1

Faculty:

Case Number: HB- -

Patient Name:

Diagnosis

Peripheral Blood:

- Normochromic hypochromic anemia

Bone Marrow:

- Normocellular for age

- No morphologic or immunophenotypic evidence of

- Adequate iron stores

Comment

-Immunophenotyping of bone marrow aspirate by flow cytometry (report HF- - ) shows

-Bone marrow aspirate was sent for cytogenetics, FISH panel for

Tumor Summary

Specimen:

Peripheral blood smear

Bone marrow aspiration

Bone marrow aspirate clot

Bone marrow core (trephine) biopsy

Bone marrow core touch preparation (imprint)

Procedure: Bone marrow

Aspiration site: R posterior iliac crest

Biopsy site: R posterior iliac crest

Histologic type:

Immunophenotyping

Immunohistochemistry: Performed

Flow cytometry:

Performed, see separate report (HF-xx-_)

Cytogenetic studies: Performed, see separate report

Specimen Source

1. Bone marrow aspirate and clot

2. Bone marrow core biopsy, decal, touch prep

3. Peripheral blood smear

Bone marrow procedure was performed by IR

Clinical Information

.

Gross Description

[by Surg Path]

Microscopic Description

CBC Results

Date/time:

PERIPHERAL BLOOD:

Erythrocytes: Normochromic hypochromic anemia with anisopoikilocytosis, mild polychromasia

White cells: Normal in number

Granulocytes: Normal morphology

Lymphocytes: Normal morphology

Monocytes: Normal morphology

Platelets: Normal number and morphology

Bone marrow

Differential (%)

Myeloblasts:

Promyelocytes:

Myelocytes:

Metas:

Bands & PMN's:

Eos:

Baso:

Monos:

Lymphs:

Plasma cells:

Erythroids:

M:E ratio

Cellularity: %, normocellular for age

Megakaryopoiesis: Adequate with normal maturation

Erythropoiesis: Adequate with normal maturation

Iron Content (aspirate): Adequate iron stores

Granulopoiesis: Adequate with normal maturation

Lymphocytes: Normal number and morphology

Plasma Cells: Normal number and morphology

Biopsy and clot section: No evidence of granuloma, fibrosis or abnormal cellular infiltrates

Iron content (biopsy and clot section):Adequate iron stores

Intradepartmental Consultation

-This casewasreviewedwitha consensus at theUniversityof Texas-Houston MedicalSchoolHematopathologyQAConferenceon xx/xx/xxxx.

Non Clinical Documentation

CPT:88305 x 2, 88313 x 2, 88311, 85097, 85060, 88342, 88341 x

The positive controls and internal negative controls for the special stains have been reviewed, and appropriate staining is confirmed by the pathologist whose signature appears above.

Some of theimmunohistochemicaltests in this panel were developed and their performance characteristics determined by Memorial Hermann Southwest Hospital Laboratory.They have not been cleared or approved by the U. S. Food and Drug Administration.The FDA has determined that such clearance or approval is not necessary.These tests are used for clinical purposes.They should not be regarded as investigational or for research.This laboratory is regulated under the Clinical Laboratory Improvement Amendments of the 1988 (CLIA) as qualified to perform high complexity clinical testing.

Teaching Physician Statement

"I have personally reviewed the resident's preliminary interpretation and all specimen preparations and have personally issued this report".