Specimen Identification, Handling and Transport For MedLab

Identification
All specimens sent to MedLab for processing must have the following information on all specimen containers/tubes:

• First and last name
• Body site that coincides with the requisition
• Number that coincides with the requisition when there is more than one specimen
• Multiple specimens requiring individual diagnoses should be placed in separate containers.
• Requisition

The requisition must contain the following information:

• Patient name (Last,First)
• Date of birth
• Sex
• Social Security number
• Office MRN (if desired)
• Submitting physician
• Name of additional physicians to receive copy of results
• Insurance/Billing information (or attach patient face sheet with copies of insurance cards)
• Separate listing of each specimen that coincides with the labeled jars
• Clinical impression/information must also be provided for each specimen.

Handling

Blood Draws – Vacutainer Tubes

Red Top
ADDITIVE
None
MODE OF ACTION
Blood clots, and the serum is separated by centrifugation
USES
Chemistries, Immunology and Serology, Blood Bank (Crossmatch)

Gold Top
ADDITIVE
None
MODE OF ACTION
Serum separator tube (SST) contains a gel at the bottom to separate blood from serum on centrifugation
USES
Chemistries, Immunology and Serology

Light Green Top
ADDITIVE
Plasma Separating Tube (PST) with Lithium heparin
MODE OF ACTION
Anticoagulates with lithium heparin; Plasma is separated with PST gel at the bottom of the tube
USES
Chemistries

Purple Top
ADDITIVE
EDTA
MODE OF ACTION
Forms calcium salts to remove calcium
USES
Hematology (CBC) and Blood Bank (Crossmatch); requires full draw – invert 8 times to prevent clotting and platelet clumping

Light Blue Top
ADDITIVE
Sodium citrate
MODE OF ACTION
Forms calcium salts to remove calcium
USES
Coagulation tests (protime and prothrombin time), full draw required

Green Top
ADDITIVE
Sodium heparin or lithium heparin
MODE OF ACTION
Inactivates thrombin and thromboplastin
USES
For lithium level, use sodium heparin
For ammonia level, use sodium or lithium heparin

Dark Blue Top
ADDITIVE
EDTA
MODE OF ACTION
Tube is designed to contain no contaminating metals
USES
Trace element testing (zinc, copper, lead, mercury) and toxicology

Light Gray Top
ADDITIVE
Sodium fluoride and potassium oxalate
MODE OF ACTION
Antiglycolytic agent preserves glucose up to 5 days
USES
Glucoses, requires full draw (may cause hemolysis if short draw)

Yellow Top
ADDITIVE
ACD (acid-citrate-dextrose)
MODE OF ACTION
Complement inactivation
USES
HLA tissue typing, paternity testing, DNA studies

Yellow – Black Top
ADDITIVE
Broth mixture
MODE OF ACTION
Preserves viability of microorganisms
USES
Microbiology – aerobes, anaerobes, fungi

Black Top
ADDITIVE
Sodium citrate (buffered)
MODE OF ACTION
Forms calcium salts to remove calcium
USES
Westergren Sedimentation Rate; requires full draw

Orange Top
ADDITIVE
Thrombin
MODE OF ACTION
Quickly clots blood
USES
STAT serum chemistries

Light Brown Top
ADDITIVE
Sodium heparin
MODE OF ACTION
Inactivates thrombin and thromboplastin; contains virtually no lead
USES
Serum lead determination

Pink Top
ADDITIVE
Potassium EDTA
MODE OF ACTION
Forms calcium salts
USES
Immunohematology

White Top
ADDITIVE
Potassium EDTA
MODE OF ACTION
Forms calcium salts
USES
Molecular/PCR and bDNA testing

Order of the Draw

To prevent contamination of tubes with additives from other tubes it is important to draw the tubes in a SPECIFIC order called “the order of the draw”. For example, if the additive in the purple stopper tube contaminates the green stopper tube this would cause a falseley decreased calcium and increased potassium. Please, JUST DO IT. The sequence of collection of evacuated tubes in a multi-draw should be in this order:

1. Sterile/Blood cultures (yellow top or bottles)

2. Royal Blue – red label for trace metal analysis

3. Light Blue coagulation tube –NOTE: If coag tests only are ordered AND you are using a butterfly, draw a discard tube to collect the air in the tubing. Failure to do so will result in a short draw which may be rejected by the lab.

