Important Note
A complete blood count is required for interpretation. Include a copy of recent complete blood count with differential (CBCDIFF) results. If not available, submit a lavendar top tube (EDTA) and a CBCDIFF will be performed at an additional charge.
Methodology
Microscopic Examination of Wright-Giemsa Stained Smear
Useful for detecting disease states or syndromes of WBCs, RBCs,
or platelet cell lines of a patient’s peripheral blood.
Specimen Requirements
Specimen Type: 2-3 unstained, well-made
peripheral blood smears.
Container/Tube: Slide(s)
Specimen Volume: See Collection
Instructions
Collection Instructions:
Submit appropriate number of peripheral blood smears made from a
lavender-top (EDTA) tube(s) that was drawn <24 hours earlier.
Include results for CBCDIFF CBC (Complete Blood Count) with
Differential, Blood from same tube(s) of blood. Blood
smear made from fingerstick is also acceptable. Send slides in
plastic slide holder.
Note: Label
slide holder with patient’s legal name, date of birth, and
date/time of collection.
Forms: Pathology
Requisition and Advance Beneficiary Notice (ABN) Form
(Listed in Special Instructions)
Any outpatient covered by Medicare must complete and
sign an ABN (Advance Beneficiary Form) before testing will be
performed.
Specimen Retention Time
- Slides - 6 months
- EDTA Blood - 48 hours
Day(s) Test Set Up
Monday through Friday
Maximum Laboratory Time
3 days from received date
Specimen Stability
|
Specimen Type
|
Temperature
|
Time
|
| |
Ambient |
|
| |
|
|
Findings Required for Slide Review by Pathologist
|
|
First
time
|
Followup
|
|
|
|
|
|
Adult
(≥ 18 yo)
|
|
|
|
WBC >40.0
x103/uL
|
Yes
|
No
|
|
Platelet >1000
x103/uL
|
Yes
|
every 12 months
|
|
nRBC >5/100WBC
|
Yes
|
No
|
|
Lymphocytosis (≥5.0
x103/uL)
|
Yes
|
No
|
|
Monocytosis (≥2.0
x103/uL)
|
Yes
|
every 6 months
|
|
Eosinophilia (≥2.0
x103/uL)
|
Yes
|
No
|
|
Basophilia (≥0.5
x103/uL)
|
Yes
|
every 6 months
|
|
Immature cells (>3%
pros or >5% myelos)
|
Yes
|
If >5% increase
from last sample
|
|
Blasts
|
Yes
|
every 30 days
|
|
Plasma cells
(≥5%)
|
Yes
|
No
|
|
Schistocytes or
spherocytes (2+ or 3+)
|
Yes
|
No
|
|
Other abnormal or
unidentifiable cells
|
Yes
|
Yes
|
|
Malaria or other
parasite/organism
|
Yes
|
Yes
|
|
|
|
|
|
Pediatrics (≤ 17 yo)
|
|
|
|
WBC >40.0
x103/uL
|
Yes
|
No
|
|
Pancytopenia
(decreased WBC, Hgb, plts)
|
Yes
|
No
|
|
Neutropenia (ANC
≤200/uL)
|
Yes
|
No
|
|
Platelet >1000
x103/uL
|
Yes
|
every 12 months
|
|
Platelet <50
x103/uL
|
Yes
|
No
|
|
Lymphocytosis (≥5.0
x103/uL)
|
Yes
|
No
|
|
Lymphocytosis (≥85%
+ anemia or thrombocytopenia)
|
Yes
|
No
|
|
Monocytosis (≥2.0
x103/uL)
|
Yes
|
every 6 months
|
|
Blasts
|
Yes
|
every 30 days
|
|
Schistocytes or
spherocytes (2+ or 3+)
|
Yes
|
No
|
|
Other abnormal or
unidentifiable cells
|
Yes
|
Yes
|
|
Malaria or other
parasite/organism
|
Yes
|
Yes
|
When a peripheral
smear review by pathologist test is ordered, if the CBC results do
not meet criteria for slide review by pathologist the test will be
cancelled, and the following comment entered “Peripheral
smear review by pathologist test was cancelled. Laboratory findings
requiring review by pathologist are not identified in this sample.
If there is a clinical indication for a pathologist to review the
smear, please call the Pathology department at
(406)752-1789.”
Reference Values
An interpretative report will be provided.
Test Classification and CPT Coding
85060
Special Instructions
Note: Complete ALL information including
specimen source and all pertinent clinical data (clinical
symptoms, history of malignancy, chemotherapy, radiation therapy,
and tentative diagnosis) and forward with specimen.
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