CPT® Code 78135

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1. Indications

The red cell survival study (CPT® Code 78135) is indicated for patients who exhibit symptoms or conditions that may suggest hemolytic anemia. The following are specific indications for performing this procedure:

• Suspected Hemolytic Anemia - This test is utilized when there is a clinical suspicion of hemolysis, which is the premature destruction of red blood cells.
• Evaluation of Anemia - It is performed to further investigate the underlying causes of anemia, particularly when hemolytic etiology is considered.
• Assessment of Red Blood Cell Lifespan - The procedure helps determine the lifespan of red blood cells, which is critical in diagnosing and managing various hematological disorders.

2. Procedure

The procedure for the red cell survival study involves several detailed steps to ensure accurate assessment of red blood cell kinetics:

• Step 1: Baseline Blood Sample Collection - Initially, a blood sample is drawn from the patient to obtain a baseline microhematocrit measurement. This serves as a reference point for subsequent analyses.
• Step 2: Tagging of Red Blood Cells - The red blood cells are then tagged with the radioactive isotope tracer, Chromium-51 (Cr-51) Sodium Chromate. This tagging process is essential for tracking the RBCs during the study.
• Step 3: Injection of Tagged RBCs - After incubation, the tagged red blood cells are injected back into the patient’s bloodstream via intravenous administration, allowing for real-time monitoring of their lifespan.
• Step 4: Daily Blood Sampling - The patient returns for a series of daily venipunctures, which typically occur over a span of 10 to 21 days. During these visits, blood samples are collected for ongoing microhematocrit analysis to evaluate the RBC lifespan.
• Step 5: Scintillation Imaging - In conjunction with blood sampling, scintillation imaging is performed every other day. An uptake counting probe is placed over the liver, spleen, and/or precordium for 10 minutes at each site to measure the activity of the tagged RBCs.
• Step 6: Consistent Imaging Technique - The patient's skin is marked with permanent ink to ensure that the same anatomical areas are assessed during each imaging session. The liver is scanned in the midclavicular line while the patient is supine, the precordium is scanned in the third intercostal space at the left sternal border, and the spleen is scanned with the patient in a prone position at the ninth to tenth ribs.
• Step 7: Interpretation and Reporting - Finally, the physician interprets the scintigraphy images and compiles a comprehensive written report that includes the findings from the imaging as well as the laboratory data collected from the venous blood sampling.

3. Post-Procedure

After the completion of the red cell survival study, patients may be monitored for any immediate reactions to the radioactive tracer. It is important for the physician to provide the patient with the results of the study, including the interpretation of the scintigraphy images and the microhematocrit analysis. Follow-up care may be necessary depending on the findings, particularly if hemolysis is confirmed. Patients should be informed about any potential side effects related to the radioactive tracer and advised on any necessary precautions following the procedure. Additionally, the physician may recommend further diagnostic testing or treatment options based on the results of the study.