Instructions for Requisitions for Hematopathology Testing Service at UPMC-Presbyterian Hospital There are two separate requisitions for hematopathology testing. One requisition is to be used for bone marrow, peripheral blood and body fluid specimens. The second requisition is to be used for lymph node and solid tissue specimens. Please give a copy of this notification and the two requisitions to the individual responsible for filling out the requisition. PLEASE COMPLETE THE REQUISITION IN FULL. Patient Information (name, social security number, birth date, diagnosis, ICD 9 code, inpatient or outpatient status). SEND A COPY OF THE PATIENT’S INSURANCE INFORMATION. Reporting Information. Be sure to include phone and fax numbers for the requesting physician and any other physician to whom a copy is to be sent. Clinical History/Pertinent Physical findings. Type of Specimen. Time and Date specimen was obtained/sent. Testing request(s). SPECIAL INSTRUCTIONS Lymph Node/Solid Tissue Requisition: It is very important to indicate whether the entire unprocessed specimen is sent for a full hematopathologic evaluation or if only a portion of the specimen is sent for flow cytometry or other testing. It is also important to indicate if additional material will follow and if so, who will issue the primary report. Place a check mark in the appropriate box. If the entire fresh tissue specimen is sent, it will be handled per our standard lymph node diagnostic protocol: histologic sections, flow cytometry testing (if appropriate), DNA and possibly RNA storage (molecular diagnostics testing, if appropriate), cytogenetic testing (if appropriate) and other testing as needed. In these cases UPMC-Presbyterian Hematopathology will function as the primary pathologist if the case is from a UPMC facility. If only a portion of the specimen is sent for flow cytometric evaluation, limited material will be processed for histologic sections if there is sufficient tissue (H&E, PAS and MGP stains will be performed). Check “Flow Cytometric Immunophenotypic Studies” and indicate any special requests. If a portion of the specimen is being sent and the remainder is to follow for a full hematopathologic evaluation, please indicate if this is for a consultation or if UPMC-Presbyterian Hematopathology is to issue the primary pathology report. Specify testing for Molecular Oncology or Chromosome Analysis as necessary. A physician’s signature is required for Chromosome Analysis testing. Bone Marrow/Blood/Body Fluid Requisition Cytochemical stains - Indicate the specific stain(s) desired in the appropriate section. Complete information is provided in Test Specifications: Bone Marrow Laboratory. Specify testing for Molecular Oncology or Chromosome Analysis as necessary. A physician’s signature is required for Chromosome Analysis testing. Miscellaneous: See Test Specifications: Clinical Flow Cytometry Laboratory and Bone Marrow Laboratory for information on laboratory hours of operation and specimen requirements. It is always best to call the flow cytometry laboratory before sending a specimen. We can then help to insure that your sample arrives safely. Send specimens by courier or overnight express. Send specimens as early in the day as possible for optimal handling. This is particularly critical before weekends and holidays. In packaging bone marrows, please: Tightly close the biopsy container. Keep container upright. MARK THE DATE AND TIME THE BIOPSY WAS PLACED IN THE B+ fixative on the container. Package slides separately from the biopsy specimen (to avoid vapor fixation of slides). We can also facilitate specimens going to the Cytogenetics and Molecular Diagnostics laboratories.