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Bone Marrow Aspiration and Biopsy

Bone Marrow Exam, Unilateral, Bone Marrow Exam, Bilateral

Test Codes

Unilateral: O138450 (panel), Bilateral: O138449 (panel)

Department

Hematology

Instructions

• This test includes CBC with Differential, Reticulocyte Count, and Pathologist Consultation.
• Inpatients: Royal Oak inpatients are scheduled in EPIC by ordering physicians. Grosse Pointe inpatients are scheduled in EPIC by unit secretaries. Troy inpatients are scheduled through Endoscopy, 248-964-5122. Dearborn, Taylor, Trenton, and Wayne inpatients are scheduled through EPIC by ordering physicians.
• Outpatients: Outpatient bone marrow procedures must be scheduled through the appointment center, 248-577-9700, for specimen procurement and are performed Monday thru Friday only at designated time slots. Dearborn outpatients: For outpatient bone marrows that are not being performed in Interventional Radiology, the ordering physician must contact the Hematology lab (313-593-7905) to schedule.
• Outreach: Outreach clients may submit aspirate and biopsy specimens through Beaumont Laboratory. Specimen pickups must be scheduled through Customer Service, 800-551-0488, 24 hours in advance of bone marrow procedure. Outreach specimens are accepted Monday through Friday.
• Orders for bone marrows MUST contain an established diagnosis or signs/symptoms. All bone marrow requests must have the applicable ICD10 code entered into EPIC/Laboratory Information System upon order entry. While Rule Out (R/O) is often a useful way to communicate your suspicion to the consulting hematopathologist, it is NOT sufficient.

Specimen Collection Criteria

Collect (preferred specimen): A 2-4 mL aspirate in a 4.0 mL Lavender-top EDTA, a 2-4mL aspirate in a Green-top Sodium Heparin tube, an aspirate clot in B-Plus Fixative, and a 2.0 cm core biopsy in B-Plus Fixative.

• Aspirate smears are made at the bedside. 
• Allow bone marrow aspirate smears to completely dry before placing them into the provided slide holders. Complete drying reduces artifact. 
• The remaining aspirate is distributed into appropriate anticoagulant for the additional special testing required (e.g., flow cytometry, cytogenetics, molecular, cultures, etc). 
• Confirm all slides and tubes are properly labeled (patient name and sample type with two patient identifiers on each slide/sample). The information on the specimen must match the information on the requisition. If a discrepancy is identified, testing may be delayed until specimen verification can be obtained.
• Pack the slide holders together with the sodium heparin (Green-top) and EDTA (Lavender-top) tubes into the biohazard bag. 
• Place the bone marrow core biopsy and aspirate clot into the B-Plus Fix container(s). Make sure the lid is properly sealed and closed tightly. 
• For Outreach specimens, all specimens should be shipped to Beaumont Laboratory on the day of aspiration. Shipping delays may compromise cell viability. 

Physician Office/Draw Specimen Preparation

Transportation to the Laboratory must be arranged prior to specimen collection. Maintain specimen at room temperature (20-26°C or 68-78.8°F) prior to transport.

Bone marrows are procured by M.D. and/or N.P. (Nurse Practitioner) staff who have been credentialed by Hematopathology Administration. Aspirate specimens must be delivered to Hematology Laboratory so they can be distributed immediately to appropriate testing areas.

Preparation for Courier Transport

Transport: All specimens at room temperature (20-25°C or 68-77°F).

Allow bone marrow aspirate smears to completely dry before placing into the provided slide holders. Pack the slide holders together with the green-top (Sodium Heparin) and lavender-top (EDTA) tubes into a biohazard bag. Place the bone marrow core biopsy and aspirate clot into the container(s) with B-Plus Fix preservative into a separate biohazard bag. Transport 2-4 mL aspirate and 2 cm core biopsy at room temperature (20-25°C or 68-77°F). Read our complete shipping instructions.

Rejection Criteria

• Specimens not collected and processed as indicated.
• Additional orders (cytogenetics, flow cytometry) may be cancelled if insufficient aspirate is obtained.

In-Lab Processing

Aspirate and biopsy specimens are stable in B-Plus Fix indefinitely at room temperature (20-26°C or 68-78.8°F).

Storage

Specimen Stability for Testing:

Aspirate and Biopsy Specimens
Room Temperature (20-26°C or 68-78.8°F): Indefinitely
Refrigerated (2-8°C or 36-46°F): Unacceptable
Frozen (-20°C/-4°F or below): Unacceptable

Slides
Room Temperature (20-26°C or 68-78.8°F): Indefinitely
Refrigerated (2-8°C or 36-46°F): Unacceptable
Frozen (-20°C/-4°F or below): Unacceptable

Specimen Storage in Department Prior to Disposal:

Slides: Room Temperature (20-26°C or 68-78.8°F): 30 years

Laboratory

Dearborn Hematology Laboratory
Farmington Hills Hematology Laboratory
Grosse Pointe Hematology Laboratory
Royal Oak Hematology Laboratory
Taylor Hematology Laboratory
Trenton Hematology Laboratory
Troy Hematology Laboratory
Wayne Hematology Laboratory

Performed

Monday – Friday, Day Shift.
Report available within 3 business days.

Reference Range

By report.

Test Methodology

Specimen procurement by needle aspiration and biopsy.

Bone Marrow Aspiration Smears: Routine Wright/Giemsa stain. Cytochemical staining, staining for iron, and special stains if indicated.

Bone Marrow Biopsy and Aspirate Clot Sections: Routine H&E staining. Special stains, immunohistochemical stains, and stains for iron as needed.

Interpretation

By pathologist report.

Clinical Utility

This procedure can assist in the diagnosis of a variety of malignancies, granulomatous diseases, and inherited blood disorders.

CPT Codes

38221, 85097, 88305, 88312, 88313, 80525, 85046.

Contacts

Last Updated

11/23/2022