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Epic Code LAB35 Theophylline, Blood Level

Test Name Alias

Theophylline Blood Level | Aminophylline | Choledyl | Tedral | Slo-Phyllin | 8332

Interface Order Alias

10260

Specimen Requirements

Submit only one of the following specimens:


Preferred
Specimen Type: Plasma
Container/Tube: Mint Green Top (Lithium Heparin Gel)
Volume: 4.5 mL
Minimum volume: 0.5 mL plasma
Collection Instructions: Centrifuge within 2 hours. Indicate date and time of last dose.


Acceptable
Specimen Type: Serum
Container/Tube: Gold Top (Serum Separator-SST Gel)
Volume: 5 mL
Minimum volume: 0.5 mL serum
Collection Instructions: Allow specimen to clot for 30 minutes and centrifuge within 2 hours. Indicate date and time of last dose.

Specimen Transport Temperature

Refrigerate

Special Instructions

Inpatients: Please contact your local inpatient pharmacy for information regarding appropriate timing for blood drug level orders, if needed.

Avoid gross hemolysis

Specimen Stability

Ambient: 8 hours

Refrigerate: 24 hours (48 hours if aliquoted serum/plasma)

Frozen: aliquot plasma/serum for longer storage

Laboratory Retention: 72 hours

Test Frequency

Available 24 hours, usual TAT 1 day

Reference Range

5 – 15 mcg/mL

 

Critical Values Table

Performing Department

CHEMISTRY

Performing Department Laboratory Location

Spectrum Health Regional Laboratory, Grand Rapids, MI
Spectrum Health Zeeland Laboratory, Zeeland, MI

Methodology

Kinetic Interaction of Microparticles in Solution (KIMS)

CPT

80198-LAB-THEOPHYLLINE LEVEL

CDM Code

4058332

Epic Test ID

1230101210

LOINC

Theophylline Lvl: 4049-3

Beaker LOINC

LIPEMIA INDEX, SERUM: N/A
THEOPHYLLINE LEVEL: 4049-3

Mayo Access Code

SHO8332

Additional Information

Red top (plain) or Green top (Lithium Heparin, Non-Gel) are also acceptable specimen containers.

Reviewed Date

3/5/2020

Beaker Names

Beaker Procedure Name: THEOPHYLLINE LEVEL
Beaker Display Name: Theophylline, Blood Level
BEAKER TEST NAME: THEOPHYLLINE
BEAKER TEST REPORT NAME: Theophylline

Beaker Synonyms

No synonym on file

Beaker Location, Container and Temperature

BW CHEMISTRY: GREEN LI HEPARIN PST TUBE R (Preferred)-Refrigerated
BW CHEMISTRY: GOLD TOP SST TUBE R (Acceptable)-Refrigerated