Precision Pathology

Collection Instructions

  • Overview

    Purpose
    To establish proper protocol for the collection and transportation of patient specimens for routine histologic/cytologic/microbiologic examination in the Laboratory.

    Policy
    To educate the Clinician and Laboratory Staff of the pre-analytical steps when collecting and handling specimens for Anatomic Pathology and/or Microbiology examination. Upon each client set up, the Client will be educated on specimen collection and transport packaging. Orientations will be documented and stored in the client’s file. GEN.40050

    Quality Control

    1. All specimen containers are to be labeled with at least two identifiers at the time of collection (Patient’s full name is required, second identifer can be DOB).
    2. Individual slides are to be labeled with two unique identifiers. Slide holders do not serve as the “specimen container”.
    3. Liver Specimens should be accompanied with all current liver function tests (LFTs).
    4. Breast Specimens should be accompanied with mammography and ultrasound.
    5. Breast Specimens should be fixed in 10% neutral buffered formalin for at least six hours before processing, and no longer than seventy-two hours as a pre-analytical step for the purposes of breast prognostic indicator testing.

     

    Procedure
    A. Requisitions
    Attached to the properly fixed specimen should be a completed Request for pathology services requisition. The requisition form should provide information as needed for a correct interpretation of the histologic specimen, including the pre- and post- operative diagnosis and clinical data.
    ALWAYS PRINT when filling out the Specimen Requisitions.

    1. Precision Pathology has six types of Requisitions.
      – Surgical Pathology Requisition
      – Hospital Pathology Requisition
      – Hematopathology Requisition
      – Gastroenterology Requisition
      – OBGYN Requisition
      – Microbiology Requisition
    2. Required Sections of the Requisition:
      a. Patient Information Sections
      Patient Name
      Date of Birth
      Social Security Number
      Account Number
      Sex
      Age
      Insurance Documentation (may be attached to Requisition, please indicate)
      b. ICD-9 Code
      c. Specimen Information section
      Collection Date
      Collection Time
      d. Requesting Physician section
      Mark the patient’s specimen-collecting Physician along with any copy-to Physician(s).
      e. Pre-Operative Diagnosis
      Fill in the Pre-op Diagnosis section. Patient History can be included in this section.
      f. Comments Section
      The laboratory does not have access to the Patient’s Medical Record. Please include the following information to help assist in giving the most accurate diagnosis for the Patient:
      Did the Patient have surgery?
      Is this a routine test?
      Did the patient have radiation or chemotherapy?
      Did the patient have abnormal biopsies in the past?
      Does the patient have a history of cancer?
      For Bone Marrow patients, please include any blood testing results.

     

    B. Transportation
    Methodology:

    1. Specimens should be kept and stored in the clinic’s designated area to await transportation by courier or overnight mail to the Laboratory for processing.
    2. All specimens should be transported inside of a designated rigid specimen transport container within the courier vehicle. Specimens should not be transported loosely inside the courier vehicle.
    3. Specimens are not to be transported in extreme temperatures and all measures should be taken to
      maintain specimen viability.
    4. In case of an accident while transporting biohazards, Precision Pathology Services is to be called immediately and the Medical Director is to be notified.
    5. Transportation occurrences which affect specimen quality should be reported to the Operations Director
      immediately. The occurrence will be investigated and documented. Transport occurrences require Quality Improvement (QI).

     

    C. Requests for Technical-Only Aspects

    1. Specimen Processing
      a. Follow the Routine Specimen Collection instructions.
      b. Notate on the Requisition in RED the technical aspect being requested.
      Processing
      Process and Embed
      Process, Embed, Microtomy – list the number of slides and how many sections on each slide
      Process, Embed, Microtomy, staining – list the requested stains
      Other – Be very specific. Call the laboratory to consult with a histotechnician if needed.
    2. Microscope Slide Staining
      a. Tissue Fixative should be Neutral Buffered Formalin. If any other fixative type is used, call the lab to inquire if staining will work.
      b. Slides are to be positive-charged.
      c. Sections are to be picked up on positive-charged slides from a Distilled Water Bath
      d. Sections are to be placed 15mm below the frosted cover and at least 5mm from the bottom edge of the glass, microscope slide. Do not let the tissue go closer than 5mm from the bottom edge of the slide.
      e. Slides are to contain two unique patient identifiers.
      f. Do not dry slides in the oven. Send the slides to the laboratory directly from the water bath in a plastic or cardboard slide transport container.
      g. For each stain requested, send four slides.

     

    References
    Carson, F.L., Histotechnology A Self-Instructional Text, 2nd ed., ASCP Press, Chicago, 1997, pp. 80-111.

    Sheehan, D.C. and Hraphak, B.B.: Theory and Practice of Histotechnology, 2nd ed., 1980, Mosby Company, St. Louis.

