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Test Code HPWET Hematopathology Consultation, MCL Embed


Ordering Guidance


1. If requesting a peripheral blood smear evaluation only, order SPSM / Morphology Evaluation (Special Smear), Blood.

2. If requesting a hematopathology consultation on paraffin-embedded tissue and slides, order PATHC / Pathology Consultation. Also include a cover letter indicating hematopathology review requested.

3. If requesting a hematopathology consultation and only paraffin-embedded biopsy/clot samples and bone marrow aspirate are submitted, order HPCUT / Hematopathology Consultation, Client Embed.



Additional Testing Requirements


 



Shipping Instructions


Attach the green "Attention Pathology" address label (T498) to the outside of the transport container before putting into the courier mailer.



Necessary Information


The following information is required:

1. All requisitions must be labeled with:

-Patient name, date of birth, and medical record number

-Name and phone number of the referring pathologist or ordering physician

-Collection date

2. All specimens must be labeled with:

-Two patient identifiers (first and last name, date of birth, or medical record number)

-Specimen type

3. All specimens (bone marrow core biopsy, bone marrow aspirate clot, bone marrow aspirate, peripheral blood smears, and bone marrow aspirate slides), patient history, and requests must be clearly labeled with correct patient information and case number.

4. A brief history (recent clinical note is preferred), patient information, and recent complete blood cell count results (within 14 days of bone marrow specimen) are required. A complete pathology report is not expected. Hematopathology Patient Information (T676) may be used to provide patient information. Send with the specimens.

5. All pending and final reports for ancillary testing on above specimens.

 

All requisition and supporting information must be submitted in English.



Specimen Required


Multiple specimens are required to perform testing.

 

Submit each of the following (additional information below):

1. Unprocessed bone marrow core biopsy and/or clot

2. Three bone marrow biopsy touch prep slides

3. Bone marrow aspirate:

 -Fresh, unfixed, unstained slides:

  -Two direct prep

  -Three-unit prep

 -Liquid (order of collection):

  -Lavender top (EDTA): 3 mL

  -Yellow top (ACD): 6 mL

4. Two unstained peripheral blood smears (fingerstick preferred)

 

Information on collecting, packaging, and shipping specimens is available:

-Bone Marrow Core Biopsy, Clot, and Aspirate Collection Guideline

-Assistance with Bone Marrow Collection

 

Supplies: Bone Marrow Collection Kit (T793)

 

Specimen Type: Bone marrow aspirate slides

Container/Tube: Transport in plastic slide holders

Preferred: Fresh prep slides made at the time of sample collection

Acceptable: Slides made from anticoagulated sample

Collection Instructions:

1. Prepare slides of bone marrow aspirate immediately after collection or prepare slides from bone marrow aspirate in EDTA within 2 hours of collection.

2. If bone marrow units are sparse or absent or aspirate is a dry tap, make biopsy touch prep slides.

3. Make 2 good direct smears and 3 good unit preps, per unilateral collection.

4. Air dry slides.

5. Send 5 slides unfixed/unstained.

6. Place Parafilm around the slide carriers holding unstained slides to prevent exposure to formalin fumes during transport and place slides in a separate bag apart from any formalin-fixed clot or core biopsy specimens during transport. If using slide carriers, make sure they have not been used to carry fixed slides previously.

 

Specimen Type: Bone marrow aspirate in anticoagulant for possible ancillary testing

Container/Tube: Lavender top (EDTA) and yellow top (ACD)

Specimen Volume: 2 x 3 mL in EDTA and 2 x 6 mL in ACD

Collection Instructions:

1. Aspirate per standard bone marrow collection procedure.

2. Send bone marrow specimens in original tubes. Do not aliquot.

 

Specimen Type: Bone marrow clot

Container/Tube:  Bone marrow clot in 10% formalin

Collection Instructions:

1. Place 0.5 mL bone marrow aspirate in clot tube.

2. After clot has formed, place clot in 10% formalin.

3. Place Parafilm around the container to prevent exposure.

 

Specimen Type: Bone marrow core biopsy

Container/Tube: Fixed biopsy core in 10% formalin solution for transport

Collection Instructions:

1. If bone marrow units are sparse or absent or aspirate is a dry tap, make biopsy touch prep slides.

2. Place biopsy core in 10% formalin immediately after collection.

3. Fix in 10% formalin for 1 to 2 hours.

4. Place Parafilm around the 10% Formalin container to prevent exposure.

 

Specimen Type: Peripheral blood

Slides: 2

Container/Tube: Transport in plastic slide holders.

