VALPROIC ACID

LAB24

VALPROIC

Collect

One 4.5 mL Green top tube with gel separator (PST).

 

Pediatric Collection

1.5 mL whole blood or 20 full capillary tubes.

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 if tested within 24 hours. Place plasma in aliquot container and send frozen if not tested within 24 hours.

Stability (from collection to initiation)

Refrigerated: 24 hours; Frozen (-20 degrees C): greater than 24 hours

Remarks

Draw trough level just prior to the next dose. If toxicity is suspected draw at any time.

Performed by

PCL Clinical Laboratory - Core

Performed

Daily

Methodology

Immuno-Turbidimetry

Reported

Same day

Synonyms

  • Depakene
  • Depakote Level
  • LAB24

Reference Interval

50.0-100.0 ug/mL

Interpretive Data

Effective 05/20/2014:

In most patients, valproic acid concentrations of 50–100 μg/mL control generalized and partial seizures.  Seizure control may improve at levels greater than 100 μg/mL, but toxicity may occur at levels of 100–150 μg/mL.  For effective treatment, some patients may require levels outside this range.  Therefore, the expected range is provided only as a general guide, and individual patient results should be interpreted in light of clinical signs and symptoms.

Performed by

PCL Clinical Laboratory - Core

CPT Codes

80164

Collection

LAB24

VALPROIC

Collect

One 4.5 mL Green top tube with gel separator (PST).

 

Pediatric Collection

1.5 mL whole blood or 20 full capillary tubes.

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 if tested within 24 hours. Place plasma in aliquot container and send frozen if not tested within 24 hours.

Stability (from collection to initiation)

Refrigerated: 24 hours; Frozen (-20 degrees C): greater than 24 hours

Remarks

Draw trough level just prior to the next dose. If toxicity is suspected draw at any time.

Performed by

PCL Clinical Laboratory - Core

Ordering

Performed

Daily

Methodology

Immuno-Turbidimetry

Reported

Same day

Synonyms

  • Depakene
  • Depakote Level
  • LAB24
Result Interpretation

Reference Interval

50.0-100.0 ug/mL

Interpretive Data

Effective 05/20/2014:

In most patients, valproic acid concentrations of 50–100 μg/mL control generalized and partial seizures.  Seizure control may improve at levels greater than 100 μg/mL, but toxicity may occur at levels of 100–150 μg/mL.  For effective treatment, some patients may require levels outside this range.  Therefore, the expected range is provided only as a general guide, and individual patient results should be interpreted in light of clinical signs and symptoms.

Performed by

PCL Clinical Laboratory - Core

Administrative

CPT Codes

80164

VALPROIC ACID FREE & TOTAL

LAB25

Collect

Plain red.

Patient Preparation

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

Specimen Preparation

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

Unacceptable Conditions

Light blue (citrate), gray (oxalate), green (heparin), K2EDTA plasma, tubes that contain liquid anticoagulant, or gel separator tubes.

Storage/Transport Temperature

Refrigerated.

Stability (from collection to initiation)

After separation from cells: Ambient: 24 hours; Refrigerated: 1 week; Frozen: 1 month

Performed

Tue-Sat

Methodology

Quantitative Enzyme Multiplied Immunoassay Technique

Reported

1-4 days

Synonyms

  • Depakene, Free
  • Free Valproate
  • Depakote, Free
  • LAB25

Ordering Recommendations

Preferred test for therapeutic drug management in patients with renal failure or conditions that may alter albumin concentrations.

Reference Interval

Test NumberComponentsTherapeutic Range
0099308Valproic Acid, TotalTherapeutic Range: 50-125 µg/mL
Toxic: Greater than 150 µg/mL
0099791Valproic Acid, FreeEffective November 18, 2013
Therapeutic Range: 7-23 µg/mL
Toxic: Greater than 30 µg/mL
0099309Valproic Acid, Percent Free5-18 percent

Interpretive Data

Free valproic acid may be important to monitor in patients with altered or unpredictable protein binding capacity because valproic acid exhibits variable, dose-dependent protein binding. Valproic acid is also subject to drug-drug interactions due to displacement of protein binding.  Calculating percent free attempts to minimize differences in test cross-reactivity and may be useful in dose optimization. Adverse effects may include headache, somnolence and dizziness.

