Hematopathology Consultations

The Hematopathology Section provides consultation in selected cases of diagnostic difficulty.  The following is a list of instructions regarding cases to be submitted in consultation.

Each case must be accompanied by a cover letter from a physician involved in the patient’s care (Pathologist or Clinician).  The cover letter should provide:

• Pertinent clinical information (Brief clinical history)
• The reason for the consultation
• Specific questions to be answered
• The referring pathologists working diagnosis or differential diagnosis           

Provide a copy or copies of the outside pathology report(s).

Submit representative H&E stained slides along with the paraffin block.    If a paraffin block cannot be submitted, please submit at least 15 unstained slides on charged slides.

The Hematopathology Section will retain representative H&E stained slides on all cases submitted in consultation.  It is preferable to submit recut slides, rather than originals, as we cannot take responsibility to return the original slides after our review. 

Outside special stains and immunohistochemical slides will be returned to the contributing laboratory.  In selected cases if recuts cannot be prepared due to limitations in the biopsy material, the H&E slides will be returned.

Please direct the materials to Dr. Elaine S. Jaffe, Building 10, Room 3S235.

Hematopathology Accessioning

1. Review incoming paperwork (correspondence, medical records, reports) submitted with pathology specimens, to determine age, sex, date of birth, submitting physicians.  Check all incoming documents for accuracy and consistency in patient identification.
2. Contact outside hospital/ pathologist if there are inconsistencies in biographical data or case data to determine accurate information.
3. Check paperwork to determine accuracy of received materials.
   • Are all stated materials accounted for?
   • If a paraffin block was to be submitted, is it in package?
   • Enter patient information in Daily Log Sheet
   • If received materials (slides/ blocks) do not correspond to cover letter or submission form, contact outside hospital to resolve discrepancies.   Note discrepancies on incoming paperwork. 
4. Before entry in Soft Path, cases will be screened by an Attending Staff Pathologist to ensure case meets requirements for review:
   • Cover letter with adequate clinical information.
   • Suitable topic for review within expertise of staff
   • Necessary materials for additional studies, if needed
   • Appropriate for expert review – not just a “second opinion”
   • Complete data entry in Daily Log Sheet.  Pathologist will have entered status of case as:  Accepted, Held for further material or information, or Returned.
   • If case is rejected for review, enter data in File Maker Pro data base for documentation & return case by Federal Express with appropriate cover letter as designated by Staff Pathologist.
5. Determine if patient is in soft path, either because of prior consult in system or registry as NIH patient. 
6. If new patient, enter biographical data in pathology Laboratory Information System (LIS) (Soft Path).
7. Examine incoming slides and blocks, record slide/ block identification codes and enter this information in LIS, including number of slides/ blocks bearing each code. 
8. Determine from incoming correspondence if there is any clinical urgency for diagnosis, and if so, contact NIH staff immediately to obtain clearance to submit as RUSH case.
9. After entry in soft path, transport slides, blocks and paperwork in appropriate transport plastic envelope to Histology Lab.
10. Record any broken or damaged slides, block, in Soft Path, QA monitoring system. Transport broken slides to histology for repair with rest of case.   
11. Respond to incoming phone calls, inquiring about status of pathology cases. 

• • Check LIS system to determine if case is signed out. If case is signed out, pathology report may be faxed  or sent by secure email to qualified medical professionals.
  • If case is not signed out, use the LIS to print the preliminary report and provide same to the pathology fellow/ resident responsible for the case.  Record the Drs. Name, and phone number for the fellow.
  • If clinical urgency is indicated, contact fellow by phone with relevant information.

Hematopathology Sign Out and Distribution of Reports

1. Sign Out and Distribution of reports:
   • Staff pathologist signs out cases in Soft Path electronically.
   • Copies of reports are sent to all individuals on distribution list by FAX or email, password protected pdf.  FAX is generally addressed to pathologist by name. 
   • If no FAX number is available and no email address is provided, contact outside pathologist for relevant information for distribution.
   • Discard extraneous worksheets, order sheets, immuno requests, etc. 
   • Compiled paperwork is scanned for archives.
2. Respond to phone inquiries concerning instructions for submission of consultation cases.  Provide instructions, either by FAX, Email, or phone.  (See attached).
3. Supplemental reports/ revised reports. Distribute as above to contributor, file with original case. 

