Clinical & Anatomical Specimens

Specimen Collection and Preparation

Patient Preparation

Verify patient identification by having patient, parent or guardian state full name. Photo identification is mandatory for chain of custody drug screening.

Specimen Collection

The phlebotomist may collect blood samples by venipuncture or capillary draw. The doctor, a physician office employee, the patient or the patient’s guardian is responsible for collecting other specimen types.

Plasma

Draw blood in the designated color-coded tube. Immediately mix the blood by inverting gently 10-12 times. Within 30 minutes, separate the plasma by centrifugation for 10 minutes. Transfer to properly labeled, plastic vial. The vial must have sample type written on the container.

Draw blood in light blue top 3.2% sodium citrate tubes as far as vacuum will allow and mix by gentle inversion.  Centrifuge the specimen at 1700 x g for 15 minutes (or at a speed and time required to consistently produce platelet-poor plasma (platelet count less than 10,000/µL). Immediately remove top two-thirds of the plasma for the tube using a plastic transfer pipe and place in a properly labeled plastic vial.  Refer to specific test for further specimen requirements. 

Serum

Draw blood in tube containing no additives.  To obtain 3 mL serum, draw at least a full 10 mL tube.  If serum separator tube is drawn, invert tube 5 times.  Allow blood to clot for 30 minutes.  Centrifuge for 10 minutes.  If the blood was drawn in a plain red tube, transfer serum to plastic vial.  The vial must have sample type written on the container.

Urine

If random urine is required, collect a clean-catch urine in a clean container with leak-proof lid.

Timed urine collection is required for quantitative tests. Accurate test results depend on proper collection and preservative of timed urine specimens. On the day of collection, discard the first voided urine and begin timing the collection. Refrigerate urine during collection. Collect all urine for the time span designated. Include the sample collected at the end of the time span if 24 hour specimen, collect the second morning voided urine). Record collection duration.

Whole Blood

Draw blood in the designated anti-coagulant color-coded tube. Immediately mix blood by inverting the tube gently 10 to 12 times. Unless otherwise specified, submit tube unopened.

 Anatomic Specimens

Tissue Biopsy (fixed)

Place biopsy in the appropriate size container filled with 10% neutral buffered formalin.  Formalin to tissue ratio should exceed 10:1.  The following require special fixatives:            

Immunofluoresce: Michel’s fixative

Electron Microscopy: Gluteraldehyde

Flow Cytometry: Flow cytometry media

Label container with patient name, second patient identifier and specimen type (corresponding to designation on requisition).  For all breast specimens indicate time placed in fixative.

Call laboratory and page available pathologist.

Submit 4 slides cut at 4 microns for each antibody requested.  For kidney and lymph nodes, section at 2-3 microns.  Place slides in transport container.  Complete an Immunohistochemistry Request Form.  For Estrogen or Progesterone Receptor, Her2 IHC or Her2 FISH, specify time in fixation (6-48 hours) and fixative used.

Submit 4 slides cut at 4 microns for each stain requested.  Place slides in transport container.  Complete a Special Stain Request form.

Place biopsy in the appropriate size container filled with 10% neutral buffered formalin.  Formalin to tissue ratio should exceed 10:1.  Label container with patient name, second patient identifier and specimen type (corresponding to designation on requisition).  Mark Slide Only on requisition.

Cytology, non-gynecologic

Fluids: Mix fluids with equal amount of Cytolyt® Solution.  If sample volume is >50 ml, submit entire sample to laboratory immediately.  Label container with patient name, second identifier and specimen type.

Smears/Washing Brushing: Smear sample on glass slide(s) and spray fix within 3 seconds.    Place in cardboard transport pack.  For brush rinse, collect sample directly into 30 ml of Cytolyt® Solution. Label frosted end of glass slide and Cytolyt® vial with patient name and second identifier.

Fine Needle Aspiration (FNA):  For FNA express material from needle into Cytolyt®   Solution and/or smear sample on a glass slide.  Spray fix within 3 seconds.  For needle rinse, collect sample directly into 30 ml of Cytolyt®.  Label frosted end of glass slide and Cytolyt vial with patient name and second identifier.

If you would like both of these tests on the same patient, please submit 2 separate samples: one with cytology request and one with a microbiology request, as these tests require different specimen handling. 

 Microbiology:  Collect fresh.

Cytology: PreservCyt® for Urine and Cytolyt® for all others.  See above.

Pap Smear

ThinPrep®: Place sample into the PreservCyt® vial by swirling the collection device in the solution per manufacturer instructions.  Discard collection device and label container with patient name and second identifier.

SurePath™: Place sample in SurePath™ viably swirling the collection device in the solution per manufacturer instructions.  Drop the detachable head of the collection device into the solution, and label container with patient name and second identifier. 

Conventional Smear:  Smear the cervical/endocervical (or vaginal sample if post–hysterectomy) on a glass slide.  Spray fix within 3 seconds. Label frosted end of glass slide and the transport pack with patient name and second identifier.

Specimen Labeling

Label each specimen with the following:

• Patient's full name
  
• Second identifier
  Date of birth (DOB)  or
  Hospital or clinic number  or
  Patient ID number  or
  Accession number
  
• Sample source if indicated
  
• Phlebotomist's initials if indicated

Specimen Preservation

Submit sample preserved by method listed in the test directory. Frozen samples must have sample type listed on container.

Test Request Form

Submit a test request form complete with the patient’s test and billing information and any other pertinent information. It is very important that each request include the following:

• Patient’s first and last name
• Date of birth (DOB)
• Gender
• Date and time of collection
• Physician’s name
• Test(s) requested
• Pertinent clinical history (Example: for Pap smears, the patient’s last menstrual period and last Pap result)
• Signed Advanced Beneficiary Notice (ABN), if applicable
• ICD-9 Code if applicable
• Complete billing information