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Instructions for ordering
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DO NOT PLACE ORDERS without checking with Dr. Siguel first. We have temporarily suspended most orders although we usually accept research agreements.
Instructions for:
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PATIENT instructions for fatty acid analysis
DO NOT PLACE ORDERS without checking with Dr. Siguel first. We have temporarily suspended most orders although we usually accept research agreements.
Arrange for a doctor's visit, where you will have your blood pressure, weight, height, and other relevant clinical parameters measured. The doctor should complete a requisition form with relevant clinical data and previous blood test results, and send it to us.
Your doctor should order any other blood tests that you need, to be run on blood drawn at the same time (see elsewhere for suggested tests). Even a few days difference can cause a 30% normal variability in test results. Examples include Lipids (HDL, TG, TC) and thyroid tests.
There are three distinct cases where blood testing is done:
First time "baseline". Usual
procedures (there are exceptions): Patients should discontinue all oil
supplements for at least 48 hours (2-3 days; better for at least one week if
possible), to allow for the proper evaluation of body metabolism and overall
body status. This includes all oil capsules. If possible, patients should not
use IV Lipids for 48 hours before blood testing (or should use as little as
possible). They should not eat fish, tofu, chicken, pork, turkey or foods high
in PUFAs for at least 48 hours. Patients with high triglycerides (> 200
mg/dl) or low HDL (< 35 mg/dL), please inform your doctor, who may want to
request red blood cell + plasma fatty acid analysis. IBD, Crohn's disease, CF
follow usual procedures.
Monitoring, evaluation of treatment. Patients
should continue eating the same foods and eating the oils prescribed to them.
Patients should continue to eat fish and other foods even the day before blood
testing (there are exceptions).
Special cases. Patients should take a special
mixture of oils for 2 to 4 weeks and change their diet. Special cases include
patients with insulin-dependent diabetes, severe CAD, dyslipidemia.
Diet and Fasting
You should fast for 14 hours, counting from the end of the last meal (not from the time the meal started). If necessary, a 12 hour fast is OK, as long as the last meal was small. The last meal should be low in fat and calories.
Patients on TPN or tube feeding should be off TPN (or tube feeding) for 12 hours or for as long as possible. Hydration with water is OK (glucose alters fatty acid metabolism), but discontinue liquids for at least 2 hours before blood drawing. For infants, fasting should last at least 6 hours, preferably 12. Diabetics should avoid food supplements during the 12 hour fast. This may require a change in insulin for the day before blood drawing. If this is impossible, then we should be notified and will try to analyze both plasma and red cells.
Patients with unusual metabolic or nutritional status, or high TG (> 200 mg/dL) and low HDL (< 35 mg/dL) may want to request red blood cell analysis. It is especially important for these patients to follow special instructions.
Non-essential non-prescription drugs (such as anti-inflammatories), alcohol, and nutritional supplements (except vitamins and minerals) should be discontinued for at least 48 hours. Lipid lowering drugs should be continued unless instructed otherwise, to evaluate the effect of drugs on fatty acid profiles. Lipids (HDL, TG, Total Chol) and other related tests (i.e., thyroid) should be run on blood drawn at the same time.
Example: Blood drawn at 9 AM. Finish the last meal by 7-8 PM the previous evening. Eat a meal low in fat and without too many calories. You can drink (water only!) for up to 2 hours before blood is drawn. Do not remain thirsty, because then your blood will be concentrated. You are drinking the right amount of water if your urine is light yellow.
Blood drawing.
Studies have shown that your emotional state, moving, etc. may affect test results. You should arrive early and sit in the waiting room for at least 15 minutes, so you are relaxed when the blood is drawn.
If you have experienced considerable weight loss (more than 5 pounds) in the last 4 weeks, please inform your doctor and write this information on our requisition form.
The laboratory will draw a small purple-topped tube (about 3 ml) for fatty acid analysis, and additional tubes for other tests.
Note: Recommended Specimen Volume per patient is 1 ml. Minimum Specimen Volume per patient is 0.5 ml.
DOCTOR instructions for fatty acid analysis
DO NOT PLACE ORDERS without checking with Dr. Siguel first. We have temporarily suspended most orders although we usually accept research agreements.