 Hematopathology Return of Submitted Material

1. After case is signed out, pathologist will select slides to be returned. These generally consist of outside special stains. NIH retains representative H&E slides on all cases received in consultation.
   • On a regular basis, return above materials via Certified mail, return receipt requested. 
2. Examine slides/blocks being returned to determine both NIH and outside pathology identification numbers for tracking. Prepare cover letter detailing material being returned.
3. Scan cover  letter and Certified Mail Card or Fed Ex AirBill in Soft Path for archival storage and documentation.    
4. Respond to telephone inquiries requesting return of slides and/or paraffin blocks. Inform outside institutions of NIH policy to retain H&E stained slides.
5. If outside hospital wants materials sent back FED EX, request FED EX account number for billing to recipient.
6. Retrieve slides from files in sign out room.  If slides are not located, contact staff and fellows to determine if they are holding the case for some reason.

Hematopathology
Consultation Instructions (sample FAX)

The staff of the Hematopathology Section provides consultation in selected cases of diagnostic difficulty.  Detailed below are instructions regarding cases to be submitted in consultation. We ask that each case be accompanied by a cover letter from a physician involved in the patient’s care (Pathologist or Clinician), and a copy or copies of the outside pathology report(s):

The cover letter should provide contact information for the referring physicians, with phone and FAX numbers, as well as 1) Pertinent clinical information.  (Brief clinical history) 2)  Specific questions to be answered, and the referring pathologists working diagnosis or differential diagnosis.  Cases received without a cover letter containing this information will be held, pending receipt of the necessary information.          

In addition, please submit representative H&E stained slides along with the paraffin block.  For  immunohistochemical  and molecular studies,  we request a representative formalin fixed block.  If a paraffin block cannot be submitted, please submit at least 15 unstained slides on charged slides. If special stains have already been performed by the referring laboratory, please submit those for review as well.  This is particularly important if the biopsy was small and there may be limited remaining tissue for additional studies.

The Hematopathology Section will retain representative H&E stained slides on all cases submitted in consultation.  It is preferable to submit recut slides, rather than originals, as we cannot take responsibility to return the original slides after our review.  Outside special stains and immunohistochemical slides will be returned to the contributing laboratory.  In selected cases if recuts cannot be prepared due to limitations in the biopsy material, original slides will be returned.

There is no charge for consultations, as per U.S. government regulations.  However, we reserve the right not to review cases submitted for routine immunophenotypic or molecular studies, and suggest that such cases be submitted to a private reference laboratory.

Please include your FAX number or Email address, so that we can send you our findings promptly upon completion of the report.

Please send correspondence and specimens by an express delivery service (not the postal service) to:

Dr. Elaine S. Jaffe
Building 10, Room 3S235
10 Center Drive, NIH, MSC-1500
Bethesda, MD 20892-1500

Office Phone:  301-480-8040
Office FAX 301-480-8089
Email:  elainejaffe@nih.gov

Hematopathology
Form Letter:  No cover letter

RE:                JANE DOE

YOUR:         694-S 08 7837

FAX:              760-323-6195

We recently received slides/blocks on the above named patient.  It is our policy not to review a case in consultation unless it is received with an accompanying letter.    

The following is a list of instructions regarding cases to be submitted in consultation. We ask that each case be accompanied by a cover letter from a physician involved in the patient’s care (Pathologist or Clinician), and a copy or copies of the outside pathology report(s):

The cover letter should provide:

_____  1. Pertinent clinical information (Brief clinical history)

_____  2. The reason for the consultation

_____  3. Specific questions to be answered, if any

_____  4. The referring pathologists working diagnosis or differential diagnosis (if a report has not yet been issued).                 

The Hematopathology Section will retain representative H&E stained slides on all cases submitted in consultation.  It is preferable to submit recut slides, rather than originals, as we cannot take responsibility to return the original slides after our review.  Outside special stains and immunohistochemical slides will be returned to the contributing laboratory.  In selected cases if recuts cannot be prepared due to limitations in the biopsy material, original slides will be returned.

The materials will be held in our office pending receipt of the requested information.

                                                Sincerely yours,

                                                Elaine S. Jaffe, M.D.
                                                Chief, Hematopathology Section
                                                Laboratory of Pathology, NCI           

Hematopathology
Return of Slides, No consultation provided (sample)

To Whom It May Concern:

The Hematopathology Section, Laboratory of Pathology, NCI, conducts clinical investigations regarding the diagnosis and pathogenesis of lymphoproliferative disorders.  Because of our expertise in this field, we frequently receive diagnostic cases in consultation.  While we are pleased to offer consultation in selected instances, we cannot serve as a routine reference laboratory.  Cases submitted for review should have at least a preliminary work-up by the referring pathologist, including relevant immunostains or flow cytometry, sufficient to formulate a diagnostic impression.  Additionally, we do not accept “Routine Second Opinion Requests”

Cases referred for consultation should be submitted with a paraffin block or 15 unstained slides, to allow for ancillary studies.  The Hematopathology Section will retain representative H&E stained slides on all cases submitted in consultation.  It is preferable to submit recut slides, rather than originals, as we cannot take responsibility to return the original slides after our review.  Outside special stains and immunohistochemical slides will be returned to the contributing laboratory.  In selected cases if recuts cannot be prepared due to limitations in the biopsy material, the H&E slides will be returned.