CPT Codes

80164; 80165
Collection

LAB25

Collect

Plain red.

Patient Preparation

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

Specimen Preparation

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

Unacceptable Conditions

Light blue (citrate), gray (oxalate), green (heparin), K2EDTA plasma, tubes that contain liquid anticoagulant, or gel separator tubes.

Storage/Transport Temperature

Refrigerated.

Stability (from collection to initiation)

After separation from cells: Ambient: 24 hours; Refrigerated: 1 week; Frozen: 1 month
Ordering

Performed

Tue-Sat

Methodology

Quantitative Enzyme Multiplied Immunoassay Technique

Reported

1-4 days

Synonyms

  • Depakene, Free
  • Free Valproate
  • Depakote, Free
  • LAB25

Ordering Recommendations

Preferred test for therapeutic drug management in patients with renal failure or conditions that may alter albumin concentrations.
Result Interpretation

Reference Interval

Test NumberComponentsTherapeutic Range
0099308Valproic Acid, TotalTherapeutic Range: 50-125 µg/mL
Toxic: Greater than 150 µg/mL
0099791Valproic Acid, FreeEffective November 18, 2013
Therapeutic Range: 7-23 µg/mL
Toxic: Greater than 30 µg/mL
0099309Valproic Acid, Percent Free5-18 percent

Interpretive Data

Free valproic acid may be important to monitor in patients with altered or unpredictable protein binding capacity because valproic acid exhibits variable, dose-dependent protein binding. Valproic acid is also subject to drug-drug interactions due to displacement of protein binding.  Calculating percent free attempts to minimize differences in test cross-reactivity and may be useful in dose optimization. Adverse effects may include headache, somnolence and dizziness.

Administrative

CPT Codes

80164; 80165

VANCOMYCIN PEAK

LAB41

VANC P

Collect

One 4.5 mL Green top tube with gel separator (PST).

Pediatric Collection

1.5 mL whole blood or 20 capillary tubes.

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 if tested within 24 hours. Place plasma in aliquot container and send frozen if not tested within 24 hours.

Stability (from collection to initiation)

Refrigerated: 24 hours; Frozen (-20 degrees C): Greater than 24 hours

Remarks

Include dosage information. Draw peak levels 1-2 hours after the end of a 60 minute infusion. Random levels are not necessary for patients with normal renal function and appropriate peak levels.

Performed by

PCL Clinical Laboratory - Core

Performed

Daily

Methodology

Enzymatic

Reported

Same day

Synonyms

  • LAB41

Reference Interval

20.0-40.0 ug/mL

Interpretive Data

Reported peak therapeutic ranges for vancomycin vary considerably. Both the dosage regimen  and  the  timing  of  sample  collection  may  affect  the  peak  therapeutic  range.  For  patients  on  concomitant  vancomycin  and  aminoglycoside  treatment,  peak  vancomycin concentrations  exceeding  30  μg/mL  are  associated  with  nephrotoxicity.  Serum concentrations above 80 μg/mL are associated with ototoxicity.   For effective treatment, some patients may require serum or plasma levels outside these ranges. Therefore,  the  expected  ranges  are  provided  only  as general guidance,  and  individual  patient  results should be interpreted in light of clinical signs and symptoms.

Performed by

PCL Clinical Laboratory - Core

CPT Codes

80202

Collection

LAB41

VANC P

Collect

One 4.5 mL Green top tube with gel separator (PST).

Pediatric Collection

1.5 mL whole blood or 20 capillary tubes.

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 if tested within 24 hours. Place plasma in aliquot container and send frozen if not tested within 24 hours.

Stability (from collection to initiation)

Refrigerated: 24 hours; Frozen (-20 degrees C): Greater than 24 hours

Remarks

Include dosage information. Draw peak levels 1-2 hours after the end of a 60 minute infusion. Random levels are not necessary for patients with normal renal function and appropriate peak levels.

