Intrauterine Fetal Demise/Stillborn Follow-up Profile

CPT: 84443; 85025; 85613; 85732; 86147(x2); 86592; 86747(x2)
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Test Details

Test Includes

Anticardiolipin antibodies (ACA), IgG, IgM, quantitative; complete blood count (CBC) with differential; lupus anticoagulant profile with reflex; parvovirus B19 (human), IgG, IgM; rapid plasma reagin (RPR), qualitative test; thyroid-stimulating hormone (TSH)

Use

A recent American Congress of Obstetricians and Gynecologists (ACOG) practice bulletin made recommendations as to the appropriate use of laboratory tests that should be performed as part of the investigation of the cause of late term (greater than 20 weeks) fetal demise.6 The authors suggested that maternal testing for thyroid stimulating hormone (TSH), human parvovirus B19 IgG and IgM, lupus anticoagulants, and anticardiolipin antibodies could provide useful information for future pregnancy management.

Methodology

See individual tests.

Specimen Requirements

Specimen

Serum; citrate plasma; whole blood and whole blood or LabCorp buccal swab kit (Buccal swab collection kit contains instructions for use of a buccal swab.)

Volume

6 mL serum, 2 mL plasma, full whole blood tube, and 7 mL whole blood or LabCorp buccal swab kit

Container

Red-top tube or gel-barrier tube, blue-top (sodium citrate plasma) tube, lavender-top (EDTA whole blood) tube, and yellow-top (ACD whole blood) tube or LabCorp buccal swab kit

Patient Preparation

Avoid warfarin (Coumadin®) therapy for two weeks and heparin therapy for two days prior to the test.

Collection

Citrated plasma samples should be collected by double centrifugation. Blood should be collected in a blue-top tube containing 3.2% buffered sodium citrate.1 Evacuated collection tubes must be filled to completion to ensure a proper blood to anticoagulant ratio.2,3 The sample should be mixed immediately by gentle inversion at least six times to ensure adequate mixing of the anticoagulant with the blood. A discard tube is not required prior to collection of coagulation samples, except when using a winged blood collection device (ie, "butterfly"), in which case a discard tube should be used.4,5 When noncitrate tubes are collected for other tests, collect sterile and nonadditive (red-top) tubes prior to citrate (blue-top) tubes. Any tube containing an alternate anticoagulant should be collected after the blue-top tube. Gel-barrier tubes and serum tubes with clot initiators should also be collected after the citrate tubes. Centrifuge for 10 minutes and carefully remove 2/3 of the plasma using a plastic transfer pipette, being careful not to disturb the cells. Deliver to a plastic transport tube, cap, and recentrifuge for 10 minutes. Use a second plastic pipette to remove the plasma, staying clear of the platelets at the bottom of the tube. Transfer the plasma into a LabCorp PP transpak frozen purple tube with screw cap (LabCorp N° 49482). Freeze immediately and maintain frozen until tested. To avoid delays in turnaround time when requesting multiple tests on frozen samples, please submit separate frozen specimens for each test requested.

Please print and use the Volume Guide for Coagulation Testing to ensure proper draw volume.

Storage Instructions

Refrigerate serum and whole blood. Freeze plasma.

Causes for Rejection

Hemolysis; clotted specimen; citrate plasma contamined with heparin (ie, drawn with blood gases); citrate plasma specimen received unfrozen

Clinical Information

Footnotes

1. Adcock DM, Kressin DC, Marlar RA. Effect of 3.2% vs 3.8% sodium citrate concentration on routine coagulation testing. Am J Clin Pathol. 1997 Jan; 107(1):105-110. 8980376
2. Reneke J, Etzell J, Leslie S, Ng VL, Gottfried EL. Prolonged prothrombin time and activated partial thromboplastin time due to underfilled specimen tubes with 109 mmol/L (3.2%) citrate anticoagulant. Am J Clin Pathol. 1998 Jun; 109(6):754-757. 9620035
3. National Committee for Clinical Laboratory Standardization. Collection, Transport, and Processing of Blood Specimens for Coagulation Testing and General Performance of Coagulation Assays; Approved Guideline. 5th ed. Villanova, Pa: NCCLS; 2008. Document H21-A5:28(5).
4. Gottfried EL, Adachi MM. Prothrombin time and activated partial thromboplastin time can be performed on the first tube. Am J Clin Pathol. 1997 Jun; 107(6):681-683. 9169665
5. McGlasson DL, More L, Best HA, Norris WL, Doe RH, Ray H. Drawing specimens for coagulation testing: Is a second tube necessary? Clin Lab Sci. 1999 May-Jun; 12(3):137-139. 10539100
6. ACOG Practice Bulletin No. 102. Management of stillbirth.Obstet Gynecol. 2009; 113(3):748-761.