Send us a completed requisition
form for the fatty acid profile EFA-SRÔ.
Include your patient's clinical history, including copies of previous blood
test results. Submit other information you think will help interpret test
results. Consult with use first to determine whether you need a plasma (most
common) or red cell analysis.
Order any other tests to be run at the same
time as the fatty acid profile EFA-SRÔ.
Examples include Lipids (HDL, Trig, Total Chol) and thyroid tests. See our suggested list.
Choose the appropriate diet for your patient
BEFORE blood testing, and inform him/her whether he/she should take oil
supplements, drugs, avoid certain foods, etc. This part is critical for proper
test interpretation. Consult before ordering.
LABORATORY TECHNICIAN instructions for fatty acid analysis
DO NOT PLACE ORDERS without checking with Dr. Siguel first. We have temporarily suspended most orders although we usually accept research agreements.
Before blood drawing, refrigerate (do not freeze) the purple top blood tubes. Draw one pediatric or small purple-topped EDTA tube for plasma and RBCs (about 3-5 ml). For red cell analyses there are two ways to ship specimens: either separated (into plasma and red cells) and frozen, or whole blood (not separated) REFRIGERATED but NOT FROZEN.
Separated blood: separate plasma,
RBCs, preferably in a refrigerated centrifuge. (If necessary, we can use serum
instead of plasma. Beware of serum separators though, because they contain
fat-like compounds. Be SURE to spin long enough to pack the cells, separate the
plasma. Do not use serum separator tubes.)
Do not use all the plasma; discard the middle layer with some plasma, white
cells, RBCs, platelets (otherwise the plasma will contain cells, and the RBCs
will contain plasma).
You should have two tubes with plasma and two tubes with RBCs. As soon as
possible, wrap the tubes in foil or a dark material. Minimize heat, light and
air (which oxidize RBCs). Freeze at least overnight, and keep samples frozen so
that they are shipped cold.
Send us 1/2 the sample. Keep the other half. We do this to save time for the
patient in case the sample is lost in transit.
You can include several patients' samples in one box. Include some dry ice or a
freezer pack to keep the temperature cold. Ship early in the week, not Thursday
or later. Ship by next-morning mail.
Frozen plasma will last for months in regular refrigerators, and for years at
-70 C. However, we found that some RBCs deteriorate quickly once separated from
plasma.
Whole blood, not frozen, next day delivery.
On the same day as the sample is collected, send it at room temperature, in the
original blood collection tube, in packaging approved by an overnight delivery
service such as Federal Express (available upon request). Draw an extra small
tube and keep it refrigerated for 1 to 2 weeks in case the original tube is
lost (sometimes we can use the leftover from a regular CBC test). We use whole
blood to analyze RBCs, and also to simplify procedures for doctors who cannot
separate plasma and freeze. Major problem: sample kept at room temperature near
a heater or on hot days in the summer.
Whole blood must be sent cool (if possible, avoid sending on hot days);
however, beware of freezing, which hemolyzes red cells. Draw whole blood and
keep refrigerated until late in the day. Ship as late as possible in the day
for next day morning delivery. If possible, surround the box inside another box
with icepack. Dry ice is sometimes refused by some shippers unless they are
warned; otherwise the smoke is misinterpreted as a fire. Be careful not to let
the whole blood touch ice; it will hemolyze.
Technical Questions by FAX or
Mail
Billing instructions
DO NOT PLACE ORDERS without checking with Dr. Siguel first. We have temporarily suspended most orders although we usually accept research agreements.
Samples that
are billed to health providers or research only (doctors, hospitals, HMOs).
No insurers. No Medicare at this time.
This section applies only to qualified providers who can order blood tests or to research samples ordered by a provider. We cannot accept clinical samples from patients or individuals not authorized to order blood testing. Health providers (i.e., hospitals) agree to pay directly c/o Siguel. Call to discuss pricing information. No samples accepted from patients or doctors for direct billing to insurance (assignment) at this time. |
Research samples are accepted with the understanding that they are to be used only for research purposes (as defined in the pertinent state and federal regulations). Not for clinical purposes or for diagnosis and treatment of a disease. Test cannot be billed to the insurer or used for medical care/clinical purposes. Must be paid in advance c/o EssentialFats LLC., PO Box 10187 Dept N, Gaithersburg, MD 20898. Different quality control and regulations apply.
