Potential of an age adjusted D-dimer cutoff value to improve the exclusion of pulmonary embolism in older patients: A retrospective analysis of three large cohorts. Gel-barrier (mottled red/gray, gold, or cherry red-top) tubes contain clot activator and gel for separating serum from cells but include no anticoagulant. Since BNP is cleared by your kidneys, it may also mean that your kidneys are not functioning properly. Please verify that the diagnosis code (ICD code) you have chosen demonstrates medical necessity for the test as documented in the physicians patient record. 0000016872 00000 n Considerations for Single and Multiple Sample Collection. It also helps them monitor how well treatments are working. Plasma Preparation Tube (PPT): Contains EDTA. Allow the blood films to air dry. 2023 Laboratory Corporation of America Holdings. Send plasma in a plastic transport tube labeled Plasma, EDTA. Send whole blood in a lavender-top tube. Any tube containing an alternate anticoagulant should be collected after the blue-top tube. A properly executed Advance Beneficiary Notice (ABN) must be submitted with the specimen if medical necessity is not demonstrated by the ICD code chosen. The most common reason for delay in receiving results is inaccurate or out-of-date personal information on record with your health care providers or in your Labcorp Patient portal personal profile. With some needle assemblies, you may slide the collection tube into the holder, carefully pushing the tubes forward until the needle touches the stopper. At the time of specimen pickup, inform your professional service representative that you have a frozen specimen to be picked up. Note: LabCorp works with health care providers to minimize the total volume collected from pediatric and geriatric patients. 18. Mottled red/gray-top, gold-top, or cherry red-top (gel-barrier) tube: Contains clot activator and gel for separating serum from cells, but not anticoagulant. Failure to push the spreader slide completely across the flat slide. 0000007790 00000 n This test gives your When frozen plasma is required, place plastic transport tube(s) immediately in the freezer compartment of the refrigerator, and notify your professional service representative that you have a frozen specimen to be picked up. 13. IGs are associated with infections, a variety of inflammatory disorders, cytokine therapy, neoplasia, hemolysis, tissue damage, seizures, metabolic abnormalities, myeloproliferative neoplasms, and with the use of certain medications such as steroids.3, Pregnancy-associated leukocytosis may also show increased immature granulocytes without clinical significance. Put the Frozen Specimen Keeper containing the specimens in your lockbox according to the pictorial instructions provided (see link above). Your provider orders this test to look for higher levels of BNP in your blood to check for cardiovascular disease. A possible physiologic explanation for the appearance of immature granulocytes in the peripheral blood of pregnant women, increased alkaline phosphate activity in granulocytes, and increased glycogen content of lymphocytes may be found in the excretion curves of hormones during pregnancy. Refer to Coagulation Collection Procedures for directions. The tube will retract below the guideline. (Special note for light blue [sodium citrate] tubes used for coagulation studies: Always fully seat and hold the tube securely on the Vacutainer hub while filling.). Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. Siemens Healthcare Diagnostics Products GmbH; 2010. 0000806074 00000 n Label the specimen appropriately (see Specimen Containers). Exclusionary claim of PE in patients with high PTP scores has not been established. Analytical and clinical evaluation of the Bayer ADVIA Centaur Automated B-type natriuretic peptide assay in patients with heart failure: A multisite study. What is BMP panel blood test? Effect of 3.2% vs 3.8% sodium citrate concentration on routine coagulation testing. Common causes of a poor blood film. 2. 0000025332 00000 n NorDx Respiratory Panel Quick Guide (non MidCoast), NorDx Respiratory Panel Quick Guide (MidCoast only), 2022 Acceptable Tan Top Usage for Hematology, 2022 Acceptable Alternate Tube Types for Chemistry, 2019 Scarborough NorDx Urine Toxicology Guide, Tick-Bourne Disease Pathogen Testing Information, Individually Orderable IGE Allergens Chart with Test Codes, Biotin Interference Thresholds--Scarborough site, Biotin Interference Thresholds--non-Scarborough sites, Laboratory Corporation of America (LabCorp) Test Menu, Critical Laboratory Values - Scarborough & MMC, Critical Laboratory Values - Mid Coast Hospital. Label the specimen appropriately. Place the collection tube in the upright position in the rack, and allow the blood to clot at room temperature for 30 to 60 minutes. 