain.

Urinary mercury levels predominantly reflect acute or chronic elemental or inorganic mercury exposure. Urine concentrations in unexposed individuals are typically less than 10 µg/L. 24 hour urine concentrations of 30 to 100 µg/L may be associated with subclinical neuropsychiatric symptoms and tremor while concentrations greater than 100 µg/L can be associated with overt neuropsychiatric disturbances and tremors. Urine mercury levels may be useful in monitoring chelation therapy.

The ACGIH Biological Exposure Index (BEI) for arsenic in urine is 35 µg/L. The ACGIH BEI is based on the sum of inorganic and methylated species. For specimens with a total arsenic concentration between 35-2000 µg/L, fractionation is automatically performed to determine the proportions of inorganic, methylated and organic species.  It may be appropriate to request fractionation for specimens with a total arsenic greater than 30 µg/gCRT despite a total arsenic concentration less than 35 µg/L. If low-level chronic poisoning is suspected, the µg/gCRT ratio may be a more sensitive indicator of arsenic exposure than the total arsenic concentration.

Administrative

CPT Codes

82175; 83655; 83825; 82300; if reflexed, add 82175

HEINZ BODY STAIN

LAB4416

Collect

Lavender (EDTA), pink (K2EDTA), or green (sodium or lithium heparin).

Specimen Preparation

Transport 5 mL whole blood. (Min: 2 mL)

Unacceptable Conditions

Samples greater than 96 hours old.  Specimens from infants under 6 months of age; test results are unreliable.

Storage/Transport Temperature

Refrigerated. Ship Sunday-Thursday only.

Stability (from collection to initiation)

Ambient: unacceptable; Refrigerated: 96 hours; Frozen: Unacceptable

Performed

Mon-Fri

Methodology

Supravital Stain

Reported

1-4 days

Ordering Recommendations

Use as a non specific screen for  hemolysis due to drugs/toxins, enzyme deficiencies, thalassemias and unstable hemoglobins.

Reference Interval

Effective August 17, 2015.
Direct: Negative
Induced: Normal

Interpretive Data

Refer to report.

CPT Codes

85441; 85445
Collection
LAB4416

Collect

Lavender (EDTA), pink (K2EDTA), or green (sodium or lithium heparin).

Specimen Preparation

Transport 5 mL whole blood. (Min: 2 mL)

Unacceptable Conditions

Samples greater than 96 hours old.  Specimens from infants under 6 months of age; test results are unreliable.

Storage/Transport Temperature

Refrigerated. Ship Sunday-Thursday only.

Stability (from collection to initiation)

Ambient: unacceptable; Refrigerated: 96 hours; Frozen: Unacceptable
Ordering

Performed

Mon-Fri

Methodology

Supravital Stain

Reported

1-4 days

Ordering Recommendations

Use as a non specific screen for  hemolysis due to drugs/toxins, enzyme deficiencies, thalassemias and unstable hemoglobins.
Result Interpretation

Reference Interval

Effective August 17, 2015.
Direct: Negative
Induced: Normal

Interpretive Data

Refer to report.

Administrative

CPT Codes

85441; 85445

HELICOBACTER PYLORI AG - STOOL

LAB397

Collect

Stool.

Patient Preparation

To avoid false negative results, no antibiotics, proton pump inhibitors, or a bismuth preparation should be administered to patient for 14 days prior to specimen collection.

Specimen Preparation

Transfer 5 g stool to an unpreserved stool transport vial (ARUP supply #40910). Available online through eSupply using ARUP Connect™or contact ARUP Client Services at (800) 522-2787. (Min: 1 g)

Unacceptable Conditions

Gastric specimens, swabs or tissue. Specimens in media or preservatives.

Storage/Transport Temperature

Frozen.

Stability (from collection to initiation)

Ambient: 2 hours; Refrigerated: 72 hours; Frozen: 1 month.

Performed

Sun-Sat

Methodology

Qualitative Enzyme Immunoassay

Reported

Within 24 hours

Synonyms

  • LAB397

Additional Technical Information

Ordering Recommendations

As an alternative to the H. pylori urea breath test, order this test to diagnose H. pylori.

Reference Interval

Negative

CPT Codes

87338
Collection

LAB397

Collect

Stool.

Patient Preparation

To avoid false negative results, no antibiotics, proton pump inhibitors, or a bismuth preparation should be administered to patient for 14 days prior to specimen collection.

