In this section
All specimens should be sent to the laboratory in an appropriately labelled specimen pot that is large enough to easily accommodate the specimen. It is unsafe practice to label specimen pots in advance of a procedure.
Factors affecting performance
The following is a list of factors known to significantly affect the performance of examination and interpretation of results:
- Failure to follow the specimen acceptance policy will result in a delay to specimen processing and reporting.
- Failure to supply adequate clinical information may result in a delay to requesting of specimen investigations and reporting.
- Failure to label requests as urgent or HSC205 will result in a delay to specimen processing and reporting.
- Failure to fix specimens appropriately and in a timely manner will adversely affect specimen integrity and subsequent histological examination.
- Failure to follow instructions for the specific specimen requirements will prevent necessary examinations from being performed.
- Failure to disclose high risk status of the specimen will put staff at unnecessary risk of infection.
- Specimens for frozen section placed in 10% neutral buffered Formalin will result in a frozen section not being performed and therefore a rapid report would not be possible.
- Specimens for cytology being placed into 10% neutral buffered Formalin as opposed to being sent fresh, in saline or cytological fixative as appropriate for the sampel type and test required
- Failure to contact consultant/laboratory in advance for a frozen section may result in a delay or even a scenario where it cannot be performed, due to a lack of availability of technical staff and/or Consultant staff.
- Specimens for immunofluorescence placed in 10% neutral buffered Formalin will prevent necessary immunofluorescence examinations.
Should any of these factors affect the issuing of a final report, then an incident may be raised in Ulysses. If a final report is able to be issued, factors that may have affected this result will be included in this report.
Specimen fixation
Specimens for routine histology are required to be placed into 10% neutral buffered Formalin, which is available on request from the laboratory. Formalin is used to fix the specimen and preserve the tissue in as life-like state as possible. If there is a delay between the removal of the tissue and fixation in Formalin, this can adversely impact the specimen integrity and therefore report.
To ensure proper specimen fixation, the following guidelines should be adhered to:
- Specimen container – should be appropriately sized and large enough to easily accommodate the specimen
- Formalin – ensure adequate volumes of Formalin are used
- 1:5 tissue to Formalin ratio for very large specimens
- 1:10 tissue to Formalin ratio for small specimens where possible
- Ensure the details on the specimen pot and request card match and are legible
- Ensure the lid of the specimen container is securely fastened
- Use a plastic biohazard sealable specimen bag (where possible) for the specimen pot and place the request card in the pocket
All specimens in Formalin should be stored at room temperature and not in the fridge prior to transport to the laboratory.
High risk specimens
All specimens from patients who are identified as (or are likely to be) in the high-risk category must be clearly labelled to ensure the health and safety of all staff. The following are common hazard group 3 pathogens considered high risk (this list is not exhaustive): HIV, AIDS, TB, Hepatitis B and Hepatitis C. Specimens from patients with Covid-19, who are immunosuppressed, drug abusers and other high risk groups are also considered high risk.
Any samples taken where the patient is suspected of having TB MUST be divided within theatre so as to provide sufficient samples for Histology (sent in formalin) and Microbiology (sent in an empty sterile container).
To ensure health and safety of staff, high risk specimens are to be fully fixed before being processed by the laboratory. The date and time that the specimen is taken should be recorded on the request card for all high-risk specimens to enable the laboratory to calculate the fixation time on receipt. This information will minimise the infection risk to staff and prevent undue delay to processing.
Frozen sections and immunofluorescence investigations will not be performed on any high risk or potentially high-risk specimen.
Frozen sections
Booking cardiothoracic frozen section requests
To book a cardiothoracic frozen please liaise with the cardiothoracic booking clerks who can access the shared electronic diary for booking such requests. The laboratory access the electronic diary regularly to see what frozen sections are booked. Any changes to these booking should be communicated to the Histopathology department as soon as these changes are known.
Booking other frozen section requests
Frozen section requests, from either Wythenshawe or Tameside, need to be booked 24 hours in advance by calling the secretarial service on 0161 291 4813 to ensure the availability of the appropriate scientific and consultant staff.
