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Test Code HPWET Hematopathology Consultation, MCL Embed


Advisory Information


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


 



Necessary Information


1. Collection date and patient date of birth are required.

2. The referring pathologist's and clinician's name and phone numbers are required.

3. All specimens must be labeled with specimen type.

4. All specimens, patient history, and requests should be clearly labeled with correct patient information, and case number.

5. Although a complete pathology report is not expected, a brief history and patient information is required. Use the Hematopathology Patient Information (T676) in Special Instructions.



Specimen Required


Information on collecting, packaging, and shipping specimens, is available in Special Instructions:

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

-Assistance with Bone Marrow Collection  

 

Submit the following specimens:

 

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), green top (heparin), and yellow top (ACD)

Specimen Volume: 3 mL in EDTA, 3 mL in heparin, and 4 mL in ACD

Collection Instructions:

1. Aspirate per standard bone marrow collection procedure.

2. Send specimens in original tubes. Do not transfer to other tubes or containers.

 

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, see Special Instructions

2. If not ordering electronically, complete, print, and send a Hematopathology/Cytogenetics Test Request (T726) with the specimen.

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
PBPC Peripheral Blood No, (Bill Only) No
PPPC Particle Prep No, (Bill Only) No
PBTC Peripheral Blood, TC No, (Bill Only) No
DCALP Decalcification No, (Bill Only) No
BMBPC Bone Marrow Biopsy No, (Bill Only) No

Testing Algorithm

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: FISH, flow cytometry, microarray, molecular and/or next-generation sequencing (NGS) testing) will be reported and billed separately. While reported separately, these results will continue to be considered and referred to in the pathology final 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 tech at 507-284-5600.

 

See Pathology Consultation Ordering Algorithm in Special Instructions.

Reporting Name

Hematopathology Consult

Specimen Type

Varies

Specimen Stability Information

Specimen Type Temperature Time Special Container
Varies Ambient

Reject Due To

No specimen should be rejected.

Clinical Information

Diagnosis of a hematologic disease requires thorough and accurate morphologic examination of peripheral blood, bone marrow and interpretation of ancillary testing results (eg, cytochemistry, immunohistochemistry, flow cytometric immunophenotyping, chromosome analysis, FISH testing, and molecular genetics) by a highly qualified hematopathologist. With recent advent of new understanding and more treatment options, more ancillary tests are available. Efficient utilization and accurate interpretation of these tests are crucial in patient care. These tests can assist in rendering an accurate diagnosis and could also provide prognostic prediction and potential indication or guidance of therapy.

Reference Values

An interpretive report will be provided.

Day(s) and Time(s) Performed

Monday through Saturday

Reporting Monday through Friday; Varies

Analytic Time

3 days from arrival date. Note: Cases requiring additional material and/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

NY State Approved

Yes

Test Classification

Not Applicable