University Hospital Limerick Laboratory User Manual Histology File Name: MP-L-HIS-USERMAN Edition No.: 04 Date of Issue: 7 th October 2015 HISTOLOGY

Transcription

1 HISTOLOGY Contents 1. Index: Test Repertoire - Histology Laboratory Details Background Information Quality Assurance Specimen Collection, Handling and Storage Specimen Labelling Specimen Containers Specimen Transport Instructions for Frozen Sections Instructions for Routine Histology Diagnostic (Fluid) Cytology Immunohistochemistry Special Stains Additional Requests Post Mortem Histology Critical Alert Results Referral Tests Page 1 of 10

2 1. Index: Test Repertoire - Histology Frozen Sections Routine Histology Diagnostic (Fluid) Cytology Immunohistochemistry Special Stains Post Mortem Histology Referral Tests 2. Laboratory Details Location: University Hospital Limerick Section: Histopathology Department Hours: :30 Monday-Friday :00 Saturday On-Call/Emergency: Autopsy service provided Contact Histopathologists on-call Clinical advice is available from reporting Histopathologists, 24hours a day, 7 days of the week. Contact Telephone: Report Enquiries: Secure Fax: (Laboratory Office) (Laboratory) Pathologist in Administrative Charge 2015/2016: Dr. Olu Ipadeola Tel: Chief Medical Scientist: Ms. Naomi Cronin Tel: / Consultant Staff: Dr. Elizabeth Mulcahy Tel: Dr. Peter Faul Tel: Dr. Vourneen Healy Tel: Dr. Olu Ipadeola Tel: Dr Emer Caffrey Tel: Senior Scientific Staff: Tel: Page 2 of 10

3 3. Background Information The Histology Laboratory currently has a staff of 6 Histopathologists, 14 Medical Scientists, 1 Laboratory Assistant and 1 student Medical Scientist. There are 4 centrally placed Clerical Staff who are shared between the various laboratory disciplines. The Histology Laboratory processes 22,000 Histopathology specimens yearly. The Histology Laboratory located in the University Hospital Limerick is the Central Histology Laboratory servicing the Mid-Western Area. The services provided include: Routine Surgical Histology Special Stains Frozen Sections Post Mortem Histology Immunohistochemistry Referral Tests The laboratory is located in the Pathology Department in the University Hospital Limerck, Dooradoyle, Limerick. Histology Reports are now available on APEX / ilab to authorised Consultants. Cytology Reports are now available on Medibridge to authorized Users 4. Quality Assurance The Histology Laboratory is a member of the following external quality assessment schemes: UKNEQAS for Cellular Pathology Techniques UKNEQAS for Her 2 Immunohistochemistry UKNEQAS for Breast Hormone Immunohistochemistry UKNEQAS for Lymphoma Immunohistochemistry UKNEQAS for Routine ICC Immunohistochemistry UKNEQAS for Alimentary Tract Immunohistochemistry 5. Specimen Collection, Handling and Storage Specimen collection is at the discretion of the Clinician. Sharps used for specimen collection must be disposed of in appropriate sharps waste disposal bins. Sharps must not be sent to the Histology Laboratory under any circumstances. Routine Histology Specimens must be placed directly into formalin and can be stored at room temperature until transported to the Histology Laboratory. Sample should be completely immersed in formalin. Frozen Section specimens must be sent dry directly to the Histology Laboratory FNA slides for Cytology Referral should be stored at room temperature until transported to the Histology Laboratory. Non-gynaecological fluid samples for Cytology Referral should be stored at 4-6 C until transported to the Histology Laboratory. 6. Specimen Labelling The most current edition of the University Hospital Limerick Histology Request Form and the approved Specimen Containers must be used in all cases. 1. Request Forms and Specimens must be labelled correctly with: Patient s Full Name Hospital Number (n/a for GP s) Date of Birth Ward / Location Specimen Type Request Forms must also contain the following information: Patient s Full Address Name of Requesting Clinician Clinical Details 2. All details on the request form must correspond to those on the specimen container. 3. Specimen labels must be fixed onto the side of the specimen container, not the lid. (See figure 1) 4. Request forms must not be stuck onto specimen containers as an alternative to a correct specimen label Page 3 of 10