Preferred: 2 fresh prep fingerstick slides

Acceptable: 2 slides made from whole blood in EDTA, made within 8 hours of collection

Collection Instructions:

1. Prepare 2 good quality smears of even thickness from fingerstick.

2. Alternatively, prepare good quality smear from EDTA whole blood within 8 hours of collection.

3. Submit unstained and unfixed slides.

4. Place Parafilm around the slide carriers holding unstained slides to prevent exposure to formalin fumes during transport and place slides in a separate bag apart from any formalin-fixed clot or core biopsy specimens during transport. If using slide carriers, make sure they have not been used to carry fixed slides previously.


Forms

1. Hematopathology Patient Information (T676) is required.

2. If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:

-Hematopathology/Cytogenetics Test Request (T726)

-Benign Hematology Test Request (T755)

Useful For

Obtaining a rapid, expert opinion for diagnosis of hematologic and non-hematologic diseases using unprocessed bone marrow biopsy specimens referred by the primary pathologist

 

Obtaining special studies that are not available locally

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
BMAPC Bone Marrow Aspirate No, (Bill Only) No
BMBPC Bone Marrow Biopsy No, (Bill Only) No
BMCPC Bone Marrow Clot No, (Bill Only) No
DCALP Decalcification No, (Bill Only) No
PBPC Peripheral Blood No, (Bill Only) No
PBTC Peripheral Blood, TC No, (Bill Only) No
PPPC Particle Prep No, (Bill Only) No

Testing Algorithm

Laboratory approval is required prior to ordering this test. Contact Mayo Clinic Laboratories at 800-533-1710.

 

A Mayo Clinic hematopathologist will provide a full bone marrow workup that includes an evaluation of the specimen and determination of a diagnosis provided within a formal pathology report.

 

Ancillary Testing:

Based on Mayo Clinic-approved algorithms or at a staff hematopathologist's discretion, ancillary testing may be performed to assist in rendering an accurate diagnosis and provide important prognostic information. These test results (eg, cytochemical stains on bone marrow aspirate smear, immunohistochemical stains on bone marrow biopsy or clot sections, chromosome analysis, fluorescence in situ hybridization, flow cytometry, microarray, molecular and/or next-generation sequencing testing) will be reported and billed separately. While reported separately, these results will continue to be considered and referred to in the final pathology interpretation.

 

If ancillary testing (eg, flow cytometry) is desired by the client outside of this consultation, each test must be ordered separately. Tests ordered outside of the consultation may or may not be integrated into the final pathology report based on the staff hematopathologist's discretion.

 

If the volume of bone marrow aspirate is limited, prioritization of testing will be determined by the staff hematopathologist. Testing requested or suggested by the referring physician (immunostains, molecular studies, etc) may not be performed if deemed unnecessary by the reviewing staff hematopathologist.

 

Note: Calls are not routinely made; however, depending on the nature of the case, a call may be placed to the ordering provider or pathologist. These situations include, but are not limited to, a new diagnosis of acute leukemia or aggressive high-grade lymphoma. To contact a Mayo Clinic Hematopathologist, call the Hematopathology Communications team at 507-284-5600.

 

For more information see Pathology Consultation Ordering Algorithm

Reporting Name

Hematopathology Consult

Specimen Type

Varies

Specimen Stability Information

Specimen Type Temperature Time Special Container
Varies Ambient

Reference Values

An interpretive report will be provided.

Day(s) Performed

Monday through Saturday

Report Available

3 to 7 days; Cases requiring additional material or ancillary testing may require additional time.

Performing Laboratory

Mayo Clinic Laboratories in Rochester

CPT Code Information

85007 (if appropriate)

85060 (if appropriate)

85097 (if appropriate)

88305 (if appropriate)

88311 (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
HPWET Hematopathology Consult In Process

 

Result ID Test Result Name Result LOINC Value
71098 Interpretation 60570-9
71099 Participated in the Interpretation No LOINC Needed
71100 Report electronically signed by 19139-5
71101 Addendum 35265-8
71102 Gross Description 22634-0
71446 Material Received 85298-8
71103 Disclaimer 62364-5
71827 Case Number 80398-1

Test Classification

Not Applicable

Method Name

Medical Interpretation

Specimen Minimum Volume

See Specimen Required