Specialized Laboratory Collections
Blood Bank
All Blood Bank specimens must have accurate patient identification. All specimens drawn are given a label with patient’s full name, date of birth, and medical record number or Social Security number. This label is usually computer generated. The individual drawing the specimen will verify patient demographics after patient is accurately identified from patient identification band, initial the label, and document the time specimen is drawn. This is our method of indicating positive identification of the patient with 3 unique identifiers.
Blood for crossmatching will not be drawn by phlebotomist if patient does not have a wrist band with their name and medical record number, or if there is any discrepancy between band and request label.
Specific transfusion requirements for blood components:
• Date of surgery
• Type of surgery
• Indication for transfusion
Exceptions:
• In emergency situations, when a wrist band is not available, the phlebotomist will put a red Blood Bank identification wrist band on the patient. The band will be on all Blood Bank records for the next 3 days. Do not remove this identification band. If it is removed, blood cannot be transfused to the patient, the specimen will have to be redrawn, and laboratory work will have to be repeated causing delays which may impede patient care.
Cytology
Body Fluids:
• Fresh body fluids are the specimen of choice. Some specimens can be sent to the laboratory in original container in which they were collected (pleural, thoracentesis, etc.) Others, should be put in a clean, dry container. DO NOT add any type of fixative to container. DO NOT ADD FORMALIN.
• Label container with patient’s full name, date of birth or medical record number, date and time of collection, type of specimen, and physician. Place specimen in Ziploc® portion of biobag.
• Complete a Laboratory Request Form and attach it to the outside of Ziploc® portion of biobag. Deliver immediately to laboratory.
• .
Conventional Method:
• Smears are made from material collected from various regions (vaginal, endocervical, and endometrial smears). Proper specimen collection, preparation, and careful labeling are essential to enhance the accuracy of evaluation of smear.
• Write patient’s full name and date of birth on frosted end of a clean, glass slide with pencil.
• Smear material collected evenly over clean, glass slide. Spray slide immediately with a spray fixative. DO NOT let smear dry before spraying.
• When spray is dry, place slide(s) in a cardboard or plastic holder.
• Label slide holder with patient’s full name, date of birth or medical record number, date and time of collection, type of specimen, and physician. Place specimen in Ziploc® portion of biobag.
• Complete a Laboratory Request Form and attach it to outside of Ziploc® portion of biobag. Deliver to laboratory.
Gastric and Esophageal Brushings:
• Please call the Laboratory at 207 283 7187 for specific instructions.
Gastric Specimens:
• Due to the digestive properties of the specimen, these should be submitted only Monday through Friday (8 a.m. to 4:30 p.m.).
Gynecological Material:
• Southern Maine Medical Center’s primary test method is the ThinPrep® which requires special collection materials. Please refer to #TRAP “Cytology, Endocervical” in the alphabetical test listing.
Fine Needle Aspiration of Cystic Lesions of the Pancreas:
• Fine needle aspirates of cystic lesions of the pancrease require special handling, therefore, please contact 1 of the pathologists prior to the procedure. In case you are not able to reach the pathologist, do the following:
— Aspirate the specimen in a syringe or syringes, remove the needle, cap the syringe and hand deliver it to cytology with the request for CEA, amylase, mucin, and cytology. Do not add any fixative (formalin, CytoLyt, or alcohol), EDTA, or heparin to the specimen. Tests for CEA will be referred to Mayo Medical Laboratories and the remainder of the testing will be performed inhouse. If you have any questions please call 207-283-
7187.. Products of Conception:
• Any specimen or material collected in the emergency room, delivery room, or operating room for products of conception, D & C, etc., are sent to pathology routinely with formalin added.
• Label specimen with patient’s full name, date of birth or medical record number, date and time of collection, type of specimen, and physician.
Spinal Fluid:
• Spinal fluid for cytology studies must be sent to the laboratory immediately. Spinal fluid should be in a separate tube labeled for cytology. DO NOT add any formalin to the tube.
