Benign Hematology Test Request

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Ship specimens to: Billing Information Mayo Clinic Laboratories • An itemized invoice will be sent each month. 3050 Superior Drive NW • Payment terms are net 30 days. Rochester, MN 55901 Call the Business Office with billing related questions: Customer Service: 855-516-8404 800-447-6424 (US and Canada) 507-266-5490 (outside the US) Visit www.MayoClinicLabs.com for the most up-to-date test and shipping information. T755 ©2021 Mayo Foundation for Medical Education and Research Page 1 of 2 MC0767-07Arev0421 Patient Information (required) Patient ID (Medical Record No.) Client Account No.

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CONSULTATION/MORPHOLOGY EVALUATION ERYTHROCYTES: HEREDITARY : MEGALOBLASTIC ANEMIA PATHC Pathology Consultation ERYTHROCYTOSIS FOL Folate, Serum (submit stained slides and block) BPGMM 2,3-Bisphosphoglycerate Mutase, Full GAST Gastrin, Serum HPWET Hematopathology Consultation, Sequencing Analysis, Varies MHCZ Methylmalonic Aciduria and MCL Embed (submit core biopsy, REVE1 Erythrocytosis Evaluation, Whole Blood Homocystinuria, cbIC Type, Full Gene clot section and bone marrow aspirate) EPO Erythropoietin, Serum Analysis, Varies HPCUT Hematopathology Consultation, Hereditary Erythrocytosis Mutations, MHDZ Methylmalonic Aciduria and Client Embed (submit bone marrow HEMP Whole Blood Homocystinuria, cbID Type, Full Gene aspirate and embedded core biopsy and Analysis, Varies clot section) ERYTHROCYTES: IMMUNOLOGY MMAP Methylmalonic Acid, Quantitative, Plasma ABYSR Antibody Screen with Reflexed Antibody ERYTHROCYTES: ENZYMOPATHIES Identification, RBC MMAS Methylmalonic Acid, Quantitative, Serum AK1 Adenylate Kinase Activity, Blood CATR Cold Agglutinin Titer, Serum MMAU Methylmalonic Acid, Quantitative, Urine G6PD1 Glucose 6-Phosphate Dehydrogenase BTR Isoagglutinin Titer, Anti-B, Serum ACASM Pernicious Anemia Cascade, Serum Enzyme Activity, Blood PLINK Paroxysmal Nocturnal Hemoglobinuria, B12 Vitamin B12 Assay, Serum GPI1 Glucose Phosphate Isomerase Enzyme PI-Linked Antigen, Blood Activity, Blood FB12 Vitamin B12 and Folate, Serum G6PDB Glucose-6-Phosphate Dehydrogenase ERYTHROCYTES: MEMBRANE DISORDERS METABOLISM: METALS (G6PD) Full Gene Sequencing, Varies HAEV1 Hemolytic Anemia Evaluation, Blood CERS Ceruloplasmin, Serum GSH Glutathione, Blood KCNN4 KCNN4 Full Gene Sequencing, Varies FERR Ferritin, Serum HAEV1 Hemolytic Anemia Evaluation, Blood FRAG Osmotic Fragility, Erythrocytes FECHZ Ferrochelatase (FECH) Gene, Full Gene HK1 Enzyme Activity, Blood RBCME Red Blood Cell Membrane Evaluation, Analysis, Varies PFK1 Phosphofructokinase Enzyme Activity, Blood HFE Hemochromatosis HFE Gene Analysis, Blood Blood ERYTHROCYTES: METHEMOGLOBIN PGK1 Enzyme Activity, FEC Iron and Total Iron-Binding Capacity, Blood METR1 Cytochrome b5 Reductase Enzyme Serum Activity, Blood P5NT Pyrimidine 5’ Nucleotidase, Blood TRSF Transferrin, Serum PK1 Enzyme Activity, Blood MET Methemoglobin and Sulfhemoglobin, Blood NEZPP Zinc Protoporphyrin, Blood PKLRG Pyruvate Kinase Liver and Red Blood Cell (PKLR), Full Gene Sequencing and Large MEV1 Methemoglobinemia Evaluation, Blood MOLECULAR BENIGN HEMATOLOGY STUDIES Deletion Detection, Varies LEUKOCTYES NGHHA Hereditary Hemolytic Anemia EEEV1 Red Blood Cell (RBC) Enzyme Evaluation, Comprehensive Panel, Blood MURA Lysozyme (Muramidase), Plasma Next-Generation Sequencing, Varies TPI1 Triosephosphate Isomerase Enzyme LYMPHOCYTES NGCDA Congenital Dyserythropoietic Anemia Activity, Blood Panel, Next-Generation Sequencing, ALPS Alpha Beta Double-Negative T Cells Varies ERYTHROCYTES: GENERAL for Autoimmune Lymphoproliferative Syndrome, Blood NGMEM Red Blood Cell Membrane Panel, HGB_Q Hemoglobin, Qualitative, Urine Next-Generation Sequencing, Varies CRGSP Cryoglobulin and Cryofibrinogen Panel, PLHBB Plasma Free Hemoglobin, Plasma Serum and Plasma NGENZ Red Blood Cell Enzyme Panel, Next-Generation Sequencing, Varies RTIC Reticulocytes, Blood ATR Isoagglutinin Titer, Anti-A, Serum KCNN4 KCNN4 Full Gene Sequencing ERYTHROCYTES: HEMOGLOBIN DISORDERS LCMS Leukemia/Lymphoma Immunophenotyping, Flow Cytometry, ADDITIONAL TESTS REVE1 Erythrocytosis Evaluation, Whole Blood Varies (INDICATE TEST ID AND NAME) HBEL1 Hemoglobin Electrophoresis Evaluation, NKSP Natural Killer (NK)/Natural Killer T (NKT) Blood Cell Subset Panel, Blood HGBCE Hemoglobin Variant, A2 and F VISCS Viscosity, Serum Quantitation, Blood HAEV1 Hemolytic Anemia Evaluation, Blood MEV1 Methemoglobinemia Evaluation, Blood SDEX Sickle Solubility, Blood THEV1 Thalassemia and Hemoglobinopathy Evaluation, Blood and Serum

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