Performed by

PCL Clinical Laboratory - Core

Ordering

Performed

Daily

Methodology

Enzymatic

Reported

Same day

Synonyms

  • LAB41
Result Interpretation

Reference Interval

20.0-40.0 ug/mL

Interpretive Data

Reported peak therapeutic ranges for vancomycin vary considerably. Both the dosage regimen  and  the  timing  of  sample  collection  may  affect  the  peak  therapeutic  range.  For  patients  on  concomitant  vancomycin  and  aminoglycoside  treatment,  peak  vancomycin concentrations  exceeding  30  μg/mL  are  associated  with  nephrotoxicity.  Serum concentrations above 80 μg/mL are associated with ototoxicity.   For effective treatment, some patients may require serum or plasma levels outside these ranges. Therefore,  the  expected  ranges  are  provided  only  as general guidance,  and  individual  patient  results should be interpreted in light of clinical signs and symptoms.

Performed by

PCL Clinical Laboratory - Core

Administrative

CPT Codes

80202

VANCOMYCIN RANDOM

LAB40

VANC R

Collect

One 4.5 mL Green top tube with gel separator (PST).

Pediatric Collection

1.5 mL whole blood or 20 capillary tubes.

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 if tested within 24 hours. Place plasma in aliquot container and send frozen if not tested within 24 hours.

Stability (from collection to initiation)

Refrigerated: 24 hours; Frozen (-20 degrees C): Greater than 24 hours

Remarks

Include dosage information. Trough levels should be drawn immediately before the next dose. Peak levels should be drawn 15-30 minutes after the end of a 60 minute infusion. Random levels are not necessary for patients with normal renal function and appropriate peak levels.

Performed by

PCL Clinical Laboratory - Core

Performed

Daily

Methodology

Enzymatic

Reported

Same day

Synonyms

  • LAB40
  • VANC R

Reference Interval

Effective 05/20/2014:

5 - 40 ug/mL

Interpretive Data

For effective treatment, therapeutic ranges for vancomycin vary considerably.  Concentrations above 80 μg/mL are associated with ototoxicity.   Therefore,  the  expected  ranges  are  provided  only  as  guidelines,  and  individual  patient  results should be interpreted in light of clinical signs and symptoms.

Performed by

PCL Clinical Laboratory - Core

CPT Codes

80202

Collection

LAB40

VANC R

Collect

One 4.5 mL Green top tube with gel separator (PST).

Pediatric Collection

1.5 mL whole blood or 20 capillary tubes.

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 if tested within 24 hours. Place plasma in aliquot container and send frozen if not tested within 24 hours.

Stability (from collection to initiation)

Refrigerated: 24 hours; Frozen (-20 degrees C): Greater than 24 hours

Remarks

Include dosage information. Trough levels should be drawn immediately before the next dose. Peak levels should be drawn 15-30 minutes after the end of a 60 minute infusion. Random levels are not necessary for patients with normal renal function and appropriate peak levels.

Performed by

PCL Clinical Laboratory - Core

Ordering

Performed

Daily

Methodology

Enzymatic

Reported

Same day

Synonyms

  • LAB40
  • VANC R
Result Interpretation

Reference Interval

Effective 05/20/2014:

5 - 40 ug/mL

Interpretive Data

For effective treatment, therapeutic ranges for vancomycin vary considerably.  Concentrations above 80 μg/mL are associated with ototoxicity.   Therefore,  the  expected  ranges  are  provided  only  as  guidelines,  and  individual  patient  results should be interpreted in light of clinical signs and symptoms.

Performed by

PCL Clinical Laboratory - Core

Administrative

CPT Codes

80202

VANCOMYCIN TROUGH

LAB39

VANC T

Collect

One 4.5 mL Green top with gel (PST), plasma (lithium heparin).

 

Pediatric Collection

At least 0.5 mL whole blood collected in a microtainer, green top with gel, lithium heparin plasma.

Unacceptable Conditions

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

Storage/Transport Temperature

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

Stability (from collection to initiation)

Before centrifugation: Ambient, 1 hour.

After centrifugation: Ambient, 8 hours; Refrigerated, 48 hours; Frozen, Unacceptable.

Plasma aliquot: Ambient, 8 hours; Refrigeratd, 48 hours; Frozen (-20 degrees C), Greater than 48 hours.

Remarks

Include dosage information. Trough levels should be drawn immediately before next dose. Random levels are not necessary for patients wiith normal renal function and appropriate peak levels.

