Ordering Recommendations

Requistions from referring laboratories must include the following information:
 
  1. Subject's Information 
  • Legal First Name, Last Name, and Middle Initial
    • Or other unique identifier (I.e. UNOS, Life Sharing ID, or NMDP GRID Number)
    • Avoid using nicknames or aliases
    • The name on the requisition should match the name on the specimens EXACTLY
  • Social Security Number
    • Required for all solid organ recipients
  • Medical Record Number
  • Sex
  • Date of Birth
  • ICD diagnosis code
  • Registration or bulk account number for billing
  1. Information for requesting physician, authorized person, or clinical laboratory:
  • Name
  • PID #
  • Phone or pager number
  1. Specimen Information
  • Source
  • Collection Date and Time
  • Phlebotomist Initials
  1. Urgency of request (STAT or Routine)
  2. Requested test or testing protocol
  • HLA Typing or Histocompatibility Testing must additionally include:
    • Subject's status (kidney, recipient, related donor, etc.)
    • Relationship to prospective recipient, if applicable
    • Transplant date, if known
  1. Address for where the written or electronic laboratory report should be sent

Performed

Monday - Friday

Methodology

Flow Cytometry

Reported

Routine: 1 week

Synonyms

  • Transplant Lymphocyte Crossmatch
  • Autologous Flow Cytometric Crossmatching
  • Autologous Flow Cytometric Crossmatch
  • Flow Cytotoxic Crossmatch (FCXM)
  • HLA Crossmatch, Autologous
  • HLA Crossmatch, Auto
  • Autologous Crossmatching
  • Autologous Crossmatch
  • HLA Crossmatching
  • ITL Lab
  • Immunogenetics and Transplantation Lab
  • HLA Lab
  • Histocompatibility Lab

Performing Lab

Immunogenetics and Transplantation Lab (ITL)

CPT Codes

86825

Turnaround Time

7 days

Add-on Eligibility

Yes, within 48 hours of collection

Specimen Type

Blood

Specimen Volume

Yellow Top (Recipient): 40 mL (Minimum: 20 mL)
Red Top (Recipient): 10 mL (Minimum: 10 mL)

Collection Container

  1. 4 10 mL ACD Whole Blood Tubes (Yellow Top Vacutainer)
  • These must be collected from the Recipient
     
     
 
AND
 
  1. 1 10 mL Serum Tube (Red Top Vacutainer)
  • This must be collected from the Recipient

Pediatric Collection

For pediatric patients, call 858-657-5739 for special instructions.

Unacceptable Conditions

  1. Lack of referral requisition
  2. Grossly hemolyzed specimens
  3. Severely clotted specimens collected in ACD Whole Blood Tubes (Yellow Top Vacutainer)
  4. Specimens containing particulate matter or exhibiting obvious contamination
  5. Commingled specimens
  6. Specimens that have been improperly collected, stored, or transported
  • ACD Tubes not received within 72 hours of collection
  • Serum Tubes not received within 7 days of collection
  • Specimens collected using tubes other than ACD Whole Blood Tubes (Yellow Top Vacutainer) or Serum Tubes (Red Top Vacutainer)
    • Sodium Heparin Tubes are accepted, but ACD Tubes are preferred
  • Specimens that have been refrigerated or frozen
  • Specimens that are leaking or received in broken containers
  1. Specimens received with insufficient volume for testing
  2. Unlabeled or mislabeled specimens
  • Multiple specimen tubes bridged with one label
  • Multiple specimen tubes taped together with one label affixed
  • Unlabeled specimen tubes placed in a labeled container

Storage/Transport Temperature

Transport Instructions      
Collection Location Specimen Type Transport Temperature Timeframe
ED/Inpatient ACD Whole Blood Tube Room Temperature Specimen must be received by the lab within 72 hours of collection
Serum Tube Room Temperature Specimen must be received by the lab within 7 days of collection
Laboratory/Outpatient/Off-Site ACD Whole Blood Tube Room Temperature Specimen must be received by the lab within 72 hours of collection
Serum Tube Room Temperature Specimen must be received by the lab within 7 days of collection

Storage: Room Temperature

Stability (from collection to initiation)