4 Note 1: Specimens with request forms stuck onto container as an alternative to a correct specimen label will be treated as unlabelled and returned to the sender. Note 2: Any specimens received without clinical details will be returned to the sender. Histology Specimen Rejection Criteria: Any request form that does not have: 1. Patients full first name* 2. Patients Surname* 3. Date of Birth 4. Hospital Number (n/a for GP s) 5. Patient s full address 6. Specimen type* 7. Clinical Details * If specimen type is not labelled on the request form or container then sample should be rejected however if the container is labelled the sample can be accepted. Any specimen that does not have 1. Patient s full first name* 2. Patients Surname* 3. Date of Birth/ Hospital number 4. Specimen Type Specimen labelling fails to meet Request Form Completion and Specimen Labelling Policy LI-L-HIS-RECDISC* Specimen and form details do not match 7. Specimen Containers Large Specimens Large specimens must be put into the 2.5 Litre, or 5 Litre specimen containers, as appropriate. (Figure 1) 5 Litre Specimen Container Specimen label on side of container (2.5 Litre Specimen Container) Figure: 1 Large Specimen Containers Page 4 of 10

5 SMALL SPECIMENS Small specimens must be put into one of the following containers (Figure 2): 20ml universal 40ml red-topped 120ml yellow-topped 180ml white-topped container Figure: 2 8. Specimen Transport 1. Specimens must be sent to the Histology Laboratory during routine working hours only, 8.00am to 5.00pm Monday to Friday only. Samples for frozen section, cytology and glass slides e.g. FNA s should not be sent via the chute system. 2. Specimens need to be Triple-Packed in the approved transport containers to meet current EU transport regulations. Primary container = Specimen Container(See Figures 1 & 2) Secondary Container = Small Specimens: Individual Plastic Sealable Bags (Figure 3) Large Specimens: Plastic Sealable Box (Figure 4) Tertiary Container = Outer Sealable Container (See Figure 4 & 5) 3. Absorbent material (available from MegaPak) should be placed in the secondary container to contain any spills. 4. Specimen Request Forms should be placed in a sealed plastic bag and placed on top of the secondary container. Figure: 3 Secondary Containers - Small Specimens: Individual Plastic Sealable Bags Approved Secondary Page 5 of 10

6 Container Approved Tertiary Container Figure 4 Secondary Containers - Large Specimens: Plastic Sealable Box Approved Sealed Tertiary Container Figure 5 Tertiary Container - Outer Sealable Container Note: GPs availing of the Shannon Doc Courier Service are compliant with the above listed Instructions. CLEANING OF TRANSPORT CONTAINERS Note: Responsibility for cleaning lies with the Sender Secondary Containers should be wiped daily with disinfectant (Trigene 1:50 dilution). In the event of a spillage, the Tertiary Container should also be wiped with disinfectant (Trigene 1:50 dilution). SPILLAGES Major Clinical Incidents must be reported to in accordance with the UL Hospitals Risk Management Procedure. Use a disposable mask and gloves when cleaning up all spillages. Formalin Spill Cover small formalin spillages with disposable absorbent towels. For larger formalin spillages, use a formaldehyde Spill Kit (Spill-X-FP from VWR International), to polymerise the formalin. The area should then be wiped with disinfectant (Trigene 1:50 dilution). Biological Hazard Known biohazard specimens, fresh tissue and cytology fluid spills should be cleaned with absorbent towel which must then be collected into an autoclave bag, and autoclaved before disposal. The area should then be wiped with disinfectant (Trigene 1:50 dilution). Page 6 of 10

