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Test Code MISCLM Hemolytic Anemia Evaluation

Additional Codes

 

MAYO Test ID

HAEVP

EPIC Test ID

LAB2608

 

Reporting Name

Hemolytic Anemia Evaluation

Useful For

Evaluation of lifelong or inherited hemolytic anemias, including red cell membrane disorders, unstable or abnormal hemoglobin variants, and red cell enzyme disorders

 

This evaluation is not suitable for acquired causes of hemolysis.

Profile Information

Test ID Reporting Name Available Separately Always Performed
HAEV Hemolytic Anemia Interpretation No Yes
A2F Hemoglobin A2 and F No Yes
HBEL Hemoglobin Electrophoresis, B No Yes
UNHB Unstable Hemoglobin, B No Yes
FRAGO Osmotic Fragility Yes, (Order FRAG) Yes
SCTRL Shipping Control Vial No Yes
G6PD G-6-PD, QN, RBC Yes Yes
PK Pyruvate Kinase, RBC Yes Yes
GPI Glucose Phosphate Isomerase, B Yes Yes
HEXK Hexokinase, B No Yes
PBSM Morphology Review No Yes

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
GLTI Glutathione, B No No
SDEX Hemoglobin S, Scrn, B Yes No
IEF IEF Confirms No No
MASS Hb Variant by Mass Spec, B No No
RBCE Reflexed RBC Enzymes No No
HPFH Hemoglobin F, Red Cell Distrib, B No No
ATHAL Alpha-Globin Gene Analysis Yes No
WASQR Alpha Globin Gene Sequencing, B Yes, (Order WASEQ) No
WBSQR Beta Globin Gene Sequencing, B Yes, (Order WBSEQ) No
WBDDR Beta Globin Cluster Locus Del/Dup,B Yes, (Order WBDD) No
WGSQR Gamma Globin Full Gene Sequencing Yes, (Order WGSEQ) No
HAEVA Hemolytic Anemia Summary Interp No No

Testing Algorithm

This is a consultative evaluation in which the case will be evaluated and appropriate tests performed, at an additional charge, and the results interpreted. If a peripheral blood smear is provided, the morphologic features will be incorporated into the interpretation. If a Hemolytic Anemia Patient Information sheet (T705) is received with the sample, the reported clinical features or clinical impression will be incorporated into the interpretation.

 

The most common RBC enzymes (G6PD,pyruvate kinase, glucose phosphate isomerase, and hexokinase) will always be performed. If these are normal, the second-tier enzymes will be performed (provided sufficient sample volume is available). If second-tier enzymes are desired, even if the first-tier testing is abnormal, fill out the Hemolytic Anemia Patient Information sheet (T705) and indicate this desire. Cation exchange HPLC, capillary electrophoresis, and hemoglobin stability studies will always be performed. Reflex testing required to identify a hemoglobin abnormality can be added as the case requires. Osmotic fragility and eosin-5-maleimide (EMA) binding (band 3) flow cytometry will be performed on all cases. A normal shipping control for osmotic fragility (OF) is necessary to exclude false-positive results due to preanalytical artifact.

 

OF and EMA binding testing will be canceled if no shipping control is received or if the shipping control is abnormal.

 

 

HAEVA / Hemolytic Anemia Summary Interpretation, an additional consultative interpretation that summarizes all testing, will be provided after test completion to incorporate subsequent results into an overall evaluation if 1 or more of the following molecular tests are reflexed on the Hemolytic Anemia Evaluation:

-ATHAL / Alpha-Globin Gene Analysis

-WASQR / Alpha-Globin Gene Sequencing, Blood

-WBSQR / Beta-Globin Gene Sequencing, Blood

-WBDDR / Beta-Globin Cluster Locus Deletion/Duplication, Blood

-WGSQR / Gamma-Globin Full Gene Sequencing

 

Note: RBCE / Reflexed RBC Enzymes, Blood (second-tier enzymes) includes: adenylate kinase, phosphofructokinase, phosphoglycerate kinase, triosephosphate isomerase, and pyrimidine 5' nucleotidase.

Performing Laboratory

Mayo Medical Laboratories in Rochester

Specimen Type

Control
Whole Blood ACD-B
Whole Blood EDTA
Whole Blood Slide


Advisory Information


Preliminary screening tests, such as complete blood count with peripheral smear and direct Coombs test with a negative result, should be run before ordering this evaluation.

 

Cold agglutinin disorders and autoimmune disorders should be excluded prior to testing. This evaluation is not suitable for acquired causes of hemolysis.



Shipping Instructions


Specimens must arrive within 72 hours of draw.



Necessary Information


Include recent transfusion information.

 

Include most recent CBC results.



Specimen Required


Two whole blood EDTA specimens, 2 whole blood ACD specimens, an EDTA control specimen, and 2 well-made peripheral blood smears (Wright stained or fixed in absolute methanol) are required for testing.

