Lab Test Procedure : Anatomic Pathology Specimen Collection and General Information

Includes - General Surgical Pathology as well as muscle, nerve, kidney, skin biopsies, and products of conception as well as Fetal and Autopsy Pathology.

Policy
By medical staff policy, all specimens removed in surgery with the exception of hardware, (See Surgical Services Policy titled “Specimens, Pathological”) are submitted to pathology.

On-line – Information is also available on line at Anatomic Pathology Information and Specimen Requirements.

Histology Laboratory Hours
Routine Operation – 0700 - 1630 Monday through Friday excluding holidays.
STAT procedures needed during off hours require a call to the Pathologist On-Call and may be arranged as needed. Please call ahead for any referred in biopsies etc.

Electron Microscopy Laboratory Hours
Routine Operation – 0800 -1630 Monday through Friday excluding holidays.

Communication
Please call the Pathology Office aproximately 30 minutes prior to delivering a frozen section specimen whenever possible. Call Pathology with any questions regarding STAT processing or proper preservation and transportation.

Telephone Assistance
Pathology Office (330)543-8572
Director of Pathology – Dr. Robert Novak (330)543-8725
Director of Anatomic Path – Dr. Agamanolis (330)543-8219
Histology Lab (330)543-8743
Electron Microscopy Lab (330)543-8279
Off-Hours-Centralized Core Lab (330)543-8417
Akron Children’s Operator (1-800-262-0333) (330)543-1000

Requisitions - Follow the laboratory policy which minimally requires date and time of specimen collection, appropriate patient identifiers including birthdate, sex, specimen type, ordering physician and diagnosis for on-site specimens. Referenced in specimens require the surgical number of the referring pathology department if applicable, type of transport solution used, and appropriate billing information. Fill in appropriate blanks if you are using an on-line or Akron Children’s form. Make sure the patient location is clear.
Surgical Requisition – Use for submission to Histology of all specimens (tissue and non-tissue) from Akron Children’s Hospital patients. Complete specimen information clearly and completely.
Body Fluid Requisition – Use for submission of body fluids – CSF, Broncial Lavage, Pleural, Abdominal, Joint, and Tumor/Cyst aspirates.

Specimen Labeling
Follow the hospital policy on labeling a specimen (Specimen Labeling/Request Form Completion), making sure that the specimen and the requisition have two matching patient identifiers and dates. The Surgical Requisition is designed to allow for multiple specimens on the same patient in an A, B, C… format. Label the SIDE of the container with the patient label and appropriate letter. Do not use the lid of the container for labeling as lids could be interchanged. Include two identifiers which are also on the paperwork.

Transportation
• Surgery – Routine surgical specimens are taken from the individual surgery suites to the surgical specimen room. Specimens for routine diagnostic histology are collected by histology technicians a minimum of twice a day at 1130 and 1500 hours. Specimens not being put in formalin and requiring frozen sections and/or other special studies will be delivered by surgery personnel to Histology.
• Patient Care Units and Outpatient Offices are responsible for the transportation of specimens to the lab.
• Off-campus ACH facilities – AGMC special care nursery, Mahoning Valley, Hudson, ACHP’s should use the courier routinely used to send specimens to the Akron Campus.
• Non ACH facilities–Summa, AGMC, Youngstown, etc. should call Pathology.

Couriers may be arranged by calling 330-543-8572.
0800 to 1600, deliver all specimens not otherwise indicated to Histology;
1600 to 0800, specimens should be sent to Centralized Core Lab.
Weekends-Do not send fresh specimens on nights or weekends unless the On-call Pathologist has been notified. The address below should then indicate:
ATTENTION - Centralized Core Lab Rm 5460

Shipping Address and Information for Referred–In Specimens
Akron Children’s Hospital
One Perkins Square
Akron, Ohio 44308

Daytime ATTENTION – Histology Laboratory, Rm 4531
or
After 1600 and on Weekends ATTENTION – CCL, Rm 5460

Specimen Preservation – See Chart on separate page.

Always separate specimens from different sources into separate containers. Specimens being sent Fresh require a sterile container. Place small specimens on a saline wet gauze while larger specimens can simply be placed in the container. Do not place specimens on dry gauze as it will cause dehydration.