Performed by

PCL Clinical Laboratory - Core

Performed

Daily

Methodology

Enzymatic

Reported

Same day

Synonyms

  • LAB39
  • VANC T

Reference Interval

Effective 07/15/2014:

10.0-20.0 ug/mL

Before 07/15/2014:

5 - 10 ug/mL

 

Interpretive Data

Trough vancomycin serum concentrations of >= 10.0 μg/mL usually ensure that the concentration is above the minimum inhibitory concentrations of most vancomycin-sensitive pathogens. Trough concentrations above 20.0 μg/mL are associated with nephrotoxicity.   For effective treatment, some patients may require serum or plasma levels outside these ranges.  Therefore,  the  expected  ranges  are  provided  only  as  general guidance,  and  individual  patient  results should be interpreted in light of clinical signs and symptoms.

Performed by

PCL Clinical Laboratory - Core

CPT Codes

80202

Collection

LAB39

VANC T

Collect

One 4.5 mL Green top with gel (PST), plasma (lithium heparin).

 

Pediatric Collection

At least 0.5 mL whole blood collected in a microtainer, green top with gel, lithium heparin plasma.

Unacceptable Conditions

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

Storage/Transport Temperature

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

Stability (from collection to initiation)

Before centrifugation: Ambient, 1 hour.

After centrifugation: Ambient, 8 hours; Refrigerated, 48 hours; Frozen, Unacceptable.

Plasma aliquot: Ambient, 8 hours; Refrigeratd, 48 hours; Frozen (-20 degrees C), Greater than 48 hours.

Remarks

Include dosage information. Trough levels should be drawn immediately before next dose. Random levels are not necessary for patients wiith normal renal function and appropriate peak levels.

Performed by

PCL Clinical Laboratory - Core

Ordering

Performed

Daily

Methodology

Enzymatic

Reported

Same day

Synonyms

  • LAB39
  • VANC T
Result Interpretation

Reference Interval

Effective 07/15/2014:

10.0-20.0 ug/mL

Before 07/15/2014:

5 - 10 ug/mL

 

Interpretive Data

Trough vancomycin serum concentrations of >= 10.0 μg/mL usually ensure that the concentration is above the minimum inhibitory concentrations of most vancomycin-sensitive pathogens. Trough concentrations above 20.0 μg/mL are associated with nephrotoxicity.   For effective treatment, some patients may require serum or plasma levels outside these ranges.  Therefore,  the  expected  ranges  are  provided  only  as  general guidance,  and  individual  patient  results should be interpreted in light of clinical signs and symptoms.

Performed by

PCL Clinical Laboratory - Core

Administrative

CPT Codes

80202

VANILLYLMANDELIC ACID URINE

LAB750

Collect

24-hour or random urine. Refrigerate 24-hour specimens during collection.

Patient Preparation

Abstain from medications for 72 hours prior to collection.

Specimen Preparation

Transfer 4 mL aliquot from a well-mixed 24-hour or random collection to an ARUP Standard Transport Tube. (Min: 1 mL) Record total volume and collection time interval on transport tube and test request form.

Unacceptable Conditions

Specimen types other than urine.

Storage/Transport Temperature

Refrigerated.

Stability (from collection to initiation)

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

Notes

Moderately elevated VMA (vanillylmandelic acid) can be caused by a variety of factors such as essential hypertension, intense anxiety, intense physical exercise, and numerous drug interactions (including some over-the-counter medications and herbal products).

Medications that may interfere with catecholamines and their metabolites include amphetamines and amphetamine-like compounds, appetite suppressants, bromocriptine, buspirone, caffeine, chlorpromazine, clonidine, disulfiram, diuretics (in doses sufficient to deplete sodium), epinephrine, glucagon, guanethidine, histamine, hydrazine derivatives, imipramine, levodopa (L-dopa, Sinemet®), lithium, MAO inhibitors, melatonin, methyldopa (Aldomet®), morphine, nitroglycerin, nose drops, propafenone (Rythmol), radiographic agents, rauwolfia alkaloids (Reserpine), tricyclic antidepressants, and vasodilators.  The effects of some drugs on catecholamine metabolite results may not be predictable.