    Gomella, L.G. and Haist, S.A.: Clinician’s Pocket Reference, 2002, McGraw Hill Company inc., United States of America.

    CAP Checklist, June 2010 GEN.40050, GEN.40100, GEN.40104, GEN.40108, GEN.40116, GEN.40125, GEN.40491, GEN.40500, GEN.40511, GEN.40515, GEN.40522, GEN.40700

    CLIA Regulation, 1989.

    Texas Administrative Code Title 25, Part 1, Subchapter K (See attached to this Collection Manual).

    Precision Laboratories Collection Manual, 2010

  • Specimens Not Accepted

    Purpose
    To establish a protocol for identifying specimens not accepted at Precision Pathology Services.

    Procedure
    A. Radioactive Material
    Precision Pathology Services DOES NOT ACCEPT radioactive material; which may include Sentinel Lymph Nodes, Breast Biopsies, Prostate “Seeds” etc. (PPS Staff see Procedure 5.3 for handling instructions)
    Note: During routine facility visits, if requested, pathologists will remove radioactive seeds from tissue specimens and give the seeds to the facility for storage or disposal. The tissue will then be submitted to PPS by the facility per routine protocols.

    B. FRESH Tissue that is Positive or Suspicious for HEPATITIS B, C, HIV, or TUBERCULOSIS:
    Precision Pathology Services DOES NOT ACCEPT fresh Hepatitis B, C, HIV, or TB specimens. Due to exposure risk, these specimens must be submitted to the lab in 10% Neutral Buffered Formalin or Bouins fixative. Peripheral Blood smears need to be performed at the Client’s site on these specimens.

    C. Creutzfeldt-Jakob Disease
    The lab does not accept any specimen suspected of Creutzfeldt-Jakob disease, including brain or cerebrospinal fluid.
    PPS staff, see Lab Gen Procedure 5.4 for further reference.

    References
    Roby Joyce, MD FCAP. Precision Pathology Services Medical Director, CEO, President

  • Return Request Specimens

    Purpose
    To establish a protocol for handling specimens which have been requested for return.

    QC
    Communication with the laboratory is vital to ensure proper handling and turnaround of any return request.
    Client Services for the laboratory can be reached at 210-646-0890.

    Procedure
    A. Request for Body Part Returned
    Patients requesting body parts to be returned may be done by following the Texas Administrative Code Title 25 Part 1, Subchapter K.
    – Human materials removed during surgery, labor and delivery, autopsy, embalming, or biopsy shall be subjected to proper disposal method per Texas Admin Code Title 25.
    PPS Staff, see Client Services for TX Admin Code 25 reference materials.

    1. Call PPS at 210-646-0890 on any specimen for which a return is requested.
    2. Fill out the requisition completely for submission to pathology. Ensure that there are clear notes on what the doctor is requesting (e.g. Gross exam, processing, special testing), and that there is a note that a return has been requested on the specimen.
    3. If the body part is being requested back for burial, please send fresh.
    4. Wrap the body part securely and place in a sturdy container/box for transport. Label the wrapping, and the container with the patient’s information.
    5. Place the body part with the paperwork in a refrigerator until courier pick-up.
    6. Hardware may be submitted in formalin, and does not require refrigeration.
    7. Fill out the Specimen Logbook.
    8. Fill out the Precision Pathology Services release form. PPS can fax over a release form upon initial call (step 1) if needed.
    9. Fax, or send release form with specimen to PPS.
    10. Specimens will only be released to a funeral home. Funeral Home arrangements and fees are the patient’s responsibility.

     

    B. Request for Fetus Release
    Parents requesting fetus to be returned may be done by following the Texas Administrative Code Title 25 Part 1, Subchapter K.
    – Human materials removed during surgery, labor and delivery, autopsy, embalming, or biopsy shall be subjected to proper disposal method per Texas Admin Code Title 25.

    1. Call PPS at 210-646-0890 on any fetal remain for which a return is requested.
    2. Fill out the requisition completely for submission to pathology. Ensure that there are clear notes on what the doctor is requesting (e.g. Gross exam, autopsy, special testing), and that there is a note that a return has been requested on the specimen.
    3. Attach Labor/Delivery notes and/or ER notes. (Any information is helpful.)
    4. Wrap the fetus securely and place in a sturdy container/box for transport. Label the wrapping, and the container with the patient’s information.
    5. Place the fetus with the paperwork in a refrigerator until courier pick-up.
    6. Fill out the Specimen Logbook.
    7. Fill out Precision Pathology Services release form. PPS can fax over a release form upon initial call (step 1) if needed.
    8. Fax, or send release form with specimen to PPS.
    9. Fetal remains will only be released to a funeral home. Funeral Home arrangements and fees are the patient’s responsibility.

