Download Bone Marrow Transcription Template

1
Faculty:
Case Number: HBPatient Name:
-
Diagnosis
Peripheral Blood:
Bone Marrow:
Comment
-Immunophenotyping of bone marrow aspirate by flow cytometry (report HF-
-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-_)
Not performed
Cytogenetic studies: Performed, see separate report
Not performed
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
.
-
) shows
2
Gross Description
[by Surg Path]
Microscopic Description
CBC Results with cell differential to be inserted here
Date/time:
PERIPHERAL BLOOD:
Erythrocytes:
White cells:
Granulocytes:
Lymphocytes:
Monocytes:
Platelets:
Case Number: HB-
-
Bone marrow
Differential (%)
Myeloblasts:
Promyelocytes:
Myelocytes:
Metas:
Bands & PMN's:
Eos:
Baso:
Monos:
Lymphs:
Plasma cells:
Erythroids:
M:E ratio
Cellularity:
Megakaryopoiesis:
Erythropoiesis:
Iron Content (aspirate):
Granulopoiesis:
Lymphocytes:
Plasma Cells:
Biopsy and clot section:
3
Iron content (biopsy and clot section):
Intradepartmental Consultation
-This case was reviewed with a consensus at the University of Texas-Houston
Medical School Hematopathology QA Conference on xx/xx/xxxx.
Non Clinical Documentation
CPT:88305 x 2, 88313 x 2, 88311, 85097, 85060
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 the immunohistochemical tests 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".