Bone Marrow, Path Collect with CBC and Flow Cytometry

Bone Marrow, Path Collect with CBC and Flow Cytometry

BM CBCFL

CPT coding for bone marrow studies varies depending on testing required, which is dependent on complexity of the case and the type and number of samples submitted.

NOTE: THIS IS THE TYPICAL BONE MARROW TEST TO ORDER FOR SAMPLES COLLECTED BY A PATH CONSULTANTS PATHOLOGIST AT THEIR FNA/BIOPSY CLINIC.

Methodology:
Collection of Bone Marrow aspirate and biopsy from the iliac crest after injection of local anaesthetic. Blood is also collected via venipuncture for a CBC. Slides are prepared from the blood and bone marrow specimens. Fractions of the BM are placed in anticoagulant as needed for subsequent testing (EDTA, heparin, and/or RPMI media).

Microscopic examination of stained bone marrow and blood slides. Wright-Geimsa, H&E and iron stains are routinely performed on all bone marrows.
Flow cytometry based on patient clinical history and lab findings; presumptive diagnosis; and blood/bone marrow microscopic findings.
Additional studies including IHC stains, reticulin stain, cytogenetics and other molecular studies (FISH, PCR, gene sequencing) may be added at pathologist direction.

M, Tu, W, Th, F (must be scheduled in advance)

2-3 days (excluding weekends and holidays)

BM and flow cytometry studies are both reported with a pathologist interpretation of findings.

Required for diagnosis of most leukemias, myelodysplasia, and myeloma. Useful for diagnosis or staging of lymphomas. Often performed to evaluate unexplained low or high cell counts (WBC, RBC and/or platelets) in the blood. Periodic repeat BM studies may be performed post-treatment for hematologic malignancies to evaluate remission or progression.

Contact the PC FNA/Biopsy clinic to schedule a Bone Marrow procedure at 541-808-9480. The clinic will ask that the patient clinical notes and a recent CBC be faxed to their number, so the pathologist can review these before the procedure. The patient should be advised by their physician to discontinue anticoagulant therapy (warfarin, dabigatran, rivaroxaban, or apixaban) if possible 3 days before the BM procedure. The patient should arrive at the clinic 15 minutes before the scheduled procedure. If the patient BMI is equal or greater than 40, instead call Interventional Radiology at 541-302-7777. Specimens to be collected: 1. BM slides prepared fresh. 2-3 pull slides and 2-3 push slides from the aspirate. Also submit 2-3 touch preps from the BM biopsy. 2 BM in EDTA (lavender tube). For flow cytometry and/or PCR/gene sequencing if needed. 3. BM in heparin (green tube). For cytogenetics and/or FISH testing if needed. 4. BM in RPMI. For flow cytometry if testing will be delayed beyond 24 hours. 5. Blood slides. 2 unstained slides preferred. 6. Blood in EDTA (lavender). Or provide a copy of the automated CBC results from within 48 hours of the BM collection. 7. BM core biopsy in formalin. If an aspirate cannot be obtained, place the biopsy in saline or RPMI instead of formalin. 8. BM clot in formalin. Keep blood and bone marrow slides in a separate bag from formalin containers. Formalin results in later discoloration of slides during staining. If the referring physician wants Pathology Consultants to send out tests not performed locally (e.g., cytogenetics or FISH/molecular testing), notify the scheduler.

N/A

Refrigeration is preferred if testing will not be done within 1-2 hours.

Label all specimens with 2 patient specific identifiers. Also note either “Bone Marrow” or “Blood” on each vacutainer tube.

Insufficient bone marrow for interpretation (eg, ‘dry tap’). Frozen specimens. Very old specimens with no freshly prepared slides submitted. NOTE: Given the difficulty of recollection, an attempt will be made to salvage sub-optimal specimens before initiating a recall. In such cases, the limitations of the study will be noted in the pathologist interpretation if the case is reported.

Surplus liquid samples are held for 7 days in the refrigerator. Blood and BM slides are saved for at least 10 years.

N/A

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