Performed

Sun, Tue-Sat

Methodology

Quantitative High Performance Liquid Chromatography-Tandem Mass Spectrometry

Reported

1-4 days

Synonyms

  • 3-methoxy-4-hydroxy-mandelic acid
  • VMA, Urine
  • LAB750

Ordering Recommendations

Initial test for the diagnosis and monitoring of neuroblastoma. Should be ordered concurrently with Homovanillic Acid (HVA), Urine (0080422).

Reference Interval


Components
Reference Interval
Vanillylmandelic Acid - per 24h18 years and older0.0-7.0 mg/d
The VMA-to-creatinine ratio will be reported when the patient is under 18 years, the urine collection is random or other than 24 hours, or the urine volume is less than 400 mL/24 hours
Vanillylmandelic Acid - ratio to CRT0-2 years
3-5 years 
6-17 years
18 years and older
0-27 mg/g CRT
0-13 mg/g CRT
0-9 mg/g CRT
0-6 mg/g CRT
Creatinine, Urine - per 24hMale
3-8 years: 140-700 mg/d
9-12 years: 300-1300 mg/d
13-17 years: 500-2300 mg/d
18-50 years: 1000-2500 mg/d
51-80 years: 800-2100 mg/d
81 years and older: 600-2000 mg/d
Female
3-8 years: 140-700 mg/d
9-12 years: 300-1300 mg/d
13-17 years: 400-1600 mg/d
18-50 years: 700-1600 mg/d
51-80 years: 500-1400 mg/d
81 years and older: 400-1300 mg/d

Interpretive Data

Vanillylmandelic acid (VMA) results are expressed as a ratio to creatinine excretion (mg/g CRT). VMA mass per day (mg/d) is not reported on specimens from patients younger than 18 years of age, or for random specimens, urine collection periods other than 24 hours, or urine volumes less than 400 mL/d. No reference interval is available for results reported in units of mg/L. Slight or moderate increases in catecholamine metabolites may be due to extreme anxiety, essential hypertension, intense physical exercise, or drug interactions. Significant increase of one or more catecholamine metabolites (several times the upper reference limit) is associated with an increased probability of a secreting neuroendocrine tumor.

CPT Codes

84585
Collection

LAB750

Collect

24-hour or random urine. Refrigerate 24-hour specimens during collection.

Patient Preparation

Abstain from medications for 72 hours prior to collection.

Specimen Preparation

Transfer 4 mL aliquot from a well-mixed 24-hour or random collection to an ARUP Standard Transport Tube. (Min: 1 mL) Record total volume and collection time interval on transport tube and test request form.

Unacceptable Conditions

Specimen types other than urine.

Storage/Transport Temperature

Refrigerated.

Stability (from collection to initiation)

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

Notes

Moderately elevated VMA (vanillylmandelic acid) can be caused by a variety of factors such as essential hypertension, intense anxiety, intense physical exercise, and numerous drug interactions (including some over-the-counter medications and herbal products).

Medications that may interfere with catecholamines and their metabolites include amphetamines and amphetamine-like compounds, appetite suppressants, bromocriptine, buspirone, caffeine, chlorpromazine, clonidine, disulfiram, diuretics (in doses sufficient to deplete sodium), epinephrine, glucagon, guanethidine, histamine, hydrazine derivatives, imipramine, levodopa (L-dopa, Sinemet®), lithium, MAO inhibitors, melatonin, methyldopa (Aldomet®), morphine, nitroglycerin, nose drops, propafenone (Rythmol), radiographic agents, rauwolfia alkaloids (Reserpine), tricyclic antidepressants, and vasodilators.  The effects of some drugs on catecholamine metabolite results may not be predictable.
Ordering

Performed

Sun, Tue-Sat

Methodology

Quantitative High Performance Liquid Chromatography-Tandem Mass Spectrometry

Reported

1-4 days

Synonyms

  • 3-methoxy-4-hydroxy-mandelic acid
  • VMA, Urine
  • LAB750

Ordering Recommendations

Initial test for the diagnosis and monitoring of neuroblastoma. Should be ordered concurrently with Homovanillic Acid (HVA), Urine (0080422).
Result Interpretation