     

    C. Request for Returns (General)
    Any biohazardous substance collected and sent for pathology must follow the Texas Admin Code Title 25 Part 1, Subchapter K. e.g. Hardware, gallstones, etc
    Call PPS at 210-646-0890 upon collection for guidance.

  • General Histology and Non-GYN Cytology Specimens

    Purpose
    To establish proper protocol for routine histologic/non-GYN cytologic specimens.

    Policy
    Expected turnaround time (TAT) for routine histologic and non-GYN cytologic specimens is 24-48 hours.

    QC
    The most important step in the histological exam is Fixation. If a specimen is improperly fixed, the histology of the tissue is compromised or lost. Because many histologic samples cannot be recovered or repeated, it is critical for everyone involved with the tissue specimen to have a working understanding of fixation.

    Procedure
    A. Tissue Preparation for General Histology
    Fixatives of choice for Histology are:
    • 10% Neutral Buffered Formalin for transportation from Collecting Facility to Laboratory.
    • Bouin’s fixative for Bone Marrow specimen processing.
    • RPMI for specimens (e.g. Lymph Nodes) processed for genetic testing
    • Saline for fresh specimens
    • CytoRich Red for fluid specimens

    1. Fixatives are used to:
      a. Prevent autolysis (cell self destruction from enzymes)
      b. Prevent putrefaction (bacterial destruction of the cell)
      c. To harden the tissue (make tissue easier to handle)
      d. To kill infectious agents.
    2. In order to maximize accurate results for tissue examination, the person handling the original specimen should:
      a. Pre-label the specimen containers with Patient Name, DOB, Collection Date, and Collection Site.
      b. Put the specimen in fixative as soon as it is removed from the patient. This must not wait until the procedure is over. Small specimens are especially susceptible to autolysis and putrefaction.
      c. Completely cover the specimen with fixative. A 1:20 ratio (size of specimen to formalin) is ideal. This is especially crucial for large specimens.
      d. Seal the container and check for leaks. Formalin is a caustic chemical and should be handled with care. Double check containers to confirm they are all labeled with the Patient Name, DOB, Collection Date, and Collection Site.
      e. Fill out the Pathology Requisition.
      Note: Breast specimens must have the Collection Time and Fixation Time filled out on the Requisition.
      f. Place the container with the requisition in a specimen transportation bag and place in the designated specimen pick-up area.
      g. According to the facility’s courier set-up, call for a pick-up or wait for the scheduled pick-up time.
    3. For Amputation of Large Appendages
      a. Cover the transected bone with an absorbent pad (e.g. thick gauze, cloth), to prevent sharp edges from perforating the containing bag.
      b. Place the appendage inside a red biohazard bag (or similar transport bag), and wrap tightly around the appendage. Tape firmly closed.
      c. Label the wrapped appendage with patient information. If this wrapping is not labeled, the specimen is not considered properly labeled by CAP and CLIA regulations.
      d. Place the wrapped appendage into a brown biohazard box. Tape firmly closed.
      e. Place the box inside another red biohazard bag. Tie or tape closed.
      f. Make sure the completed requisition and accompanying paperwork are with the specimen. It is preferred to put the paperwork in a small bag and tape that bag to the bagged box containing the appendage.
      e. Have the specimen in the designated pick-up area for the courier to retrieve.
      If refrigeration is available, refrigerate the appendage at 4°C until courier pick-up.
      Note: If the patient or family would like to request this appendage to be returned for burial, make a note on the requisition stating the request and contact information for the hospital staff member to contact. If a note is not made on the requisition, laboratory staff may not store the appendage in a manner appropriate for burial.
      See Collection Procedure 3000.2 Return Request Specimens for further details on how to send specimens with a request for return.

     

