Specimen Collection Manual and Test Catalog

Preferred collection types: All specimens below will automatically be ordered with the above procedure code. Specimen types not collected will be marked as uncollected or collected and canceled by lab staff.

• Bone marrow aspirate:
  • Bone marrow aspirate collection for morphology:
    • Initial aspirate (1-2 mL, NO heparin) in a lavender-top (K2 EDTA) tube labeled as “bone marrow aspirate for slide prep”. *Mix sample well and ensure there are adequate spicules in sample. Slides will be made at processing site. Sample must be sent out ASAP post collection, and slides made immediately once received into laboratory.
  • Bone marrow aspirate collection for flow cytometry:
    • One (1) green-top (sodium heparin) tube with 2-3 mL (minimum) of bone marrow aspirate labeled "bone marrow aspirate."
  • Bone marrow aspirate for reference testing (appropriate test automatically driven by age):
    • One (1) green-top (sodium heparin) tube with 2-3 mL (minimum) of bone marrow aspirate labeled "bone marrow aspirate."
  • Bone marrow aspirate for molecular testing:
    • Two (2) lavender-top (K2 EDTA) tubes with 2-3 mL (minimum) of bone marrow aspirate labeled "bone marrow aspirate molecular."  
• Bone marrow tissue biopsy and clot section
  • 2-3 touch preps slides (4-5 imprints on each), must be made before placing core biopsy into fixative.
  • Bone marrow biopsy in (B-fixative) or formalin tube.
  • Blood clot (only if biopsy is inadequate) in (B-fixative) tube or formalin.
  • Bone marrow or blood clot in RPMI acceptable (not available at all collection location).
• Peripheral blood
  • One (1) lavender-top K2 (EDTA) tube labeled as "blood", or a blood smear slide made within 24 hours of bone marrow biopsy (please include CBC with differential analyzer printout). 

Bone marrows collected at hospital locations are to be scheduled in advance with the Hematology Department at each site to ensure proper collection and timely transportation of specimen to GMC for processing. 
GMC: (570) 271-6323 
GWV: (570) 808-5869 (questions only). Scheduling performed by IR or CTC Cancer Center staff. 
GCMC: (570) 703-4253 
GLH: (717) 242-7069 
Call Client Services at 1-800-695-6491 for bone marrow transport kits if located at an outside facility. Bone marrows performed during non-business hours must be reviewed and approved by CP pathologist on call. 
Video: bone marrow specimen collection instructions 
This bone marrow request form must accompany specimen.

Package bone marrow biopsy and clot sections in a separate bag to make sure no formalin/B-fixative is near the unstained slides as this will cause artifact on the slides.

Peripheral blood EDTA: Refrigerated (preferred) or room temperature. 
Bone marrow aspirate EDTA: Room temperature. 
Bone marrow aspirate sodium heparin: Room temperature. 
Air dried slides: Room temperature. 
Fixed tissue in B+/formalin: Room temperature.
Fresh tissue in RPMI: Refrigerated. 
Fresh tissue without formalin: Refrigerated.

CBCD: Refrigerated: 72 hours. Room temperature: 24 hours. 
Bone marrow aspirate flow cytometry: Stable for 48 hours at room temperature. 
Bone marrow aspirate cytogenetics/FISH/molecular: 3-7 days (depends on study). 
Tissue: Stability varies depending if fixed or fresh.

SPECIMENS ARE NEVER REJECTED. SEE SUPERVISOR.

Morphologic peripheral blood and bone marrow interpretation by a pathologist. For adult patients, reflex ancillary studies including; immunohistochemistry, flow cytometry, cytogenetics (chromosome analysis), FISH studies, and molecular studies (including next generation sequencing) will be ordered by the pathologists as appropriate based on the biopsy or aspirate specimens Pediatric specimens (<18 years of age) sent for chromosome analysis and FISH studies based on COG guidelines and/or pathologist approval.

Plug, Aspriate, Touch imprints, Clot sections, Bone, Marrow, BM

Bone marrow specimens are obtained by the clinical provider to assess the following: (1) hematologic abnormalities that cannot be explained by available clinical and laboratory data, (2) stage malignant lymphomas and metastatic tumors, and (3) to monitor the patient’s therapeutic response to administered therapies. Meaningful interpretation of a bone marrow specimen requires adequate and well-prepared specimens.