Red Blood Cell Membrane Evaluation, Blood

Test Code

93767

CPT Codes
85060, 85555, 85557, 86356

Preferred Specimen

Patient:
2 well-made peripheral blood smears, and
4 mL whole blood collected in an EDTA (lavender or pink-top) tube, and

Normal Shipping Control:
4 mL whole blood collected in an EDTA (lavender or pink-top) tube

Minimum Volume

2 smears • 2 mL whole blood

Instructions

A whole blood EDTA specimen, an EDTA shipping control specimen, and 2 well-made peripheral blood smears (Wright stained or fixed in absolute methanol) are required for testing.

Patient:
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.

Normal Shipping Control:
1.) Collect a shipping control specimen from a normal (healthy), unrelated, nonsmoking person at the same time as the patient.

2.) Clearly hand write "normal control" on the outermost label.

3.) Refrigerate specimen immediately after collection.

4.) Send control specimen in original tube. Do not aliquot.

5.) Rubber band patient specimen and control vial together. The control and patient specimens must be handled in the same manner from specimen collection to receipt in the testing laboratory.

Transport Temperature

Refrigerated (cold packs)

Specimen Stability

Smears
Room temperature: Unacceptable
Refrigerated: Indeterminate
Frozen: Unacceptable
⁠⁠⁠⁠⁠⁠⁠
Whole blood
Room temperature: Unacceptable
Refrigerated: 72 hours
Frozen: Unacceptable

Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)

Gross hemolysis • Clotted

Methodology
Osmotic Lysis • Flow Cytometry

FDA Status
This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

Setup Schedule

Set up: Mon-Sat; Report available: 4-7 days

Reference Range

Result Name	Age	Reference Range
0.50 g/dL NaCL	≥12 months	3-53 %hemol
0.60 g/dL NaCL	≥12 months	14-74 %hemol
0.65 g/dL NaCL	≥12 months	4-40 %hemol
0.75 g/dL NaCL	≥12 months	1-11 %hemol

An interpretive report will be provided

Clinical Significance

Investigation of suspected red cell membrane disorders, such as hereditary spherocytosis or hereditary pyropoikilocytosis. This test is not useful for hereditary elliptocytosis.

The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.