• Label tube with patient’s full name, date of birth or medical record number, date and time of collection, type of specimen, and physician. Place specimen in Ziploc® portion of biobag.
• Complete a Laboratory Request Form and attach it to the outside of Ziploc® portion of biobag. Deliver immediately to laboratory.
• Results are usually available within 1 day. Sputum:
• Sputum should reach the laboratory within 1 hour of expectoration. An early-morning specimen produced by deep coughing is the best material.
• Collect the sputum in a clean, dry container. DO NOT
add formalin to the container.
• Label container with patient’s full name, date of birth or medical record number, date and time of collection, type of specimen, and physician. Place specimen in Ziploc® portion of biobag.
• Complete a Laboratory Request Form and attach it to the outside of Ziploc® portion of biobag. Deliver immediately to laboratory.
Urine:
• Urine collected for cytology should be sent in the fresh state. First morning specimens are acceptable for cytologic examination. Twenty-four hour urine specimens are not acceptable for cytology.
• Label container with patient’s full name, date of birth or medical record number, date and time of collection, type of specimen, and physician. Place specimen in Ziploc® portion of biobag.
• Complete a Laboratory Request Form and attach it to the outside of Ziploc® portion of biobag.
.
• Results are usually available within 1 to 2 days.
Histology
Surgical Specimens:
• Deterioration produces loss of cellular detail which is needed for accurate diagnosis. This takes place through the following:
—Drying
— Chemical decomposition
— Thermal injury
— Decomposition is speeded up by heat and slowed by cold
• Proper specimen labeling and identification are imperative for processing.
• Pertinent clinical data must be provided by attending physician to provide a complete and accurate diagnosis.
Specimen Collection:
• Ten percent formalin is provided by the Histology Laboratory. Please do not use anything other than 10% unless otherwise advised by physician or special procedure.
— Surgical tissue and biopsy collection:
• Specimen is placed in container with 10% formalin immediately unless the surgeon requests otherwise.
• Formalin should be used by 5 times the
volume of the specimen.
• Use appropriate size container. There are 4 sizes to choose from. These may be obtained through the laboratory.
• Multiple specimens from 1 procedure must be put in separate containers and labeled appropriately. Only 1 Histology Request Form needs to accompany all specimens.
• Proper labeling is essential. Please label
container directly with patient’s full name, date of birth or medical record number, date and time of procedure, source, and physician. Pertinent insurance information is also required.
• Histology Request Form must be filled out
completely.
• All specimens must be biobagged. These are provided by the laboratory. Please make sure container is tightly sealed. Do not put request form together with specimen. Either tape the requisition to outside of bag and place specimen inside or put it in outside compartment of bag.
• If more than 1 specimen is obtained, complete
only 1 Histology Request Form listing each specimen on the form. Identify each specimen on specimen container. If possible, place all specimens from 1 case into 1 Ziploc® portion of biobag.
— Frozen Sections - All frozen sections should be scheduled with Pathology at extension 6-7182. A pathologist is on call at all times to cover in the event of an unscheduled frozen section.
• Place tissue for frozen section on a moistened
saline towel and give to pathologist. Have all necessary paperwork with the specimen. DO NOT put specimen in fixative of any kind.
• Call the Pathology Laboratory and tell the secretary the case, name of surgeon requesting the frozen section, and OR room number.
• The pathologist will write his/her findings on
the form and give to the surgeon. The signed copy will be placed in the patient’s chart. The tissue will be sent to the Histology Laboratory for permanent sections.
— Urinary tract calculi (kidney, bladder, and ureteral stones) - Chemical analysis of urinary tract stones is helpful in determining future management of the patient. Different stone types respond differently to dietary and drug treatment so knowing the chemical composition may be clinically relevant.
• Place the calculi in a dry container. Cover tightly. DO NOT ADD FORMALIN.
• Label container with patient’s full name, date of birth or medical record number, date and time of collection, stone type if known, and physician. Place specimen in Ziploc® portion of biobag.
• Complete a Histology Request Form and
attach it to outside of Ziploc® portion of biobag or put into outside pocket. Send to the Histology Laboratory.