Stability:
ACD Whole Blood Tube (Yellow Top Vacutainer)
  • Room Temperature: 72 hours
  • Refrigerated: Unacceptable
  • Frozen: Unacceptable
Serum Tube (Red Top Vacutainer)
Prior to separation from cells:
  • Room Temperature: 7 days
After separation from cells:
  • Room Temperature: 7 days
  • Refrigerated: 5 days
  • Frozen at -70° C: 2 years
*Avoid repeated freeze thaws

Laboratory Storage: 
  • ACD Whole Blood Tube (Yellow Top Vacutainer): Room Temperature
  • Serum Aliquot: Frozen
Laboratory Retention: 
  • ACD Whole Blood Tube (Yellow Top Vacutainer): 14 days
  • Serum Aliquot: 2 years

Remarks

For pediatric patients or patients with low WBC counts, call 858-657-5739 for special instructions.

Collection Instructions

Labeling Instructions:
  1. Specimens must be individually labeled with the following information:
  • Complete Name and/or Donor ID
  • At least one of the following:
    • Medical Record Number
    • Date of Birth
    • Social Security Number
    • HIC #
    • Reference ID #
  • Phlebotomist signature or ID
  • Collection Date and Time
  1. When labeling blood tubes, leave a small window visible for the lab to assess the fill volume and sample integrity. Ensure that the barcode is in the correct orientation.
 

Collection Instructions:
  1. Follow the correct order of draw when collecting with additional orders and tube types
  • ACD tubes should be drawn AFTER Gray Top Vacutainers
  1. Gently, but thoroughly, invert the collection tube according to the number of inversions in the chart below
  • ACD tubes should be inverted 8 - 10 times
     

Reference Interval

T Cells
  • Negative: < 200
  • Positive: ≥ 200

B Cells
  • Negative: < 300
  • Positive: ≥ 300

Interpretive Data

The transplant lymphocyte crossmatch evaluates the recipient’s serum for the presence of pre-formed anti-donor antibodies. Flow cytotoxic crossmatch (FCXM) is performed by incubating donor lymphocytes with potential recipient serum to evaluate alloantibodies that may mediate humoral rejection.
Ordering

Ordering Recommendations

Requistions from referring laboratories must include the following information:
 
  1. Subject's Information 
  • Legal First Name, Last Name, and Middle Initial
    • Or other unique identifier (I.e. UNOS, Life Sharing ID, or NMDP GRID Number)
    • Avoid using nicknames or aliases
    • The name on the requisition should match the name on the specimens EXACTLY
  • Social Security Number
    • Required for all solid organ recipients
  • Medical Record Number
  • Sex
  • Date of Birth
  • ICD diagnosis code
  • Registration or bulk account number for billing
  1. Information for requesting physician, authorized person, or clinical laboratory:
  • Name
  • PID #
  • Phone or pager number
  1. Specimen Information
  • Source
  • Collection Date and Time
  • Phlebotomist Initials
  1. Urgency of request (STAT or Routine)
  2. Requested test or testing protocol
  • HLA Typing or Histocompatibility Testing must additionally include:
    • Subject's status (kidney, recipient, related donor, etc.)
    • Relationship to prospective recipient, if applicable
    • Transplant date, if known
  1. Address for where the written or electronic laboratory report should be sent

Performed

Monday - Friday

Methodology

Flow Cytometry

Reported

Routine: 1 week

Synonyms

  • Transplant Lymphocyte Crossmatch
  • Autologous Flow Cytometric Crossmatching
  • Autologous Flow Cytometric Crossmatch
  • Flow Cytotoxic Crossmatch (FCXM)
  • HLA Crossmatch, Autologous
  • HLA Crossmatch, Auto
  • Autologous Crossmatching
  • Autologous Crossmatch
  • HLA Crossmatching
  • ITL Lab
  • Immunogenetics and Transplantation Lab
  • HLA Lab
  • Histocompatibility Lab

Performing Lab

Immunogenetics and Transplantation Lab (ITL)

CPT Codes

86825

Turnaround Time

7 days

Add-on Eligibility

Yes, within 48 hours of collection
Collection

Specimen Type

Blood

Specimen Volume

Yellow Top (Recipient): 40 mL (Minimum: 20 mL)
Red Top (Recipient): 10 mL (Minimum: 10 mL)

Collection Container

  1. 4 10 mL ACD Whole Blood Tubes (Yellow Top Vacutainer)
  • These must be collected from the Recipient
     
     
 
AND
 
  1. 1 10 mL Serum Tube (Red Top Vacutainer)
  • This must be collected from the Recipient

Pediatric Collection

For pediatric patients, call 858-657-5739 for special instructions.