    B. Fine Needle Aspiration (FNA)

    1. The FNA Kit consists of:
      Three 50mL tubes, partially-filled with CytoRich Red fluid
      Each tube is for a single specimen, allowing for three cases per kit.
    2. Fixatives are used to:
      a. Prevent autolysis (cell self destruction from enzymes)
      b. Prevent putrefaction (bacterial destruction of the cell)
      c. To harden the tissue (make tissue easier to handle)
      d. To kill infectious agents.
      e. Prevents the tissue from drying out.
    3. FNA Collection:
      a. Estimate the amount of the Specimen and pour out any excess CytoRich Red from the 50mL tube to create a 50/50 ratio.
      b. Eject the Specimen into the 50mL container of CytoRich Red, maintaining a 50/50 ratio of specimen to fixative.
      c. A minimum of 30mL of Specimen is preferred. Sending the entire Specimen is ideal.
      Note: This method can be used for an FNA of any site.
      If a core biopsy is collected, insert it into a 20mL formalin vial and follow normal biopsy collection procedures.
      Do not send sharps to the laboratory. Always remove needles from syringes. Never send a syringe containing a needle to any laboratory.
    4. In order to maximize accurate results for cytology testing, the person collecting and handling the original specimen should:
      a. Pre-label all FNA Kit containers and slides. Individual slides must be labeled with a minimum of one patient identifier, and the slide holder must be labeled with a minimum of two patient identifiers. (e.g. Full Name and Birthdate)
      b. Seal the container(s) after specimen has been inserted and check for leaks. Double check the containers and slides to confirm they are all labeled with the Patient Name, DOB, Collection Date, and Collection Site.
      c. Fill out the Pathology Requisition.
      d. Place the container(s) in the sealable portion of a specimen transportation bag and place in the requisition in the side pocket. Then place specimen transport bag in designated specimen pick-up area.
      e. According to the facility’s courier set-up, call for a pick-up or wait for the scheduled pick-up time.

     

    C. Urine Specimen Preparation for Cytology

    1. The fixative of choice is reagent Alcohol.
    2. Fixatives are used to:
      a. Prevent autolysis (cell self destruction from enzymes)
      b. Prevent putrefaction (bacterial destruction of the cell)
      c. To harden the tissue (make tissue easier to handle)
      d. To kill infectious agents.
      e. Prevents the tissue from drying out.
    3. Urine Specimen Preparation for Cytologic Review
      a. Have the patient urinate into a urine catch cup labeled with their name.
      b. Receive the specimen from the patient in the labeled catch cup.
      c. Pre-label the specimen transportation container with the Patient Name, Collection Date, and “Urine” for the Site.
      d. Pour the specimen into the Pre-labeled specimen transportation container, leaving room for the fixative to be added. Specimen/Fixative ratio should be 1:1, (equal amounts of each).
      e. Pour fixative (50% Alcohol) into specimen transportation container, make sure ratio of specimen to fixative is 1:1.
      f. Apply the lid to the transport container and tighten. Double check specimen transport container for Patient Name, Collection Date, and “Urine” as Collection Site.
      g. Completely fill out the Precision Pathology Requisition.
      h. Put specimen and requisition in specimen bag for transportation.
      i. According to the facility’s courier set-up, call for a pick-up or wait for the scheduled pick-up time.
      Note: Any questions regarding a specimen or its fixation should be directed to the Laboratory
      Director.

     

    D. All Other Body Fluids

    1. The fixative of choice is Cyto Rich Red.
      Note: Fresh specimens for HIV, TB, HepB or HepC are not accepted at the Laboratory. The specimen must be placed in fixative.
    2. Fixative should be added to all fluid immediately after collection for optimal results.
      a. Estimate the amount of the Specimen and pour out any excess CytoRich Red from the 50mL tube to create a 50/50 ratio.
      b. Eject the Specimen into the 50mL container of CytoRich Red, maintaining a 50/50 ratio of specimen to fixative.
      c. A minimum of 30mL of Specimen is preferred. Sending the entire Specimen is ideal.
    3. For specimens sent to the Laboratory the same day, and/or very large amounts of specimen (e.g. 1L vacutainers), the specimen may be sent fresh. The specimen is to be kept refrigerated until pick-up.
    4. In order to maximize accurate results for cytology testing, the person collecting and handling the original specimen should:
      a. Pre-label all FNA Kit containers and slides. Individual slides are to be labeled with a minimum of two unique patient identifiers, and the slide holder is also to be labeled with a minimum of two patient identifiers. (e.g. Full Name and Birthdate)
      b. Seal the container(s) after specimen has been inserted and check for leaks. Double check the containers and slides to confirm they are all labeled with the Patient Name, DOB, Collection Date, and Collection Site.
      c. Fill out the Pathology Requisition.
      d. Place the container(s) in the sealable portion of a specimen transportation bag and place in the requisition in the side pocket. Then place specimen transport bag in designated specimen pick-up area.
      e. According to the facility’s courier set-up, call for a pick-up or wait for the scheduled pick-up time

    References
    James L Humphreys, MD FCAP. Surgical Pathology Supervisor.Precision Pathology Services

    Elena Lavrovskaya, MD FCAP. Cytological Pathology Supervisor. Precision Pathology Services

  • Bone Marrow Specimens

    Purpose
    To establish a protocol for handling bone marrow specimens.