Specimen Preparation

Transfer 5 g stool to an unpreserved stool transport vial (ARUP supply #40910). Available online through eSupply using ARUP Connect™or contact ARUP Client Services at (800) 522-2787. (Min: 1 g)

Unacceptable Conditions

Gastric specimens, swabs or tissue. Specimens in media or preservatives.

Storage/Transport Temperature

Frozen.

Stability (from collection to initiation)

Ambient: 2 hours; Refrigerated: 72 hours; Frozen: 1 month.
Ordering

Performed

Sun-Sat

Methodology

Qualitative Enzyme Immunoassay

Reported

Within 24 hours

Synonyms

  • LAB397

Additional Technical Information

Ordering Recommendations

As an alternative to the H. pylori urea breath test, order this test to diagnose H. pylori.
Result Interpretation

Reference Interval

Negative
Administrative

CPT Codes

87338

HEMATOCRIT

LAB289

HCT

Collect

One 4 mL Purple top (EDTA whole blood).  Minimum volume 1.0 mL.

Pediatric Collection

At least 0.5 mL whole blood in a 1.0 mL microtainer, purple top (EDTA whole blood).

Unacceptable Conditions

Sample not properly identified; incorrect container; clotted sample; frozen sample.

Storage/Transport Temperature

Internal: Deliver to lab immediately at ambient temperature.
Offsite: Do not centrifuge. Send at 2-8 degrees C if transport time will exceed 24 hours.

Stability (from collection to initiation)

Ambient: 24 hours; Refrigerated: 36 hours; Frozen: Unacceptable.

Performed by

PCL Clinical Laboratory - Core

Notes

Blood volume of 0.5 mL or less in a 4.0 mL purple top (EDTA whole blood) is unacceptable. Blood volume between 0.5 mL and 1.0 mL in a 4.0 mL purple top (EDTA whole blood) is a suboptimal specimen and results will be reported with this disclaimer: "Low volume sample, results may be unreliable."

Performed

Daily

Methodology

Automated Cell Counter

Reported

Routine requests are reported within 8 hours.

Synonyms

  • LAB289
  • HCT

Reference Interval

Component Sex From Age To Age Normal Low Normal High Units
HEMATOCRIT M/F 0 4D 45.0 67.0 %
M/F 4D 15D 39.0 66.0 %
M/F 15D 1M 31.0 55.0 %
M/F 1M 7M 28.0 42.0 %
M/F 7M 2 33.0 39.0 %
M/F 2 13 34.0 45.0 %
M/F 13 18 37.0 49.0 %
M 18 150 39.2 50.2 %
F 18 150 35.7 46.7 %

Performed by

PCL Clinical Laboratory - Core

CPT Codes

85014

Collection

LAB289

HCT

Collect

One 4 mL Purple top (EDTA whole blood).  Minimum volume 1.0 mL.

Pediatric Collection

At least 0.5 mL whole blood in a 1.0 mL microtainer, purple top (EDTA whole blood).

Unacceptable Conditions

Sample not properly identified; incorrect container; clotted sample; frozen sample.

Storage/Transport Temperature

Internal: Deliver to lab immediately at ambient temperature.
Offsite: Do not centrifuge. Send at 2-8 degrees C if transport time will exceed 24 hours.

Stability (from collection to initiation)

Ambient: 24 hours; Refrigerated: 36 hours; Frozen: Unacceptable.

Performed by

PCL Clinical Laboratory - Core

Notes

Blood volume of 0.5 mL or less in a 4.0 mL purple top (EDTA whole blood) is unacceptable. Blood volume between 0.5 mL and 1.0 mL in a 4.0 mL purple top (EDTA whole blood) is a suboptimal specimen and results will be reported with this disclaimer: "Low volume sample, results may be unreliable."
Ordering

Performed

Daily

Methodology

Automated Cell Counter

Reported

Routine requests are reported within 8 hours.

Synonyms

  • LAB289
  • HCT
Result Interpretation

Reference Interval

Component Sex From Age To Age Normal Low Normal High Units
HEMATOCRIT M/F 0 4D 45.0 67.0 %
M/F 4D 15D 39.0 66.0 %
M/F 15D 1M 31.0 55.0 %
M/F 1M 7M 28.0 42.0 %
M/F 7M 2 33.0 39.0 %
M/F 2 13 34.0 45.0 %
M/F 13 18 37.0 49.0 %
M 18 150 39.2 50.2 %
F 18 150 35.7 46.7 %

Performed by

PCL Clinical Laboratory - Core

Administrative

CPT Codes

85014

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