Frequently Asked Questions
Find answers to common questions about TLab testing, specimen collection, shipping, results, and other laboratory services.
TLab frequently asked questions, organized into general information, physician, and patient tabs.
TLab Inc. (TLab) is a CAP-accredited and CLIA-certified high-complexity translational diagnostics laboratory that provides molecular imaging diagnostics to licensed healthcare practitioners. Our focus is on complex infectious and inflammatory diseases, as seen in Lyme disease and its co-infections.
TLab is CLIA-certified for high-complexity laboratory testing and maintains CAP accreditation.
TLab currently offers the following tests:
- Bartonella henselae 23s rRNA FISH Molecular Imaging (blood).
- Borrelia burgdorferi OspA (Outer Surface Protein A) mRNA FISH Molecular Imaging (blood). This species of Borrelia is the primary cause of Lyme disease in North America.
- Borrelia genus 23s rRNA FISH Molecular Imaging (blood). This test detects other Borrelia species that cause Lyme disease globally, including B. garinii and B. afzelii.
- Babesia odocoilei 18s rRNA FISH Molecular Imaging (blood).
- Babesia genus 18s rRNA FISH Molecular Imaging (blood).
- BNR – High Resolution Blood Smear Imaging (Biofilms, NETs, Red Blood Cell Inclusions) (blood).
- Nerve Fiber Demyelination Assay and EDNF counts (CIDP test) (skin).
Fluorescence In Situ Hybridization (FISH) is a molecular imaging technique used to detect a pathogen's genetic signature (ribosomal RNA) in blood or tissue samples. Highly specific probes bind to sections of pathogen rRNA. When excited by specific laser frequencies under a confocal laser microscope, the bound probes fluoresce, allowing direct visualization of target RNA within intact cells.
The BNR test examines specially prepared whole-blood samples using differential staining and high-resolution bright-field microscopy to identify biofilm (B), neutrophil lysis/degranulation (N), and red blood cell inclusions (R). Results may include estimates of biofilm load, the degree of neutrophil activation, and alterations in red blood cell morphology. The amount of observable biofilm (Biofilm Load) may indicate a persistent infection. Biofilm formation can reduce the effectiveness of antibiotics and allow bacteria to persist. Neutrophil lysis creates neutrophil extracellular traps (NETs), composed of nucleic acids released when neutrophils encounter pathogens. Red blood cell deformities may indicate microbial interactions or parasitization, although morphology can be altered by multiple factors.
Bartonella is a genus of gram-negative bacteria that infects red blood cells and endothelial cells, often leading to persistent, low-grade infections in humans and animals. Bartonella is transmitted by vectors such as fleas, ticks, lice, and sandflies and can also be acquired through scratches or bites from infected animals. Several Bartonella species cause disease, including Bartonella henselae, the agent of Cat Scratch Disease, and Bartonella quintana, responsible for Trench Fever.
Babesia is a protozoan parasite that infects red blood cells, causing a malaria-like illness known as babesiosis. It is primarily transmitted through tick bites but can also spread via blood transfusions or from mother to child during pregnancy. Symptoms range from mild flu-like fatigue and body aches to severe hemolytic anemia, which can lead to jaundice and organ complications. Babesia often co-infects with Lyme disease and other vector-borne pathogens, making diagnosis and treatment more complex.
Borrelia is a genus of spiral-shaped bacteria, or spirochetes. These bacteria can actively move through tissues, invade joints, nerves, and even the heart, and are well known for their ability to evade the immune system. Unlike many bacteria that remain in the bloodstream, Borrelia prefers to persist in tissues, making detection and treatment challenging. Borrelia burgdorferi is the primary cause of Lyme disease in North America. Globally, other Borrelia species cause Lyme disease, including B. garinii and B. afzelii. B. miyamotoi causes relapsing fever.
To order TLab tests, establish an account by completing the Contact Form on our website. You will receive an invitation link to our secure client portal, where you can access requisition forms and request collection kits. If you would like to order collection kits to have on hand at your office, you may request them by emailing us at info@tlabdx.com. Also, if you would like us to drop-ship a kit directly to a patient, just email us at info@tlabdx.com with the patient's name and address. Then, please be sure to provide the patient with all necessary forms and instruct them to place the completed forms in the kit when shipping it back to us.
Anytime you want to access requisitions, please go to tlabinc.sharefile.com and log in with your email address and password. In this folder, you will find all the forms needed to order TLab testing.
One blood collection kit is sufficient for any combination of TLab blood tests. The kit includes two EDTA (purple-top) tubes and two ACD (yellow-top) tubes. EDTA tubes must be drawn before ACD tubes during venipuncture.
Yes, our kits include two lavender top (EDTA) tubes to ensure at least one is viable.
TLab molecular imaging detects ribosomal RNA within intact cells, whereas PCR-based assays detect DNA. Each methodology has strengths and limitations. Direct comparative outcome studies have not been published.
Reimbursement is highly variable and dependent on the insurance policy.
