Bone Marrow (SBM)

- For hematopoietic neoplasms involving the bone marrow

Specimen and Surgical Procedure

Specimen...................................................................................

List all that apply

- Peripheral blood smear

- Bone marrow aspiration

- Bone marrow aspirate clot (cell block)

- Bone marrow core (trephine) biopsy

- Bone marrow core touch preparation (imprint)

- Other (specify): ______

Procedure.......................................................................... aspiration and biopsy

Aspiration and biopsy site................ R/L/bilateral iliac crest(s)/other (specify: ____)

Neoplasm

Histologic type.............................................................................

Immunophenotyping (flow cytometry and/or immunohistochemistry)..

Classify as one or more of the following

- Performed, see separate report (FLW-__-____)

- Performed, see above immunoperoxidase table

- Not performed

Cytogenetic studies......................................................................

Classify as one of the following

- Performed, see separate report (CTG-__-____)

- Not performed

Hematologic

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