Triesta

Advanced Test Launched

SAMPLE PREPARATION AND PACKAGING FOR COURIER PICKUP

BLOOD PROCESSING AND PACKAGING FOR COURIER PICKUP

1)	The tubes of blood must be centrifuged with their stoppers in place, for 10 minutes to ensure adequate separation of serum or plasma from the clot or cells.
2)	Specimens should be centrifuged within 2 hours of collection.
3)	For tests that require serum, the blood must be allowed to clot for 30 minutes at room temperature before centrifuging.
4)	For tests that require plasma, the blood can be centrifuged immediately after collection.
5)	If a serum separator gel tube (yellow top) or plasma separator gel tube (green top) is used, the serum or plasma can be stored on the gel barrier as long as there is no leakage of red cells into the serum/plasma. The tube must be kept stoppered.
6)	If a non-gel tube is used, the serum or plasma must be immediately pipetted (aliquot preparation) into a clean plastic screw top container unless instructed otherwise. Care should be taken to not transfer red cells with the serum or plasma. All specimen aliquots must be properly labeled.
7)	Every patient must have a separate request form. The test request form should be folded and placed in along with the specimen into a leak proof bag.
8)	Temperatures to be maintained are mentioned in our test list.

SURGICAL PATHOLOGY:

Common Guidelines :
1)	The biopsy / FNAandclinical impression must be mentioned on the request form.
2)	Request forms with 'FNA/ biopsy of retroperitoneal mass/ abdominal mass' are not informative if the exact location is not mentioned.
3)	In case of lymph nodes, the location of the node (especially in the neck) is needed.
4)	All specimen containers (or envelopes in case of slides/blocks) must be labeled with the following details at least: patient's full name, age, sex, medical records number and doctor's name.

Cytology/ FNA :
1)	As far as possible, both fixed and airdried smears of FNA must be sent. This is because if the aspirate is highly contaminated with blood, air- dried smearsstainpoorly and make interpretation difficult.
2)	For procedures done elsewhere, the smears may be put in a fixative, removed after 5minutes, fixative evaporated and then put in paper/ box, labelled as 'fixed' by diamond marker pencil and sent.
3)	The slides should be fixed immediately after smearing to avoid drying artifacts.
4)	For air-dried smears, the smears must dry before being wrapped in paper.
5)	Crush preparations of core biopsies must not be made. A touch imprint of the biopsy may be made and the core tissue itself must be sent for processing.
6)	For fluids (peritoneal/ pleural/ pericardial etc) being sent for cytology from an outside hospital/lab, the fluid must be allowed to stand for an hour. After decanting the supernatant, smears can be made from the sediment. If adequate sediment is obtained, formalin must be added and specimen sent to the lab (for cell block preparation).

Surgical Specimens
1)	It is anticipated that lesions will be resected according to a defined surgical protocol. If the surgical resection differs from the protocol, eg if dissection does not extend to the deep fascia or skin when this is the norm (eq. skin sparing mastectomy or modified radical neck dissection), this should be clearly indicated on the request form.
2)	The surgeon should orientate the resec t ion spec imens . A code of orientation can be established using either different lengths of suture or metal staples/clips or ink. The code should be anatomically relevant and assist in accurate evaluation of the specimen and its margins.
3)	If more than one piece of tissue is removed; it should be made clear how the samples are orientated with respect to each other in order to simplify assessment of the size of the lesion and distance to margins.
4)	Wherever relevant, the radiology findings must be mentioned on the pathology test request form. This will facilitate diagnosis.
5)	The specimen should be sent to the laboratory as soon as possible. If this is not possible, it should be immediately placed in a fixative (buffered formalin is recommended) whose volume is at least twice that of the specimen size. In the latter circumstance, and by arrangement with the pathologist, the surgeon must make controlled incision/s into the lesion, thus preserving the integrity of key margins while allowing immediate penetration of fixative. The incision should be made from the posterior aspect or from the skin inwards. Hollow viscera must be cut open and then incision/s made in the lesion. In general, the benefits of rapid fixation (good morphological conservation with preservation of mitotic figures and retention of proteins such as the ER/PR in breast cancer) outweigh the desire to preserve the specimen intact before examination by the pathologist preservation of mitotic figures and retention of proteins such as the ER/PR in breast cancer) outweigh the desire to preserve the specimen intact before examination by the pathologist
6)	For samples being sent from outside laboratories, Small biopsies may be put in a small bottle containing formalin. Quantity of formalin added to preserve the tissue specimen in transit, must be just enough to cover the tissue biopsy. For larger specimens, it is recommended that after initial fixation, the specimen is wrapped in formalin soaked cotton and placed in a strong plastic bag with identifying label. The bottle or vacutainer must be recapped/ plastic bag should be sealed tightly and additionally fortified by brown tape. The bottle/ vacutainer/ plastic bag must then be packed in a corrugated cardboard box along with the request form and couriered to the laboratory. If slides and blocks are being sent, these should be placed in cardboard slide boxes. Please place slide box in cloth lined envelope.
7)	If specimen is a whole lymph node excision biopsy (specially for the diagnosis of lymphoma), it must be bisected using a sharp knife / scalpel and put it into formalin immediately, for good / optimal fixation for routine reporting and Immunohistochemistry. Small node less than 1 cm need not be bisected.