4. Red – Non-Additive

5. Red Gel separator tube (speckled or “tiger” top)

6. Green (heparin)

7. Green/Gray mottled Plasma Separator Tube (PST) with heparin

8. Lavender/purple top and/or pink (EDTA)

9. Gray top (Oxalate/fluoride tube)

• For routine histology processing: Submit the specimen in 10% Formalin (NBF) in an appropriate sized container. There should be 10 times the volume of fixative to the volume of tissue and the fixative must cover the specimen completely. Containers must be securely tightened to eliminate any leakage. Label the container according to the guidelines listed under “Identification”. Specimens in formalin may be held at room temperature until they are transported to MedLab

• For Immunofluorescence: Submit the tissue in an appropriate sized screw-capped container with Michel’s fixative. There should be 10 times the volume of fixative to the volume of tissue and the fixative must cover the specimen completely. Containers must be securely tightened to eliminate any leakage. Label the container according to the guidelines listed under “Identification”. Specimens in Michel’s fixative may be held at room temperature until they are transported to MedLab.

• For Culture: Contact MedLab for specimen collection, handling and transport for all cultures. Some types of cultures have sensitive requirements. Check guidelines before obtaining material for culture. For tissue culture- Submit at least 0.5 cm of tissue in a sterile container with sterile saline or without fixative (RPMI will be accepted for certain cultures). For fluid samples, submit in a sterile container without fixative. Send immediately at room temperature. For stool samples (example: for an O&P), submit in a sterile container without fixative.

• For cytology: For pap smears use thin-prep vials and containers following Hologic guidelines.  For other body fluids- submit fluid in a sterile container without fixative. For urine cytology, call ahead to retain a MedLab container pre-filled with 50:50 methanol:sterile saline solution. Submit any slides made during the procedure in 100% alcohol solution (can be provided by MedLab) and/or as air-dried slides in proper plastic slide holders.

Transport

• All specimens for an individual patient and the corresponding requisition should be placed in a single biohazard specimen bag. The bag must be closed securely with the specimen jar(s) in the secured area of the bag, and the requisition in the outer pocket.
• Specimens should be counted at the collection location, and the number recorded, for verification of how many specimens were sent to MedLab.
• Large volume offices may use large transport bags to secure the individual specimen bags for safe transport by the courier
• Specimens can be placed in a lockbox on the outside of the office for pickup by the courier after office hours or phone MedLab at 773-478-6333 to schedule a pickup.

Specimen Identification, Handling and Transport For MedLab

Identification
All specimens sent to MedLab for processing must have the following information on all specimen containers/tubes:

• First and last name
• Body site and procedure description that coincides with the requisition
• Number/Order of specimens coincides with the requisition for cases with multiple specimens
• Multiple specimens requiring individual diagnoses should be placed in separate containers

The requisition must contain the following information:

• First and last name
• Date of birth
• Sex
• Social Security number
• Office MRN (if desired)
• Submitting physician
• Name of any additional physicians to receive a copy of the results
• Insurance/Billing information (or attached patient face sheet with copies of insurance cards)
• Clinical impression/Patient History must be provided for each specimen
• Specimen site and procedure description

Handling

• For Immunophenotyping (flow cytometry): Submit the tissue in RPMI in a sterile container, a minimum of 2mm of tissue is recommended. There should be enough RPMI to cover the specimen (RPMI should be stored in the refrigerator.). Call MedLab as soon as possible, as these specimens are considered “rush” cases and will need to be transported immediately to the laboratory. If RPMI is not available, unfixed tissue in a sterile container will be accepted. For body fluids, such as pleural fluid, a minimum of 50 cc is recommended in a sterile container. Call MedLab as soon as possible, as these specimens are considered “rush” cases and will need to be transported immediately to the laboratory.
• For Intra-operative Consultation: Submit at least a 5mm piece of unfixed tissue (formalin fixed tissue will not be accepted). Call ahead to notify the laboratory and make transport arrangements for the specimen. Frozen sections will be attempted on smaller piece of tissue, if requested. Turnaround time for the consultation is under 20 minutes upon receipt of the specimen in the laboratory.
• For cultures: Submit at least 0.5 cm of tissue in a sterile container with sterile saline or without fixative (RPMI will be accepted for certain cultures). For fluid samples, submit in a sterile container without fixative. Send immediately at room temperature. For stool samples (example: for an O&P), submit in a sterile container without fixative.
• For cytology: Submit fluid in a sterile container without fixative. For urine cytology, call ahead to retain a MedLab container pre-filled with 50:50 methanol:sterile saline solution. Submit any slides made during the procedure in 100% alcohol solution (can be provided by MedLab) and/or as air-dried slides in proper plastic slide holders.

Transport

• • All specimens for an individual patient and the corresponding requisition should be placed in a single biohazard specimen bag. The bag must be closed securely with the specimen jar(s) in the secured area of the bag.
  • Any slides must be placed in a slide holder to prevent damage.
  • The specimens and/or slides with a requisition and patient information should be placed in a large specimen biohazard bag for pickup.

S

• pecimens should be counted at the collection location and the number recorded for verification.
• Please call MedLab (847)979-8184 to schedule a pickup.

For any questions regarding testing and collection procedures, please contact MedLab at (847)979-8184