 

Patient:

Specimen Type: Blood

Container/Tube: Lavender top (EDTA) and yellow top (ACD)

Specimen Volume:

EDTA: Two 4-mL vials

ACD: Two 6-mL vials

Collection Instructions:

1. Immediately refrigerate specimens after draw.

2. Send specimens in original tubes. Do not aliquot.

3. Prepare smears.

4. Rubber band patient specimen and control vial together.

 

Patient:

Specimen Type: Slides

Container/Tube: Blood smears

Specimen Volume: 2 well-made peripheral blood smears

Collection Instructions: Collect 2 well-made peripheral blood smears (Wright stained or fixed in absolute methanol).

 

Shipping Normal Control:

Specimen Type: Whole blood

Container/Tube: Lavender top (EDTA)

Specimen Volume: 4 mL

Collection Instructions:

1. Draw a control specimen from a normal (healthy), unrelated, nonsmoking person at the same time as the patient.

2. Label clearly on outermost label normal control.

3. Immediately refrigerate specimen after draw.

4. Send specimen in original tube. Do not aliquot.

5. Rubber band patient specimen and control vial together.


Specimen Minimum Volume

EDTA Blood: 3 mL
ACD Blood: 5 mL

Specimen Stability Information

Specimen Type Temperature Time
Control Refrigerated 72 hours
Whole Blood ACD-B Refrigerated 72 hours
Whole Blood EDTA Refrigerated 72 hours
Whole Blood Slide Refrigerated

Reference Values

Definitive results and an interpretive report will be provided.

Day(s) and Time(s) Performed

Monday through Saturday

CPT Code Information

Hemolytic Anemia Evaluation

82657-Hexokinase, B

82955-G-6-PD

83020-Hemoglobin electrophoresis

83021-Hemoglobin A2 and F

83068-Hemoglobin stability

84087-Glucose phosphate isomerase

84220-Pyruvate kinase

85060-Morphology review

85557-Osmotic fragility

 

Band 3 Fluorescence Staining, RBC

88184

 

Reflexed RBC Enzymes

83915 (if appropriate)

 

Glutathione, Blood

82978 (if appropriate)

 

Hemoglobin Variant by Mass Spectrometry (MS), Blood

83789 (if appropriate)

 

IEF Confirms

82664 (if appropriate)

 

Hemoglobin F, Red Cell Distribution, Blood

88184 (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
HAEVP Hemolytic Anemia Evaluation 14869-2

 

Result ID Test Result Name Result LOINC Value
HEXK_ Hexokinase, B 49216-5
PK_ Pyruvate Kinase, RBC 32552-2
9095 Hemoglobin, Unstable, B 4639-1
9064 Osmotic Fragility, RBC 34964-7
G6PD_ G-6-PD, QN, RBC 32546-4
GPI_ Glucose Phosphate Isomerase, B 44050-3
2380 Hemoglobin A 20572-4
13082 Morphology Review 59466-3
2381 Hemoglobin A2 42245-1
SCTRL Shipping Control Vial 40431-9
9992 Hemolytic Anemia Interpretation 59466-3
37437 Reviewed By 19139-5
2382 Hemoglobin F 42246-9
2383 Variant 32017-6
3306 Osmotic Fragility, 0.50 g/dL NaCl 23915-2
3307 Osmotic Fragility, 0.60 g/dL NaCl 23917-8
29224 Variant 2 32017-6
29225 Variant 3 32017-6
3308 Osmotic Fragility, 0.65 g/dL NaCl 23919-4
3309 Osmotic Fragility, 0.75 g/dL NaCl 30543-3
2101 Interpretation 49316-3
3310 Osmotic Fragility Comment 59466-3

Analytic Time

3-25 days if structural and/or molecular studies are required (not reported Saturday or Sunday)

Reject Due To

Hemolysis

Mild OK; Gross reject

Lipemia

NA

Icterus

NA

Other

NA

Method Name

HAEV: Consultative Interpretation

A2F: Cation Exchange/High-Performance Liquid Chromatography (HPLC)

HBEL: Capillary Electrophoresis

UNHB: Isopropanol and Heat Stability

FRAGO: Osmotic Lysis

G6PD, PK, GPI, HEXK, RBCE, GLTI: Kinetic Spectrophotometry (KS)

PBSM: Consultant Review

BND3 (eosin-5-maleimide (EMA) binding): Flow Cytometry

MASS: Mass Spectrometry (MS)

IEF: Electrophoresis

HPFH: Flow Cytometry

HAEVA: Consultative Interpretation

Forms

1. New York Clients-Informed consent is required. Please document on the request form or electronic order that a copy is on file. An Informed Consent for Genetic Testing (T576) is available in Special Instructions.

2. Hemolytic Anemia Patient Information (T705) in Special Instructions. Please fill out for a more complete evaluation by the signing Hematopathologist.

3. If not ordering electronically, complete, print, and send a Benign Hematology Test Request Form (T755) with the specimen (http://www.mayomedicallaboratories.com/it-mmfiles/benign-hematology-test-request-form.pdf)

Test Classification

See Individual Test IDs

Additional Tests

Test ID Reporting Name Available Separately Always Performed
BND3 Band 3 Fluorescence Staining, RBC No Yes