Should the notice for a frozen section be less than 24 hours, the service may be unavailable.
Frozen sections will not be performed on any high-risk or potentially high-risk specimen.
When booking a frozen section, please provide the following information;
- Patient information
- High risk status
- Clinical information
- Clinician name
- Theatre number
- Contact number
The specimen for frozen section should be transported to the laboratory in an appropriately labelled dry specimen container and must arrive by 4.30pm. Formalin must not be added. Specimens should be handed directly to the technical staff at histopathology specimen reception as a matter of urgency to ensure a timely report is issued.
When the specimen is ready to be sent to the laboratory, or if there is a delay in theatre, please contact specimen reception 0161 291 4800. If a frozen section is no longer required, please contact the laboratory immediately to cancel.
Once the frozen section has been taken
Once taken, the specimens should be delivered to the department fresh (not in formalin) as soon as practically possible, together with a tracking form / book to audit the delivery of the specimen to the department. Wythenshawe frozen sections requests are delivered directly to the Histopathology department at Wythenshawe: specimens taken at Tameside are taken directly to the Tameside Pathology laboratory. Delay in delivery of the specimen will delay the issuing of the frozen section report.
If the frozen section service is no longer required, please ring the laboratory as soon as possible to notify us of the cancellation.
A preliminary report will be issued stating the diagnosis obtained from the frozen section. To ensure a timely report is available, please provide contact details of where this report should be issued. A full report will follow once the tissue has been formalin fixed and paraffin sections examined by a Pathologist.
Skin immunofluorescence
Skin biopsies requiring immunofluorescence need two samples to be taken from the same area. One is to be placed in formalin; the other for immunofluorescence should be placed in Mikel’s medium which is obtainable from the Histopathology Department at Salford Royal Hospital. Specimens should be sent to Wythenshawe hospital histopathology; to be tracked then booked onto the laboratory information management system and then packaged by laboratory staff for hospital transport to Salford Royal hospital. Reports are returned to Wythenshawe histopathology, where they are then uploaded onto the laboratory information system.
Oral immunofluorescence samples
The Oral Pathology Department at Oxford Road Campus has special gel tubes to preserve the specimens. Please contact them for advice on how to source the relevant specimen containers and any instructions that need to be adhered to for taking the specimen.
Specimens should be sent to Wythenshawe hospital histopathology in the gel tubes; these will be tracked then booked onto the laboratory information management system and then packaged by laboratory staff for hospital transport to Oxford Road Campus. Reports will be entered and released by Oxford Road and will either be available via the patient chart on HIVE or printed and issued to the appropriate location.
If the specimen taken is larger than the containers in use then please contact the histopathology department at Oxford Road Campus for further advice.
All renal biopsies should be transported to the laboratory immediately to enable urgent processing of the specimen. All specimens placed into gel transport medium for immunofluorescence should be stored in the fridge if immediate transport to the laboratory in unavailable.
Pregnancy remains
The emergency gynaecology unit is based at Wythenshawe. It is important to ensure that the request form and PS1 form is completed fully to prevent undue delay and distress to the patient following the loss of a pregnancy. If documentation is incomplete, it may be necessary for the sender to contact the patient to confirm details.
Requests for Post Mortems (PM) on pregnancy remains that are over 12 weeks gestation should be sent to Paediatric Mortuary at Oxford Road Campus with consent and clinical history. All pregnancy remains sent to Wythenshawe Histopathology must have an accompanying fully completed PS1 form.
Limbs
Amputated limbs for disposal should not be sent to either the Mortuary or Histopathology for disposal. Should any limbs be received for disposal, the requesting theatre will be contacted and arrangements made for the limb to be returned immediately
Haematological Cancer Diagnostics (HCD)
All Histology HCD samples should be fixed in 10% buffered formalin and labelled clearly with the correct patient identifiers in accordance with the departments acceptance policy.
The request should be entered onto the HOD system and allocated a unique HODS number at the clinic where the specimen has been taken.
These must be sent directly to Central Specimen Reception (CSR) on the ground floor of the Clinical Sciences Building, ORC.
(Last updated April 2023)