    Procedure
    Specimen Preparation for Bone Marrow
    Expected TAT: 24-172 hours (depending on testing needed)
    The Clinician will receive a Preliminary Diagnosis call from the Pathologist within 24 hours of specimen receipt.
    Contents:
    2 bottles Bouin’s Fixative                                       1 Cold Pack
    2 slide containers, each containing 5 slides           1 Specimen Bag
    1 Purple Top containing EDTA                               1 Instruction Sheet
    1 Green Top containing Sodium Heparin               1 Transport Box

    1. A Bone Marrow study usually consists of an aspirate and biopsy, or just an aspirate.
      G. Always be specific about the sampling site (right or left posterior iliac crest or sternum).
    2. The optimal amount of aspirate is 4-5 mL. A portion of the aspiration is used at the bedside to make 4-6 particle crush smears.
      a. To create a particle crush smear, particles should be placed in the center of the glass slide.
      b. Another slide is positioned directly over the first slide, and the two slides are gently placed together and then pulled apart in a plane parallel to their surfaces.
      i. These smears should be quickly air-dried.
      ii. Direct smears of the aspirate prior to clotting are also helpful. These are made as you would a Peripheral Blood Smear (see below).
      c. At least 1-2 mL of aspirate is to be placed in the purple top (EDTA) tube and at least 0.5 – 1mL of aspirate should be placed in the green top (sodium heparin) tube.
      d. The remainder of the aspirate is allowed to clot and then is placed in one of the containers of Bouin’s Fixative.
    3. The trephine biopsy should immediately be gently imprinted (touched) several times per slide on two or three glass slides to make trephine imprints. Air dry these immediately. Place the biopsy in the second container of Bouin’s fixative.
    4. A copy of the CBC and one or two unstained peripheral blood smears or tube of peripheral blood should be accompany the bone marrow. If no peripheral blood was obtained, finger stick smears are acceptable.
    5. Special Studies that will be performed as necessary on the marrow are the following:
      a. Chromosome (Cytogenetic) Studies: Performed on 0.5 – 1.0 mL of unclotted aspirate in a sodium heparin tube. Maintain at room temperature. Performed at CorePath Laboratories on 2020 Babcock, Ste 30 SA, TX 78229.
      b. Flow Cytometry: Place at least 1-2mL of marrow aspirate in EDTA tube. Maintain at room temperature. Performed at CorePath Laboratories on 2020 Babcock, Ste 30 SA, TX 78229.
      c. FISH: FISH may be performed on the same sample (sod hep tube) sent for chromosome studies.
      d. Molecular Diagnostics: Includes polymerase chain reaction (PCR) and Southern blot analysis. These may be performed on the same (EDTA) tube sent for Flow Cytometry.
      e. Cultures: A second aspirate is required for cultures, in order to maintain sterility.
      Aspirate about 5mLs into syringe, remove needle, and cap. Usual studies done are aerobic/anaerobic, acid fast, and fungal cultures.
    6. When the marrow is prepared for transport:
      a. Be sure ALL SLIDES AND CONTAINERS ARE LABELED WITH THE PATIENT’S NAME and COLLECTION DATE. Indicate the date and time the clot and biopsy were placed in fixative on the requisition.
      b. Be sure to close containers tightly to omit any specimen leaks, or specimen destruction. The fumes of the Bouin’s fixative have the ability to destroy the slide specimens.
      c. Place the dried slides into the plastic slide containers for protection. The slides must be thoroughly dry before placing in the plastic containers to prevent artifact.
      d. Place the bottles of Bouin’s fixative into the provided plastic bag. Seal the bag to eliminate any fumes from escaping. Insert all items into the Bone Marrow Kit Box.
    7. Enclosed paperwork should include: The most recent CBC results, Patient Demographic information, Hematopathology Requisition containing; Patient’s age and/or date of birth, Diagnosis (if known), site of the Biopsy, Requesting physician names, and any Special Studies that may be requested. Always Print when filling out specimen requisitions, and do not use colored inks or pencils.
    8. Questions? Please call Dr. Peggy Stoll direct at 210-757-8399 or at Precision Pathology Services at 210-646-0890.
    9. Send to: Please call Precision Pathology Services to arrange a specimen pick-up.

    References
    Peggy Stoll, MD FCAP. Precision Pathology Services Hematopathologist

    Jacqueline Ackley, MD FCAP. Precision Pathology Services Hematopathologist

  • Renal Biopsy Specimens

    Purpose
    To establish a protocol for handling renal biopsy specimens.

    Procedure
    Renal Biopsies
    Note: Multiple cores are recommended for transplants.