— Foreign bodies (fragment of glass, metal, splinters, etc.) - The surgeon makes the decision to send foreign bodies to the Pathology Laboratory.
• Place the foreign body in a dry container. It is not necessary to add 10% formalin; however, formalin is acceptable.
• Label container with patient’s full name, date of birth or medical record number, date and time of collection, type of foreign body, and ordering physician. Place specimen in Ziploc® portion of biobag.
• Complete a Histology Request Form and
attach it to the outside of Ziploc® portion of biobag. Send to Histology Laboratory.
— Bone marrow - The specimen requirement is a bone marrow aspirate in an EDTA tube, a biopsy in
10% formalin, a minimum of 4 smears, and 2 peripheral blood smears.
• All specimens delivered to the laboratory
must be labeled with patient’s full name, date of birth or medical record number, date and time of collection, and site of aspiration/ biopsy (left or right iliac). It must be received in the laboratory within 1 hour of aspiration.
• A Histology Request Form must accompany the bone marrow specimen. A Complete Blood Count (CBC) must be (or have been) run within 24 hours.
• Specimens may be submitted at any time, but the test is set up Monday through Friday and results are usually available within 3 days.
— Cytology specimen collection - The purpose in the collection of cytology specimens is to facilitate the processing, diagnosis, and accuracy of the detection of tumor cells in fluids.
• For conventional Pap smears, only fixed slides will be accepted. The patient’s name must be written on all slides submitted.
• Fill out a Laboratory Request Form for each cytology specimen that is sent to the laboratory. The laboratory cannot accept any specimen without a request form.
• Label cytology container with patient’s full name, date of birth or medical record number, date and time of collection, type of specimen, and physician. Place specimen in Ziploc® portion of biobag.
• If the cytology specimen is fluid (ie, urine or sputum), refrigerate after collection. DO NOT ADD ANY FIXATIVE.
• All cytology specimens delivered to the laboratory between 4:30 p.m. and 7 a.m., Monday through Friday, weekends, and holidays, are to be left in the Clinical Laboratory refrigerator. A laboratory technologist should be notified. The Pathology Department will be closed during this time.
Microbiology
Following are some general guidelines for collection, labeling, and transport of routine microbiology specimens:
General Consideration for Collection and Transport:
• Sterile containers must be used for all cultures.
• Specimens should be transported to Southern Maine
Medical Center (SMMC) as soon as possible.
• Collection containers should be closed securely and precautions taken to prevent leakage of specimen during transport. These specimens are to be considered biohazardous and must be biobagged with paperwork put in the secondary pocket.
• Whenever possible, specimens should be obtained prior to the administration of antibiotics.
• Specimen source is required on specimen container and request form for processing.
• DO NOT USE EXPIRED TUBES OR MEDIUM FOR SPECIMEN COLLECTION.
• Specimens should be properly labeled with patient’s full name, date of birth or medical record number, location of patient, date and time of collection, and source. Refer to individual test listings in “Alphabetical Test Listing” for proper transport media.
Laboratory Instructions for Sputum Collection:
• Instruct patient to obtain material from a deep cough, which is expectorated into a sterile container. The volume of specimen need not be large (3 mL). The specimen should be brought to the laboratory as soon as possible. A Gram stain is performed on all sputum cultures. Induced specimens on transtracheal aspirates are recommended for adult patients who can not produce sputum. Antibiotic sensitivities will be performed on pathogens isolated.
• Be sure that the cap is securely sealed on container once specimen is collected. A leaky container is a biohazard.
Stool Culture:
• Collect specimen in Cary-Blair media
Stool Specimen Collection for Ova and Parasites:
• Random collection - A random stool specimen collected every other day for a total of 3 specimens is recommended for an accurate examination for intestinal parasites. Specimens should be mixed thoroughly in a preservative according to instructions on the outside of the special container (EcoFix™ kit).
Stool Specimen Collection for Clostridium difficile:
• Collect specimen in a screw-capped, sterile container without transport media.