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Test Code 2636 Pediatric Lipid Panel, includes cholesterol, triglycerides, HDL, calculated LDL and non-HDL cholesterol

Specimen Containers and Fixatives

Gold Top Tube (SST)

Specimen Required

NorthShore Lab Services: draw 1.3 mL (0.8 min) blood, centrifuge and submit 0.5 mL (0.3 min) refrigerated serum

Hospital setting: submit 1.3 mL (0.8 min) blood

Client Special Instructions

Should only be ordered on patients <20 years of age.

Day(s) and Time(s) Performed

Chemistry

Daily, 24 hours

Reference Values

FASTING samples ages 2 – 19 years and NON-FASTING samples ages 9 – 11 and 17 – 19 years

TOTAL CHOLESTEROL

<170 Acceptable

170 – 199 Borderline

≥200 High

HDL Cholesterol (mg/dL)

>45 Acceptable

40-45 Borderline

<40 Low

Non-HDL Cholesterol (mg/dL)

<120 Acceptable

120-144 Borderline

≥145 High

FASTING Sample, ages 2 – 19 years

LDL Cholesterol (mg/dL)

<110 Acceptable

110 – 129 Borderline

≥130 High

Triglyceride (mg/dL)

Ages 0 – 9 years

<75 Acceptable

75 – 99 Borderline

≥100 High

Ages 10 – 19 years

<90 Acceptable

90 – 129 Borderline

≥130 High

Current guidelines for non-fasting samples are limited to cholesterol, HDL cholesterol and non-HDL cholesterol in the age ranges of 9 – 11 years and 17 – 19 years.

Method Name

See individual tests in panel.

CPT Code Information

80061

LOINC Code Information

24331-1

Fasting

It is preferred that the patient be fasting when the sample is collected.