Reference Interval


Components
Reference Interval
Vanillylmandelic Acid - per 24h18 years and older0.0-7.0 mg/d
The VMA-to-creatinine ratio will be reported when the patient is under 18 years, the urine collection is random or other than 24 hours, or the urine volume is less than 400 mL/24 hours
Vanillylmandelic Acid - ratio to CRT0-2 years
3-5 years 
6-17 years
18 years and older
0-27 mg/g CRT
0-13 mg/g CRT
0-9 mg/g CRT
0-6 mg/g CRT
Creatinine, Urine - per 24hMale
3-8 years: 140-700 mg/d
9-12 years: 300-1300 mg/d
13-17 years: 500-2300 mg/d
18-50 years: 1000-2500 mg/d
51-80 years: 800-2100 mg/d
81 years and older: 600-2000 mg/d
Female
3-8 years: 140-700 mg/d
9-12 years: 300-1300 mg/d
13-17 years: 400-1600 mg/d
18-50 years: 700-1600 mg/d
51-80 years: 500-1400 mg/d
81 years and older: 400-1300 mg/d

Interpretive Data

Vanillylmandelic acid (VMA) results are expressed as a ratio to creatinine excretion (mg/g CRT). VMA mass per day (mg/d) is not reported on specimens from patients younger than 18 years of age, or for random specimens, urine collection periods other than 24 hours, or urine volumes less than 400 mL/d. No reference interval is available for results reported in units of mg/L. Slight or moderate increases in catecholamine metabolites may be due to extreme anxiety, essential hypertension, intense physical exercise, or drug interactions. Significant increase of one or more catecholamine metabolites (several times the upper reference limit) is associated with an increased probability of a secreting neuroendocrine tumor.

Administrative

CPT Codes

84585

VARICELLA (VZV) CULTURE

LAB3271
UHCVZV

Collect

Swab in M6 viral transport medium: Lesion scrapings, Tissue Lesions

One mL bronchial alveolar lavage (BAL) in a sterile container

Unacceptable Conditions

Sample not properly identified; incorrect container; insufficient sample volume; specimens older than 48 hours that have not been frozen at -70 degrees C.

Storage/Transport Temperature

Internal: Deliver to lab immediately.
Offsite: Refrigerate or keep on ice in M6 transport media. Transport same day. If delivery is not expected within 24 hours, freeze at -70 degrees C and ship on dry ice.

Stability (from collection to initiation)

Temperature-labile organism

Refrigerated: 24 hours; Frozen (-70 degrees C): Greater than 24 hours

Remarks

VZV is cell-associated; optimal specimens should include cells as well as fluid from lesions.

Performed by

PCL Clinical Laboratory - Virology

Performed

Daily

Methodology

Spin-enhanced tissue culture/immunofluorescence.

Reported

7 - 10 days

Synonyms

  • LAB3271
  • UHCVZV

Performed by

PCL Clinical Laboratory - Virology

CPT Codes

87254

Collection

LAB3271
UHCVZV

Collect

Swab in M6 viral transport medium: Lesion scrapings, Tissue Lesions

One mL bronchial alveolar lavage (BAL) in a sterile container

Unacceptable Conditions

Sample not properly identified; incorrect container; insufficient sample volume; specimens older than 48 hours that have not been frozen at -70 degrees C.

Storage/Transport Temperature

Internal: Deliver to lab immediately.
Offsite: Refrigerate or keep on ice in M6 transport media. Transport same day. If delivery is not expected within 24 hours, freeze at -70 degrees C and ship on dry ice.

Stability (from collection to initiation)

Temperature-labile organism

Refrigerated: 24 hours; Frozen (-70 degrees C): Greater than 24 hours

Remarks

VZV is cell-associated; optimal specimens should include cells as well as fluid from lesions.

Performed by

PCL Clinical Laboratory - Virology

Ordering

Performed

Daily

Methodology

Spin-enhanced tissue culture/immunofluorescence.

Reported

7 - 10 days

Synonyms

  • LAB3271
  • UHCVZV
Result Interpretation

Performed by

PCL Clinical Laboratory - Virology

Administrative

CPT Codes

87254

VARICELLA ZOSTER AB IGG (CSF)

LAB3339

Collect

CSF.

Specimen Preparation

Transfer 0.5 mL CSF to an ARUP Standard Transport Tube. (Min: 0.3 mL)

Unacceptable Conditions

Specimens other than CSF. Contaminated or heat-inactivated specimens.

Storage/Transport Temperature

Refrigerated. Also acceptable: Frozen.

Stability (from collection to initiation)

Ambient: 8 hours; Refrigerated: 2 weeks; Frozen: 1 year

Performed

Sun - Sat

Methodology

Semi-Quantitative Chemiluminescent Immunoassay

Reported

Within 24 hours

Synonyms

  • VZV IgG CSF
  • LAB3339
  • VZV IGG

Ordering Recommendations

Generally not recommended for the diagnosis of acute disease/encephalitis. May aid in diagnosing varicella-zoster virus vasculopathy.

Reference Interval

Effective August 20, 2012

134 IV or less: Negative - No significant level of IgG antibody to varicella-zoster virus detected.
135-165 IV: Equivocal - Repeat testing in 10-14 days may be helpful.
166 IV or greater: Positive - IgG antibody to varicella-zoster virus detected, which may indicate a current or past varicella-zoster infection.

Interpretive Data

The detection of antibodies to varicella-zoster in CSF may indicate central nervous system infection.  However, consideration must be given to possible contamination by blood or transfer of serum antibodies across the blood-brain barrier.

CPT Codes

86787
Collection

LAB3339

Collect

CSF.

Specimen Preparation

Transfer 0.5 mL CSF to an ARUP Standard Transport Tube. (Min: 0.3 mL)

Unacceptable Conditions

Specimens other than CSF. Contaminated or heat-inactivated specimens.

Storage/Transport Temperature

Refrigerated. Also acceptable: Frozen.

Stability (from collection to initiation)

Ambient: 8 hours; Refrigerated: 2 weeks; Frozen: 1 year
Ordering

Performed

Sun - Sat

Methodology

Semi-Quantitative Chemiluminescent Immunoassay

Reported

Within 24 hours

Synonyms

  • VZV IgG CSF
  • LAB3339
  • VZV IGG

Ordering Recommendations

Generally not recommended for the diagnosis of acute disease/encephalitis. May aid in diagnosing varicella-zoster virus vasculopathy.
Result Interpretation

Reference Interval

Effective August 20, 2012

134 IV or less: Negative - No significant level of IgG antibody to varicella-zoster virus detected.
135-165 IV: Equivocal - Repeat testing in 10-14 days may be helpful.
166 IV or greater: Positive - IgG antibody to varicella-zoster virus detected, which may indicate a current or past varicella-zoster infection.

Interpretive Data

The detection of antibodies to varicella-zoster in CSF may indicate central nervous system infection.  However, consideration must be given to possible contamination by blood or transfer of serum antibodies across the blood-brain barrier.

Administrative

CPT Codes

86787

VARICELLA ZOSTER AB IGM (CSF)

LAB3340

Collect

CSF.

Specimen Preparation

Transfer 0.5 mL CSF to an ARUP Standard Transport Tube. (Min: 0.3 mL)

Unacceptable Conditions

Specimen types other than CSF. Contaminated or heat-inactivated specimens.

Storage/Transport Temperature

Refrigerated.

Stability (from collection to initiation)

Ambient: 8 hours; Refrigerated: 2 weeks; Frozen: 1 year

Performed

Mon-Fri

Methodology

Semi-Quantitative Enzyme-Linked Immunosorbent Assay

Reported

1-5 days

Synonyms

  • VZV IgM CSF
  • LAB3340
  • VZV IGM

Ordering Recommendations

Not recommended. Refer to Varicella-Zoster Virus by PCR (0060042) or Meningitis/Encephalitis Panel by PCR (2013305).

Reference Interval

0.90 ISR or less: Negative - No significant level of IgM antibody to varicella-zoster virus detected.
0.91-1.09 ISR: Equivocal - Repeat testing in 10-14 days may be helpful.
1.10 ISR or greater: Positive - Significant level of IgM antibody to varicella-zoster virus detected, which may indicate current or recent infection. However, low levels of IgM antibodies may occasionally persist for more than 12 months post-infection.

Interpretive Data

The detection of antibodies to varicella-zoster in CSF may indicate central nervous system infection.  However, consideration must be given to possible contamination by blood or transfer of serum antibodies across the blood-brain barrier.