    1. Single Core/Scant Material
      a. Submit 1mm cubes from both ends of core for Electronmicroscopy (EM).
      b. Submit 2/3 of remaining core for Light Microscopy (LM), and 1/3 for Immunofluorescence (IF).
      Note: If the submitted core shows limited glomeruli, the core is to be divided the core into two halves and submit each half in both LM and IF only.
    2. Two Cores
      a. Submit 1mm cubes from the ends of both cores for EM.
      b. Divide the remaining material from both cores into halves.
      c. Submit one half from the first core and one half from the second core for LM.
      d. Submit remaining halves from both cores for IF.
    3. Three or More Cores
      a. Submit one entire core with adequate glomeruli for LM.
      b. Submit 1mm cubes from the ends of the remaining cores for EM.
      c. Submit remaining renal tissue for IF.
    4. Submit in a PPS Renal Biopsy Kit to the laboratory for processing.
    5. Enclosed paperwork should include:
      a. PPS Requisition, fully completed
      b. Renal Clinical Data Sheet, fully completed

     

    References
    Ami Bhalodia, MD. Precision Pathology Services Nephropathologist

  • Gout Specimens

    Purpose
    To establish a protocol for handling gout specimens.

    Policy
    Expected turnaround time (TAT) for routine gout specimens is 24-48 hours.

    QC
    Never submit gout specimens in saline. The gout crystals will dissolve.
    Never submit gout specimens in formalin.

    Procedure

    1. In order to maximize accurate results for Pathology, the person collecting and handling the original specimen should pre-label a 95% ETOH (alcohol) Container with:
      a. Patient’s Name
      b. Collection Date
      c. Collection Site.
      d. This specimen MUST NOT BE SUBMITTED INTO FORMALIN.
      e. This specimen may be submitted fresh, without any fixative or moisturizing agent, but 95% ETOH produces better results.
    2. Insert the specimen into the container. Close the container and tighten the lid.
    3. According to the facility’s courier set-up, call for a pick-up or wait for the scheduled pick-up time.

    References
    Roby Joyce, MD FCAP. Precision Pathology Services Medical Director, CEO, President

  • Specimen Preparation for Flow Cytometry

    Purpose
    To establish a protocol for correct preparation of flow cytometry specimens.

    Policy
    Expected turnaround time (TAT) for routine flow specimens is 24-48 hours.

    QC
    This specimen MUST NOT BE SUBMITTED INTO FORMALIN.

    Procedure
    Specimen Preparation for Flow Cytometry
    In order to maximize accurate results for Flow Cytometry, the person collecting and handling the original specimen should:

    1. Pre-label a container of RPMI with the Patient’s Name, Collection Date, Collection Time, and Collection Site.
    2. Insert the specimen into the pre-labeled container.
    3. Seal the container and insert it into a specimen transport bag with a cold (not frozen) pack.
    4. Fill out a Patient Surgical Requisition and insert it into the side pocket of the specimen transport bag.
    5. Hold the specimen in a 4° Celsius refrigerator until the courier arrives for pick-up.
    6. Call Precision Pathology at 210-646-0890 for a “STAT” pick-up and let them know you have a FRESH Specimen in RPMI for Flowcytometry.

    References
    Peggy Stoll, MD FCAP. Precision Pathology Services Hematopathologist

  • Muscle Biopsy for Enzyme Studies

    Purpose
    To establish a protocol for handling muscle biopsy for enzyme studies specimens.

    Policy
    The expected turnaround time (TAT) for routine muscle for enzyme study specimens is seven business days.

    QC

    1. Muscle Biopsies for Enzyme Studies receive optimal patient test results when testing begins within one hour of collection.
    2. Procedures should be scheduled for a no later than 14:00 pick-up time, due to time constraints on specimen processing.
    3. City traffic and specimen travel time should be considered when scheduling the patient for biopsy.
    4. If located outside the 1604 loop, muscle biopsy procedures must be scheduled with PPS in advance, so a histotechnician can be on-site for immediate specimen handling.
    5. When scheduling in advance, a PPS courier will bring all transport materials and stand by to transport the specimen.

    Procedure

    1. CALL THE LABORATORY AT 210-646-0890 AT LEAST 24 HOURS IN ADVANCE OF THE PROCEDURE TO ENSURE THE LABORATORY HAS A LOGISTICS DRIVER ON STAND-BY TO PICK UP THE SPECIMEN STAT.
    2. Select a muscle that is neither asymptomatic, nor end stage.
    3. For proximal weakness, biceps or quadriceps are preferred.
    4. For distal weakness, brachioradialis or anterior tibial muscle tissue is preferred.
    5. Never biopsy the gastrocnemius muscle in children. Gastrocnemius biopsies are only acceptable in adults.
    6. Do not biopsy a muscle recently needled by electromyography or injected with medication.
    7. Infiltrate the skin with anesthesia, but do not infiltrate the muscle tissue.
    8. Incise the skin and muscle fascia. Retract the skin, exposing the muscle tissue.
    9. As atraumatically as possible, by blunt dissection, longitudinally separate several fascicles (at least 5mm across) to greater than the width of the muscle biopsy clamp.
    10. Insert the muscle biopsy clamp onto the muscle. Close the clamp tight enough to hold the muscle in place, to prevent contraction.
    11. Incise the muscle outside the edges of the clamp, leaving at least 1mm on each edge outside the clamp.
    12. Keep the specimen in the muscle clamps.
    13. The specimen should be put into a small, pre-labeled, container with two-three drops of saline. DO NOT SUBMERGE speciman in saline.
    14. Then, place the smaller container into the larger container and pack ice around the smaller container. Be sure the smaller container is labeled with two patient identifiers (including full patient name).
    15. Hand the specimen directly to the PPS Couier for delivery to the laboratory STAT, without any delays.
      Note: Both specimen containers must be labeled with two patient identifiers (patient’s full name, and one other identifier, such as date of birth). Be certain the requisition is completely filled out with all pertinent information.

