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.

Count specimens to be transported to CPC. Place all specimens in the large transport bag (if to be transported at the same temperature). Record the date and number of specimens on the transport bag so that the count can be verified upon arrival to the lab.

Extreme temperatures should be avoided to best preserve blood and culture specimens for analysis. Specimens requiring different transport temperatures must be bagged separately with accompanying test order requisitions. If specimen lock box must be located out of doors during temperature extremes, please contact Consolidated Pathology Consultants client services department to request insulated specimen temperature protection bags.

Please call CPC Pathology (847) 996-1030 to schedule a pickup.

Safety for safe handling of 10% buffered formalin fixative chemicals:

Formalin is a hazardous chemical and must not be poured in drains or sewer systems. Expired formalin should be returned to Consolidated Pathology Consultants for proper disposal. Please note the following information to safely handle 10% buffered formalin specimen jars.

Hazard Pictograms (GHS-US) :

Formalin (10% buffered) is considered hazardous. Please note the following warnings when handling formalin.

Combustible liquid.
Toxic if swallowed, in contact with skin or if inhaled.
Causes severe skin burns and eye damage.
May cause an allergic skin reaction.
Causes serious eye damage.
Suspected of causing cancer.
Causes damage to organs.
Toxic to aquatic life

Submit the tissue in 10% Formalin (NBF) in an appropriately sized container. The container provided by CPC Pathology is adequate for the large majority of biopsy and excisional specimens. There should be 10 times the volume of fixative to the volume of tissue, but at a minimum, the tissue should be immersed in the fixative fluid. For large specimens, the specimen to formalin ratio should be 4 parts formalin to tissue. Containers must be securely tightened to eliminate any leakage.

Label the container according to the guidelines listed under “Identification and Specimen Labeling”. Specimens in formalin may be held at room temperature until they are transported to CPC Pathology. Refer to “Transport” section for further information.

Place the fluid in either an empty container (does not have to be sterile, unless cultures are needed), and either refrigerate as is, or dilute with normal saline (no more than double original amount of fluid). Alternatively place fluid in cytolyte solution, which can be left at room temperature. Containers must be securely tightened to eliminate any leakage.

Label the container according to the guidelines listed under “Identification and Specimen Labeling”. Call CPC Pathology as soon as possible, as these specimens are considered “rush” cases and will need to be transported immediately to the laboratory. Refer to “Transport” section for further information.

Expunge aspiration material onto a properly labeled slide, and smear with a second slide. Properly label the slide to include: site, stain, last and first name. Allow some smears to air-dry (for Diff-Quik staining), and transport in a plastic slide holder.  Place other slides immediately into alcohol transport vial (for papanicolau staining). Although the ratio of air-dried to alcohol fixed slides varies upon practices, the preferred ratio is 1:1.

If a significant amount of fluid is aspirated (more than can be reasonably smeared on slides) refer to “How do I send fluid for cytology”.

For tissue or fluid, submit at least 0.5 cm (5.0 mm, 5.0 cc’s) in a sterile container. Tissue should be placed on a piece of sterile gauze moistened with sterile saline. Do not refrigerate. Please indicate on the requisition form what specific type(s) of cultures are needed (aerobic, anaerobic, fungal, etc). Cultures can also be collected a pink top Copan swab with Amies agar gel.  This swab is suitable for aerobic, anaerobic and fungal cultures.  AFB cultures can also be performed on this swab, but fresh tissue is preferred. Please keep in mind that anaerobic cultures should not be refrigerated. Always verify the culture swab expiration date prior to collection.  Expired swabs must be discarded.  Expired swabs will be rejected by the reference laboratory.

Label the culture container or swab with: site/source, collection date, patient last and first name. For further information on temperature requirements refer to guidelines from Lab Corp for specimen collection, handling and transport, as some types of cultures have sensitive requirements.

Obtain a UTM-RT specimen collection kit from CPC. Follow collection instructions on the UTM-RT collection package. Label the container with the: site, collection date, patient last and first name. Store specimen refrigerated if there is a delay in transport. Always verify that the UTM viral culture media is not expired prior to collection.  Expired swabs must be discarded.  Expired swabs will be rejected by the reference laboratory.

Submit the tissue in an appropriately 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 and Specimen Labeling”. Specimens in Michel’s fixative may be held at room temperature until they are transported to CPC Pathology.

Submit fresh POC tissue in RPMI culture media or sterile saline.  POC specimens submitted in formalin cannot be tested for karyotype or chromosome studies.  Refrigerate specimen if transport is delayed, do NOT FREEZE. Call CPC to arrange a dedicated courier pick up and transport to the laboratory.

Joint fluids for cell counts should be submitted in a lavender, EDTA tube and mixed well by gentle inversion 8-10 times. Maintain specimen at room temperature before and during transport to the laboratory.

Joint fluids for crystal examination must NOT be submitted in Formalin. Tissue that comes for crystal or gout analysis must be submitted fresh or in 100% alcohol. There may be chalky white deposits on the cut surface of the tissue, indicating a deposit of crystals.

Fresh fluids in a syringe (needle removed) may be used for cultures (aerobic/anaerobic/fungal) or a pink top bacterial culturette may be inoculated and submitted for cultures.

Maintain fluids at room temperature prior to and during transport to the laboratory. Do not subject joint fluid specimens to temperature extremes.

Blood to citrated anticoagulant ratio must be 9:1 to yield accurate test results.  Because of the limited vacuum in these tubes, use a needle and holder (not a butterfly) to collect coagulation study (PT/PTT) specimens. If a butterfly is required, first collect other non-anticoagulated required tubes or use another blue top Vacutainer® tube to purge the butterfly line of air and then proceed with drawing the test specimen tube.  Fill tube to the black fill line indicator or allow all of the tube vacuum to be extinguished. If tubes are under-filled or overfilled the specimen will be rejected and test orders canceled.

Following proper fill, label the tubes appropriately and gently invert 8-10 times to ensure adequate mixing.Do not centrifuge.  Specimen may be stored at room temperature before and during transport to the laboratory.

Calculi must be submitted completely dry. Specimens should not be submitted in liquid (formalin, urine, blood, etc), in gauze, filters, taped, or on Q-tips. There will be delay in analyzing and reporting specimens not received completely dry.

Core needle biopsies should be preferred for testing if they are representative of the tumor. Cold ischemia time should be kept to less than 1 hour and samples should be fixed in 10% neutral buffered formalin (NBF; formalin in water, 10% by volume, pH 7.4) for no less than 6 hours. Record cold ischemic time (time between specimen removal and time in formalin). Also record the time specimen was placed in 10% buffered formalin on the test requisition.

Biopsies must be sent to CPC and be processed within 48 hours from collection. HER2 guidelines recommend formalin fixation no shorter than 6 hours and no longer than 48 hours for excisional biopsy specimens. In addition, needle core biopsies require no shorter than one-hour formalin fixation.

This test is time-sensitive. If specimen is collected before 10:00 AM (not preferred) the tubes must be incubated at 37 degrees Celsius for 16-24 hours prior to transport to LabCorp. Specimens collected after 10:00 AM are incubated and processed by Labcorp. CPC asks clients to please consider incubation requirements when specimens are collected Friday or Saturday in conjunction with a national Holiday. Quantiferon tubes must be received by LabCorp within 70 hours after incubation by CPC and no more than 94 hours from the time of collection.

A special kit is required to collect blood.  Contact Consolidated Pathology Consultants to order kits.

Container: The QuantiFERON® collection kit contains the QuantiFERON® blood tubes and instructions for the collection and handling of:
(1) gray-top (with white ring) uncoated (nil)
(2) green-top (with white ring), TB1 tube
(3) red-top (with white ring), TB2 tube
(4) purple-top (with white ring), mitogen-coated

Collection: Refer to collection instructions included with draw kit. Special specimen collection kit contains four gel-barrier tubes as noted above. All four tubes are required for a single test result. Each tube is designed to draw only 1 mL and fill time may be longer than other blood collection tubes. Because of the limited vacuum in these tubes, use a needle and holder (not a butterfly) to collectQuantiFERON® specimens. If a butterfly is required, first collect other required tubes or use another Vacutainer® tube to purge the butterfly line of air and then proceed with drawing theQuantiFERON tubes. Fill tubes to the black fill line on the tube. If tubes are underfilled or overfilled (see kit insert), immediately collect a replacement tube.
Following proper fill, label the tubes appropriately and shake tubes 10 times firmly enough to ensure the entire surface of the tube is coated with blood cells to solubilize the antigen on the tube walls. After shaking, the volume may fall below the fill line. Do not centrifuge or refrigerate specimens.

Return each of the four properly filled, labeled, and shaken tubes to the box labeled “QFT® kit.” Seal the top by removing tape from the adhesive. To preserve cellular viability, specimens should be collected and sent the same day, at room temperature, so as to arrive at the lab as soon as possible and within 14 hours of collection.

Please indicate date and time of venipuncture on the tubes and on the test request form. If the specimen has been incubated for 16 to 24 hours at 37°C ± 1°C, please mark the top of the specimen box where indicated to denote incubation.

• Culture

Specify specific pathogen if not Salmonella, Shigella, Campylobacter, or enterohemorrhagic E coli(EHEC). Check expiration date of transport; do not use expired devices.

Fecal specimens for different tests often need different transport containers and different transport conditions. Specimens should be portioned out to separate devices of each type for each test requested before sending to the laboratory.

Stool for bacterial culture and enterohemorrhagic E coli Shiga toxin by EIA should be submitted in the orange top C&S transport vial. Only a thumbnail-size portion of stool, about 1 g or 1 mL, should be added to the vial. Overfilling the vial will reduce recovery of stool pathogens.

Specimen: Stool or rectal swab
Volume: 1 g, 1 mL, or one swab in stool C&S transport vial (usual bacterial swab transport is not acceptable although the swab may be used)
Container: Stool culture transport vial is required; diapers are not acceptable. Culture collection swab may be used to collect rectal swabs or a swab of fecal material, then swab should be placed in stoolculture transport vial (Para-Pak® C&S orange).

• Ova and Parasite

Concentration of material and examination of specimen for ova and parasites by conventional iodine/saline and trichrome staining. This will not detect Cryptosporidium, Cyclospora cayetanensis, or Microsporidium.

Special Instructions: Include any pertinent clinical and travel history on the test request form, which must indicate special request for Cyclospora Smear, Stool— at an additional charge. If Schistosoma haematobium infection is suspected, submit a urine specimen for Ova and Parasites Examination, Urine.
Specimen: Sputum or feces
Volume: 3 to 4 mL sputum or 5 mL feces
Minimum Volume: 3 mL
Container: O & P transport container with formalin and PVA (Para-Pak® pink and gray)

• C. difficile Toxins A and B, EIA

A separate specimen is required for culture or for the toxin B cytotoxin assay.
Specimen: Stool
Volume: 5 g
Minimum Volume: 0.5 g or 0.5 mL liquid stool
Container: Sterile screw-cap container, no preservative.
Storage Instructions: Specimen should be kept refrigerated and transported to the laboratory within 24 hours of collection. If a longer period is required, the specimen should be frozen at -70°C on dry ice.
Causes for Rejection: Inappropriate specimen transport conditions (eg, room temperature) or transport device; unlabeled specimen or name discrepancy between specimen and request label; specimen received after prolonged delay (usually more than 72 hours)