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HelpTest ID 70016 Hematopathology Consultation, Wet Tissue
Useful For
Obtaining a rapid, expert opinion on unprocessed specimens referred by the primary pathologist
Obtaining special studies not available locally
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| 82972 | Peripheral Blood Smear Examination | No | No |
| 9172 | Bone Marrow Bx | No | No |
| 9196 | Bone Marrow Aspirate | No | No |
| 61648 | HemePath, Level I, Gross Exam | No | No |
| 61649 | HemePath, Level II, Wet Tissue | No | No |
| 61661 | HemePath, Level III, Wet Tissue | No | No |
| 61662 | HemePath, Level IV, Wet Tissue | No | No |
| 61663 | HemePath, Level V, Wet Tissue | No | No |
| 61664 | HemePath, Level VI, Wet Tissue | No | No |
| 61123 | HemePath Consult, Outside Slide | No, (Bill Only) | No |
| 61124 | HemePath Consult, w/Slide Prep | No, (Bill Only) | No |
| 62373 | HemePath Consult, w/USS Prof | No, (Bill Only) | No |
| 61125 | HemePath Consult, w/Comp Rvw of His | No, (Bill Only) | No |
Testing Algorithm
This request will be processed as a consultation case. An interpretation, which includes an evaluation of the specimen and determination of a diagnosis, will be provided by staff hematopathologists within a formal pathology report to the referring pathologist.
-This test should be ordered when submitting any wet tissue or liquid specimen along with a request for a Hematopathology consultation
-This test should be used when all processing of a formalin-fixed biopsy core is to be performed by Mayo Clinic.
-This test can be used when requesting that a Mayo Hematopathologist provides full bone marrow workup, including appropriate ancillary testing, interpretation, and reporting. This could include processing of the formalin-fixed biopsy as above or use of a paraffin-embedded bone marrow biopsy block, as long as a wet tissue or liquid specimen is also submitted.
-Appropriate additional stains and other ancillary testing may be performed in order to render an accurate diagnosis. The additional stains and tests ordered will have the results included within the final pathology report and will be charged separately.
-If requesting a peripheral blood smear evaluation only, order SPSM / Morphology Evaluation (Special Smear).
-If requesting a Hematopathology consultation on paraffin-embedded tissue and slides only, order 70012 / Pathology Consultation.
-If requesting stand-alone specific testing, please refer to the MML catalog for order codes.
-Flow cytometry on blood or bone marrow order LCMS / Leukemia/Lymphoma Immunophenotyping by Flow Cytometry
-Flow cytometry for tissue order LLPT / Leukemia/Lymphoma Immunophenotyping by Flow Cytometry, Tissue
-Chromosome analysis, order CHRBM / Chromosome Analysis, Hematologic Disorders, Bone Marrow
Note: Testing requested by the referring physician (immunostains, molecular studies, etc) may not be performed if deemed unnecessary by the reviewing Mayo Hematopathologist. For all pathology consultations, ancillary testing necessary to determine a diagnosis is ordered at the discretion of the Mayo pathologist.
See Pathology Consultation Ordering Algorithm in Special Instructions.
Special Instructions
Reporting Name
HemePath Consultation, Wet TissueSpecimen Type
Varies
Forms:
1. Hematopathology Patient Information Sheet (T676) in Special Instructions
2. If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:
Hematopathology/Cytogenetics Test Request Form (T726) (http://www.mayomedicallaboratories.com/it-mmfiles/hematopathology-request-form.pdf)
Benign Hematology Test Request Form (T755) (http://www.mayomedicallaboratories.com/it-mmfiles/benign-hematology-test-request-form.pdf)
Specimens needed to provide a complete pathology consultation:
1. Recent peripheral blood smear with CBC report
2. Bone marrow biopsy and clot (unprocessed)
3. Bone marrow aspirate (stained and unstained slides, and liquid)
4. All pending and finalized reports for ancillary testing on above specimens
Additional Information:
All specimens, patient history, and requests should be clearly labeled with correct patient information, and case number. Collection date and patient date of birth are required. All specimens must be labeled with specimen type. Although a complete pathology report is not expected, a preliminary pathology report is required in order to ensure that the specimen is known to a referring pathologist. The name and phone number of the ordering pathologist and a brief history are essential to achieve a consultation fully relevant to the ordering physician's needs.
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. Air dry slides.
