Test Required

Volume of Blood/Container

Blood Tests

CBCD + F, retics, DIC profile, Serum B12, serum and red cell folate

3 x 5 mL EDTA (mauve top), 1 x 5 mL citrate, 1 x 5 mL plain

For all patients being potentially considered for AML19, send peripheral blood for molecular biology clearly labelled as "possible AML19 patient".

4 x EDTA tubes.

HEMO profile, urate, Ferritin, iron studies, SPE, Ig levels, thyroid function

1 x 5 mL heparin, 1 x 5 mL plain

Blood group & red cell antibodies

1 x 7.5 mL EDTA (pink top)

Viral serology-HbsAg, HCV, Herpes simplex/zoster, CMV. HIV test

Please make it clear that it is CMV serology (not viral load) that is needed.

1 x 5 mL plain (request long term storage)

*HLA Typing

2 x 10 mL CPDA (yellow top), 1 x 10 mL plain, 1 x 6 mL EDTA (pink top).

This sometimes gets missed so please follow up and check it has been done, ideally before treatment begins. Contact SCT Coordinator so they know who the patient is.

Bone Marrow

Bone marrow aspirate and trephine (if the blast count is very high, very occasionally this may not be necessary, discuss with consultant)

Arrange with Laboratory Haematology Registrar and ensure that they know they may be entered into a trial.

Cell surface marker analysis on bone marrow. Only send blood as well if there is a specific indication, e.g. dry tap

In addition to the standard surface markers done here, all possible AML19 patients require 2 tugs of 1 mL of the first 2 pulls to go onto EDTA (not transport medium), to be sent to Auckland.

Arrange with surface marker lab. (ext: 80917).

Due to the hypercellularity of bone marrow, especially at presentation, there is a high change of clotting within the EDTA tube if overfilled, affecting the flow MRD results.

Therefore, aspirate collection is recommended in this order:

• 1–2 mL each in x2 EDTA tube for MRD flow at labplus (max 2 mL).
• Aspirate slides.
• 3–4 mL in EDTA for molecular oncology.
• 1–2 mL each in x2 RPMI for local testing.

Cytogenetics and appropriate molecular biology on BM. Storage of DNA

Haematology Registrar will deal with BM samples.

Consider whether cytogenetics needed on blood, e.g. if there is a dry tap

Blood 10 mL in heparin (may require more if WBC count very low)

Swabs

Microbiology-swabs from nostrils, throat, swabs of any infected lesions

Label forms ‘for bacterial and fungal cultures’ and ‘New Leukaemic’.

Radiology

Sinus CT

All patients

Chest X-Ray

All patients

Other

ECG

All patients

ECHO for LVEF

All patients, before they receive intensive chemotherapy. For further details of LVEF monitoring, see Cardiotoxicity and Cytotoxic Drugs in the Drug Usage section. ECHO request

MSU, Sputum, Stool

According to clinical indications

Blood cultures

If clinically indicated.

CSF

Only in patients with suspicion of CNS disease at diagnosis and for all others at times of intrathecal treatment.

Send CSF to Haematology Lab for cell counts, "cytospin" and microscopic examination. If the term cytospin isn’t used, the sample will go to Cytology instead of the Haematology Lab.

Referrals

Dental assessment (special form) on all intensively treated patients.

Hickman line insertion, Psychologist assessment

All patients being treated intensively should be referred at the time of diagnosis for assessment. However, treatment may need to be delayed depending on the counts, etc.

Fertility Centre if appropriate.

See separate section on fertility in Red Book. These discussions would usually be undertaken by the consultant.

Social work assessment

All patients should be referred for a baseline assessment of their needs.

Hickman line insertion

Psychologist assessment

On an individual basis but many patients find very valuable.

OT, Physio, Social Worker, Dietitian, Wig specialist

Nurses to organise