0000908091 00000 n Send plasma in a plastic transport tube labeled Plasma, Sodium Citrate. Send whole blood in a blue-top tube. Ordering a Test. 1. You will likely need to fast for at least eight hours before your basic metabolic panel blood test. Send plasma in a plastic transport tube labeled Plasma, Sodium Fluoride. Send whole blood in a gray-top tube. Label the tube carefully and clearly with all pertinent information or bar code. Mix blood with anticoagulant thoroughly, using a rolling wrist motion and by inverting the tube gently 4 or 10 times. 4. Urine specimens are inappropriate for lipase. Gottfried EL, Adachi MM. 0000020643 00000 n Lott JA, Speicher CE, Nemesnszky E. Is serum amylase an obsolete test in the diagnosis of acute pancreatitis? Send whole blood in a yellow-top tube. Use: Sodium fluoride whole blood or plasma. They found that this cutoff identified patients with abnormal function from a population of 200 patients with a sensitivity of 95.9%, specificity of 86%, positive predictive value of 98%, and a negative predictive value of 89%. 0000001776 00000 n Testing schedules may vary. The chemical has been chosen to preserve some feature of the specimen and to work with the method used to perform the test. 4 0 obj <> endobj xref Permit the vacuum tube to fill completely. What is the purpose of the BNP test? To allow adequate mixing, slowly invert the tube eight to ten times (four times for citrate tubes) using a gentle wrist rotation motion. 0.7 mL (Note: This volume does not allow for repeat testing.). Do I need to fast for a basic metabolic panel (BMP)? 21. Patients with subsegmental/peripheral PE or distal DVT may have a normal Innovance D-dimer result.9,10. In some cases, additional time should be The most common reason for delay in receiving results is inaccurate or out-of-date personal information on record with your health care providers or in your Labcorp Patient portal personal profile. Gray-top tube: Contains sodium fluoride (a preservative) and potassium oxalate (an anticoagulant). 5. Frozen Gel Packs. WebBlue-top tube (also light blue-top tube): Contains sodium citrate. Providers use a BNP or an NT-proBNP test to diagnose heart failure. Get the App Telemedicine Toolkit Let us help you navigate the new normal of virtual healthcare. Always check the test description to determine whether a gel-barrier tube is acceptable. All microscopic slides, as well as paraffin blocks, should be clearly labeled using two patient identifiers. Failure to keep the entire edge of the spreader slide against the slide while making the film. If specimen is centrifuged before clotting is complete, a fibrin clot will form on top of the cell. Several studies on D-dimer for exclusion of venous thromboembolism (VTE) have been revaluated using an age-specific cutoff.20-23 The aim was to improve the effectiveness of D-dimer testing in ruling out VTE.20-23 The cutoff provided with the patient result is the manufacturer-determined value for exclusion of VTE; however, it has been determined that D-dimer values increase with age, and this can make VTE exclusion of an older population difficult. 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Presence of one or more of the following may be indication for further investigation: hemoglobin <10 g/dL, hemoglobin >18 g/dL, MCV >100 fL, MCV <80 fL, MCHC >37%, WBC >20,000/mm3, WBC <2000/mm3, presence of sickle cells, spherocytes, Pappenheimer bodies, basophilic stippling, stomatocytes, schistocytes (fragmented RBCs), target cells, oval macrocytes, teardrop red blood cells, abnormal cell populations, nucleated red blood cells in other than the newborn, blood parasites (malarial or Babesia organisms or the possibility of parasitic organisms), hypersegmented neutrophils, agranular neutrophils, hyposegmented neutrophils (Pelger-Hut anomaly or pseudo-Pelger-Hut [pelgeroid] cells), mononuclear cells in which apparent nucleoli are prominent (blast-like cells), presence of metamyelocytes, myelocytes, promyelocytes, neutropenia, presence of plasma cells, peculiar atypical lymphocytes, significant increase or decrease in platelets or bizarre platelets. Biotin interference would falsely decrease the result of this assay. Anchor the vein. Kraus M. Fibrin(ogen) degradation products, D-dimer. The negative predictive value is further enhanced through the use of a clinical probability model along with D-dimer in