For insurance, you must verify that the information is accurate and you must be responsible for any errors (e.g., patient no longer eligible). Patient must sign statement of responsibility. Complete the requisition form for each patient.
Shipping Instructions
Please call the lab at 410-502-9445 to request blood packaging material, EFA-SRÔ forms, and shipping labels. The sample packaging material will include tubes, a small Styrofoam box with absorbent material, inner and outer plastic bags, a Federal Express bag, and a pre-addressed shipping label.
Include the following information in the package: a) the patient's name, b) birthdate, c) sample collection date and time, d) the referring laboratory and/or doctor's name, address, phone and fax numbers, and e) a copy of the EFA-SRÔ form.
Obtain and COMPLETE a requisition form with individual information. Send both pages to Siguel c/o EssentialFats LLC. Send a copy of the first page only with your blood sample to KKI.
Mail regulations often require blood specimen packaging to include the
following:
Watertight primary receptacle.
Watertight secondary packaging with biohazard
labeling.
Absorbent material (desiccant) placed between
the primary receptacle and the secondary packaging.
Sturdy outside packaging constructed of
corrugated fiberboard (cardboard), wood, metal, or plastic.
Other specimens: Oils and foods can be sent with ice packs or frozen. Stable food samples such as oils or oil capsules can be sent by any means that accepts such samples, i.e., regular mail, UPS, etc. There is no rush if the sample is stable. Unstable samples must be sent refrigerated to be delivered next day or next morning. Examples include open flax seed or fish oils or tissue samples such as chicken. Most specimens can be frozen and sent frozen or refrigerated (with ice packs). Dry ice is rarely allowed by shipping companies.
Before sealing the package:
Complete the Test Requisition
Form. Send (or fax) a copy of the front and back page to EssentialFats LLC.
and a copy of the front page with your specimen request to the appropriate
laboratory.
Make a copy of the Test Requisition Form for
your records.
Ensure the sample tubes are properly labeled.
Each label must contain Patient Name and Date of Sample Collection. Samples not
bearing this information cannot be accepted for testing.
Note: Use a plastic transport tube whenever possible, to minimize chance of
breakage.
Secure screw caps with adhesive tape or lab
film. Wrap them in paper or aluminum foil to protect them from light.
Package labeled specimens in a sealable
plastic bag. Place in an appropriate mailing container (such as a Styrofoam
cooler). Include insulation material to prevent breakage and dry ice or an ice
pack to keep cold. BE CAREFUL: whole blood should not be frozen!
Seal container with strapping tape.
Place container inside cardboard outer box;
seal with strapping tape, and ship (include requisition form front page).
Safety and Confidentiality Precautions
All specimens should be handled as if infectious. Precautions should be taken to protect all health care workers from exposure to HIV and the hepatitis virus.
For specimen issues and technical questions: contact us.
SHIP TO (Laboratory performing test):
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Attn: Dr. Ann Moser Phone 410-502-9445 Fax 410-502-8279 |
Indicate that you want Dr. Siguel's fatty acid profile, the EFA-SRÔ. Tell them it is a research sample, to be billed to Dr. Siguel. Patient samples are accepted only from providers or hospitals that guarantee payment. Please indicate if you want trans fatty acids analyzed. Indicate plasma and/or RBCs
Other useful documents in web
site
Requisition forms for the FA profile EFA-SRÔ.
Prototype letter for requesting your blood test results, for requesting a copy of your medical history.
Diagnostic tests you may need ordered at the same
time as the FA profile EFA-SRÔ.
Fatty acid metabolism brochure for patients, doctors.
Examples of a patient EFA-SRÔ report.
Reference values.
Guidelines to interpret fatty acids.
Deciding whether to seek reimbursement.
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© 1998 Edward
Siguel. All rights reserved |
modified 1/15/00 |