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Register NowIntrauterine Fetal Demise/Stillborn Profile (Extended)
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CPT Code:
81240; 81241; 83090; 84443; 85025; 85300; 85303; 85306; 85613; 85732; 86147(x2); 86592; 86747(x2)
Overview:
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.
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. PubMed 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. PubMed 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. PubMed 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. PubMed 10539100
6. ACOG Practice Bulletin No. 102. Management of stillbirth.Obstet Gynecol. 2009; 113(3):748-761.
Collection Details:
Patient Preparation:
Avoid warfarin (Coumadin®) therapy for two weeks and heparin therapy for two days prior to the test.
Collection Instructions:
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.
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.
Refrigerate serum and whole blood. Freeze plasma.