Test Id : HPWET

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, flow cytometry, microarray, molecular and/or next-generation sequencing testing) will be reported and billed separately. While reported separately, these results will continue to be considered and referred to in the final pathology 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 team at 507-284-5600.

For more information see:

Pathology Consultation Ordering Algorithm

Multiple Myeloma: Laboratory Screening

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. Orders for HPCUT require MCL prior authorization.

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

All requisition and supporting information must be submitted in English.

Each of the following items is 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. Hematopathology Patient Information (T676); 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.

All specimens are required to perform testing.

Supplies: Bone Marrow Collection Kit (T793)

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

Specimen Volume: 5 Total slides: 2 direct smears and 3 unit prep slides; unfixed and unstained, per unilateral collection

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 aspirate clot in 10% formalin

Specimen Volume: 0.5 mL

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

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: 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

Specimen Volume: 2 Unstained and unfixed slides

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.

• Multiple Myeloma: Laboratory Screening
• Hematopathology Patient Information
• Pathology Consultation Ordering Algorithm
• Bone Marrow Core Biopsy, Clot, and Aspirate Collection Guideline
• Assistance with Bone Marrow Collection

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)

See Specimen Required

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

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, flow cytometry, microarray, molecular and/or next-generation sequencing testing) will be reported and billed separately. While reported separately, these results will continue to be considered and referred to in the final pathology 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 team at 507-284-5600.

For more information see:

Pathology Consultation Ordering Algorithm

Multiple Myeloma: Laboratory Screening

Diagnosis of a hematologic disease requires thorough and accurate morphologic examination of peripheral blood and bone marrow as well as interpretation of ancillary testing results (eg, cytochemistry, immunohistochemistry, flow cytometric immunophenotyping, chromosome analysis, and fluorescence in situ hybridization and molecular testing) by a highly qualified hematopathologist. With recent advent of new understanding and treatment options, more ancillary tests are available. Efficient utilization and accurate interpretation of these tests are crucial for patient care. These tests can assist in rendering an accurate diagnosis and could provide prognostic prediction and potential indication or guidance of therapy.

An interpretive report will be provided.

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.

All appropriate stained/unstained slides, biopsy tissue, and aspirate are required 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.

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;61(13)3226-3233. doi:10.1080/10428194.2020.1798950

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.

Monday through Saturday

• 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 account representative. For assistance, contact Customer Service.

Not Applicable

85007 (if appropriate)

85060 (if appropriate)

85097 (if appropriate)

88305 (if appropriate)

88311 (if appropriate)