the decision process.12-15 Values less than 0.5 mg/L FEU in an individual with a low clinical risk of venous thrombosis can serve as the basis for not performing more expensive diagnostic tests for DVT and PE. (Press Enter or Space to Go to Landing Page or Press Down to expand Menu), Federally Qualified Health Centers (FQHCs), Combatting Modern Slavery and Human Trafficking Statement. For Patients, 2023 mystylit.com. It helps them diagnose heart failure, so they can develop a treatment plan. Label tubes in front of the patient immediately after collection, confirming all necessary information with the patient. Assessments of stained smears are performed if results meet specific numeric and/or instrument flagging criteria. All rights reserved. The Role of BNP Testing in Heart Failure. The Frozen Specimen Keeper will be left in your lockbox for reuse. Prepare the film immediately, as soon as the drop of blood has been placed on the slide. When frozen serum is required, place the plastic transport tube(s) (prepared above) immediately in the freezer compartment of the refrigerator. Every person has their own range of BNP or NT-proBNP level range. You dont need to do anything to prepare for a BNP test or NT-proBNP test. A needle length of 1 to 1 inches permits an angle of entry that will not pierce both vein walls and enter tissue. D-dimer levels can be elevated in many clinical circumstances, especially in hospitalized patients. Serum is obtained from clotted blood that has not been mixed with an anticoagulant (a chemical that prevents the clotting of blood). Your doctor orders a lab test. NT-proBNP levels over 900 pg/mL may be a sign of heart failure. Collect in a plastic lavender-top (EDTA) tube. 1. Fernandes B, Hamaguchi Y. Additional information regarding LOINC codes can be found at LOINC.org, including the LOINC Manual, which can be downloaded at LOINC.org/downloads/files/LOINCManual.pdf. Always use the proper vacuum tube for tests requiring a special anticoagulant (eg, EDTA, heparin, sodium citrate, etc) or preservative. Yellow-top tube: Contains acid citrate dextrose (ACD) solution. Remove the stopper and carefully aspirate plasma, using a separate disposable Pasteur pipette for each tube. Follow the manufacturer's recommendations on properly setting the needle. The LOINC codes are copyright 1994-2021, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. Remove the tube carefully without disturbing the contents. In some cases, additional time should be Lipase isoforms and amylase isoenzymes: Assays and application in the diagnosis of acute pancreatitis. Collect in a plastic lavender-top (EDTA) tube. Place the tube(s) in a designated freezer. Place the sharps container within reach. 15. All Rights Reserved. Heart failure means your heart isnt pumping blood as it should. Cleveland Clinic is a non-profit academic medical center. Prothrombin time and activated partial thromboplastin time can be performed on the first tube. Upon centrifugation, a gel barrier is formed between the plasma and the cellular components of the blood. Your provider will clean your arm and insert a needle. Following the collection, preparation, and transport instructions suggested by LabCorp supports the best possible test results. hWnH~mKHl+/DQjeg}([W)%RN 0. 0000003453 00000 n 0000653536 00000 n When plasma is required, follow these steps. 3. Slides must not be touched on any area except the long slide edges or frosted ends. 0000729662 00000 n Note: If a patient has intravenous (IV) solutions going into one or both arms, it is acceptable to puncture the vein 3 to 4 inches below the site of the IV. 6. Dispose of the used needle in a sharps container according to the provisions of your exposure control plan, and fill the vacuum tubes according to the provisions of your exposure control plan. Your levels can also be lower if you have obesity or kidney failure. Blood films may be prepared from venous blood (venipuncture) or capillary puncture blood. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event. 0000024854 00000 n Follow the steps in. 0000009669 00000 n Red-top tube: Contains no anticoagulant or preservative. 0000876850 00000 n 0000910226 00000 n You can do this quickly while the patient's arm is elevated. Thread the needle into the holder and tighten it firmly. 0000021170 00000 n (Minimum clotting time is 30 minutes for patients with an intact clotting process. Gel-barrier tubes and serum tubes with clot initiators should also be collected after the citrate tubes. Gently tap tubes containing additives to dislodge any material that may be adhering to the stopper. All Rights Reserved. 