Type: K

Test 733

SuperUser Account — Tue, 16 Sep 2008 21:53:21 GMT

Test: Ketone Bodies, Serum
Number: 004887
CPT: 82009
Synonyms: Acetest® ; Acetoacetate ; Acetone, Semiquantitative, Serum ; Blood Acetone ; Ketones, Semiquantitative, Blood ; Nitroprusside Reaction
Test Includes: Detection in serum of acetone and acetoacetic acid only
Special Instructions: Lactic acid, phosphorus, and electrolytes should also be measured in possible ketoacidosis.
Specimen: Serum
Volume: 1 mL
Minimum Volume: 0.1 mL
Container: Red-top tube or gel-barrier tube
Collection: If a red-top tube is used, transfer separated serum to a plastic transport tube. Capillaries should be filled as much as possible using technique to avoid air bubbles. Free flowing heelstick. Cap sample to prevent acetone evaporation.
Storage Instructions: Refrigerate
Reference Interval: None detected
Use: Diagnose ketonemia, ketoacidosis resulting from diabetes mellitus,¹ alcoholism, stress,² starvation, intestinal disorders including emesis, glycogen storage disease (von Gierke), infantile organic acidemias, and other metabolic disorders. Determining the presence of ketone bodies is useful when isopropanol ingestion is suspected.
Limitations: False-negatives or falsely weak reactions may occur. Up to 33% of cases of diabetic ketoacidosis also have lactic acidosis. Acidosis shifts ketone bodies to β-hydroxybutyrate; however, β-hydroxybutyrate is not measured by nitroprusside, which reacts with both acetoacetic acid and acetone.² The reagent is 5-20 times more sensitive to acetoacetic acid than to acetone and does not react with β-hydroxybutyrate. Thus, as ketoacidosis is treated, an apparent positive Acetest® is found while there is an actual reduction of total plasma ketone body concentration. Acidosis shifts equilibrium toward β-hydroxybutyrate (unmeasured) but treatment of ketoacidosis results in increased acetoacetate (measured) and thus a more positive “acetone” reaction, before ketone bodies decrease.² Nonketotic coma in diabetes may be caused by hyperosmolarity.³
Methodology: Nitroprusside reaction (Acetest®)
Additional Information: Strongly positive serum acetone without severe acidosis, with normal anion gap, bicarbonate and plasma glucose suggests the possibility of rubbing alcohol intoxication. Look for dehydration with ketosis.¹ Ketoacidosis in diabetes usually occurs with decreased plasma pH and bicarbonate, increased glucose and other abnormalities. As ketoacidosis and metabolic acidosis are treated, hypokalemia may become evident. A normal or low potassium on admission of a patient with ketoacidosis may indicate severe potassium depletion.¹ Thus, potassium is among the parameters to follow in treatment of ketoacidosis. Hypophosphatemia may evolve. Acetone may be elevated due to absolute or relative starvation, especially in children. A significant mortality rate exists; in children younger than 10 years of age, diabetic ketoacidosis is reported to account for 70% of diabetes related deaths.⁴
Footnotes:

Bienia R and Ripoll I, “Diabetic Ketoacidosis,” JAMA, 1979, 241(5):510-1.
Schade DS and Eaton RP, “Differential Diagnosis and Therapy of Hyperketonemic State,” JAMA, 1979, 241(19):2064-5.
Vaisrub S, “Hyperosmolar Diabetic Coma - Ketotic and Nonketotic,” JAMA, 1974, 227(3):317-8 (editorial).
Bonadio WA, Gutzeit MF, Losek JD, et al, “Outpatient Management of Diabetic Ketoacidosis,” Am J Dis Child, 1988, 142(4):448-50

Test 1883

SuperUser Account — Tue, 16 Sep 2008 22:43:54 GMT

Test: Kiwi Fruit
Number: 064766
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: Red-stopper tube or gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 2030

SuperUser Account — Tue, 16 Sep 2008 22:50:13 GMT

Test: Kochia
Number: 068957
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: Red-stopper tube or gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 2082

SuperUser Account — Tue, 16 Sep 2008 22:52:34 GMT

Test: Kapok
Number: 069625
CPT: 069625
Specimen: Serum
Volume: 0.2 mL
Container: Red-stopper tube or gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 4145

