Ordering Guidance

Preliminary screening tests, such as complete blood cell 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 collection.

Necessary Information

At minimum, include recent transfusion information and most recent complete blood cell count results.

Metabolic Hematology Patient Information (T810) is strongly recommended. Testing may proceed without this information, however if the information requested is received, any pertinent reported clinical features and data will drive the focus of the evaluation and be considered in the interpretation.

The laboratory has extensive experience in hemoglobin variant identification and many cases can be confidently classified without molecular testing. However, molecular confirmation is always available, subject to sufficient sample quantity (eg, multiplex ligation-dependent probe amplification testing requires at least 2 mL of specimen in addition to protein testing requirements). If no molecular testing or specific molecular tests are desired, utilize the appropriate check boxes on the form. If the form or other communication is not received, the reviewing hematopathologist will select appropriate tests to sufficiently explain the protein findings, which may or may not include molecular testing.

Specimen Required

The following specimens are required for testing:

2 Patient whole blood EDTA specimens

2 Patient whole blood ACD specimens

1 Shipping control whole blood EDTA specimen (collected from a healthy individual)

2 Well-made peripheral blood smears (Wright stained or fixed in absolute methanol)

For complete instructions, refer to the Specimen Collection and Labeling Instructions for Osmotic Fragility Testing of Erythrocytes.

Shipping Control Specimen:

Specimen Type: Whole blood (non-patient)

Container/Tube: Lavender top (EDTA)

Specimen Volume: 4 mL

Collection Instructions:

1. Collect a shipping control specimen from a healthy person unrelated to the patient at the same time (or within 4 hours) as the patient specimen.

Note: The shipping control specimen can be collected from a phlebotomist, volunteer or another heathy patient.

2. Clearly handwrite "CONTROL" on the outermost label of the tube.

3. Refrigerate (or place on cold gel pack/small amount of wet ice) specimen immediately after collection.

4. Send shipping control in the original tube. Do not aliquot.

5. Keep the shipping control and the patient specimens together, either rubber banded or in a bag.

Additional Information:

1. The shipping control and patient specimens must be handled identically from the time of collection through receipt in the testing laboratory.

2. If the shipping control is not sent with the patient specimen, test cancellation is likely.

3. The shipping control specimen evaluates whether the patient result has been compromised by handling conditions such as temperature, motion, or other transportation interferences, as temperature and handling extremes can adversely impact the integrity of the specimen.

Patient Specimen:

Specimen Type: Whole blood

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

Specimen Volume: Two 4-mL EDTA tubes AND two 6-mL ACD tubes

Collection Instructions:

1. Collect and label patient specimens.

2. Refrigerate (or place on cold gel pack/small amount of wet ice) specimen immediately after collection.

3. Send whole blood specimens in the original tubes. Do not aliquot.

4. Keep the shipping control and the patient specimens together, either rubber banded or in a bag.

Additional Information: The shipping control and patient specimens must be handled identically from the time of collection through receipt in the testing laboratory.

Patient Specimen:

Specimen Type: Slides

Container/Tube: Blood smears

Specimen Volume: 2 Well-made peripheral blood smears

Collection Instructions:

1. Prepare 2 peripheral blood smears from the EDTA tube collected from the patient.

2. Either stain the smear with Wright stain or fix the smear with absolute methanol prior to shipping.