Test ID: HAEVP
Hemolytic Anemia Evaluation
NY State Approved 
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Evaluation of hemolytic anemias of obscure cause
Profile Information A profile is a group of laboratory tests that are ordered and performed together under a single Mayo Test ID. Profile information lists the test performed, inclusive of the test fee, when a profile is ordered and includes reporting names and individual availability.
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| HAEV | Hemolytic Anemia Interpretation | Yes | Yes |
| A2F | Hemoglobin A2 and F | Yes | Yes |
| HBEL | Hemoglobin Electrophoresis, B | No | Yes |
| UNHB | Hemoglobin, Unstable, B | Yes | Yes |
| FRAGO | Osmotic Fragility | No | Yes |
| SCTRL | Sex of Control Vial | No | Yes |
| G6PD | G-6-PD, QN, RBC | Yes | Yes |
| PK | Pyruvate Kinase, RBC | Yes | Yes |
| GPI | Glucose Phosphate Isomerase, B | Yes | Yes |
| HEXK | Hexokinase, B | No | Yes |
| PBSM | Morphology Review | No | Yes |
Reflex Tests Lists test(s) that may or may not be performed, at an additional charge, depending on the result and interpretation of the initial test(s)
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| GLTI | Glutathione, B | No | No |
| HPFH | Hemoglobin F, Red Cell Distrib, B | Yes | No |
| SDEX | Hemoglobin S, Scrn, B | Yes | No |
| IEF | IEF Confirms | No | No |
| BND3 | Band 3 Fluorescence Staining, RBC | No | No |
| MASS | Hb Variant by Mass Spec, B | No | No |
| RBCE | Reflexed RBC Enzymes | No | No |
| HGBMO | HGB Electrophoresis, Molecular | No | No |
Testing Algorithm Delineates situation(s) when tests are added to the initial order. This includes reflex and additional tests.
This is a consultative evaluation in which the case will be evaluated at Mayo Medical Laboratories, the appropriate tests performed at an additional charge, and the results interpreted.
Note: RBCE/23544 Reflexed RBC Enzymes, Blood includes: adenosine deaminase, adenylate kinase, phosphofructokinase, phosphoglycerate kinase, triosephosphate isomerase, and pyrimidine 5' nucleotidase.
Special Instructions and Forms Describes specimen collection and preparation information, test algorithms, and other information pertinent to test. Also includes pertinent information and consent forms to be used when requesting a particular test
Method Name A short description of the method used to perform the test
HAVE/9992: Consultative Interpretation
A2F/83341: Cation Exchange/High-Performance Liquid Chromatography (HPLC)
HBEL/81428: Capillary Electrophoresis
UNHB/9095: Isopropanol Stability
FRAG/9064: Osmotic Lysis
G6PD/8368, PK/8659, GPI/9158, HEXK/2630, RBCE/23544, GLTI/2635: Kinetic Spectrophotometry (KS)
PBSM/13082: Consultant Review
SDEX/9180: Hemoglobin S Solubility
HPFH/8270, BND3/83141: Flow Cytometry
MASS/60286: Mass Spectrometry (MS)
IEF/81644: Electrophoresis
HGBMO/29374: Polymerase Chain Reaction (PCR) Analysis/Multiplex Ligation-Dependent Probe Amplification (MLPA), Polymerase Chain Reaction (PCR)/DNA Sequencing
(PCR is utilized pursuant to a license agreement with Roche Molecular Systems, Inc.)
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
Specimen Type Describes the specimen type needed for testing
Whole blood
Whole Blood EDTA
Whole Blood Slide
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.
See Recommendations for Collection of Control Specimens for FRAG, HSEP, and HAEVP in Special Instructions.
Specimens must arrive within 96 hours of draw and on Monday through Friday only.
Two whole blood EDTA specimens and 2 whole blood ACD specimens in addition to an EDTA control specimen are required. Include 2 well-made peripheral blood smears, Wright stained or fixed in absolute methanol.
Patient:
Container/Tube: Lavender top (EDTA) and yellow top (ACD [solution B])
Specimen Volume:
EDTA: Two 5-mL vials
ACD (solution B): Two 6-mL vials
Slides: Two peripheral blood smears, Wright stained or fixed in absolute methanol
Collection Instructions:
1. Immediately refrigerate specimens after draw.
2. Do not transfer blood to other containers.
3. Prepare smears.
4. Rubber band patient specimen and control vial together.
Additional Information:
1. Patient's age and sex are required.
2. For information on thalassemias and appropriate test ordering, see Thalassemia Tests in Special Instructions.
Forms:
1. New York Clients-Informed consent is required. Please document on the request form or electronic order that a copy is on file. An Informed Consent for Genetic Testing (Supply T576) is available in Special Instructions.
2. Thalassemia/Hemoglobinopathy Information Sheet (Supply T358) is available in Special Instructions
3. If not ordering electronically, please submit a Hematopathology/Molecular Oncology Request Form (Supply T241) with the specimen.
Normal Control:
Container/Tube: Lavender top (EDTA)
Specimen Volume: 5-mL
Collection Instructions:
1. Draw a control specimen at the same time from a normal, unrelated, non-smoking individual.
2. Clearly write normal control on outermost label and also indicate sex of control on the same label.
3. Immediately refrigerate specimens after draw.
4. Do not transfer blood to other containers.
5. Rubber band control vial and patient specimen together.
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | Mild OK; Gross reject |
| Lipemia | NA |
| Icterus | NA |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Control | Refrigerated | 4 days |
| Whole blood | Refrigerated | 4 days |
| Whole Blood EDTA | Refrigerated | 4 days |
| Whole Blood Slide | Refrigerated | |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Hemolytic anemia (HA) is characterized by increased red cell destruction and a decreased red cell life span. Patients have decreased hemoglobin concentration, hematocrit, and red blood cell count. Blood smear abnormalities may include spherocytes, acanthocytes, schistocytes, stomatocytes, polychromasia, and target cells. Osmotic fragility also is increased due to the presence of spherocytes.
HAs may be congenital or acquired. Inherited hemolytic disorders may include red cell membrane fragmentation, red cell enzyme defects, or abnormal structure of the hemoglobin molecule in the red cell. Examples of congenital HA include spherocytic HA and glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, which may be intermittent, often brought on by certain drugs, fava bean ingestion, or infections. Some hemoglobinopathies also may demonstrate a hemolytic process. Examples of acquired HA include: autoimmune HA, direct Coombs-positive HA, disseminated intravascular coagulation, and drug-induced HA.
This consultative evaluation looks for the cause of increased red cell destruction and includes testing for hereditary spherocytosis, hemoglobinopathies, and red cell metabolism abnormalities.
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.
Definitive results and an interpretive report will be provided.
Interpretation Provides information to assist in interpretation of the test results
An interpretive report will be provided.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Preliminary screening tests, such as complete blood count with peripheral smear and direct Coombs test, should be run before ordering this evaluation.
This group of tests should not ordinarily be requested in patients who are likely to have immune hemolytic anemia (HA), such as that due to either warm or cold antibodies or to paroxysmal nocturnal hemoglobinurias. Coombs tests, tests for cold agglutinins, sucrose hemolysis, and Hams and Crosby tests are not part of the HA evaluation. In general, the foregoing tests should have been done prior to requesting a HA evaluation. Since Wilson disease is another rare cause for acute intermittent hemolysis, testing for Wilson disease also may be appropriate prior to requesting HA evaluation.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Beutler E: Glucose-6-phosphate dehydrogenase deficiency and other enzyme abnormalities. In Hematology. Fifth edition. Edited by E Beutler, MA Lichtman, BS Coller, TJ Kipps. New York, McGraw-Hill Book Company, 1995, pp 564-581
2. Hoyer JD, Hoffman DR: The thalassemia and hemoglobinopathy syndromes. In Clinical Laboratory Medicine. Second edition. Edited by KD McMlatchey. Philadelphia, Lippincott, Williams and Wilkins, 2002, pp 866-895
Method Description Describes how the test is performed and provides a method-specific reference
A hematopathologist who is an expert in these disorders evaluates the case, appropriate tests are run, and an interpretive report is issued.
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday through Friday; Varies
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
Hemolytic Anemia Evaluation
82657-Hexokinase, B
82955-G-6-PD
83020-Hemoglobin electrophoresis
83021-Hemoglobin A2 and F
83068-Hemoglobin stability
84087-Glucose phosphate isomerase
84220-Pyruvate kinase
85060-Morphology review
85557-Osmotic fragility
Reflexed RBC Enzymes
82657 (if appropriate)
Glutathione, Blood
82978 (if appropriate)
Hemoglobin Variant by Mass Spectrometry (MS), Blood
83789 (if appropriate)
Hemoglobin Electrophoresis, Molecular
81257-HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, Alpha thalassemia, Hb Bart hydrops fetalis syndrome, HBH disease) gene analysis for common deletions or variant (eg, Southeast Asian, Thai, Filipino, Mediterranean, alpha3.7, alpha4.2, alpha20.5, and Constant Spring) (if appropriate)
81401-HBB (hemoglobin, beta) (eg, sickle cell anemia, hemoglobin C, hemoglobin E), common variants (eg, HbS, HbC, HbE) (if appropriate)
81403-HBB (hemoglobin, beta, beta-globin) (eg, beta thalassemia), duplication/deletion analysis (if appropriate)
Hemoglobin S, Screen, Blood
85660 (if appropriate)
Hemoglobin F, Red Cell Distribution, Blood
88184 (if appropriate)
Band 3 Fluorescence Staining, RBC
88184 (if appropriate)
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| HEXK_ | Hexokinase, B | 49216-5 |
| PK_ | Pyruvate Kinase, RBC | 32552-2 |
| 9095 | Hemoglobin, Unstable, B | 4639-1 |
| 9064 | Osmotic Fragility, RBC | 34964-7 |
| G6PD_ | G-6-PD, QN, RBC | 32546-4 |
| GPI_ | Glucose Phosphate Isomerase, B | 44050-3 |
| 2380 | Hemoglobin A | 20572-4 |
| 13082 | Morphology Review | In Process |
| 2381 | Hemoglobin A2 | 4551-8 |
| SCTRL | Sex of Control Vial | N/A |
| 9992 | Hemolytic Anemia Interpretation | 59466-3 |
| 2382 | Hemoglobin F | 4576-5 |
| 2383 | Variant | 32017-6 |
| 3306 | Osmotic Fragility, 0.50 g/dL NaCl | 23915-2 |
| 3307 | Osmotic Fragility, 0.60 g/dL NaCl | 23917-8 |
| 29224 | Variant 2 | In Process |
| 29225 | Variant 3 | In Process |
| 3308 | Osmotic Fragility, 0.65 g/dL NaCl | 23919-4 |
| 3309 | Osmotic Fragility, 0.75 g/dL NaCl | 30543-3 |
| 2101 | Interpretation | 49316-3 |
| 3310 | Osmotic Fragility Comment | In Process |
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