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15.3 Lymph Node and Tissue Biopsies Principle High-quality sections for routine light microscopy are necessary, but not always sufficient, for the interpretation of lymph node or bone marrow biopsies. Immunophenotypic and genetic studies are often required for the proper diagnosis and classification of a hematopoietic neoplasm. Adequate fixation and timely and appropriate technical handling of the tissue are, therefore, even more important than with other specimens. A Gross Examination and Specimen Processing Once a resected lymph node specimen is received, its size, shape and capsule situation will be described. It will then be transversely sliced into uniformly 3mm-thick sections. The cut surface will be examined carefully and the gross appearance documented in detail. Then at least 2 representative sections will be submitted for routine fixation immediately (See Figure 15.2). Bone marrow trephine core biopsies will not be sectioned unless actual bone marrow tissue is 1 cm in length. See Bone Marrow Biopsy Flow Chart (Figure 15.1). 15 HEMATOLOGY 15.1 Instrumentation The CELL-DYN 3700CS System will be used routinely at JCML. It is a multi-parameter, automated hematology analyzer with a manual Closed Sampler designed for in vitro diagnostic use in clinical laboratories. (See Appendix D). 15.2 Procedures The CELL-DYN 3700CS System generates the following hematologic measurements on EDTA-anticoagulated whole blood: WEC - White Blood Cell or Leukocyte count HCT - Hematocrit NEU - Neutrophil absolute count MCV - Mean Corpuscular Volume %N - Neutrophil percent MCH - Mean Corpuscular Hemoglobin LYM - Lymphocyte absolute count MCHC - Mean Corpuscular Hemoglobin %L - Lymphocyte percent Concentration MONO - Monocyte absolute count RDW - Red Cell Distribution Width %M - Monocyte percent PLT - Platelet or Thrombocyte count EOS - Eosinophil absolute count MPV - Mean Platelet Volume %E - Eosinophil percent PDW - Platelet Distribution Width BASO - Basophil absolute count PCT - Plateletcrit %B - Basophil percent RETIC % - Reticulocyte Percent RBC - Red Blood Cell or Erythrocyte count RETIC ABS - Reticulocyte Absolute HGB - Hemoglobin concentration IRF - Immature Reticulocyte Fraction In addition, Wright's-stained peripheral blood smears will be made routinely for use as a back- up in the evaluation of peripheral blood morphology. Figure 15.2- Flow Chart for Processing of Lymph Node and Tissue Biopsies 71 SHELL-MCCLURG-059516