Special studies - Culture and/or Chromosome studies (FISH, Cytogenetics, Karyotypes, Microbiology)
Tissue specimens for the above studies must always be delivered fresh.

PRODUCTS OF CONCEPTION
(Stillborn, Fetus, Intact Gestational Sac, Curetted Products of Conception, Placentas)

Products of conception are evaluated at the request of the attending obstetrician and with the agreement of the Department of Pathology of the referring hospital. The general purpose of these evaluations is to establish the mechanism of fetal loss and to determine whether or not there are implications for future reproduction or immediate implications for the care of the post partum patient. The expectations for a provisional anatomical diagnosis should be one week and for the Final Report should be approximately 6 weeks.

• Follow General Information provided at the beginning of this procedure to obtain contact numbers, specimen labeling, requisition information, etc. for notification of the Akron Children’s Pathology Department. Provide Gestational Age instead of birthdate.
• Validate proper requisition (stamped with mother’s hospital card) and specimen labeling as listed above. Always label the specimen container not the lid and be sure to include date of service.
• Place in sterile container using sterile wrappings. Maintain aseptic techniques. No fixative should be added. Store refrigerated.
• Provide mother’s reproductive and Clinical History.
• Include a signed and witnessed Release for Autopsy and Disposition of Remains form (mandatory for all fetuses over 20 weeks). This may take the form of a written consent witnessed, signed, and faxed by one of the parents (provided they are 18 years or older and of sound mind), grandparents, or legal guardians.
• Fetal Death Certificate for all fetuses 20 weeks or greater.
• Indicate if funeral services are planned and any appropriate contact information and numbers.
• Delivery should be to the Security Office located beside the Emergency Department where Security will escort the courier to CCL for small cases or the morgue for larger cases.

SPECIMEN PRESERVATION OF TISSUE AND/OR FLUIDS FOR PATHOLOGIC EXAM

 

Specimen Type

In-House

Referred In, @ Night, or Expected Delay

Routinespecimens e.g. Hernia Sacs/Hydroceles, Small Fluid Filled Cysts,

Tonsils, GI Biopsies, etc.

Formalin - Add approximately 3 times the volume of fixative relative to the size of the specimen.

Formalin Add approximately 3 times the volume of fixative relative to the size of the specimen. Keep cold at 4oC.

Frozen Sections-Indicate FS on Req

Fresh-Deliver STAT.  Notify Pathology 38572

Have operator notify Pathologist on call.

Lymph Nodes/Biopsies

Fresh-Deliver STAT

Transport on a wet saline gauze in a cup. Deliver STAT.

Tumor/Tumor Biopsies

Fresh-Deliver STAT to Histology;

Have operator notify Pathologist on call.

Skin Biopsy for FA

Fresh-Deliver STAT; Keep moist on Telfa pad. Do not immerse in saline or wrap in soaking gauze.

Place in Histocon and transport cold. May be stored up to 24 hours.  Deliver STAT.

Kidney for FA and Immunohistochemistry

Place in Histocon and transport cold. Can not be sent in Glutaraldehyde.

Place in Histocon and transport cold. May be stored up to 24 hours.  Can not be sent in Glutaraldehyde.

Kidney for EM ONLY –

Place specimen in 2.5% Glutaralde-hyde available by calling the Lab (38279).  Store at 4oC.  Do not freeze.

Place specimen in 2.5% Glutaralde-hyde available by calling the Lab (38279).  Store at 4oC.  Do not freeze.

Nerve Biopsies Histology and EM

Fresh-Place on a saline moistened gauze or telfa pad.  Do not immerse in saline or wrap in soaking gauze. Deliver STAT.

If delay > 24 hours expected, place specimen in 2.5% Glutaraldehyde which is available by calling the Lab (38279).  Store at 4oC.  Do not freeze.

Muscle Biopsies – Histology and EM

Fresh-Place on a moist saline gauze. Do not soak or immerse or expose to heat.  Deliver STAT.

Fresh–Place on a moist saline gauze & inside a sealed baggie or Petri dish.  Keep cold during transport using ice chips.

