Hematopathology

Bone Marrow

1. Two forms of patient ID are required by the College of American Pathologists (CAP). Label ALL primary* specimen containers wall (not the lid) and ALL bone marrow-touch preps, peripheral smears and tubes with two (2) identifiers that include patient first and full last name, date collected and add LEFT or RIGHT and specimen type to respective specimens at the time of collection. Place one (1) of the peel-off labels from the Test Requisition onto each specimen container, if available. Submitted slides must be labeled with 2 acceptable positive patient identifiers at the time of collection. Examples of acceptable identifiers include, but are not limited to: patient name, date of birth, hospital number, social security number, requisition number, accession number, unique random number or clinical chart numbers that identify the patient from whom the laboratory specimen was obtained. A location (e.g., hospital room number) is not an acceptable identifier. 

*Primary specimen container is the innermost container received by the laboratory that actually holds the specimen. 

2. Submit at least 1 peripheral blood smear if available.

3. Submit at least 4–6 bone marrow smears and, when biopsy is performed, 2 touch imprint slides. Smears and touch imprint slides should be submitted in tightly wrapped plastic containers, bags, and/or cardboard holders. Always separate them from formalin-fixed specimens. Unstained smears exposed to the slightest trace of formalin vapor will not stain properly.

4. Submit the bone marrow clot in formalin. Make sure the clot has formed before putting it in formalin. Label as “Clot” and add LEFT or RIGHT, if applicable.

5. Submit the bone marrow core in formalin. Label as “Core” and add LEFT or RIGHT, if applicable.

6. For flow cytometry, submit 3 mL of bone marrow aspirate or peripheral blood in an EDTA (lavender, the PREFERRED tube type for Flow cytometry) or heparin tube.

7. For chromosome analysis (classical cytogenetics) or FISH studies, submit 3 mL of bone marrow aspirate or peripheral blood in a heparin (green, the MANDATORY tube type for Cytogenetics) tube.

8. For molecular studies, submit 1 mL of bone aspirate or peripheral blood in a lavender (EDTA) tube. Consultation with a Quest Diagnostics Genetics Counselor at 1.866.GENE.INFO (1.866.436.3463) is recommended before acquiring specimens for molecular testing. Three to six (3-6) mL of peripheral blood in a lavender (EDTA) tube is required for molecular testing and Leumeta assays.

Complete a Hematopathology Test Requisition, including: 

• Patient’s full first and last name 
• Date of birth
• Source of specimen 
• Submitting physician’s name, NPI number, and telephone number 
• Date of collection 
• Source of specimen 
• Clinical history 
• Most recent CBC results

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