Test Catalog

Test Id : HPWET

Hematopathology Consultation, MCL Embed

Useful For
Suggests clinical disorders or settings where the test may be helpful

Obtaining a rapid, expert opinion for diagnosis of hematologic and non-hematologic diseases using unprocessed bone marrow biopsy specimens referred by the primary pathologist

 

Obtaining special studies that are not available locally

Highlights

If a bone marrow pathology consultation is requested, the Mayo Clinic hematopathologists approach the diagnosis in the same way as Mayo Clinic's own in-house cases.

 

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.

Reflex Tests
Lists tests that may or may not be performed, at an additional charge, depending on the result and interpretation of the initial tests.

Test Id Reporting Name Available Separately Always Performed
BMAPC Bone Marrow Aspirate No, (Bill Only) No
BMBPC Bone Marrow Biopsy No, (Bill Only) No
BMCPC Bone Marrow Clot No, (Bill Only) No
DCALP Decalcification No, (Bill Only) No
PBPC Peripheral Blood No, (Bill Only) No
PBTC Peripheral Blood, TC No, (Bill Only) No
PPPC Particle Prep No, (Bill Only) No

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

Laboratory approval is required prior to ordering this test. Contact Mayo Clinic Laboratories at 800-533-1710.

 

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 at a staff hematopathologist's discretion, ancillary testing may be performed to assist in rendering an accurate diagnosis and provide important prognostic information. These test results (eg, cytochemical stains on bone marrow aspirate smear, immunohistochemical stains on bone marrow biopsy or clot sections, chromosome analysis, fluorescence in situ hybridization [FISH], flow cytometry, microarray, molecular and/or next-generation sequencing [NGS] testing) will be reported and billed separately. While reported separately, these results will continue to be considered and referred to in the pathology final interpretation.

 

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 the 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 tech at 507-284-5600.

 

See Pathology Consultation Ordering Algorithm

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Method Name
A short description of the method used to perform the test

Medical Interpretation

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Hematopathology Consult

Aliases
Lists additional common names for a test, as an aid in searching

Acute leukemia consultation

Acute lymphocytic leukemia-differentiate T from non-T cell forms

Bone Marrow Consultation

Cytochemical

Hematology Consultation

HPWET

PATHC

Pathology Consultation

Surgical Pathology Consultation, Slides or Blocks

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

Laboratory approval is required prior to ordering this test. Contact Mayo Clinic Laboratories at 800-533-1710.

 

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 at a staff hematopathologist's discretion, ancillary testing may be performed to assist in rendering an accurate diagnosis and provide important prognostic information. These test results (eg, cytochemical stains on bone marrow aspirate smear, immunohistochemical stains on bone marrow biopsy or clot sections, chromosome analysis, fluorescence in situ hybridization [FISH], flow cytometry, microarray, molecular and/or next-generation sequencing [NGS] testing) will be reported and billed separately. While reported separately, these results will continue to be considered and referred to in the pathology final interpretation.

 

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 the 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 tech at 507-284-5600.

 

See Pathology Consultation Ordering Algorithm

Specimen Type
Describes the specimen type validated for testing

Varies

Ordering Guidance

Prior laboratory approval is required to order this test. Contact Mayo Clinic Laboratories at 800-533-1710.

 

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

2. If requesting a hematopathology consultation on paraffin-embedded tissue and slides, order PATHC / Pathology Consultation. Also include a cover letter indicating hematopathology review requested.

3. If requesting a hematopathology consultation and only paraffin-embedded biopsy/clot samples and bone marrow aspirate are submitted, order HPCUT / Hematopathology Consultation, Client 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. A brief history (recent clinical note is preferred), patient information, and recent complete blood cell count results (within 14 days of bone marrow specimen) are required. 

4. A complete pathology report is not expected. See Hematopathology Patient Information (T676) to provide patient information.

5. All specimens must be labeled with specimen type.

6. All specimens (bone marrow core biopsy, bone marrow aspirate clot, bone marrow aspirate, peripheral blood smears, and bone marrow aspirate slides), patient history, and requests should be clearly labeled with correct patient information and case number.

7. All pending and final reports for ancillary testing on above specimens.

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Multiple specimens are required to perform testing.

 

Submit each of the following (additional information below):

1. Unprocessed bone marrow core biopsy and/or clot

2. Three bone marrow biopsy touch prep slides

3. Bone marrow aspirate

-Fresh, unfixed, unstained slides:

--Two direct prep

--Three unit prep

-Liquid (order of collection):

--Lavender top (EDTA): 3 mL

--Yellow top (ACD): 6 mL

4. Two unstained peripheral blood smears (fingerstick preferred)

 

Information on collecting, packaging, and shipping specimens is available:

-Bone Marrow Core Biopsy, Clot, and Aspirate Collection Guideline

-Assistance with Bone Marrow Collection

 

Supplies: Bone Marrow Collection Kit (T793)

 

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. Make 2 good direct smears and 3 good unit preps, per unilateral collection.

