Chrono-Log 490 4+4 Instruction Manual page 16

Reporting Format:
PLATELET AGGREGATION STUDIES:
DATE __________________________________
PHYSICIAN _________________________________ TIME BLOOD DRAWN: ___________
INSTITUTION: ______________________________ DEPARTMENT: ____________________
PATIENT ___________________ I.D. _______________ DATE OF BIRTH: ______________
AGE: ________ SEX: (M) (F)
CLINICAL HISTORY: ______________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
AGONIST
ADP, 5 µ µ µ µ M
ADP, 10 µ µ µ µ M
COLLAGEN, 2 µ µ µ µ g/mL
COLLAGEN, 5µ µ µ µ g/mL
ARACHIDONIC ACID,
0.5 mM
EPINEPHRINE, 5 µ µ µ µ M
RISTOCETIN, 1.25 mg/mL
RISTOCETIN, 0.5 mg/mL
* ± ± ± ± 2SD
INTERPRETATION:
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
TEST PERFORMED BY: ___________________________________ INTERPRETED BY: _______________________________________________
Document # 49044IM1
Revision 7.5
Dated February 16, 2017
HCT ___________ PLT CT _________ BT _________
OPTICAL AGGREGATION TEST RESULTS
NORMAL RANGES
(Mean ± ± ± ± 1 SD)
69 - 88%
71 - 88%
70 - 94%
*
74 - 99%
78 - 88%
87 - 102%
0%
CONTROL PATIENT
VALUE VALUE
15
TEST
RESULTS
(Normal, Reduced,
Increased)