Hematopathologic Diagnostic Pathway

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.

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).

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

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