Tax ID #: 83-1383863
Place of Service Code: 11
Procedure Codes:
- 87207 – High Resolution Blood Smear Imaging
- 88365 – Bartonella henselae Molecular Imaging (blood)
- 88365 – Babesia odocoilei Molecular Imaging (blood)
- 88365 – Borrelia burgdorferi OspA Molecular Imaging (blood)
TLab does not provide medical consultation services. Clinical interpretation and patient management remain the responsibility of the ordering practitioner.
Because TLab's RNA FISH molecular imaging detects active bacterial RNA, it may be useful for monitoring treatment effectiveness over time. Some clinicians retest patients at three-month intervals to monitor response to therapy, while others wait until symptoms improve to confirm bacterial clearance.
Many practitioners choose to retest after a course of treatment to determine whether bacterial RNA is still detectable. A recommended testing approach may include baseline testing before treatment begins, follow-up testing every 3-4 months during treatment, and retesting at treatment completion to confirm whether the infection has cleared.
TLab tests are only available through a signed requisition from a licensed physician or appropriately qualified healthcare practitioner with a TLab account. Please speak with your doctor about whether testing is appropriate for your care. TLab does not provide requisition forms directly to patients. Ordering physicians must provide those for you.
If you would like a specimen collection kit shipped directly to you, please ask your physician's office to request one. Kit requests must come from the ordering physician's office. If you are interested in receiving TLab testing, please speak with your practitioner and inform them of TLab's test offerings. If they would like to order the test for you, someone from their office can visit our website (www.tlabdx.com) and complete the contact form. We will contact their office to set up their account. Once they are set up with an account, we can send them specimen collection kits and give them access to our client portal, which gives them access to the forms necessary for ordering TLab testing.
Many practitioners perform blood draws in their offices. Others may refer patients to commercial laboratories. At your practitioner's request, TLab can ship collection kits directly to you. Patients have several options for blood draw facilities. Based on our experience, AnyLabTestNow locations are often willing to perform the draw. Other options include a primary care physician's office, as many have an in-house phlebotomist, or mobile phlebotomy services that perform home visits. Hospital outpatient labs may also be an option. However, we have received reports that LabCorp and Quest Diagnostics often do not perform blood draws for specialty testing, so we recommend calling your chosen facility in advance to confirm its policies.
Due to state regulatory restrictions, we do not accept specimens from New York & Rhode Island.
Yes. For international patients, email the patient's name, email address, and mailing location. TLab coordinates shipment via FedEx International Economy.
For international shipments from Europe and Middle East, patients and practitioners should contact RED Labs by email (info@redlabs.be) for specimen ordering and collection kits.
Specimens must be shipped using the TLab kit via FedEx on the same day as collection. U.S. samples must ship Monday–Thursday. International samples must ship on Monday. All required forms must be included in the kit.
TLab does not participate in Medicare, Medicaid, or any insurance plans. Patients cannot submit claims to Medicare or Medicaid for services rendered by our lab. You may, however, submit receipts to your private insurance provider for possible reimbursement. Insurance reimbursement varies depending on the policy.
You complete the TLab Billing and Claims form and include it with the kit. We accept credit cards and checks. If you are uncomfortable writing that information down, please note it on the form, and we will be happy to reach out to you for payment once we receive your specimen. We do not charge until we receive a viable specimen.
You may email us at info@tlabdx.com to request a statement or receipt.
TLab does not charge for rejected specimens. We only charge once a viable specimen is received.
Turnaround time is approximately 4–6 weeks. Results are delivered to the ordering practitioner's secure portal as soon as they are available.
No. We currently do not offer expedited testing services.
TLab delivers results to the ordering physician's office through our HIPAA-compliant portal. Due to the high-resolution images included in the report, we do not email or fax results. Upon a patient's request, we can send a paper copy of the results through the mail.
As soon as any reports become available, they will be delivered to the ordering physician's office.
Once the results are ready, they are delivered to the ordering physician's office, and the physician will receive an alert email.
TLab delivers test results directly to the ordering physician's ShareFile portal, a HIPAA-compliant online system. Patients should request results from their ordering provider, as laboratory reports require clinical interpretation. Upon request, TLab can mail a paper copy of the test report to the patient's registered address.
TLab does not provide medical advice or consultation services. Results must be interpreted by your ordering practitioner.
There are many reasons that a sample can be rejected, some of which can include:
- The temperature is above the acceptance criteria.
- The specimen was received 3 days after collection.
- The specimen was hemolyzed.
- The specimen was drawn in NY, PA, and RI.
There is no need to hold any medication before testing, as the test detects ribosomal RNA sequences. Antibiotics may, by causing more rapid bacterial breakdown, release more rRNA, potentially making it easier to detect. We have not formally studied this; however, anecdotally, we are seeing tests become more positive for a period of time after antibiotics are started. Then, near the end of treatment, we observe consecutive negative results, suggesting that the test could help identify the endpoint of treatment.
We think that 2 or 3 consecutive negative results could be helpful in discerning the endpoint of treatment, provided they are clinically correlated and consistent.