     

    References
    University of Texas Health Science Center (UTHSC)

  • Hirschsprung's Disease Specimens

    Purpose
    To establish a protocol for handling Hirschsprung’s Disease specimens.

    Procedure

    1. Materials Needed
      a. Telfa Pad
      b. Saline
      c. Sterile container
    2. Procedure
      a. Place the fresh specimen on a “taco” of telfa pad that has been soaked in saline.
      b. Place the telfa taco into a sterile container. Do not add fixative. A container emptied of fixative is not suitable for this specimen.
      c. Make sure the specimen container is labeled with two, unique patient identifiers. (e.g. Patient’s full name, and date of birth)
      d. Put the container on ice.
      e. Call for a STAT pick-up: 210-646-0890
      Note: The laboratory can only accept specimens for Hirshsprung’s between 0300 and 1530, Monday through Friday. Call the Laboratory with any questions.

    References
    Christus Santa Rosa Hospital, City Centre Pathology Department, San Antonio, TX.

  • Nerve Biopsy Specimens

    Purpose
    To establish a protocol for handling nerve biopsy specimens.

    Materials
    Centrifuge Tube – Large
    Tongue Blade
    10% Neutral Buffered Formalin (NBF)
    Glutaraldehyde (for Electronmicroscopy)

    QC
    Procedures should be scheduled for a no later than 14:00 pick-up time, due to time constraints on specimen processing.
    NOTE: If located outside the 1604 loop, nerve biopsy procedures must be scheduled with PPS in advance, so a histotechnician can be on-site for immediate specimen handling.

    Procedure

    1. Submit 3cm of sural/posterior tibial nerve (or less of peroneal/other sensory diminishing nerve), sutured at each end and affixed to a longitudinally-split portion of tongue blade with a notch at each end, so the nerve is lying straight.
      Do not stretch or freeze nerve. Results will be very suboptimal.
    2. Place the tongue blade with specimen into the centrifuge tube and fill enough to cover with 10% NBF.
    3. If Electronmicroscopy (EM) is requested, place a small portion of the specimen into the glutaraldehyde.
    4. Label the specimen container with two unique patient identifiers (patient’s full name, and one other identifier, such as date of birth).
    5. Be certain the requisition is completely filled out with all pertinent information.
    6. Call PPS at 210-646-0890 for a STAT pick up.

    References
    University of Texas Health Science Center (UTHSC)

  • Chromosome Analysis Specimens

    Purpose
    To establish a protocol for handling chromosome analysis specimens.

    Policy
    Expected turnaround time (TAT) for routine chromosome analysis specimens is 2-3 weeks.

    QC
    In order to maximize accurate results for Chromosome Analysis, the person collecting and handling the original Product(s) of Conception (POC) specimen should:
    Pre-label an empty dry biopsy container with:

    1. Patient’s Name
    2. Collection Date
    3. Collection Time
    4. Collection Site

     

    Procedure
    Monday-Thursday
    1. Moisten a piece of gauze with saline.
    2. Wrap the piece of gauze very loosely around the specimen.
    3. Insert the specimen into the specimen container.
    4. Seal the container and insert it into a specimen transport bag.
    5. Fill out a Patient Surgical Requisition and insert it into the side pocket of the specimen transport bag.
    6. Hold the specimen in a 4° Celsius refrigerator until the courier arrives for pick-up.
    7. In-town: Call Precision Pathology at 210-646-0890 and let them know you have a FRESH Specimen for Cytogenetics.
    Rural: If the normal courier pick-up time is missed, hold the specimen in a 4° Celsius refrigerator until the next day pick-up.
     * This specimen MUST NOT BE SUBMITTED IN FORMALIN. *
    Friday
    1. Place the specimen in a dry specimen container.
    2. Cover the specimen in RPMI.
    3. Seal the container and insert it into a specimen transport bag.
    4. Fill out a Patient Surgical Requisition and insert it into the side pocket of the specimen transport bag.
    5. Hold the specimen in a 4° Celsius refrigerator until the courier arrives for pick-up.
    6. Call the Laboratory before 1700 to arrange handling. If the specimen is ready after 1700, call the Pathologist on-call.
    Saturday-Sunday
    1. Place the specimen in a dry specimen container.
    2. Cover the specimen in RPMI.
    3. Seal the container and insert it into a specimen transport bag.
    4. Fill out a Patient Surgical Requisition and insert it into the side pocket of the specimen transport bag.
    5. Hold the specimen in a 4° Celsius refrigerator until the courier arrives for pick-up on Monday. Call and alert the Laboratory to ensure timely pick-up.
    Reminder: These specimens are to be kept moist with saline-soaked gauze.
                       DO NOT SUBMERGE IN SALINE.

