Geisinger Medical Laboratories Test Catalog

Order Display Name: Geisinger Epic Procedure Code Or ID CPT Code:  

DISSEMINATED INTRAVASCULAR COAGULATION (DIC) PROFILE WITH INTERPRETATION BY PATHOLOGIST

ORDERING INFORMATION:
Geisinger Epic Procedure Code: LAB3483         Geisinger Epic ID: 119771

SPECIMEN COLLECTION
Specimen type:
 Platelet-free sodium citrate plasma AND EDTA whole blood. See Specimen Required
Preferred collection container:
Alternate Collection Container:
Other size blue-top (3.2% sodium citrate) tubes (e.g., 1.8 mL, 4.5 mL)
Specimen required:
GMC, GWV, GCMC, GLH, GJSH and GMCM: One (1) EDTA lavender-top tube and two (2) sodium citrate blue-top tubes. Prepare two (2) 1 mL aliquots of plasma for Coagulation Interpretation.

GSACH, GBH, GSWB: One (1) EDTA lavender-top tube and three (3) sodium citrate blue-top tubes. Prepare four (4) 1 mL aliquots of plasma: Two (2) 1 mL aliquots for Fibrinogen and two (2) 1 mL aliquots for Coagulation Interpretation.
Special notes:
 Test may only be collected and performed on inpatients at testing laboratory locations (see below).

  • Ideally the patient should not be receiving anticoagulant medication as it may interfere with testing and cause erroneous results. See Anticoagulation Impact on Coagulation Tests.
  • If the patient’s hematocrit (HCT) is >55%, the volume of anticoagulant in the tube should be adjusted. Contact a performing location for special tube preparation to reduce the citrate in the collection tube. For those patients with HCT >65.4% see LAB3632 Stago Sodium Citrate Adjustment Chart for formula to determine amount of citrate removal required.
  • When possible, use fresh venipuncture to collect blood to avoid activation of coagulation by tissue thromboplastin. Blood may be drawn from an indwelling catheter or vascular access device. Draw sample from a lumen that has not been heparinized or flush the line with 5 mL of saline, and discard or use the first 5-10 mL of blood for other purposes.
  • Tubes should be >90% filled.
  • Immediately mix gently after collection by inverting the tube end over end 5 to 6 times. Avoid vigorous mixing or additional inversion. Observe for the presence of clots. Recollect if fibrin clots observed.
  • Transport at ambient temperature to processing location and processing should be completed within 4 hours.
  • Butterfly device collections, draw a discard tube first to remove air from collection tubing.
SPECIMEN PROCESSING
Specimen processing instructions:
Centrifuge the citrated blue-top tubes at designated time and speed to obtain platelet free plasma. Using a plastic pipette, carefully remove plasma from cells, avoiding platelet/buffy layer by leaving a thin layer of plasma on top the cells. The centrifuged plasma should be aliquoted (1 mL per aliquot) into clearly labeled polypropylene tubes. Two aliquots needed. Check the residual specimen for clot and if present discard sample and redraw specimen. Freeze upright and transport on dry ice.
Submit EDTA specimen for platelet testing. 
Transport temperature:
 Plasma aliquots: Frozen
EDTA whole blood: Refrigerated
Specimen stability:
 Plasma Room temperature: 4 hours
Plasma Frozen -20°C: 2 weeks
Plasma Frozen -70°C: 6 months
EDTA Room temperature: 24 hours
EDTA Refrigerated: 72 hours
Rejection criteria:
 Plasma: Clotted, hemolyzed, improperly filled tubes, improper anticoagulant ratio (HCT >55% and citrate not adjusted), refrigerated specimens, or stability exceeded. Note: Specimen suspected of thawing in transport, indicated by slant in aliquot or specimen in lid of tube, will have testing performed, and the comment “interpret results with caution as thawing suspected” added to results.

EDTA: Clotted, frozen, underfilled, overfilled, hemolyzed, or centrifuged specimens. Specimens beyond stability limits.
TEST DETAILS
Reference interval:
 See Individual test procedure
CPT code(s):
 85610, 85730, 85384, 85379, 85049 and either 80503, 80504, or 80505 (depending on complexity)
Note: The billing party has sole responsibility for CPT coding.  Any questions regarding coding should be directed to the payer being billed.  The CPT codes provided by GML are based on AMA guidelines and are for informational purposes only.
Test includes:
 PTINR, APTT, Fibrinogen, D-Dimer, Platelet Count, and Pathologist interpretation of results.
Methodology:
Electronic resistance detection enhanced by hydrodynamic focusing and flow cytometry
Functional mechanical clot-based
Immunoturbidity
Microlatex Agglutination
Synonyms:
DIC Profile
Clinical significance:
DIC can manifest as bleeding, clotting, or concurrent bleeding and clotting. It is often a result of severe organ dysfunction. The diagnosis is clinical and laboratory tests are available to support the diagnosis if necessary. The DIC panel includes those tests that are readily available (PT, APTT, D-dimer, and Platelet count) to evaluate for DIC. This profile allows the clinical team to have an interpretation for the results by the pathologist. Please see the individual tests for their clinical significance.
Doctoral Director(s:)
Michelle Grant DO    
Review Date: 09/12/2023

Performing Locations

Geisinger Medical Center

Performing laboratory: Coagulation
Technical Lead: Margaret Knowles-Tuchman
Frequency: Daily, all shifts
Performed STAT? Yes

Geisinger Wyoming Valley Medical Center

Performing laboratory: Coagulation
Technical Lead: Mary Glazenski    
Frequency: Daily, all shifts    
Performed STAT? Yes

Geisinger Shamokin Area Community Hospital

Performing laboratory: Coagulation
Technical Lead: Kelly Alleman    
Frequency: Daily, all shifts    
Performed STAT? Yes

Geisinger Bloomsburg Hospital

Performing laboratory: Coagulation
Technical Lead: Kristen Hall  
Frequency: Daily, all shifts    
Performed STAT? Yes

Geisinger Community Medical Center

Performing laboratory: Coagulation
Technical Lead: Robert Furcon  
Frequency: Daily, all shifts    
Performed STAT? Yes

Geisinger Lewistown Hospital

Performing laboratory: Coagulation
Technical Lead: Melissa Cramer  
Frequency: Daily, all shifts    
Performed STAT? Yes

Geisinger Medical Center Muncy

Performing laboratory: Coagulation
Technical lead: Mariana Moyer    
Frequency: Daily, all shifts    
Performed STAT? Yes

Geisinger Jersey Shore Hospital

Performing laboratory: Coagulation
Technical lead: Lori Bechdel    
Frequency: Daily, all shifts    
Performed STAT? Yes

Geisinger South Wilkes-Barre

Technical lead: Bernadette Johnson    
Frequency: Daily, all shifts    
Performed STAT? Yes
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