0000010201 00000 n Gumaste VV, Dave PB, Weissman D, Messer J. Lipase:amylase ratio. The CMS web site is available to assist you with this verification. WebB-type Natriuretic Peptide (BNP) Testing. Permission is granted in perpetuity, without payment of license fees or royalties, to use, copy, or distribute the LOINC codes for any commercial or non-commercial purpose, subject to the terms under the license agreement found at https://loinc.org/license/. Eichinger S. D-Dimer testing in pregnancy. When using a bench-top centrifuge, employ a balance tube of the same type containing an equivalent volume of water. You may have a small bruise. To facilitate making the vein more prominent, the patient may be asked to hold firmly to a rubber ball, a thick wad of gauze, etc. It is recommended to ask all patients who may be indicated for this test about biotin supplementation. Be sure to use only tubes with a 3.2% sodium citrate concentration. Blood tests are very common and safe. Do not use oxalate, EDTA, or citrate plasma. 0000008247 00000 n Air drying techniques are usually not satisfactory. The Clinical Laboratory Standards Institute (CLSI) is an excellent resource for additional information. Serum lipase is usually normal in patients with elevated serum amylase, without pancreatitis, who have peptic ulcer, salivary adenitis, inflammatory bowel disease, intestinal obstruction, and macroamylasemia. 0000014084 00000 n (See Figure 3.). 3. Predicting the risk of recurrence of venous thromboembolism. Place the tip of the pipette against the side of the tube, approximately inch above the cell layer. Do not collect in glass. 0000015671 00000 n Do not use gel-barrier tubes to submit specimens for therapeutic drug monitoring. Use: EDTA whole blood or plasma. Use: Serum or clotted whole blood. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. For additional information regarding preparation of serum samples, view the following video: 1. 0000947383 00000 n Hold the spreader by the frosted end between the right thumb and the index finger. Processing and Results. This assay has been designed to minimize interference from heterophilic antibodies. The LOINC codes are copyright 1994-2021, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. Also, a clot tube (eg, red-top tube or gel-barrier) that does not clot should be brought to the attention of the physician. Repeat for the second collection slide. Unless otherwise indicated, serum specimens may be sent at room temperature. Also, the gel barrier may not be intact and could cause improper separation of serum and cells, possibly affecting test results. 11. Please refer to the specimen requirements for the test(s) of interest available in the Directory of Services. 5. Do not blow on the slides. Puncture the diaphragm of the stopper by pushing the tube forward and initiating vacuum suction. Elevated D-dimer levels are observed in all diseases and conditions with increased coagulation activation, eg, thromboembolic disease, DIC, acute aortic dissection, myocardial infarction, malignant diseases, obstetrical complications, third trimester of pregnancy, surgery, or polytrauma.12-17 However, in the context of venous thromboembolism, symptoms being present since a certain period of time, eg, longer than a week, may produce normal D-dimer values.18 For the diagnosis of DIC a scoring system has been suggested, in which elevated D-dimer levels represent the major indicator of DIC.12 While increased levels of D-dimer are not specific for DVT or PE, low D-dimer levels may be used to rule out these conditions. Never freeze glass tubes. Be sure to use only tubes with a 3.2% sodium citrate concentration. If youre taking these drugs to treat heart failure, your BNP or NT-proBNP test results may be lower than if youre not taking them. This clotted blood is then centrifuged, yielding serum, which contains two types of protein: albumin and globulin. The LOINC codes are copyright 1994-2021, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. The BD Vacutainer Plasma Preparation Tube (PPT) is a plastic evacuated tube used for the collection of venous blood in order to prepare undiluted plasma for use in molecular diagnostic testing. 49482). (See Figure 15.). What is the best bitrate for YouTube videos? Handle all slides only by the frosted ends or by the edges. 