Ordering Guidance

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

2. If requesting a hematopathology consultation and only paraffin-embedded biopsy/clot samples (ie, no tubes of liquid bone marrow aspirate), order PATHC / Pathology Consultation. Also include a cover letter indicating hematopathology review requested.

3. If requesting a hematopathology consultation using biopsy or clot samples for embedding and processing at Mayo Clinic Laboratories (MCL) and tubes of liquid bone marrow aspirate, order HPWET / Hematopathology Consultation, MCL Embed. Orders for HPWET require MCL prior authorization and use of an MCL-provided kit (Bone Marrow Collection Kit, T793).

Shipping Instructions

Attach the green "Attention Pathology" address label (T498) to the outside of the transport container before putting into the courier mailer.

Necessary Information

All requisition and supporting information must be submitted in English.

Each of the following items are required:

1. All requisitions must be labeled with:

-Patient name, date of birth, medical record number, and either case number or pathology ID

-Name and phone number of the referring pathologist or ordering provider

-Collection date

2. Including a preliminary pathology report ensures appropriate identification and provides a gross description. Hematopathology Patient Information (T676) may be used to provide patient information; print and submit with the case.

3. A recent Hematology/Oncology clinical note; print and submit with the case

4. Complete blood cell count (CBC) results from testing performed within 14 days of bone marrow collection.

5. Indicate clinical reason/context

6. All pending and final reports for ancillary testing on submitted specimens.

Specimen Required

All specimens are required to perform testing.

Additional Information:

All specimens and paperwork must be labeled with:

-Two patient identifiers (patient name, date of birth, medical record number, case number, or pathology ID

-Specimen type

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

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

-Assistance with Bone Marrow Collection

Specimen Type: Bone marrow aspirate

Slides: 5

Preferred: Freshly prepared slides made at the time of specimen collection

Acceptable: Slides made from EDTA bone marrow specimen, within 2 hours of collection

Submission Container/Tube: Plastic slide holder

Collection Instructions:

1. Prepare slides of bone marrow aspirate.

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

3. Air dry slides. Do not place on hot plate to dry.

4. Place Parafilm around the slide carriers holding unstained slides to prevent exposure to formalin fumes during transport. Place slides in a separate bag apart from any formalin-fixed clot or core biopsy specimens. If using slide carriers, make sure they have not been used to carry fixed slides previously.

Specimen Type: Bone marrow aspirate

Container/Tube: Lavender top (EDTA) and yellow top (ACD solution A or B)

Specimen Volume: 2 x 3 mL in EDTA and 2 x 6 mL in ACD solution A or B

Collection Instructions:

1. Aspirate per standard bone marrow collection procedure.

2. Send bone marrow specimens in original tubes. Do not aliquot.

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: Bone marrow core biopsy

Container/Tube: Fixed biopsy core embedded in paraffin block

Collection Instructions: Process and embed core in paraffin.

Specimen Type: Blood

Slides: 2

Preferred: 2 Freshly prepared fingerstick slides

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

Submission Container/Tube: Plastic slide holder

Collection Instructions:

1. Prepare 2 smears of even thickness.

2. Place Parafilm around the slide carriers holding unstained slides to prevent exposure to formalin fumes during transport. Place slides in a separate bag apart from any formalin-fixed clot or core biopsy specimens. If using slide carriers, make sure they have not been used to carry fixed slides previously.