SuperUser Account — Wed, 17 Sep 2008 02:13:50 GMT

Test: Kidney Stone Retest, Limited
Number: 242347
CPT: 81003; 82030; 82340; 82507; 82570; 83735; 83945; 84105; 84300; 84392; 84560; 83986
Synonyms: Kidney Stone Metabolic Prevention Profile
Test Includes: Urine: calcium; citrate; creatinine; cyclic AMP; magnesium; oxalate; pH; phosphorus; sodium; specific gravity; sulfate; total volume; uric acid
Special Instructions: Include a retest patient history questionnaire. Only order this profile after the initial profile has been completed.
Specimen: Urine (24-hour), frozen
Volume: Two 100 mL specimens. For instructions, see Kidney Stone Retest.
Container: Plastic urine containers (one preserved, one unpreserved)
Collection: Record total volume for each 24-hour specimen. A pH must be taken on a fresh fasting random urine.
Storage Instructions: Freeze
Additional Information: A collection kit containing all materials necessary for the profile is available.
References:

“Prevention and Treatment of Kidney Stones”, National Institutes of Health Consensus Development Conference Statement, March 28-30, 1988.

Test 4189

SuperUser Account — Wed, 17 Sep 2008 02:19:28 GMT

Test: Kidney Stone Urine Test Combination With Saturation Calculations
Number: 306266
CPT: 81003; 82131; 82140; 82340; 82436; 82507; 82570; 83735; 83935; 83945; 84105; 84133; 84300; 84392; 84560
Test Includes: Ammonia; calcium; chloride; citrate; creatinine; cystine; magnesium; osmolality; oxalate; pH; phosphorus; potassium; sodium; sulfate; total volume; uric acid; saturation ratios: brushite, calcium oxalate, monosodium urate, struvite; graph review
Specimen: Urine (24-hour)
Volume: Two 100 mL urine aliquots, frozen
Container: Urine container
Collection: Collect a single 24-hour urine collection without preservative. Take two 100 mL aliquots of this urine and freeze. Write total volume on aliquot with other clinical information. Also, write total volume on the requisition. Graphic analysis of results is mailed to client.
Storage Instructions: Freeze
Use: Evaluate stone composition, metabolic factors affecting stone formation; work up nephrolithiasis

Test 4283

SuperUser Account — Wed, 17 Sep 2008 02:32:08 GMT

Test: K-ras Gene Mutation Detection
Number: 480090
CPT: 83891; 83896 (x8); 83898 (x8); 83907; 83912
Special Instructions: Please provide a copy of the pathology report. Please direct any questions regarding this test to Customer Service at 800-533-0567.
Specimen: Formalin-fixed, paraffin-embedded (FFPE) tissue
Volume: Five precut, unstained slides from paraffin block in 10-?M sections, and one H&E reference slide or formalin-fixed, paraffin-embedded tissue block containing ≥50% tumor.
Minimum Volume: 2 mm x 2 mm tumor area
Container: Slides, blocks
Collection: Please provide five unstained slides and one H&E-stained slide at 10 ?M or a tissue block.
Storage Instructions: Maintain blocks and slides at room temperature.
Causes for Rejection: Tumor block containing insufficient tumor tissue or tumor fixed in a heavy metal fixative; broken or stained slides.
Use: Mutations in the K-ras oncogene are frequently found in human cancers. They are common in pancreatic cancer, colorectal cancer, lung adenocarcinoma, gall bladder cancer, bile duct cancer and thryoid cancer. These mutations may indicate prognosis and drug response and many new cancer therapies are being targeted to the K-ras pathway. This assay detects seven K-ras mutations in codons 12 and 13, allowing determination of whether there is a correlation between K-ras mutation status and drug response.
Limitations: The provided tumor tissue should be composed of ≥50% tumor cells for accurate test interpretation. Preparation of DNA from tissue samples is dependent on the quality of the specimen provided. Inadequate DNA extraction may occur in a significant number of paraffin-embedded samples. The methods used in this assay are highly selective and, depending on the total amount of DNA present, can detect approximately 1% of mutant in a background of wild-type genomic DNA. The assay has a limit of detection of between 5 and 10 copies.
Methodology: Amplification refractory mutation system (ARMS) and real-time polymerase chain reaction using Scorpions? technology
References: ???Hilger RA, Scheulen ME, Strumberg D. The Ras-Raf-MEK-ERK Pathway in the Treatment of Cancer. Onkologie. 2002; Dec 25(6):511-518.
???Bachireddy P, Bendapudi PK, Felsher DW. Getting at MYC through RAS. Clin Cancer Res. 2005; Jun 15; 11(12):4278-4281.
???Han SW, Kim TY, Jeon YK, et al. Optimization of Patient Selection for Gefitinib in Non-Small Cell Lung Cancer by combined analysis of Gefitinib in Non-Small Cell Lung Cancer by combined analysis of Epidermal Growth Factor Receptor Mutation, K-ras Mutation, and AKT Phosphorylation. Clin Cancer Res. 2006; Apr 15; 12(8):2538-2544.
???Pao W, Wang TY, Riely JG, et al. KRAS Mutations and Primary Resistance of Lung Adenocarcinomas to Gefitinib or Erlotinib. PloS Medicine. 2005; Jan 2(1):57-61.

Test 4492

SuperUser Account — Wed, 17 Sep 2008 03:00:04 GMT

Test: Kaolin Clotting Time (KCT)
Number: 500128
CPT: 85347
Synonyms: KCT
Special Instructions: Testing is performed at Esoterix Coagulation Laboratory: UY#300056.
Specimen: Plasma, frozen
Volume: 2 mL
Minimum Volume: 1 mL
Container: Blue-top (sodium citrate) tube
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.^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 and carefully remove the plasma using a plastic transfer pipette, being careful not to disturb the cells. Transfer the plasma into a LabCorp PP transpak frozen purple tube with screw cap (LabCorp N^o 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.
Storage Instructions: Freeze. Stable at room temperature for up to 4 hours.
Patient Preparation: Do not draw from an arm with a heparin lock or heparinized catheter.
Reference Interval: 50-130 units
Use: The KCT is a sensitive screening test of lupus anticoagulants (LA) in patients with a history of thrombosis.^6,7,8,9,10
Limitations: Due to the heterogeneity of LA antibodies, no single assay will identify all cases.⁷ The KCT is prolonged in patients with factor deficiencies of all factors except factor VII or XIII deficiency.¹¹ Platelet-poor plasma must be used for this test as the presence of platelets causes all the clot-based tests to loose sensitivity for the presence of lupus anticoagulants. The KCT test can be affected by the presence of therapeutic plasma heparin. Specific inhibitors to coagulation factors can cause prolongation of this test.
Methodology: In the kaolin clotting time (KCT) test, kaolin, a negatively-charged particulate activator, is incubated with test plasma to activate the contact factors and the intrinsic system.¹¹ Calcium chloride is added and the mixture is timed until a clot forms.
Additional Information: The intrinsic mechanism requires the presence of all coagulation factors except factor VII and XIII. In the KCT, unlike TTIT, dRVVT, and aPTT, no reagent phospholipid is added, so plasma phospholipids are required for the reaction to proceed. For this reason, the KCT is sensitive to the presence of lupus anticoagulants, when if present, will generally prolong the KCT. All clot-based tests are potentially affected by factor deficiencies. The KCT is prolonged in any except factor VII or XIII deficiency. Lupus anticoagulants are nonspecific antibodies that extend the clotting time of phospholipid-dependent clotting assays such as the KCT.^7,10 Unlike specific factor antibodies, LA are usually associated with venous thrombosis, pulmonary embolism, arterial thrombosis, and recurrent fetal loss.¹² LA do not specifically inhibit coagulation factors; rather they neutralize anionic phospholipid-protein complexes that are involved in the coagulation process. Prolongation of clot-based assays is highly dependent on the sensitivity of the reagent employed. Reagents with reduced amounts of phospholipid, such as KCT, aPTT-LA, and dilute Russell viper venom (dRVVT), have enhanced sensitivity for LA.⁷ Testing for lupus anticoagulant (LA) and the antiphospholipid syndrome that is associated with these antibodies is described in more detail in the APS section. The KCT is sensitive to deficiency or inhibition of factors in the intrinsic pathway. These include the contact factors; high molecular weight kininogen (HMWK); prekallikrein; and factor XII along with procoagulant factors XI, IX, VIII, X, V, prothrombin, and fibrinogen.^10,12,13,14 An extended KCT can be seen in acquired deficiencies of intrinsic factors II, IX, and X that result from vitamin K deficiency or the use of oral anticoagulants that block vitamin K-dependent production of procoagulant factors. These conditions also affect the level of factor VII, an extrinsic pathway factor. Since factor VII has a short half-life relative to the vitamin K-dependent factors of the intrinsic pathway, vitamin K-dependent factor deficiency can often result in an extended PT with a normal aPTT and KCT. Consumption coagulopathy, such as disseminated intravascular coagulation (DIC), can produce an extended KCT due to depletion of intrinsic factors. The KCT can also be extended in conditions that reduce the production of procoagulant factors (eg, severe liver disease or malnutrition). Inhibitors, both factor specific and nonspecific, can also prolong the KCT.
Footnotes:

