Turnaround Time / Stat Testing
LCL takes pride in its continued efforts to routinely expedite all procedures performed on-site. These procedures may be identified by the heart symbol next to the test name on the complete menu . We will work with customers to further expedite testing as requested. As a matter of policy, if extenuating circumstances should arise to cause a significant delay in completion of a testing request, the appropriate institution will receive verbal and/or written notification. Procedures are performed as after hours stats only with approval of the medical director. Stat testing fees will be assessed per test.
General Information and Guidelines
A courier service is provided during morning business hours to local customers at no additional cost. Stat courier service is available for late afternoon, evening and weekends for expedited testing at an extra fee. Routine specimen pick-ups can be scheduled by calling LCL and leaving a message. Pick-ups should be scheduled before 10: 00 AM for same day service. Samples must be properly labeled and packaged in a biohazard safe transport bag prior to receipt by courier. Each sample type should be in a separate transport bag. Customers may also use outside shipping services to send specimens (example: Fed. Express). For more details on the shipment of frozen samples, please request Specimen Shipping Instructions.
Sample Labeling and Test Requisition
Each of the sample tubes must have the patient's first and last name, date, time of collection, and type of specimen. The sample must be accompanied by a completed test requisition which contains patient information, specimen collection data, and customer account information. These three sections of the requisition must be as complete as possible so as not to delay testing and to assist the laboratory with proper sample assessment for pretesting treatment and accurate result interpretation. This includes not only the usual information such as name, ID #, date of birth, age, sex and, lab. ID #, ordering physician, but should also include vital information such as patient's recent and current coagulation therapy and complete patient diagnosis and/or condition. Information about the specimen collection technique and sample handling as well as the date and time collected should always be listed on the request form. Institution name, phone #, and fax # are also necessary for account information. Refer to the LCL specimen request form for further explanation and details. NOTE: Serial samples collected from the same patient at different times must be accompanied by separate request forms and should be sent in separate transport bags.
If the requisition is incomplete upon receipt, the appropriate institution will be contacted to furnish the necessary data before testing is implemented. If there is a change in patient information or if tests are to be added and/or cancelled, regulations require that LCL obtain written approval for the changes. A special form will be faxed to the institution for clarification of patient information or for signed approval of added and/or cancelled tests.
All preliminary and final reports will be faxed to the originating institution. The original final report will be forwarded in the mail. Reports may be faxed to the ordering physician as noted on the requisition. Reports which contain stat, critical and /or clinically relevant test values will be documented and reported by phone.
Billing and Fee Changes
We will provide the hospital, reference laboratory, clinic or medical group with direct billing monthly. We do not bill insurance companies. Payment of invoices is net 30 days from date of invoice. Late fees may apply on all past due invoices. As new scientific advances occur, Louisiana Coagulation Laboratory may deem it necessary to add to or change certain components or methodologies of our tests and/or prices. Sometimes these are subject to change without notice. We will make every effort to inform our clients of any changes as soon as possible.
Good quality testing still must begin with good sample collection techniques. Most coagulation testing requires samples to be collected in 3.2% sodium citrate using a 9:1 ratio of blood to anticoagulant. Vacutainer tubes when properly filled will meet this criterion. This may also be accomplished using whole blood collected in syringes and then dispensed in a 9:1 ratio sodium citrate (example: 4:5 ml of whole blood mixed with 0.5 ml sodium citrate).
This ratio is based on a normal hematocrit and should be adjusted if the hematocrit is > 55%.
Formula to adjust citrate volume
X= 100 - Patient Hct x Total to be collected
595 - Patient Hct (Ex: 5 ml volume is routinely used)
The sample should be free of heparin contamination and tissue thromboplastin. This can be accomplished by collecting the sample as follows: 1) Using a trauma free venipuncture. 2) Collecting some other sample tube first. 3) Avoiding hemolysis. 4) Flushing catheters with saline and then discarding at least 5ml of blood before collecting the coagulation sample.
Samples should be mixed by gentle inversions several times after filling the tubes.
Sample volumes are calculated based on what is required to run a procedure as a single test. In many instances we realize that a battery of tests may be performed with less than the outlined sample volume. For a single test request at least two aliquots of 0.5 ml of plasma is sufficient. This allows for rechecking of abnormal or unusual results. Multiple aliquots are required when different types of tests are being performed using different automated systems. 6ml of plasma may be sufficient for most extensive workups. Some individual judgment may be used in the collection of these samples for extensive workups or when collecting samples from infants. You may call us if you would like assistance in making an adjustment to the volume of blood required as calculated using the test menu outline.
Citrated samples may be transported as whole blood. It is best to process specimens immediately after collection. Samples should be centrifuged at 1500xg for 15 minutes to create platelet poor plasma. If there is a possibility of testing for lupus anticoagulant then double-spin is recommended to prevent platelet contamination which can yield a false negative LA test result. Platelet poor plasma is separated and stored in plastic tubes. Samples should then be frozen if testing will be delayed. Store samples at -20 degrees C if they will be used within a few days. For long term storage samples should be placed at -70 degrees C. Freezers with freeze/thaw cycles should be avoided.
Most EDTA and ACD samples are maintained as whole blood and transported under refrigeration (cold packs) or room temperature.
Serum samples should be collected in plain red top tubes, separated from the clot and transported frozen.
Sample Processing for Citrates (light blue top tubes) Samples:
3.2% Sodium Citrate (light blue top tube) is the anticoagulant of choice used to collect most samples used for coagulation testing. Samples for Protime studies may be held as a whole blood in the collection tube for up to 24 hours at room temperature. Samples for APTT studies may be held as a whole blood in the collection tube for up to 4 hours at room temperature. Samples for Heparin levels should be centrifuged and tested or separated from the cells and platelets within one hour of collection.
The best practice protocol to use for diagnostic coagulation testing would be to separate the citrated plasma from the cells as soon as possible after collection, but no later than 4 hours post collection. The samples should be double spun to obtain platelet poor plasma. Samples should then be stored as 1 ml aliquots in polypropylene test tubes. If testing is to be delayed the citrated plasma samples should be stored at minus 20 degrees C. The exception would be for Anti-Xa testing for heparin levels. These samples should be separated from the cells and platelets within one hour of collection. Delays in the processing of these samples may cause a false decrease in the level of anti-Xa detected.
The specific shipping conditions of a specimen are critical to the maintenance of the stability of the sample during transport, so shipping instructions must be verified for each procedure. Frozen specimens from outside the range of our courier service must be properly packed for shipment using 5 lbs of dry ice. A few test procedures require whole blood samples which must be maintained at room temperature and therefore does not require dry ice for shipment. It is also recommended to select the shipping time to insure arrival at LCL during regular working hours, Monday through Friday only. Refer to the specimen test requirements and shipping instructions for more details.