Hematopathology Consultation, Wet Tissue
Obtaining a rapid, expert opinion on unprocessed specimens referred by the primary pathologist
Obtaining special studies not available locally
Testing Algorithm Delineates situation(s) when tests are added to the initial order. This includes reflex and additional tests.
A Mayo Clinic hematopathologist will provide a full bone marrow workup which includes an evaluation of the specimen and determination of a diagnosis provided within a formal pathology report.
When a consultation is requested, the client is responsible for submitting the following specimens:
1. Wet (fresh) core biopsy and/or bone marrow aspirate clot submitted in formalin
2. Bone marrow aspirate samples collected in:
a. Lavender top (EDTA): molecular testing
b. Yellow top (ACD): flow cytometric testing
c. Green top (sodium heparin): chromosome analysis and FISH testing
3. Slides prepared from bone marrow and peripheral blood
Based on Mayo Clinic-approved algorithms and/or a staff hematopathologists' discretion, ancillary testing may be performed in order to render an accurate diagnosis and provide important prognostic information. These test results will be incorporated into the consultative report and will be billed and reported separately.
-Tier 1 Testing: eg, cytochemical stains on bone marrow aspirate smear, immunohistochemical stains on bone marrow biopsy or clot sections, chromosome analysis, FISH, flow cytometry and/or molecular testing will be added as appropriate. Results will be incorporated into the pathology report, as well as, some separate standalone results may be released. All will be charged.
-Tier 2 Testing: eg, Next Generation Sequencing (NGS) or microarray testing will only be added upon approval of the ordering physician/pathologist (client).
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 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/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, please call the Hematopathology Communications team, 507-284-5600.
If a client chooses to embed the clot/biopsy, the bone marrow aspirate specimens (tubes) should be sent in the same package as the bone marrow biopsy/clot sections. Embedding at the client site may delay specimen arrival at Mayo Medical Laboratories and preclude the ability to perform some ancillary testing due to specimen stability.
If a consultation is requested and only formalin-fixed, paraffin-embedded (FFPE) samples will be submitted, please order 70012 / Pathology Consultation.
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
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 Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
The laboratory will provide a pathology consultation.
Results of the consultation are reported in a formal pathology report that includes a description of ancillary test results (if applicable) and an interpretive comment. When the case is completed, results may be communicated by a phone call. The formal pathology report is faxed.
In our consultative practice, we strive to bring the customer the highest quality of diagnostic pathology, in all areas of expertise, aiming to utilize only those ancillary tests that support the diagnosis in a cost-effective manner, and to provide a rapid turnaround time for diagnostic results.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
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.