Submission Requirements

Special Instructions for Specimen Collection and Preparation

It is essential that the sample requirement instructions for the specimen preservation and sample collection be carefully followed.

Serum or Plasma

For tests requiring serum or plasma, draw 10 mL of blood for each 5 mL. of serum or plasma. For serum, allow the blood to clot for 30 minutes. Separate cells from serum or plasma, preferably within one hour. Pipette serum or plasma into a clean plastic vial and label. Please be careful not to transfer red cells to the vial. Note: Many tests specifying submission of serum are acceptable when submitted on the clot if delivered to the laboratory on the same day blood is drawn. Please confirm with our laboratory representatives that the test you are submitting is stable on the clot. When using a serum separator tube, follow instructions on page 9.

Frozen Sample

Samples requiring freezing should be placed in the freezer immediately after separation and transfer of the serum to the plastic vial. Samples should NOT be frozen in a glass tube as this will lead to cracking upon thawing.

24 Hour Urine Collection

The patient should be instructed to consume a normal amount of liquid during the collection period, unless there are medical contraindications. Alcoholic beverages should be avoided during collection.

1. On the first day of collection, instruct the patient to discard the first morning urine specimen and note the time.
2. All urine voided in the next 24 hours is to be collected in a clean bottle. If the complete 24 hour urine collection is not submitted, the total volume for the 24 hour period must be noted on requisition.
3. The final collection should be the first morning urine voided on the second day.
4. Keep the urine refrigerated during the collection period, even if a preservative is present in the container.

Cytology

When labeling specimen containers, please include the source of the specimen as well as the standard information. It is essential that pertinent clinical history be included.
For GYN Specimens: Information regarding the menstrual status of the patient (LMP), previous significant findings, and the results of prior abnormal cytology are required, as well as age or date of birth.

Important information regarding unsatisfactory cytology report

The following criteria have been established for reporting unsatisfactory gynecological cytology reports, based on The Bethesda System for Reporting Cervical/Vaginal Cytologic Diagnoses:

• Lack of patient information on the specimen and or/ requisition.
• A slide is broken and cannot be repaired.
• Scant squamous epithelial component (well-preserved and well-visualized squamous epithelial cells covering less than 10% of the slide surface)
• Obscuring blood, inflammation, thick areas, poor fixation, air-drying artifact, contaminant, etc. that preclude interpretation of approximately 75% or more of the epithelial cells.
• Erroneous sampling e.g., Interpretation is omitted because a lateral wall sample is required for the diagnosis of adenosis in DES exposed patients

The following criteria have been established for issuing an unsatisfactory non-gynecologic cytology specimen:

• Inadequate sampling e.g., lack of six to eight clusters of follicular cells on at least two sides.
• Non-deep cough sample in sputa.

Gynecologic Pap Smears

The slides must be first labeled with the patient’s last name in pencil on the frosted end. The examiner must take two good, hard samples with a stick, brush or swab, one of the cervix and the other of the endocervix. The swabs must be rapidly smeared with a firm pass on surface of the appropriately labeled half of the slide. The entire slide surface excluding the label area should be covered with the collected specimen and the smear should not be too thick. When the smearing of the two samples is completed, immediately fix the slide with a spray fixative, or plunge the slide in 95% alcohol and submit in a closed-top bottle.

Other Mucosal or Skin Smear Specimens

May be fixed as per directions for GYN pap smears.

Sputum

The deep morning cough specimen is the most satisfactory. Multiple samples recommended. Induced specimens using heated aerosol is recommended when little or no sputum is produced. Store specimens in wide mouthed jars containing 50% alcohol solution. KEEP REFRIGERATED

Fluid Specimens

• Small quantity Fluids: mix fluid with an equal quantity of 50% alcohol. Submit as soon as possible. KEEP REFRIGERATED.
• Large quantity Fluids: including urine, body cavity fluids, and gastrointestinal washings may be submitted in bottles containing an equal amount of 50% alcohol solution. KEEP REFRIGERATED. NOTE: Refrigeration is essential to retard cellular deterioration and bacterial growth.
• Eye fluids: should be submitted as soon as possible.

Brushings

Immediately fix the slide with a spray fixative or by dropping into 95% alcohol solution. Again, it is essential to avoid air drying of smears. If you are using nonslotted ethanol jars, place paper clips on frosted ends of slides to prevent slide-slide contact. NOTE: If desired, drop the cut-off tip of the brush into 95% alcohol solution.

Aspiration

• Lesions and masses: We recommend 95% alcohol solution rather than spray fixation to achieve superior cell morphology. Express a droplet from syringe onto a slide. Using a second slide, the material is pulled gently and quickly between the slides for an even layering. Fix immediately. Several slides can be made in this manner.
• Cyst fluids: Mix aspirated fluids with an equal volume of 50% alcohol solution. Keep refrigerated until submission.

Microbiology Specimens

Be sure to indicate the source of the specimen, the tests desired, and any antibiotic the patient is receiving on the requisition form. Refrigerate all specimens when holding them overnight except for spinal fluid, blood cultures or specimens for fastidious organisms, which must be sent to the lab immediately.

Blood

1. Decontamination of skin using 70% alcohol and tincture of iodine must be performed. First clean puncture site with alcohol. Then disinfect with the iodine and allow site to air dry.
2. Perform venipuncture and withdraw specimen. Invert bottle to mix specimen. Remove the iodine by cleaning area with isopropyl alcohol.

Blood cultures for MAI and/or fungi drawn in Dupont Isolator must be delivered to the laboratory by 2:00 p.m. They are not to be incubated.

Urine

Void midstream urine into a sterile container. Refrigerate as soon as possible. For acid fast bacillus, submit first morning urine.

Cerebrospinal and Other Fluids

Collect specimens in sterile tubes. Do not refrigerate. If anaerobic organisms are suspected, submit part of the specimen in an anaerobic transport. system in addition to the sterile container.

Sputum

Sputum from deep, first morning coughs are the most desirable. Collect in the sputum container. Avoid excessive contamination by saliva.

Swab Culture (including genital tract)

Obtain all specimens using aseptic technique to avoid contamination with other organisms. Submit all swabs in a transport medium. Be sure to label the culture tubes and fill out all appropriate information on the requisition form. For isolation of N. Gonorrhea, use special transport system (Amies with charcoal). DO NOT REFRIGERATE.

Collection for gc/chlamydia-PCR

Use M4 transport media

Histopathology-Gross and Microscopic Routine Specimens

1. Fill in the appropriate clinical information on the requisition form. Label the source of each specimen on the form and the specimen container (NOT ON THE LID OF THE CONTAINER).
2. Place specimens in container with 10% buffered formalin. Be careful not to crush the specimen. Avoid cautery for small specimens. Place the SECURELY-TIGHTENED CONTAINER into the sealable specimen transport bag. The requisition is placed in the outside pocket.