Ordering Guidance

For B-cell acute lymphoblastic leukemia minimal residual disease testing in either blood or bone marrow, order BALLM / B-Cell Lymphoblastic Leukemia Monitoring, Minimal Residual Disease Detection, Flow Cytometry, Varies.

For bone marrow specimens being evaluated for possible involvement by a myelodysplastic syndrome (MDS) or a myelodysplastic/myeloproliferative neoplasm (MDS/MPN) including chronic myelomonocytic leukemia (CMML), order MYEFL / Myelodysplastic Syndrome by Flow Cytometry, Bone Marrow.

Bronchoalveolar lavage specimens submitted for evaluation for leukemia or lymphoma are appropriate to send for this test.

This test is not appropriate for and cannot support diagnosis of sarcoidosis, hypersensitivity pneumonitis, interstitial lung diseases, or differentiating between pulmonary tuberculosis and sarcoidosis (requests for CD4/CD8 ratios). Specimens sent for these purposes will be rejected.

This test is not intended for products of conception (POC) specimens. For POC specimens see CMAPC / Chromosomal Microarray, Autopsy, Products of Conception, or Stillbirth.

Additional Testing Requirements

For bone marrow testing, if cytogenetic tests are desired along with this test request, an additional specimen should be submitted. It is important that the specimen be obtained, processed, and transported according to instructions for the other test.

Shipping Instructions

Specimen must arrive within 4 days of collection.

Necessary Information

The following information is required:

1. Pertinent clinical history, including reason for testing or clinical indication/morphologic suspicion

2. Specimen source

3. For tissue specimens:

-Tissue type

-Location

-Pathology/diagnostic report, including the client surgical pathology case number

4. For spinal fluid specimens:

-Spinal fluid cell and differential counts

Specimen Required

Submit only 1 of the following specimens:

Specimen Type: Whole blood

Container/Tube:

Preferred: Yellow top (ACD solution A or B)

Acceptable: Lavender top (EDTA) or Green top (sodium heparin)

Specimen Volume: 10 mL

Collection Instructions:

1. Send whole blood specimen in original tube. Do not aliquot.

2. Label specimen as blood.

3. Include 1 to 2 unstained blood smears labeled with 2 unique identifiers.

Specimen Stability Information: Ambient 4 days/Refrigerated 4 days

Specimen Type: Bone marrow

Container/Tube:

Preferred: Yellow top (ACD solution A or B)

Acceptable: Lavender top (EDTA) or green top (sodium heparin)

Specimen Volume: 1 to 5 mL

Collection Instructions:

1. Submission of bilateral specimens is not required.

2. Send bone marrow specimen in original tube. Do not aliquot.

3. Label specimen as bone marrow.

4. Include 1 to 2 unstained bone marrow smears labeled with 2 unique identifiers.

Specimen Stability Information: Ambient 4 days/Refrigerated 4 days

Note: A fresh (less than 4 days post-collection), unfixed, nonembedded bone marrow core biopsy, bone or bone lesion is acceptable as an equivalent source for bone marrow aspirate for this test only in the event of a dry tap during the bone marrow harvesting procedure. Indicate "dry tap" in performing lab notes or paperwork when submitting this specimen type.

Specimen Type: Fluid

Sources: Serous effusions, pleural, pericardial, or abdominal (peritoneal fluid)

Container/Tube: Body fluid container

Specimen Volume: 20 mL

Collection Instructions:

1. If possible, fluids should be anticoagulated with heparin (1 U/mL of fluid).

2. Label specimen with fluid type.

Specimen Stability Information: Refrigerated 4 days/Ambient 4 days

Additional Information: The volume of fluid necessary to phenotype the lymphocytes or blasts in serous effusions depends upon the cell count in the specimen. Usually, 20 mL of pleural or peritoneal fluid is sufficient. Smaller volumes can be used if there is a high cell count.

Specimen Type: Tissue

Supplies: Hank's Solution (T132)

Container/Tube: Sterile container with 15 mL of tissue culture medium (eg, Hank's balanced salt solution, RPMI, or equivalent)

Specimen Volume: 5 mm(3) or larger biopsy

Collection Instructions:

1. Send intact specimen (do not mince)

2. Specimen cannot be fixed.

Specimen Stability Information: Ambient 4 days/Refrigerated 4 days

Specimen Type: Spinal fluid

Container/Tube: Sterile vial

Specimen Volume: 1 to 1.5 mL

Collection Instructions:

1. An original cytospin preparation (preferably unstained) should be included with the spinal fluid specimen so correlative morphologic evaluation can occur.

2. Label specimen as spinal fluid.

Specimen Stability Information: Refrigerated 4 days/Ambient 4 days

Additional Information: The volume of spinal fluid necessary to phenotype the lymphocytes or blasts depends upon the cell count in the specimen. A cell count should be determined and submitted with the specimen. Usually, 1 to 1.5 mL of spinal fluid is sufficient. Smaller volumes can be used if there is a high cell count. If cell count is less than 10 cells/mcL, a larger volume of spinal fluid may be required. When cell counts drop below 5 cells/mcL, the immunophenotypic analysis may not be successful.