7 RISK ASSESSMENT RISK ASSESSMENT Substance name Hazard / Risk phrases Manual reference Fixed and unfixed human tissue B - Formalin Xn, R20/21/22, R36/37/38, R40, R43. MSDS Trigene No specific hazards MSDS Key Xn = Harmful B = Biohazard / risk of infection. Wear gloves and protective clothing R20/21/22 = Harmful by inhalation, in contact with skin and if swallowed R36/37/38 = Irritating to eyes, respiratory system and skin R 40 = Limited evidence of a carcinogenic effect R 43 = May cause sensitisation by skin contact The R36/37/38 risk is not applicable if the volume of formalin is less than 125ml * A copy of MSDS available from Laboratory if required 9. Instructions for Frozen Sections Frozen Sections must be pre-booked with the Histology Laboratory Frozen Sections will not be processed on patients with TB, Hepatitis B, C or HIV. If a suspicion of such infection exists, clinical staff must inform the laboratory. Contact the Laboratory directly at The Scientist taking the call will ask questions relating to the specimen and will ensure that a Histopathologist is available for the stated time before confirming the booking Samples must be sent in a dry container no fixative, via porter to the laboratory. Samples for frozen sections should never be sent via the Chute system The normal turn around time for frozen sections is minutes after arrival in the laboratory however if multiple specimens are received the turn around time will be exceeded. Please write contact number for phoned report Frozen Section reports will be phoned by the reporting Histopathologist to either the Consultant Surgeon or staff at the given contact phone number. When phoning the report the Histopathologist will state the Name and Chart Number of the Patient and the Type and Location of the biopsy and will note the identification of the person receiving the report before dictating the report. It is important to cancel a frozen section if it is no longer required as Laboratory Staff will be on hold awaiting its arrival. 10. Instructions for Routine Histology Specimen requirements: For fixation purposes, Samples (including bone marrows) for routine Histology must be sent in 10% Formalin Pre-filled formalin pots are available for collection from the Laboratory for smaller biopsies Larger specimens and organs should be sent in 2.5L and 5L containers with 10% formalin added * For very large specimens, contact the Laboratory directly and an extra large specimen container (10L or 20L) will be provided. Samples should be clearly labelled with Patient and specimen details *Placentas are only to be placed in 2.5L container, twin placentas to be placed in 5L containers only. Specimen acceptance: In house specimens for Histology are usually brought directly to the Laboratory by porter and are accompanied by a docket / record book that must be signed by a member of staff. Specimens from Ennis, Nenagh and St. Johns Hospital are to be brought directly to the Histology Cut-Up Laboratory. The Register for Receipt of Histology Specimens must be signed on delivery of the specimens Specimens from outside locations including Croom, Regional Maternity Hospital and GPs are received via Laboratory reception. Nenagh, Ennis, Croom, St. Johns Hospital and Regional Maternity Hospital specimens are accompanied by dockets that must be signed by a member of staff. GP specimens do not have accompanying dockets. If discrepancies are found, the specimen may be returned to its point of origin for correction along with the docket and request form. If the specimens are being returned to an outside source a return letter outlining the problem is included. Urgent Samples Urgent surgical specimens must be requested by consultation with Consultant Histopathologist on duty. Page 7 of 10

8 Turnaround times Turnaround times are as follows: Small biopsy Breast Needle Core 6 days Prostate Needle Core Lung Needle Core Liver Needle Core Lymph Node Needle Core 10 days GI Endoscopic biopsy Cancer Resection Breast Resection GI Resection 10days 10 days Non-biopsy, Other Cervix LLETZ Skin Wedge of Lung, Liver Urinary Tract Lymph Node Turnaround times for urgent processing is 2 working days after receipt (applies only to small biopsies) 10 days Turnaround time for specimens requiring Special Stains or Immunohistochemistry may exceed times listed above. 11. Diagnostic (Fluid) Cytology The Histology Laboratory processes Diagnostic - Non-Gynaecological Cytology (fluid cytology) samples from various Hospitals and outside sources. The samples are sent to the Cytology Laboratory, St. James Hospital, Dublin on a daily basis Monday to Thursday. Non-Gynaecological Cytology (fluid cytology) samples received in Histopathology laboratory are referred onto the Cytology Laboratory, St James Hospital, Dublin. Cytology Specimen Requirements for the Referral of Non-Gynaecological Cytology Specimens to St. James Hospital Specimen Type Volume Sample Container Fixation Comment Bronchial Aspirate / BAL N/A Universal Container Unfixed Sample High risk patients must be identified Brushes N/A Universal Container (containing Cytolyt Fixative) 10mls Cytolyt Fixation Cut brush off and place in Cytolyt Fixative CSF N/A Universal Container Unfixed Sample Laboratory staff to prepare cytospin slides for referral Fine Needle Aspirates N/A Universal Container (containing Cytolyt Fixative) Expel aspirate and rinse needle in 10mls Cytolyt Fixative One air dried slide can be submitted in addition to needle rinse in Cytolyt. Multiple slides are not to be submitted. Urine 20mls Universal Container Unfixed Sample No early morning/ first void of the day urines to be submitted. No full voided urines of 24 hour collections to be submitted. Serous Fluid Approx 20-70mls Universal Container / Small Pot Unfixed Sample Page 8 of 10 No collection bags or large pots to be submitted