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
365200 Stillborn Follow-up Profile 004264 TSH uIU/mL 11580-8
365200 Stillborn Follow-up Profile 006072 RPR 20507-0
365200 Stillborn Follow-up Profile 163312 Parvovirus B19, IgG index 5273-8
365200 Stillborn Follow-up Profile 163330 Parvovirus B19, IgM index 5274-6
365200 Stillborn Follow-up Profile 117003 PTT-LA sec 34571-0
365200 Stillborn Follow-up Profile 117891 dRVVT sec 6303-2
365200 Stillborn Follow-up Profile 117893 Lupus Reflex Interpretation 75514-0
365200 Stillborn Follow-up Profile 161812 Anticardiolipin Ab,IgG,Qn GPL U/mL 3181-5
365200 Stillborn Follow-up Profile 161830 Anticardiolipin Ab,IgM,Qn MPL U/mL 3182-3
365200 Stillborn Follow-up Profile 005025 WBC x10E3/uL 6690-2
365200 Stillborn Follow-up Profile 005033 RBC x10E6/uL 789-8
365200 Stillborn Follow-up Profile 005041 Hemoglobin g/dL 718-7
365200 Stillborn Follow-up Profile 005058 Hematocrit % 4544-3
365200 Stillborn Follow-up Profile 015065 MCV fL 787-2
365200 Stillborn Follow-up Profile 015073 MCH pg 785-6
365200 Stillborn Follow-up Profile 015081 MCHC g/dL 786-4
365200 Stillborn Follow-up Profile 105007 RDW % 788-0
365200 Stillborn Follow-up Profile 015172 Platelets x10E3/uL 777-3
365200 Stillborn Follow-up Profile 015107 Neutrophils % 770-8
365200 Stillborn Follow-up Profile 015123 Lymphs % 736-9
365200 Stillborn Follow-up Profile 015131 Monocytes % 5905-5
365200 Stillborn Follow-up Profile 015149 Eos % 713-8
365200 Stillborn Follow-up Profile 015156 Basos % 706-2
365200 Stillborn Follow-up Profile 115398 Immature Cells N/A
365200 Stillborn Follow-up Profile 015909 Neutrophils (Absolute) x10E3/uL 751-8
365200 Stillborn Follow-up Profile 015917 Lymphs (Absolute) x10E3/uL 731-0
365200 Stillborn Follow-up Profile 015925 Monocytes(Absolute) x10E3/uL 742-7
365200 Stillborn Follow-up Profile 015933 Eos (Absolute) x10E3/uL 711-2
365200 Stillborn Follow-up Profile 015941 Baso (Absolute) x10E3/uL 704-7
365200 Stillborn Follow-up Profile 015108 Immature Granulocytes % 38518-7
365200 Stillborn Follow-up Profile 015911 Immature Grans (Abs) x10E3/uL 51584-1
365200 Stillborn Follow-up Profile 015945 NRBC % 58413-6
365200 Stillborn Follow-up Profile 015180 Hematology Comments: 18314-5
Reflex Table for RPR
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 006464 RPR, Quant. 006464 RPR, Quant. 31147-2
Reflex Table for PTT-LA
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 117040 PTT-LA Mix 117005 PTT-LA Mix sec 75510-8
Reflex 2 000000 117842 000000 sec 3282-1
Reflex Table for PTT-LA
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 117040 PTT-LA Mix 117005 PTT-LA Mix sec 75510-8
Reflex 2 000000 117036 000000 sec 50760-8 117020
Reflex 3 000000 117842 000000 sec 3282-1
Reflex Table for Immature Cells
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115399 Immature Cells
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 115247 Neutrophils % 23761-0
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 115250 Lymphs % 737-7
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 115251 Monocytes % 744-3
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 115252 Eos % 714-6
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 115253 Basos % 707-0
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 115398 Immature Cells N/A
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 115254 Neutrophils Absolute x10E3/uL 753-4
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 115255 Lymphs (Absolute) x10E3/uL 732-8
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 115256 Monocytes(Absolute) x10E3/uL 743-5
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 115257 Eos (Absolute Value) x10E3/uL 712-0
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 115258 Baso(Absolute) x10E3/uL 705-4
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 115260 Differential Comment 18723-7
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 005034 RBC Comment 6742-1
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 015171 Platelet Comment 9317-9

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