Nasal Biopsies/Bronchial Brush preps for Cilia for EM

Fresh-Deliver STAT to Electron Microscopy.  Call EM at 38572.

Place specimen in 2.5% Glutaralde-hyde available by calling the Lab (38279).  Store at 4oC.  Do not freeze.

Bone Marrow Biopsies

B+Fixative(Zink-formalin)-Deliver STAT

B+Fixative(Zink-formalin)-Deliver STAT

Aspirate e.g. thyroid

Fresh-Deliver STAT to CCL

Place in Cyto-Lyte.  Deliver STAT.

Large Fluid filled Cyst, Body Fluid other than CSF, Bronchial Lavage

Fresh-Deliver STAT to CCL

Refrigerate @ 4oC (Keep cold during transport).  Deliver STAT.

Non Tissue Specimens

No fixative (Items part of a criminal investigation should follow surgery’s procedure for chain of command documentation.)

No fixative (Items part of a criminal investigation should follow surgery’s procedure for chain of command documentation.)

Specimen other than blood for Karyotype

Fresh-Deliver STAT to Cytogenetics

Hanks, Keep cold.  Deliver STAT to Cytogenetics Monday thru Friday only.

Products of Conception– Fetal, Stillborn, Placenta, Gestation Sac, Curettings.

Fresh-Deliver to Histology; Send completed Placental form/requisition.

See separate page for details.

Refrigerate @ 4oC (Keep cold during transport) Send/ complete Placental form/requisition.

Possible specimens from Mahoning Valley are Highlighted.


 

 

SPECIMEN PRESERVATION OF TISSUE AND/OR FLUIDS FOR PATHOLOGIC EXAM

 

Specimen Type

In-House

Routinee.g. Hernia Sacs/Hydroceles, Small Fluid Filled Cysts, Tonsils, GI Biopsies, etc.

Formalin - Add approximately 3 times the volume of fixative relative to the size of the specimen.

Lymph Nodes/Biopsies

Fresh-Deliver STAT to Histology;

Tumor/Tumor Biopsies

Fresh-Deliver STAT to Histology;

Skin Biopsy for FA

Fresh-Deliver STAT; Keep moist on Telfa pad. Do not immerse in saline or wrap in soaking gauze.

Kidney for FA and Immunohistochemistry

Place in Histocon and transport cold. Can not be sent in Glutaraldehyde.

Kidney for EM ONLY –

Place specimen in 2.5% Glutaralde-hyde available by calling the Lab (38279).  Store at 4oC.  Do not freeze.

Nerve Biopsies Histology and EM

Fresh-Place on a saline moistened gauze or telfa pad.  Do not immerse in saline or wrap in soaking gauze. Deliver STAT.

Muscle Biopsies – Histology and EM

Fresh-Place on a moist saline gauze. Do not soak or immerse or expose to heat.  Deliver STAT.

Nasal Biopsies/Bronchial Brush preps for Cilia for EM

Fresh-Deliver STAT to Electron Microscopy.  Call EM at 38572.

Bone Marrow Biopsies

B+Fixative(Zink-formalin)-Deliver STAT

Aspirate e.g. thyroid

Fresh-Deliver STAT to CCL

Large Fluid filled Cyst, Body Fluid other than CSF, Bronchial Lavage

Fresh-Deliver STAT to CCL

Non Tissue Specimens

No fixative (Items part of a criminal investigation should follow surgery’s procedure for chain of command documentation.)

Specimen other than blood for Karyotype

Fresh-Deliver STAT to Cytogenetics

Products of Conception– Fetal, Stillborn, Placenta, Gestation Sac, Curettings.

Fresh-Deliver to Histology; Send completed Placental form/requisition.

See separate page for details.

FROZEN SECTION/Interoperative Consult

Fresh – Deliver STAT to Histology

            

DEFINITIONS
FRESH – No preservative is to be put on the specimen. Some specimens need to be kept moist with a saline gauze.

FROZEN – Does not refer to the condition of the specimen; Deliver STAT as a FRESH specimen (with no preservative) to Histology for immediate examination by the Pathology staff. This may also be referred to as an Interoperative Consult. or IOC.

                                                         

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