9 Special Precautions: A sample of large aspirate must be transferred to a universal container for Cytology. Mix well before taking sample. Samples must be appropriately labelled with patient details and sample type and location details A Histology request form is used for Cytology Requests. Please tick the Cytology Box on the request form. Request forms must be appropriately labelled with patient details and sample type and location details If other tests are also required on the sample, the non Cytology tests will need to be performed first. Some of these tests may affect the sample quality. For this reason it is recommended that a separate sample be sent for Cytology. It is advisable to store fluid cytology in a fridge if collected out of hours. Aspirate / FNA Slides must be labelled using pencil with Patient name, Chart no and Date of Birth. It is important to label the slide prior to spray fixation. If the label is written over the fixative film, processing will remove it. Reports: When reports are received they are forwarded to the requesting Location / Consultant. Electronic copies of cytology reports are available on Medibridge A hard copy of all reports is retained in the Pathology Laboratory Office. Turnaround times: Turn around times for Diagnostic Cytology is days. 12. Immunohistochemistry The Histology Laboratory provides an Immunohistochemistry service for the UL Hospitals. There is a broad range of antibodies available including Breast Receptors, Lymphoma Panels and Routine Screening Panels. Immunohistochemistry requests are usually requested by the Pathologist / Haematologist or by the Oncologist in charge of the Patient. Any other requests for specific Immunohistochemistry must be made through the reporting Pathologist. 13. Special Stains The Histology Laboratory provides a small selection of special stains which are performed at the request of the reporting Pathologist / Haematologist. Requests for special stains by non Pathology Staff must be made through the reporting Pathologist. 14. Additional Requests Additional requests must be made through the reporting Pathologist. 15. Post Mortem Histology Requirements In House All non-coroner and non-forensic ( i.e House) Post Mortems require Next of Kin Consent. Next of Kin consent forms are available in each ward. If no form is available in the ward a supply is available in the Mortuary, Bleep No A fully completed Death Card (available on each ward) must accompany the deceased to the Mortuary. On arrival at the Mortuary the deceased is transferred to an appropriately labelled fridge and the Mortuary Register is completed as instructed. Reports: Post Mortem reports are available from the Laboratory Office. Coroner Post Mortems are sent only to, and are available only from, the presiding Coroner and the Gardaí associated with the case. House Post Mortems are sent to the requesting Consultant only. Any queries will be forwarded to the requesting Consultant. Forensic Post Mortems All forensic Post Mortems are performed by the State Pathologist or Assistant State Pathologist. Reports on these cases are not generated by the UL Hospitals Pathology Service. Reports on these Post Mortems are not available from the UL Hospitals Pathology Service. 16. Critical Alert Results Critical results are defined as follows; Frozen section results Urgent results as verified by the Consultant Histopathologist Unexpected diagnosis Page 9 of 10

10 17. Referral Tests 24 hours notice must be provided to the Histology Laboratory in order to arrange appropriate transport. For the following tests the laboratory acts as a dispatch centre only. Reports are sent from the Referral Centre directly to the requesting location and Consultant only. The Histology Laboratory does not monitor turn around times of these reports. Tissue Specimen Referral Centre Contact details requirements Renal Biopsy Unfixed dry renal Department of Dr. Tony Dorman biopsy Renal pathology, Beaumont (office) Hospital, Dublin 9 (Laboratory) Bone Formalin Fixed Histology Dr. Conor O Keane Bone Laboratory, Mater Public Ext: 2111 Hospital, Dublin Brain Formalin Fixed Department of Dr. Niamh Brain Samples Neuropathology, Bermingham Cork University Hospital Skin for Unfixed Skin Histology Dr Niamh Leonard Immunoflourescence Biopsy and a Laboratory, formalin fixed St James skin biopsy Hospital Muscle Biopsy for Fresh Muscle Department of Dr. N. Birmingham Enzyme Analysis biopsy wrapped Neuropathology Consultant in Cling Film Cork University Neuropathologist Hospital or Linda Moloney, SMS Skin for Skin in Serology Mr. Colm McDonnell Karyotyping/ Sterile Saline Department, Chromosomal MWRH Analysis / Fibroblast Culture Products of Products of Serology Mr. Colm McDonnell Conception for Conception in Department, Fibroblast Culture/ specific media MWRH Cytogenetics Blocks and Slides n/a Contact Histology Laboratory, Limerick Occasional n/a Contact Histology Unspecified Laboratory, Referrals Limerick Page 10 of 10