0000463973 00000 n Results of this test should always be interpreted in conjunction with the patient's medical history, clinical presentation, and other findings. Follow the steps below when preparing a serum specimen for submission. Do not recap, cut, or bend any needles; dispose of them in a sharps container. Why cant I see my lab results on labcorp? Both the BNP and NT-proBNP tests show similar information, although the absolute values of NT-proBNP are about five to 10 times higher than BNP. 4. Prepare the silver gel packs that fit into the Frozen Specimen Keeper by making sure that they also are frozen. Your provider will clean your arm and insert a needle. Any delay will result in abnormal distribution of the white cells, with many of the larger white cells accumulating at the thin edge of the smear. No sample should be collected on patients receiving therapy with high biotin doses(i.e. The plastic BD PPT can be frozen at -80C prior to shipment. When drawing blood, please follow all venipuncture procedures recommended for use by recognized organizations and/or in accordance with applicable state regulations involving phlebotomy practices. McNairy M, Gardetto N, Clopton P, et al. Plasma is obtained from blood that has been mixed with an anticoagulant in the collection tube and has, therefore, not clotted. Immunoreactive trypsin is technically more difficult than lipase and probably no better.2 The serum lipase:amylase ratio may help distinguish alcoholic from nonalcoholic pancreatitis. Send plasma in a plastic transport tube labeled Plasma, EDTA from royal blue.. In some cases, additional time should be WebLavender-top (EDTA) tube Collection Do not collect in glass. Select two clean, grease-free glass collection slides with frosted ends (new ones whenever possible). Print the patient's name and date on the frosted ends of both slides. Taylor FB Jr, Toh CH, Hoots WK, Wada H, Levi M; Scientific Subcommittee on Disseminated Intravascular Coagulation (DIC) of the International Society on Thrombosis and Haemostasis (ISTH). 6. The needle may pinch or sting. Rumley A, Emberson JR, Wannamethee SG, Lennon L, Whincup PH, Lowe GD. When all samples have been drawn, remove the entire assembly from the arm. Detection of D-dimers, which specifies cross-linked fibrin degradation products generated by reactive fibrinolysis, is an indicator of coagulation activity. biotin therapy for Multiple Sclerosis or oncology patients; skin, hair and nail supplements, or multivitamins containing > 5 mg/day) until at least 12 hours after the last biotin administration. Be sure to use the centrifuge that LabCorp has provided for your use in these separations. 0000622018 00000 n 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. 16. Refer to the. In a healthy person, the white cells respond to minor infections by increasing in number and eliminating pathogens. Dao Q, Krishnaswamy P, Kazanegra R, et al. Inspect the serum for signs of hemolysis and turbidity by holding it up to the light. The following conditions are associated with an increase in D-dimer concentrations, even in the absence of venous thrombosis: Trauma or surgery within previous four weeks, Sepsis, severe infections, pneumonia, severe skin infections. Ansari-Lari M, Kickler TS, Borowitz MJ. At some patient service centers, Labcorp provides biometric screening, which includes height, weight, blood pressure, waist circumference, body mass index (BMI), and blood draw for wellness screening. 1. The needle may pinch or sting. 4. (See Figure 10.) 0000020185 00000 n For most laboratory specimens, using 20 mL plastic syringes will allow the withdrawal of adequate specimen. Occasionally, vacuum tubes lose their vacuum. Our online resources are here to support healthcare providers as well as patients. Send plasma in a plastic transport tube labeled Plasma, Sodium Citrate. Send whole blood in a blue-top tube. It doesnt mean that your heart has failed or stopped working entirely. (See Figure 5.) Labs & Appointments Toggle Labs & Appointments, Billing & Insurance Toggle Billing & Insurance, Diseases & Conditions Toggle Diseases & Conditions, OnDemand Testing Toggle OnDemand Testing, Testing by Disease & Condition Toggle Testing by Disease & Condition, Testing & Services For Toggle Testing & Services For, Hospitals & Physician Systems Toggle Hospitals & Physician Systems, Managed Care Health Plans Toggle Managed Care Health Plans, Lab Data Integrations & Tools Toggle Lab Data Integrations & Tools, Employee Wellness & Testing Toggle Employee Wellness & Testing, Government & Education Toggle Government & Education, Therapeutic Indications Toggle Therapeutic Indications, Development Phase Toggle Development Phase, Compounds & Molecules Toggle Compounds & Molecules. 