Facioscapulohumeral Dystrophy (FSHD) Sample Requirements for Prenatal Testing

University of Iowa Diagnostic Laboratories (UIDL)

Department of Pathology
Room 5231, RCP
Iowa City, Iowa 52242-1181
319-384-7212 Tel
319-384-7213 Fax

FACIOSCAPULOHUMERAL DYSTROPHY (FSHD) SAMPLE REQUIREMENTS FOR PRENATAL TESTING
Fetal Sample: Using sterile technique, collect an amniotic (AF) specimen (minimum 1 ml per week gestational age) or chorionic villus (CV) specimen (minimum 10 mg clean villi). Place amniotic fluid in a sterile centrifuge tube. Place chorionic villi in transport tube containing enough tissue culture medium to cover the entire sample. Do not allow the tissue to become dry.




Parental Sample(s): 10 ml whole blood in lavender (EDTA) top tube from each parent. If parent(s) have been tested previously at UIHC, contact the Molecular Laboratory (319-384-9568) to determine if additional blood sample is required.




Shipping Requirements:
Package should be sent by overnight courier service (i.e. UPS, FEDEX), Monday through Wednesday only.

Label the container with the patient name and date collected. Seal the containers and place in a biohazard bag.

A copy of the referring institution's consent form for prenatal testing must accompany the specimen.

Package the specimens, UIHC request form and prenatal consent form in a Styrofoam container. Add packaging material to avoid breakage. Seal the package. Mark the package to be stored at room temperature.

AF and CV samples must remain at room temperature at all times and shipped immediately after collection.

Parental blood samples shipped separately from the AF or CV specimen should be refrigerated until the time of shipment. Shipment of blood samples may be at room temperature.

Call the Cytogenetics Laboratory at 319-356-3877. Give your name, institution name, telephone number, patient name, and the tracking number for the package. Packages sent without tracking number cannot be traced if not received on time.

Sites will be notified upon receipt of sample if they are found to be suboptimal. In addition, site will be notified within one week of receipt if the specimens failed to provide optimal growth.




Ship To:
Cytogenetics Laboratory, W101GH
University of Iowa Health Care
Department of Pediatrics
200 Hawkins Drive
Iowa City, IA 52242




All information on requisition must be provided before testing is performed, including:

Patient Information: Patient full name (Last, First, MI)
Patient identifier
Date of birth
Patient address, necessary for receipt and/or refund
Date and time of collection
Ordering physician




Billing Information:
Insurance, medicare or patient will not be billed directly.
Requesting institution will be billed or if patient is prepaying, a check must accompany the sample. Visa and Mastercard accepted. Samples accompanied by prepayment funds will have a receipt returned which may be used for submission to insurance.
Institution name
Include contact person for billing questions
Phone/Fax number of contact above
Institutional address




Reporting Information:
Because of confidentiality issues the report will not be released to any other individual or institution than is listed on the UIHC request form.
Physician or institution to send report to
Address to send report to
Phone number of individual or institution above
Fax number to send report to if desired




Turn Around Time: 4-7 weeks




Contact Information: UIDL Client Services
319-384-7212 (local)
1-866-844-2522 (toll-free)

Questions regarding shipping or growth of AF or CV
specimen should be directed to the Cytogenetics Laboratory
(319)356-3877.

Questions regarding parental blood samples or testing
status should be directed to the Molecular Pathology Laboratory
(319)384-9568.
06/08

Fetal Sample:	Using sterile technique, collect an amniotic (AF) specimen (minimum 1 ml per week gestational age) or chorionic villus (CV) specimen (minimum 10 mg clean villi). Place amniotic fluid in a sterile centrifuge tube. Place chorionic villi in transport tube containing enough tissue culture medium to cover the entire sample. Do not allow the tissue to become dry.

Parental Sample(s):	10 ml whole blood in lavender (EDTA) top tube from each parent. If parent(s) have been tested previously at UIHC, contact the Molecular Laboratory (319-384-9568) to determine if additional blood sample is required.

Shipping Requirements:	Package should be sent by overnight courier service (i.e. UPS, FEDEX), Monday through Wednesday only. Label the container with the patient name and date collected. Seal the containers and place in a biohazard bag. A copy of the referring institution's consent form for prenatal testing must accompany the specimen. Package the specimens, UIHC request form and prenatal consent form in a Styrofoam container. Add packaging material to avoid breakage. Seal the package. Mark the package to be stored at room temperature. AF and CV samples must remain at room temperature at all times and shipped immediately after collection. Parental blood samples shipped separately from the AF or CV specimen should be refrigerated until the time of shipment. Shipment of blood samples may be at room temperature. Call the Cytogenetics Laboratory at 319-356-3877. Give your name, institution name, telephone number, patient name, and the tracking number for the package. Packages sent without tracking number cannot be traced if not received on time. Sites will be notified upon receipt of sample if they are found to be suboptimal. In addition, site will be notified within one week of receipt if the specimens failed to provide optimal growth.

Ship To:	Cytogenetics Laboratory, W101GH University of Iowa Health Care Department of Pediatrics 200 Hawkins Drive Iowa City, IA 52242

All information on requisition must be provided before testing is performed, including:
Patient Information:	Patient full name (Last, First, MI) Patient identifier Date of birth Patient address, necessary for receipt and/or refund Date and time of collection Ordering physician

Billing Information:	Insurance, medicare or patient will not be billed directly. Requesting institution will be billed or if patient is prepaying, a check must accompany the sample. Visa and Mastercard accepted. Samples accompanied by prepayment funds will have a receipt returned which may be used for submission to insurance. Institution name Include contact person for billing questions Phone/Fax number of contact above Institutional address

Reporting Information:	Because of confidentiality issues the report will not be released to any other individual or institution than is listed on the UIHC request form. Physician or institution to send report to Address to send report to Phone number of individual or institution above Fax number to send report to if desired

Turn Around Time:	4-7 weeks

Contact Information:	UIDL Client Services 319-384-7212 (local) 1-866-844-2522 (toll-free) Questions regarding shipping or growth of AF or CV specimen should be directed to the Cytogenetics Laboratory (319)356-3877. Questions regarding parental blood samples or testing status should be directed to the Molecular Pathology Laboratory (319)384-9568.