Hematopathology Consultation, Wet Tissue
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.
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
1. Hematopathology Patient Information (T676) in Special Instructions
2. If not ordering electronically, complete, print, and send Hematopathology/Cytogenetics Test Request Form (T726) (http://www.mayomedicallaboratories.com/it-mmfiles/hematopathology-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
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 brief history and patient information is required. Please use the Hematopathology Request form.
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
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
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
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
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
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.
No specimen should be rejected.
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.