Adcock DM, Kressin DC, and Marlar RA, “Effect of 3.2% vs 3.8% Sodium Citrate Concentration on Routine Coagulation Testing,” Am J Clin Pathol, 1997, 107(1):105-10.
Reneke J, Etzell J, Leslie S, et al, “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, 109(6):754-7.
“National Committee for Clinical Laboratory Standardization: Collection, Transport, and Processing of Blood Specimens for Coagulation Testing and General Performance of Coagulation Assays; Approved Guideline,” Third Edition, Villanova: NCCLS Document H21-A3:11(23), 1999.
Gottfried EL and Adachi MM. “Prothrombin Time and Activated Partial Thromboplastin Time Can Be Performed on the First Tube,” Am J Clin Pathol, 1997, 107(6):681-3.
McGlasson DL, More L, Best HA, et al, “Drawing Specimens for Coagulation Testing: Is a Second Tube Necessary?” Clin Lab Sci, 1999, 12(3):137-9.
Van Cott EM and Laposata M, “Coagulation,” Laboratory Test Handbook With Key Word Index, Jacobs DS, DeMott WR, and Oxley DK eds, Hudson, OH: Lexi-Comp, 2001, 327-58.
Brandt JT, Triplett DA, Alving B, et al, “Criteria for the Diagnosis of Lupus Anticoagulants: An Update. On Behalf of the Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibody of the Scientific and Standardization Committee of the ISTH,” Thromb Haemost, 1995, 74(4):1185-90.
Alving BM, “The Antiphospholipid Syndrome: Clinical Presentation, Diagnosis, and Patient Management,” Consultative Hemostasis and Thrombosis, Kitchens CS, Alving BM, and Kessler CM, eds, Philadelphia, PA: WB Saunders Co, 2002, 181-96.
Levine JS, Branch DW, and Rauch J, “The Antiphospholipid Syndrome,” N Engl J Med, 2002, 346(10):752-63.
Triplett DA, “Coagulation Abnormalities,” Clinical Laboratory Medicine, McClatchey KD, ed, 2nd ed, Philadelphia, PA: Lippincott Williams and Wilkins, 2002, 1033-49.
Adcock DM, Jensen R, Johns CS, et al, Coagulation Handbook, Esoterix Coagulation, 2002.
Bick RL, “Antiphospholipid Thrombosis Syndromes,” Clin Appl Thromb Hemost, 2001, 7(4):241-58.
Roberts HR and Escobar MA, “Less Common Congenital Disorders of Hemostasis,” Consultative Hemostasis and Thrombosis, Kitchens CS, Alving BM, and Kessler CM, eds, Philadelphia, PA: WB Saunders Co, 2002, 57-71.
Cohen AJ and Kessler CM, “Hemophilia A and B,” Consultative Hemostasis and Thrombosis, Kitchens CS, Alving BM, and Kessler CM, eds, Philadelphia, PA: WB Saunders Co, 2002, 43-56

Test 5268

SuperUser Account — Wed, 17 Sep 2008 04:56:11 GMT

Test: Ketone Solvents Exposure Profile, Blood
Number: 723114
CPT: 84600
Test Includes: Methyl ethyl kettle, blood; methyl isobutyl ketone, blood; methyl n-butyl ketone, blood
Specimen: Whole blood
Volume: 7 mL
Minimum Volume: 1.1 mL
Container: Lavender-top (EDTA) tube; submit original full, unopened tube.
Collection: Venipuncture site must be disinfected with povidone-iodine or a similar product.
Storage Instructions: Refrigerate
Causes for Rejection: Opened tube or pour-off; clotted specimen
Reference Interval: See individual tests.
Use: Monitor exposure to methyl ethyl kettle, methyl n-butyl ketone, and methyl isobutyl ketone
Methodology: Gas chromatography (GC)
Additional Information: See individual tests.