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Test Code HPCUT Hematopathology Consultation, Client Embed


Advisory Information


1. If requesting a peripheral blood smear evaluation only, order SPSMS / Morphology Evaluation (Special Smear).

2. If requesting a Hematopathology consultation and only paraffin-embedded biopsy/clot samples (ie, no bone marrow aspirate), order PATHC / Pathology Consultation.

3. If requesting a Hematopathology consultation using biopsy or clot samples for embedding and bone marrow aspirate, order HPWET / Hematopathology Consultation, MML Embed.



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 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:

 

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, and ACD

Specimen Volume: 5 mL in EDTA, 2-5 mL in ACD, and 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 embedded in paraffin block

Collection Instructions: Process and embed core in paraffin.

 

Specimen Type: Bone marrow aspirate clot

Container/Tube: Bone marrow clot embedded in paraffin block

Collection Instructions: Process and embed clot in paraffin

 

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.


Forms

1. Hematopathology Patient Information (T676) in Special Instructions

2. If not ordering electronically, complete, print, and send a Hematopathology/Cytogenetics Test Request Form (T726) with the specimen (http://www.mayomedicallaboratories.com/it-mmfiles/hematopathology-request-form.pdf)

Secondary ID

71743

Useful For

Obtaining a rapid, expert opinion on specimens referred by the primary pathologist

 

Obtaining special studies not available locally

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
COSPC Consult, Outside Slide No, Bill Only No
CSPPC Consult, w/Slide Prep No, Bill Only No
CUPPC Consult, w/USS Prof No, Bill Only No
CRHPC Consult, w/Comp Rvw of His 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 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 reported and billed separately. While reported separately, these results will continue to be considered and referred to in the Pathology final interpretation.  

-Tier 1 testing: such as cytochemical stains on bone marrow aspirate smear, immunohistochemical stains on bone marrow biopsy or clot sections, chromosome analysis, FISH, flow cytometry, 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 with the 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 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 team at 507-284-5600.

 

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.

 

See Pathology Consultation Ordering Algorithm in Special Instructions.

Reporting Name

Hematopathology Consult

Specimen Type

Varies

Specimen Stability Information

Specimen Type Temperature Time
Varies Ambient

Reject Due To

No specimen should be rejected. Any tissue specimen will be sent to Hemepath to assess and determine next steps.

Paraffin-embedded biopsy/clot samples without bone marrow aspirate. Call the client and change the order to PATHC / Pathology Consultation.

Biopsy/clot samples needing embedding. Call the client and change the order to HPWET / Hematopathology Consultation, MML Embed.

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 not only assist to render accurate diagnosis, but also could provide prognostic prediction and potential indication or guidance of therapy.

 

It is the Division of Hematopathology's mission 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 for all patients. If a bone marrow consult is requested, the Mayo Clinic hematopathologists will approach the diagnosis in the same way as Mayo Clinic's own in-house cases.

Reference Values

The laboratory will provide a pathology consultation.

Interpretation

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 physician and patient 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.

Day(s) and Time(s) Performed

Monday through Sunday

Reporting Monday through Friday; Varies

Analytic Time

3 days (additional time may be required for ancillary test results)

Performing Laboratory

Mayo Medical Laboratories in Rochester

CPT Code Information

88321 (if appropriate)

88323 (if appropriate)

88325 (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
HPCUT Hematopathology Consult In Process

 

Result ID Test Result Name Result LOINC Value
71744 Interpretation In Process
71745 Participated in Interprtation In Process
71746 Report electronically signed by In Process
71747 Addendum In Process
71748 Gross Description In Process
71749 Material Received In Process
71750 Disclaimer 62364-5
71833 Case Number In Process