2021 Laboratory Corporation of America Holdings and Lexi-Comp Inc. All Rights Reserved. How can the LabCorp patient mobile app help you? The basic metabolic panel (BMP) may be used to check the health of your kidneys, the status of your electrolyte and acid/base balance, as well as your blood glucose level all of which are related to your bodys metabolism. Permit the vacuum tube to fill completely. Transfer the plasma into a Labcorp PP transpak frozen purple tube with screw cap (Labcorp No. Freeze within 24 hours and maintain frozen until tested. After the slides are completely dry, place them in a labeled slide holder for transport to the laboratory. 0000220208 00000 n Label all tubes clearly and carefully with all pertinent information or bar code. Question 3. Lipase activity is usually absent in urine, possibly from inactivation of the enzyme. 2. hbbd```b``:"#dd]"Ax "@#a@QSl h"-+ y;&`7`S`40,&fj'30V I@ F Policy. 0000349478 00000 n Plasma: 2 mL (Plasma Separator Tube (PST)), Plasma: 0.5 mL (Plasma Separator Tube (PST)). testing to when the result is released to the ordering provider. When your heart has to work harder to pump blood, it makes more BNP. Download the Labcorp Patient mobile app to your phone or tablet to access lab results and more. 3. A BNP test is done by drawing blood from a vein in your arm using a hypodermic needle. The Innovance D-dimer assay is intended for use in conjunction with a nonhigh clinical pretest probability (PTP) assessment model to exclude deep vein thrombosis (DVT) and pulmonary embolism (PE).6 This test can be used to exclude VTE with nonhigh pretest probability (ie, low or low/moderate pretest probability). To avoid delays in turnaround time when requesting multiple tests on frozen samples, please submit separate frozen specimens for each test requested. (Water-soluble markers may wash off with freezing and transport.) Push the spreader slide rapidly over the entire length of the slide, pulling a thin smear of blood behind it. NT-proBNP levels increase with renal failure and optimal cut-off values for diagnosing heart failure have not been clearly established (1200 pg/mL is suggested by the literature). allowed for additional confirmatory or additional reflex tests. Electrochemiluminescent Immunoassay (ECLIA). 0000222343 00000 n The most appropriate slide consists of a film that is exactly one cell thick for maximum visualization of all cell types microscopically. 0000013571 00000 n 42 0 obj <>/Filter/FlateDecode/ID[<28C6C8B4400E046D073F19A495AB7B55><10C7C4E523A0FF41BDF6C6566D06A5C7>]/Index[7 56]/Info 6 0 R/Length 146/Prev 105229/Root 8 0 R/Size 63/Type/XRef/W[1 3 1]>>stream WebRed-top tube, gel-barrier tube, or green-top (lithium heparin) tube. 12. That means youll probably get your results right away, usually in under 15 minutes. If the glass syringe has been autoclaved, it should be oven dried before use. Relationship to infection and sepsis. (https://www.aafp.org/afp/2006/1201/p1893.html), (https://www.ncbi.nlm.nih.gov/books/NBK556136/), Heart, Vascular & Thoracic Institute (Miller Family), Urinating (peeing) more than usual at night (. 0000124093 00000 n If the specimen cannot be properly collected, select another site and using new, sterile collection equipment, collect the specimen. It can help your provider diagnose or evaluate heart failure and other heart problems. If alcohol is not allowed to dry, it may cause specimen hemolysis. Container Lavender-top 0000027548 00000 n Coexistence of increased serum amylase with normal lipase may be a helpful clue to the presence of macroamylasemia.1 Lipase is elevated with amylase in acute pancreatitis, but the elevation of lipase is more prolonged. Please confirm proper preparation and most 0000005011 00000 n It measures the levels of a certain type of hormone in your blood called a B-type natriuretic peptide. All Rights Reserved. endstream endobj startxref You dont need to do anything to prepare for a BNP test or NT-proBNP test. Assemble the following supplies: lab coat, gloves, labels, safety needle, needle holder, tourniquet, appropriate tubes, gauze, alcohol sponge, adhesive strip, and sharps container. D-dimer levels are known to increase with age; eg, median D-dimer levels in apparently healthy men aged 75 to 79 are about twice as high as in men aged 60 to 64.19 This increase in the basal D-dimer concentration is responsible for the decrease in the specificity of D-dimer measurements for exclusion of VTE in the elderly. Collect in a plastic lavender-top (EDTA) tube. WebTest Name Alt Spec Add-on Site Levetiracetam (Keppra) None 6d R Lamotrigine None 6d R Glycols None 24h R GREEN NO GEL SODIUM HEPARIN Test Name Alt Spec Add Failure to keep or have the spreader slide at approximately a 45 angle.