CPT Codes

86787
Collection

LAB3340

Collect

CSF.

Specimen Preparation

Transfer 0.5 mL CSF to an ARUP Standard Transport Tube. (Min: 0.3 mL)

Unacceptable Conditions

Specimen types other than CSF. Contaminated or heat-inactivated specimens.

Storage/Transport Temperature

Refrigerated.

Stability (from collection to initiation)

Ambient: 8 hours; Refrigerated: 2 weeks; Frozen: 1 year
Ordering

Performed

Mon-Fri

Methodology

Semi-Quantitative Enzyme-Linked Immunosorbent Assay

Reported

1-5 days

Synonyms

  • VZV IgM CSF
  • LAB3340
  • VZV IGM

Ordering Recommendations

Not recommended. Refer to Varicella-Zoster Virus by PCR (0060042) or Meningitis/Encephalitis Panel by PCR (2013305).
Result Interpretation

Reference Interval

0.90 ISR or less: Negative - No significant level of IgM antibody to varicella-zoster virus detected.
0.91-1.09 ISR: Equivocal - Repeat testing in 10-14 days may be helpful.
1.10 ISR or greater: Positive - Significant level of IgM antibody to varicella-zoster virus detected, which may indicate current or recent infection. However, low levels of IgM antibodies may occasionally persist for more than 12 months post-infection.

Interpretive Data

The detection of antibodies to varicella-zoster in CSF may indicate central nervous system infection.  However, consideration must be given to possible contamination by blood or transfer of serum antibodies across the blood-brain barrier.

Administrative

CPT Codes

86787

VARICELLA ZOSTER AB IGM TITER

LAB163

 

Collect

Serum separator tube.

Specimen Preparation

Separate serum from cells ASAP or within 2 hours of collection. Transfer 1 mL serum to an ARUP Standard Transport Tube. (Min: 0.1 mL) Parallel testing is preferred and convalescent specimens must be received within 30 days from receipt of the acute specimens. Mark specimens plainly as "acute" or "convalescent."

Unacceptable Conditions

Contaminated, heat-inactivated, hemolyzed, icteric, 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

Mon-Fri

Methodology

Semi-Quantitative Enzyme-Linked Immunosorbent Assay

Reported

1-5 days

Synonyms

  • VZV Antibody, IgM
  • LAB163

Ordering Recommendations

Panel that combines varicella-zoster virus IgG and IgM antibodies is preferred (0050162).

Reference Interval

0.90 ISR or less: Negative - No significant level of detectable varicella-zoster virus IgM antibody.
0.91-1.09 ISR: Equivocal - Repeat testing in 10-14 days may be helpful.
1.10 ISR or greater: Positive - Significant level of detectable varicella-zoster virus IgM antibody. Indicative of current or recent infection.  However, low levels of IgM antibodies may occasionally persist for more than 12 months post-infection or immunization.

CPT Codes

86787
Collection

LAB163

 

Collect

Serum separator tube.

Specimen Preparation

Separate serum from cells ASAP or within 2 hours of collection. Transfer 1 mL serum to an ARUP Standard Transport Tube. (Min: 0.1 mL) Parallel testing is preferred and convalescent specimens must be received within 30 days from receipt of the acute specimens. Mark specimens plainly as "acute" or "convalescent."

Unacceptable Conditions

Contaminated, heat-inactivated, hemolyzed, icteric, 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

Mon-Fri

Methodology

Semi-Quantitative Enzyme-Linked Immunosorbent Assay

Reported

1-5 days

Synonyms

  • VZV Antibody, IgM
  • LAB163

Ordering Recommendations

Panel that combines varicella-zoster virus IgG and IgM antibodies is preferred (0050162).
Result Interpretation

Reference Interval

0.90 ISR or less: Negative - No significant level of detectable varicella-zoster virus IgM antibody.
0.91-1.09 ISR: Equivocal - Repeat testing in 10-14 days may be helpful.
1.10 ISR or greater: Positive - Significant level of detectable varicella-zoster virus IgM antibody. Indicative of current or recent infection.  However, low levels of IgM antibodies may occasionally persist for more than 12 months post-infection or immunization.
Administrative

CPT Codes

86787

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