In addition, we require a cover letter that includes: 1) Pertinent clinical information (brief clinical history), 2) specific questions to be answered, and 3) the referring pathologist's working diagnosis or differential diagnosis. 

As a division of the federal government, there is no charge for diagnostic consultations. However, we reserved the right to refuse consultation for cases not fulfilling the criteria stated above, or cases we consider outside of our expertise.  You may wish to contact us in advance, to determine if we can accept the case. 

Oral pathology Consultations

In some cases, the expertise of an oral pathologist may be valuable for interpretation of oral and/or dental lesions.  In the past, the Dental Clinic at NIDCR has utilized the expertise of the Oral Pathology Department at the Walter Reed Army Medical Hospital for outside consultations.

If an oral pathology consultation is desired on biopsy material obtained at the NIH, the following procedures need to be followed.

1. The specimen should be delivered in formalin to the Histology Laboratory of the Laboratory of Pathology, NCI (LP, NCI) Building 10, Room 2S259 with a CRIS generated requisition form.  All biopsy material taken from NIH Clinical Center patients must be formally accessioned in the Laboratory of Pathology, and registered in the Laboratory Information System (LIS).
2. State on the CRIS requisition that oral pathology consultation is desired, and provide the name and address of the outside consultant to whom the specimen should be sent.  Please provide all pertinent clinical history.
3. LP, NCI will prepare duplicate H&E and unstained slides, and submit these with pertinent clinical information to the outside consultant.  When the consultation report is received, the complete text of the report will be incorporated into the final pathology report generated by LP, NCI, and provided to the NIDCR requesting physician.  The report will be forwarded to Medical Records for incorporation into the patient’s chart, and the text of the verified report will be transmitted via the CRIS system.  The requesting physician will also be provided with a Xerox copy of the outside consultation report.

INSTRUCTION FOR SUBMITTING HEMATOPATHOLOGY SPECIMENS

For lymph node biopsies and other hematolymphoid lesions, please contact Dr. Elaine S. Jaffe, Chief of Section and Medical Director, at 480-8461, or Dr. Stefania Pittaluga at 480-8465, or Theresa Davies-Hill at 301-480-8462.

Lymph node biopsies should be placed in sterile saline or media, and delivered to the Hematopathology Section directly for fresh tissue procurement and processing.

DO NOT USE FIXATIVE ON LYMPH NODE SPECIMENS, UNLESS DIRECTED BY HEMATOPATHOLOGY.

Specimen Collection and Handling

NIH Biopsy Specimens

1. Physicians are strongly encouraged to consult with the staff of the Hematopathology Section regarding any specialized testing required. (Dr. Elaine S. Jaffe, Chief of Section and Medical Director, 480-8461, or Dr. Stefania Pittaluga, 480-8465).  Questions regarding delivery of specimens may also be directed to Medical Technologist, Theresa Davies-Hill, 480-8462. The hot-seat resident can also be reached through the page operator and can take down the contact information and specific requests and discuss the logistic with the hematopathology staff. 
2. A CRIS Requisition for Anatomic Pathology Services must be completed for all submitted specimens, according to NIH guidelines. Under "Special Instructions", indicate specific needs such as marker studies and state the NIH protocol and need for evaluation of particular antigens, if required; e.g. please evaluate for expression of CD19 or CD25.   In addition, for research tissue distribution according to research protocols, a “Tissue Procurement Request Form” should be entered in CRIS before the day of surgery or procedure.
3. For special studies such as cytogenetic, flow cytometry and microbiology, the respective laboratory should be contacted in advance, appropriate CRIS orders should be placed once the case is accepted; in particular for microbiology , the Dept of Laboratory Medicine at the Clinical Center should be contacted directly and the tissue should be procured directly in the OR.
4. Specimens should be delivered fresh, in a sterile container, suspended in sterile normal buffered saline or tissue culture media (RPMI). The container should be labeled with the patient’s name, NIH identification number (MRN), and the identity of the tissue biopsy site.
5. Tissue biopsy specimens should be delivered to the Hematopathology Laboratory, Building 10, Room 2S247.