Hematopathologic Diagnostic Pathway

General Information

Lab Name

Evaluate for Heme Disorder

Lab Code

EVALHD

Epic Ordering

Hematopathologic Diagnostic Pathway

Description

Morphology, Flow Cytometry, Cytogenetics and Molecular testing are reflexively performed on the specimen, according to the Pathways Algorithm Diagrams established and maintained by the leadership of the performing labs and corresponding clinical teams.

Reflexive testing pathways provides comprehensive and cost-effective evaluation for hematopoietic disorders. Testing includes morphology, flow cytometry, cytogenetic and molecular studies in an integrated summary report. The Pathways, Evaluate for Hematopoeitic Disorder test order is an algorithm of diagnostic tests to be performed based on the clinical indications. It attempts to streamline testing, minimize unnecessary testing and maximize optimal use of limited sample materials, and was developed in conjunction with our clinicians here at UW/FHCC. One institution (Vanderbilt) published their experience with a similar Pathways-based testing, showing significant cost-savings for the institution and optimizing testing overall (see PubMed ID 24124142 ).

For questions about the Pathways/EVALHD algorithms, please contact hppathways@uw.edu.

References

Seegmiller AC, et al. Optimizing personalized bone marrow testing using an evidence-based, interdisciplinary team approach. Am J Clin Pathol 2013, 140:643-50. 24124142

Synonyms

Bone Marrow, Cytogenetics, EVALHD, Evaluate for Heme Disorder, Flow Cytometry, HDP, Immunophenotyping, Molecular, Morphology, Pathways, Surface Marker Profile (SMP)

Components

Code	Name
EHDSP	Eval Heme Disorder Specimen
EHDTYP	Eval Heme Disorder Type
EHDSTA	Eval Heme Disorder Status
EHDRPT	Eval for Heme Disorder Report

Interpretation

Method

Morphology, Flow cytometry, Cytogenetics, Molecular studies

Reference Range

See individual components

References

Seegmiller AC, et al. Optimizing personalized bone marrow testing using an evidence-based, interdisciplinary team approach. Am J Clin Pathol 2013, 140:643-50. 24124142

Guidelines

Assays Performed by Flow Cytometry

Ordering & Collection

Specimen Type: Peripheral Blood (PB), Bone Marrow (BNM), Tissue, Cerebrospinal fuild, Body fluids
Collection: Preferred:

Blood: 6 ml in Lavender top EDTA (FLOW) AND 10 mL in Green top Heparin (CYTOGENETICS) AND 6 mL in Lavender top EDTA (MOLECULAR) tubes.

Heparin tube should be routed directly to the appropriate Cytogenetics lab (FHCC or UW).

OR

Bone marrow: 2 mL in EDTA (from 1st pull, to be sent for FLOW testing) AND 3 mL in Heparin (CYTOGENETICS) AND 3 mL in EDTA (from later pull, to be sent for MOLECULAR testing)

Inpatient bone marrows must be scheduled with the Hematology laboratory by calling 206 598-6229 (UW); 206 744-3128 (HMC). Please call for all Marrows, including procedures where assistance is not needed.

Heparin tube should be routed directly to the appropriate Cytogenetics lab (FHCC or UW).

OR

Tissue: 1-3 core needle biopsies for MORPHOLOGY in formalin AND 1-3 core needle biopsies for FLOW CYTOMETRY in RPMI

OR

CSF: CSF collection tubes (from 1 of 4 pulls)

OR

Fluid: All body fluid types

Also Acceptable:

Blood: 3 mL or 10 mL EDTA (FLOW and MOLECULAR) AND 3 mL Lithium or Sodium Heparin (CYTOGENETICS).

Heparin tube should be routed directly to the appropriate Cytogenetics lab (FHCC or UW).
Handling Instructions: Tissue, CSF, or fluid samples should be transported to Lab refrigerated. Optimal results are achieved when samples are received within: 48 hours of collection for peripheral blood; 24 hours of collection for bone marrows; Samples submitted outside of this range will be evaluated for quality using appropriate internal controls and the results qualified appropriately.
Quantity: requested: Entire sample
minimum: None

Processing

Processing: Storage: Blood & Bone Marrow at Room Temperature, CSF, Tissue & FLUID in Refrigerator.

Login: EVALHD-;specimen type and comment.

Result test code: EHDSP with specimen type received (eg. BMA, BMBX, PERBLD, CSF, PLFL, ASCT, etc.)

Result test code: EHDTYP with Disorder Type provided. Leave blank, if not provided (DO NOT use INP)

Result test code: EHDSTA with Disorder Status. Leave blank, if not provided (DO NOT use INP)

***Provide extra labels and copies of requisition orders to Hematopathology/Molecular Hematopathology Lab***

Note: If specimen arrives after 6:30PM Monday-Sunday forward to Hematopath the following day.

Note2: RPMI media may be added to CSF or fluid specimens for optimal viability. Otherwise, Hematology/Hematopathology lab will add RPMI media to CSF upon receipt.

Note3: All samples to UW Cytogenetics, call the lab (206-598-4488) for pick-up. For Bone Marrows: send all requisitions provided by the Bone Marrow Techs, as indicated by a UWMC Cytogenetics sticker on the EVALHD requisition form.

Note4:All tissue samples should be routed to the Hematopathology Lab

Performance

LIS Dept Code

Hematopathology (HP)

Performing Location(s)

Other	Hematopathology, Molecular 206-606-7060 UW Hematopathology Laboratory, G7-800 Fred Hutchinson Cancer Center 825 Eastlake Avenue E. Seattle, WA 98109	Hematopathology, Molecular hours: 7:00 am - 5:30 pm M-F 8:00 am - 4:30 pm Saturday, closed on Sunday, and with reduced staffing on major holidays

Other Locations/Notes

Hematopathology Lab @ FHCC Room G7800 206-606-7060

Molecular Hematopathology Lab @ FHCC Room G7801 206-606-7070

UW-MT Cytogenetics Lab @ UW-MT Room NW125 206-598-4488

FHCC Cytogenetics Lab @ Blaine Lab, Suite 250 206-606-1395

Pathways Team @ FHCC Room G7800 206-606-1695

Frequency

Monday - Sunday

Available STAT?

On request

Billing & Coding

CPT codes
Billing Comments: CPT codes will reflect reflexive testing performed as indicated by Pathways
LOINC