4. Air dry slides.

5. Send 5 slides unfixed/unstained.

6. 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: Lavender top (EDTA) and yellow top (ACD)

Specimen Volume: 2 x 3 mL in EDTA and 2 x 6 mL in ACD

Collection Instructions:

1. Aspirate per standard bone marrow collection procedure.

2. Send specimens in original tubes. Do not transfer to other tubes or containers.

 

Specimen Type: Bone marrow clot

Container/Tube:  Bone marrow clot in 10% formalin

Collection Instructions:

1. Place 0.5 mL bone marrow aspirate in clot tube.

2. After clot has formed, place clot in 10% formalin.

3. Place Parafilm around the container to prevent exposure.

 

Specimen Type: Bone marrow core biopsy

Container/Tube: Fixed biopsy core in 10% formalin solution for transport

Collection Instructions:

1. If bone marrow units are sparse or absent or aspirate is a dry tap, make biopsy touch prep slides.

2. Place biopsy core in 10% formalin immediately after collection.

3. Fix in 10% formalin for 1 to 2 hours.

4. Place Parafilm around the 10% Formalin container to prevent exposure.

 

Specimen Type: Peripheral blood

Slides: 2

Container/Tube: Transport in plastic slide holders.

Preferred: 2 fresh prep fingerstick slides

Acceptable: 2 slides made from whole blood in EDTA, made within 8 hours of collection

Collection Instructions:

1. Prepare 2 good quality smears of even thickness from fingerstick.

2. Alternatively, prepare good quality smear from EDTA whole blood within 8 hours of collection.

3. Submit unstained and unfixed slides.

4. 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.

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Forms

1. Hematopathology Patient Information (T676) is required.

2. If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:

-Hematopathology/Cytogenetics Test Request (T726)

-Benign Hematology Test Request (T755)

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

See Specimen Required

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

No specimen should be rejected.

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Varies Ambient (preferred)

Useful For
Suggests clinical disorders or settings where the test may be helpful

Obtaining a rapid, expert opinion for diagnosis of hematologic and non-hematologic diseases using unprocessed bone marrow biopsy specimens referred by the primary pathologist

 

Obtaining special studies that are not available locally

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

Laboratory approval is required prior to ordering this test. Contact Mayo Clinic Laboratories at 800-533-1710.

 

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 at a staff hematopathologist's discretion, ancillary testing may be performed to assist in rendering an accurate diagnosis and provide important prognostic information. These test results (eg, cytochemical stains on bone marrow aspirate smear, immunohistochemical stains on bone marrow biopsy or clot sections, chromosome analysis, fluorescence in situ hybridization [FISH], flow cytometry, microarray, molecular and/or next-generation sequencing [NGS] testing) will be reported and billed separately. While reported separately, these results will continue to be considered and referred to in the pathology final interpretation.

 

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 the 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 tech at 507-284-5600.

 

See Pathology Consultation Ordering Algorithm

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

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, and fluorescence in situ hybridization [FISH] and molecular testing) 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 assist in rendering an accurate diagnosis and could also provide prognostic prediction and potential indication or guidance of therapy.

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.

An interpretive report will be provided.

Interpretation
Provides information to assist in interpretation of the test results

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. 

 

This consultative practice strives 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.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

All appropriate stained/unstained slides, biopsy tissue and aspirate are required in order to make a diagnosis. The referring pathologist's and clinician's name and phone numbers are essential. Specific diagnosis may require correlation with clinical information; this information must be sent with the specimen.

Clinical Reference
Recommendations for in-depth reading of a clinical nature

Sundaram S, Jizzini M, Lamonica D, et al: Utility of bone marrow aspirate and biopsy in staging of patients with T-cell lymphoma in the PET-Era-tissue remains the issue. ,Leuk Lymphoma. 2020 Dec;61(13)3226-3233. doi10.1080/10428194.2020.1798950

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Method Description
Describes how the test is performed and provides a method-specific reference

All requests will be processed as a consultation case. Ancillary testing will be performed as appropriate to be diagnostically indicated and at an additional charge.

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Saturday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

3 to 7 days; Cases requiring additional material or ancillary testing may require additional time.

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

Specimens embedded by Mayo Clinic will be returned to the client when testing is complete. Slides prepared at Mayo Clinic: Indefinitely. Bone Marrow aspirate: 2 weeks

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their Regional Manager. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

Not Applicable

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 Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

85007 (if appropriate)

85060 (if appropriate)

85097 (if appropriate)

88305 (if appropriate)

88311 (if appropriate)

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
HPWET Hematopathology Consult In Process
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
71098 Interpretation 60570-9
71099 Participated in the Interpretation No LOINC Needed
71100 Report electronically signed by 19139-5
71101 Addendum 35265-8
71102 Gross Description 22634-0
71446 Material Received 85298-8
71103 Disclaimer 62364-5
71827 Case Number 80398-1

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Create a PDF

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports