Providence Medford Medical Center Pathology Department

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Scarlett Terry
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1 Providence Medford Medical Center Pathology Department Anatomic pathology services including histology, cytology and autopsies are offered through Providence Medford Medical Center Pathology Department. For information regarding these services please call , Monday through Friday, 8:00 a.m. to 5:00 p.m. Please call the Clinical Laboratory at for after hour s pathologist assistance. Pathology Consultations A pathologist is available day or night for consultation. calling one of the following numbers: Days Nights & Weekends The pathologist can be reached by Copies of Reports for the Cancer Registry Copies of all histology and cytology reports diagnosing malignancies are routinely submitted to the Cancer Registry sponsored by Providence Medford Medical Center Cancer Registry. Requisition of Services Requisitions MUST accompany all specimens. These requisition forms are available upon request and should contain the following information: Patient s full legal name, address, and phone number Patient s gender, date of birth and age The name of the authorized caregiver requesting services Date and time of specimen collection, (including the time of placement in formalin) Patient s employer and complete insurance information Site of biopsy or where body fluid was collected Pre-operative diagnosis with ICD-9 code Clinical information pertinent to case Requisition forms, zinc buffered formalin specimen containers, saccomanno tubes and containers for other examinations are available through our office upon request. Note: If a RUSH is needed for specimen processing or if a FAX report is desired, please indicate this information on the requisition form. Preparation of Pathology/Cytology Transport Containers All specimen containers received in the Pathology Department must be submitted as follows: 1) Label the container with patient's full legal name and type of tissue and/or fluid submitted. 2) Place a "Bio-Hazard" label on the leak-proof, puncture-resistant container(s). 3) Place container in a leak-proof sealed plastic bag. 4) Attach requisition to outside of plastic bag to prevent contamination if leakage occurs.

2 Cytopathology Cytology examination of exfoliated cells is valuable in diagnosing malignant, premalignant, and on occasion a variety of benign disorders. It is important that all cytologic specimens be handled properly. Body cells disintegrate from enzyme activity within the cell and the surrounding fluid. Therefore, it is crucial for all cytology specimens to be processed or refrigerated IMMEDIATELY in order to slow down the enzymatic process and maintain specimen integrity. DO NOT ADD FORMALIN. Please contact Pathology Department regarding handling and/or transportation of such diagnostic specimens. Cytology Preparation Instructions Bladder Washings Urinary cytology is a useful procedure for the diagnosis, as well as follow-up, of patients with urothelial carcinoma. After washing the bladder, the specimen must be fixed in equal amounts of saccomanno fixative. PROMPT FIXATION IS ESSENTIAL. Mix thoroughly. Transport to Pathology Department along with a Breast Cyst and/or Aspirate for Malignant Cells The specimen must be kept refrigerated if immediate transport to the Pathology Department is not possible. Bronchial Washings/Brushings/Lavage If microbiology testing, cell count and/or differential are not needed, saccomanno fixative should be added in equal amounts to the specimen, mix thoroughly. PROMPT FIXATION IS ESSENTIAL. Transport to Pathology Department along with a completed requisition form. If saccomanno fixative is not available, please refrigerate specimen immediately after collection. Brushings should be in saccomanno fixative (or at least saline to prevent drying). Bronchial Washings/Brushings/Lavage for Pneumocystis See General Laboratory Instructions. The specimen submitted for Pneumocystis is handled through the Clinical Laboratory and forwarded to a reference laboratory for fluorescent studies. Cerebrospinal Fluid (CSF) Effusions of Pleural & Abdominal Cavities Fine Needle Aspiration (FNA) Diagnostic sampling of cells with the aid of a fine needle is particularly useful for organs that are unsuitable for exfoliated cytology. Pathologist performed fine needle aspirations: This procedure is scheduled by the attending physician s office in advance by calling the Pathology Department at Results are usually available to the attending physician within 24 hours.

3 Immediate readings of radiologic guided fine needle aspirate: Touch prep smears are made and placed directly in alcohol. IMMEDIATE FIXATION OF THE SMEARS IS ESSENTIAL, the biopsy itself is placed directly in a saline solution. Office fine needle aspirations: Touch prep smears are made. One slide is allowed to dry; the other slide(s) should immediately be placed in alcohol. The remainder of the specimen is placed in equal amounts of saccomanno fixative. IMMEDIATE FIXATION IS ESSENTIAL. The specimen should be immediately transported to the Pathology Department. Gastric Washings Thin Preparation PAP Smears The SurePath test pack should be used to collect specimens for PAP thin preps. Collection kits are available from the Pathology Department. Collect the specimen as per SurePath instructions. Be sure to leave the entire brush head in the preservation vial. Label the vial and send to the Pathology Department with a completed requisition form. SurePath instruction sheets are available from the Pathology Department. Conventional PAP Smears The SurePath thin prep kit is recommended for PAP collections. When the SurePath kit is not utilized, we recommend the use of a single slide on which both ectocervical and endocervical material is placed. Immediate fixation, after the cells have been deposited on the slide, prevents air drying and cell distortion. PAP kits are available upon request. Fix slides with hair spray, Pro-Fixx, or dip in alcohol that is supplied with the Pro-Fixx kit. Apply spray evenly on slide and allow drying before packaging. Write the patient s name in pencil on the frosted end of the slide. Transport to the Pathology Department along with a Sputum There are various methods of collection: Early morning collection a series of three specimens should be collected on three consecutive days using one container per specimen. Nebulizer/aerosol induced specimen is often necessary to obtain a deep cough specimen. Arrangements for this type of procedure may be made through the Respiratory Care department, If the patient cannot bring the specimen to the Pathology Department immediately, the specimen must be refrigerated, or equal amounts of saccomanno fixative must be added. This fixative is available upon request. The specimen should be transported promptly to the Pathology Department along with a Sputum for Pneumocystis Please refer to Bronchial Washings. Urine for Malignant Cells Urinary cytology is a useful procedure for the diagnosis, as well as, follow-up of patients with urothelial carcinoma. The first morning voided urine specimen is not recommended due to cell degeneration; however, a hydrated voided urine specimen is acceptable for cytological

4 evaluation. Indicate whether the specimen is voided or catheterized. Add equal amounts of saccomanno fixative to specimen. If other laboratory tests are requested, transport the specimen without fixative in a sterile container on wet ice to Pathology Department along with a completed requisition form. Anatomic Pathology Special Instructions Autopsies Arrangements are to be made by the Nursing Director, Charge Nurse, Nurse Manager or Nurse Supervisor. Outpatient autopsies or family requested autopsies are not performed at PMMC. Please complete an autopsy packet before calling the pathologist. Autopsy packets are available in the Pathology Department. The consent for autopsy and the autopsy checklist must the complete and correct. Surgical Specimens for Routine Examination The specimen should be placed in 10% Neutral Buffered Formalin and submitted to Pathology Department accompanied by a completed requisition form. Pertinent clinical information is essential. Specimen containers should be labeled appropriately (see information requirements). If results should be sent to more than one physician, indicate this on the requisition form. Note: Fixation of tissue in zinc buffered formalin or other fixatives precludes certain special studies. For specific handling instructions, please contact pathologist or Pathology Department prior to performing the biopsy. Surgical Specimens for Specialized Examination and/or Handling Frozen sections, bacteriologic cultures, or specimens being transported to another facility for testing should not be placed in a fixative. Please call the Pathology Department for special instructions. Fixatives, special handling instructions, and requisitions are available upon request by calling Electron/Fluorescent Microscopy & Immunohistochemistry Studies Please notify the pathologist or Pathology Department in advance of pending biopsy to ensure its proper handling. Make arrangements in the morning as these specimens are sent to a reference laboratory. The biopsy must be placed on a saline-soaked gauze sponge, placed on wet ice, and transported to the Pathology Department immediately along with a completed requisition form. Frozen Sections To ensure proper handling, notify the pathologist or Pathology Department in advance of a frozen section. The biopsied specimen must be placed immediately on a saline-soaked gauze sponge. The specimen must be immediately transported to the Pathology Department accompanied by a completed requisition form. After the frozen section is performed, the pathologist will contact the requesting physician. Kidney Biopsies To ensure proper handling, notify the pathologist or Pathology Department in advance of kidney biopsy. This specific biopsy should be done in the morning as arrangements must be made for transportation of the specimen to a reference laboratory. The biopsy is to be placed on a saline-

5 soaked gauze sponge and placed on wet ice. The specimen must be transported to the Pathology Department immediately along with a completed requisition form. Please include a copy of patient's H & P or consultative report to be sent along with the specimen. Nerve & Muscle Biopsies To ensure proper handling, notify pathologist or Pathology Department of pending biopsy. These biopsies should be performed early enough in the day to ensure receipt in the Pathology Department by 2:30 PM. The specimen must be transported to the Pathology Department immediately along with a completed requisition form and a copy of the H&P or consultant s report. The biopsy is to be placed on a saline-soaked gauze sponge and placed on wet ice. Care should be taken not to freeze the tissue. Chromosome and Flow Cytometry Studies of Bone Marrow To ensure proper handling, notify pathologist or Pathology Department in advance of pending biopsy. The examination is usually done in conjunction with a bone marrow aspirate and biopsy. Just prior to aspiration of bone marrow, 0.2 cc. of Sodium heparin (1000 Units per cc.) should be added to the transport media. Preservative free Sodium heparin is preferred but not required. ALLOW NO CLOTS TO FORM. Approximately 0.5 cc. of unclotted bone marrow aspirate is required for chromosome analysis, but approximately 1 cc. is needed if both studies are performed. As soon as the aspirate is collected, the tube should be capped and inverted gently to mix the media, aspirate and Heparin. NOTE: Two air dried bone marrow smears need to accompany each study requested. A Bone Marrow Chromosome Analysis Request and/or Flow Cytometry Form must accompany the specimen. The material for this specific examination should be collected in the morning as transportation arrangements must be made to a reference laboratory. The request forms and transport media may be obtained upon request from the Pathology Department. Quantitative Iron Studies To ensure proper handling, notify pathologist or Pathology Laboratory in advance of pending biopsy. The biopsy must be performed in the morning to ensure that the specimen will be in route before 1:00 p.m. The biopsy material for this examination must be placed in a Metal-Free vial dry (without fixative or saline) and transported to the Pathology Department immediately along with a completed requisition form. These Metal-Free vials may be obtained from the Pathology Department upon request.

Pathology Specimen Handling Requirements

CONWAY REGIONAL HEALTH SYSTEM CLINICAL LABORATORY Pathology Specimen Handling Requirements POLICY: Tissue or body fluids, etc. removed or collected during any procedure for purposes of Pathologist examination