Specimen:

EDTA and ACD Whole Blood

Collection Medium:

Minimum:

Draw blood in a lavender-top (EDTA) tube(s) and a yellow-top (ACD 
[solution A]) tube(s), and send 5.0 mL of fresh EDTA whole blood and 10 
mL of ACD (solution A) whole blood refrigerated. Do not transfer blood 
to other containers.

Rejection Criteria:

Specimens cannot be frozen

Delivery Instructions:

Submit specimen to laboratory as soon as possible after collection.
Specimen must be received at reference laboratory within 72 hours of 
draw.

Specimen
Instructions:

Include a control specimen drawn at the same time from a normal, 
unrelated individual: draw blood in a lavender-top (EDTA) tube(s), and 
send 5.0 mL of fresh EDTA whole blood refrigerated. Do not transfer 
blood to other containers. Label clearly on outermost label "Normal 
Control". Indicate sex of control on tube(s) label.

Send well-made peripheral blood smear, Wright stained or fixed in 
absolute methanol.

Analytic Time:

1 week

Reference Range:

Definitive results and an interpretive report will be provided.

A hematopathologist expert in these disorders evaluates the case, 
appropriate tests are run, and an interpretive report is issued.

Comments:

Note:  ACD Solution A or B is acceptable.

Patient's age and sex are required on request form for processing.

Include recent transfusion information.

Please print, complete and submit the Thalassemia/Hemoglobinopathy 
Information Sheet from the Mayo Medical Laboratories with the specimen 
and the A-1a Miscellaneous Request.

Hemolytic anemia is characterized by increased red cell destruction and 
a decreased red cell life span. Patients have decreased hemoglobin 
concentrations, hematocrit, and red blood cell count. Blood smear 
abnormalities may include spherocytes, acanthocytes, schistocytes, 
stomatocytes, polychromasia, and target cells.  Osmotic fragility also 
is increased due to the presence of spherocytes.

Hemolytic anemias (HA) may be congenital or acquired. Inherited 
hemolytic disorders may include red cell membrane fragmentation, red 
cell enzyme defects, or abnormal structure of the hemoglobin molecule 
in the red cell. Examples of congenital HA include spherocytic HA and 
glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, which may be 
intermittent, often brought on by certain drugs, fava bean ingestion, 
or infections. Some hemoglobinopathies also may demonstrate a hemolytic 
process. Examples of acquired HA include:  autoimmune HA, direct Coombs 
positive HA, disseminated intravascular coagulation, and drug induced 
HA.

This consultative evaluation looks for the cause of increased red cell 
destruction and includes testing for hereditary spherocytosis, 
hemoglobinopathies, and red cell metabolism abnormalities.

Test
Limitations:

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

This group of tests should not ordinarily be requested in patients who 
are likely to have immune HA, such as that due to either warm or cold 
antibodies or to paroxysmal nocturnal hemoglobinurias. Coombs tests, 
tests for cold agglutinins, sucrose hemolysis, and Hams and Crosby 
tests are not part of the HA evaluation. In general, the foregoing 
tests should have been done prior to requesting HA evaluation. Since 
Wilson's disease is another rare cause for acute intermittent 
hemolysis, a test for Wilson's disease also may be appropriate prior to 
requesting HA evaluation.

Methodology:

Refer to CPT code information below.

CPT Code:

82657/RBC enzymes
82955/G-6-PD
83020/Hemoglobin electrophoresis (alkaline)
83021/Hemoglobin A(2) and F
83068/Hemoglobin stability
84087/Glucose phosphate isomerase
84220/Pyruvate kinase
85060/Morphology review
85557/Osmotic fragility

If appropriate these CPT's may apply and would be charged:
82664/Agar electrophoresis
82664/Globin electrophoresis
82664/Isoelectric focusing
82978/Gutathione
85660/Hemoglobin S solubility
88184/Band 3 fluorescence staining
88184/Hemoglobin F, red cell distribution