Anatomic Pathology Specimen Collection and General Information

 

 

General Information for Anatomic Pathology

PolicyTech: Version 10

 

Anatomic Pathology includes:

All tissue specimens considered as general surgical

pathology specimens; muscle, nerve, kidney, and skin biopsies; products of

conception; and Fetal and Autopsy Pathology cases.

Policy

By medical staff policy, certain specimens removed in surgery may be exempt from

submission to Pathology (See Surgical Service Policy titled “Specimens, Pathological”).

All other specimens must be submitted to Pathology.

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 if possible. 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 approximately 30 minutes prior to delivering a frozen

section specimen whenever possible. Call Pathology with any questions regarding STAT

processing, proper preservation, and transportation.

Telephone Assistance

Pathology Office (330)543-8572

Chair of Pathology & Lab Med – Dr. Jennifer Baccon (330)543-8567

Histology Lab (330)543-8743

Electron Microscopy Lab (330)543-8279

Off-Hours: Centralized Core Lab (330)543-8417

Akron Children’s Operator (1-822-262-0333) (330)543-1000

Requisitions – Utilize EPIC orders whenever possible. 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 online 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 patients. Complete

specimen information clearly and completely.

 Body Fluid Requisition – Use for submission of body fluids – CSF,

Bronchial 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. 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, and ACHPs 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

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.

Specimen 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 expectation for a

provisional anatomical diagnosis should be two days and for the Final Report should be approximately 60

days.

 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 and 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 from (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.

 All Paperwork should be placed into an envelope and affixed to the outside of the transport

container.

 Indicate if funeral services are planned and any appropriate contact information and numbers.

 All paperwork should be placed in an envelope and affixed to the outside of the transport container.

 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
Routine specimens 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% Glutaraldehyde available by calling the Lab (38279).  Store at 4oC.  Do not freeze.	Place specimen in 2.5% Glutaraldehyde 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.