     

    * Products of Conception/Fetal Tissue for general histology processing can be submitted in formalin. Hold for courier pick-up.
    * Fetal Remains for Autopsy must be kept fresh.

    References
    Christus Santa Rosa Hospital, City Centre Pathology Department, San Antonio, TX.

  • GYN Specimens

    Purpose
    To establish proper protocol for routine GYN cytologic specimens.

    QC
    Collections performed incorrectly are at great risk of being rejected/returned for correction or recollection. Collection and submission instructions must be followed exactly.

    Collection Procedure – ThinPrep™ Broom Device

    1. Obtain an adequate sampling from the cervix using a broom-like device. Insert the central bristles of the broom into the endocervical canal deep enough to allow the shorter bristles to fully contact the ectocervix.  Push gently, and rotate the broom in a clockwise direction five times.
    2. Rinse the broom as quickly as possible into the PreservCyt® solution vial by pushing the broom into the bottom of the vial at least ten times, forcing the bristles apart. As a final step, swirl the broom vigorously to further release material.  Discard the collection device. – Tighten the cap so that the torque line on the cap passes the torque line on the vial.
    3. Label the vial with the patient’s name and at least one other patient identifier (e.g. birth date)
    4. Completely fill out the Precision Pathology OBGYN Requisition.
    5. Put the specimen and requisition in a specimen bag for transportation.
    6. According to the facility’s courier set-up, call for a pick-up or wait for the scheduled pick-up time

    c. Collection Procedure – ThinPrep™ Brush and Spatula 

    1. Obtain an adequate sampling from the ectocervix using a plastic spatula.
    2. Rinse the spatula as quickly as possible into the PreservCyt® solution vial by swirling the spatula vigorously in the vial at least ten times. Discard the spatula.
    3. Obtain an adequate sampling from the endocervix using an endocervical brush device. Insert the brush into the cervix until only the bottommost fibers are exposed. Slowly rotate ¼ or ½ turn in one direction. DO NOT OVER-ROTATE.
      NOTE: More is not better. Over-rotating the endocervical brush is a major source of error when collecting the ThinPrep™ liquid-based Pap test. In an effort to ensure adequate sampling of the endocervix, many clinicians over-rotate the brush, which results in the endocervical cells coming off the brush. This often results in “No endocervical/transition zone component identified.”
    4. Rinse the brush as quickly as possible in the PreservCyt® solution by rotating the device in the solution at least ten times while pushing against the PreservCyt® vial wall. Swirl the brush vigorously to further release material. Discard the brush.
    5. Tighten the cap so that the torque line (black mark) on the cap passed the torque line on the vial.
    6. Label the vial with the patient’s name and at least one other patient identifier (e.g. birth date)
    7. Completely fill out the Precision Pathology OBGYN Requisition.
    8. Put the specimen and requisition in a specimen bag for transportation.
    9. According to the facility’s courier set-up, call for a pick-up or wait for the scheduled pick-up time.

    ThinPrep Procedural Notes 

    1. Do not use Endocervical brush on pregnant patients, to sample the endometrium, or on inflamed or infected tissues.
    2. Test choices on Requisition:
      ThinPrep/CTGC Combo
      ThinPrep/CTGC/HPV Combo
      ThinPrep RFX HPV/CTCG Combo
      CTGC Only on ThinPrep Fluid
    3. Storage
      Keep at room temperature.

    Click here for STD Test Collection Summary – ThinPrep

    For any further collection questions, call the Laboratory at 210-646-0890.

  • Microbiology Specimens

    Call the Laboratory at 210-646-0890 or the Marketing Representative with specific collection questions.

    Click here for the Complete Microbiology Testing Matrix

  • Gluten ID Specimens

    For questions about Gluten ID testing, please contact Dr. Shelly Gunn at [email protected]

    To purchase a Gluten ID testing kit, the store is found here on the Targeted Genomics website.