4. Send 5 slides unfixed/unstained.
5. 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: EDTA, heparin, or ACD
Specimen Volume: 5 mL in EDTA, 2-5 mL in ACD, or 2-3 mL in heparin tube
Collection Instructions:
1. Aspirate per standard bone marrow collection procedure.
2. Do not transfer to other tubes or containers.
Specimen Type: Bone marrow core biopsy
Container/Tube: Fixed biopsy core in saline solution for transport or fixed biopsy core embedded in paraffin block
Collection Instructions:
1. Process and embed core in paraffin if desired.
2. If processing at Mayo is desired, place biopsy core in 10% formalin immediately after collection.
3. Fix in 10% formalin for 1 to 2 hours.
4. Transfer core to container with saline, volume sufficient to cover core.
Specimen Type: Bone marrow aspirate clot
Container/Tube: Bone marrow clot in 10% formalin or fixed clot embedded in paraffin block
Collection Instructions:
1. Place 0.5 mL bone marrow aspirate in clot tube.
2. After clot has formed, place clot in 10% formalin.
3. If embedding in paraffin, fix specimen, process and embed per your standard operating procedures.
4. If submitting to Mayo for possible processing and embedding, submit in container of 10% formalin.
Specimen Type: Peripheral blood slides and CBC
Container/Tube: Transport in plastic slide holders.
Preferred: Fresh prep fingerstick slide; include CBC values
Acceptable: Slides made from whole blood in EDTA, made within 8 hours of collection
Collection Instructions:
1. Prepare good quality smear of even thickness from fingerstick.
2. Alternately prepare good quality smear from EDTA vial within 8 hours of collection.
3. Submit unstained and unfixed slides.
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Varies | Ambient (preferred) | |
| Refrigerated | ||
Clinical Information
Diagnostic hematopathology has become an increasingly complex subspecialty, particularly with neoplastic disorders of blood and bone marrow. The clinical, therapeutic, and prognostic features of these disorders are often distinctive, while the pathologic features are quite subtle, requiring the application of ancillary studies (eg, cytochemistry, immunohistochemistry, flow cytometric immunophenotyping, cytogenetics, and molecular genetics) to establish a diagnosis. Furthermore, these ancillary studies are expensive, labor intensive, and are most efficiently utilized and interpreted in the context of the morphologic features.
It is the Division of Hematopathology's goal to provide the highest possible level of diagnostic consultative service, trying to balance optimal patient care with a cost-conscious approach to solving difficult diagnostic problems.
All blood and bone marrow studies are available within the context of a hematopathology consultation. If requesting a full bone marrow workup, the Mayo consultant will approach the diagnosis in a way consistent with Mayo Clinic practice. The Mayo Hematopathologist may call the referring physician/pathologist to discuss the case prior to performing any additional studies. Referring physicians are welcome to suggest which specific ancillary studies should be performed, but before they are done, a morphologic review by one of the Mayo consulting staff hematopathologists will confirm the diagnostic problem presented by the morphologic differential diagnosis.
Reference Values
The laboratory will provide a pathology consultation.
Cautions
Appropriate stained and unstained slides and tissue sampling/fixation are required in order to make a diagnosis on routine stains, and on which special stains or studies may be required. The referring pathologist's name and phone number are essential. Specific diagnosis may require correlation with clinical information.
Day(s) Performed
Monday through Friday; Varies
Report Available
3 daysPerforming Laboratory
Mayo Medical Laboratories in Rochester
CPT Code Information
85007-Blood smear, microscopic examination with manual differential WBC count (if appropriate)
85060-Blood smear, peripheral, interpretation by physician with written report (if appropriate)
85097-Bone marrow, smear interpretation (if appropriate)
88300-Level I-surgical pathology, gross examination only (if appropriate)
88302-Level II-surgical pathology, gross and microscopic examination (if appropriate)
88304-Level III-surgical pathology, gross and microscopic examination (if appropriate)
88305-Level IV–surgical pathology, gross and microscopic examination (if appropriate)
88307-Level V–surgical pathology, gross and microscopic examination (if appropriate)
88309-Level VI–surgical pathology, gross and microscopic examination (if appropriate)
88311-Decalcification (if appropriate)
88321-Consultation and report on referred slides prepared elsewhere (if appropriate)
88323-Consultation and report on referred material requiring preparation of slides (if appropriate)
88325-Consultation, comprehensive, with review of records and specimens, with report on referred material (if appropriate)