Unacceptable Conditions

  1. Lack of referral requisition
  2. Grossly hemolyzed specimens
  3. Severely clotted specimens collected in ACD Whole Blood Tubes (Yellow Top Vacutainer)
  4. Specimens containing particulate matter or exhibiting obvious contamination
  5. Commingled specimens
  6. Specimens that have been improperly collected, stored, or transported
  • ACD Tubes not received within 72 hours of collection
  • Serum Tubes not received within 7 days of collection
  • Specimens collected using tubes other than ACD Whole Blood Tubes (Yellow Top Vacutainer) or Serum Tubes (Red Top Vacutainer)
    • Sodium Heparin Tubes are accepted, but ACD Tubes are preferred
  • Specimens that have been refrigerated or frozen
  • Specimens that are leaking or received in broken containers
  1. Specimens received with insufficient volume for testing
  2. Unlabeled or mislabeled specimens
  • Multiple specimen tubes bridged with one label
  • Multiple specimen tubes taped together with one label affixed
  • Unlabeled specimen tubes placed in a labeled container

Storage/Transport Temperature

Transport Instructions      
Collection Location Specimen Type Transport Temperature Timeframe
ED/Inpatient ACD Whole Blood Tube Room Temperature Specimen must be received by the lab within 72 hours of collection
Serum Tube Room Temperature Specimen must be received by the lab within 7 days of collection
Laboratory/Outpatient/Off-Site ACD Whole Blood Tube Room Temperature Specimen must be received by the lab within 72 hours of collection
Serum Tube Room Temperature Specimen must be received by the lab within 7 days of collection

Storage: Room Temperature

Stability (from collection to initiation)

Stability:
ACD Whole Blood Tube (Yellow Top Vacutainer)
  • Room Temperature: 72 hours
  • Refrigerated: Unacceptable
  • Frozen: Unacceptable
Serum Tube (Red Top Vacutainer)
Prior to separation from cells:
  • Room Temperature: 7 days
After separation from cells:
  • Room Temperature: 7 days
  • Refrigerated: 5 days
  • Frozen at -70° C: 2 years
*Avoid repeated freeze thaws

Laboratory Storage: 
  • ACD Whole Blood Tube (Yellow Top Vacutainer): Room Temperature
  • Serum Aliquot: Frozen
Laboratory Retention: 
  • ACD Whole Blood Tube (Yellow Top Vacutainer): 14 days
  • Serum Aliquot: 2 years

Remarks

For pediatric patients or patients with low WBC counts, call 858-657-5739 for special instructions.

Collection Instructions

Labeling Instructions:
  1. Specimens must be individually labeled with the following information:
  • Complete Name and/or Donor ID
  • At least one of the following:
    • Medical Record Number
    • Date of Birth
    • Social Security Number
    • HIC #
    • Reference ID #
  • Phlebotomist signature or ID
  • Collection Date and Time
  1. When labeling blood tubes, leave a small window visible for the lab to assess the fill volume and sample integrity. Ensure that the barcode is in the correct orientation.
 

Collection Instructions:
  1. Follow the correct order of draw when collecting with additional orders and tube types
  • ACD tubes should be drawn AFTER Gray Top Vacutainers
  1. Gently, but thoroughly, invert the collection tube according to the number of inversions in the chart below
  • ACD tubes should be inverted 8 - 10 times
     
Result Interpretation

Reference Interval

T Cells
  • Negative: < 200
  • Positive: ≥ 200

B Cells
  • Negative: < 300
  • Positive: ≥ 300

Interpretive Data

The transplant lymphocyte crossmatch evaluates the recipient’s serum for the presence of pre-formed anti-donor antibodies. Flow cytotoxic crossmatch (FCXM) is performed by incubating donor lymphocytes with potential recipient serum to evaluate alloantibodies that may mediate humoral rejection.

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