Tissue Collection

Patient Preparation

Tissue is obtained from the Operating Rooms, Clinics, Nursing Stations and outside contributors. Questions about the specimens and the tests that may need to be performed should be directed to the Director of Anatomical Pathology and the on-call Pathologist before the medical procedure is done. This is the responsibility of the submitting physician/entity.

The specimen is obtained by the Submitting Physician from the patient. The Submitting Physician or his/her deputy must bring each tissue specimen (in a safe, secure and labeled container) with a completed, legible, Pathology Protocol form (# SP-1, #SP-2 or Autopsy Block List) for Surgical Pathology.

Type

1. Human Tissue specimens requiring pathological diagnoses.
2. Foreign bodies/prostheses – to be described only.
3. Placenta that need to be properly disposed of as of Regulated Medical Waste.
4. See Hospital Policy # LAB-4 for Handling of Human Tissue and Foreign Matter.
5. See Surgical Pathology Policy & Procedures for Handling of Stillborns or Aborted Fetuses (#AP-SH-2)
6. All specimens are routinely subjected to microscopic evaluation except for the following:
   1. Surgical Hardware, Prosthesis, except maybe clinging tissue.
   2. Specimens that cannot physically be decalcified, sectioned or stained.
   3. Items to be submitted to the NYPD via the UHB Public Safety Dept. (i.e. Bullet)
   4. Specimens submitted for disposal only.
   5. Specimens for research purposes only.
   6. Placentas not in accordance with the guidelines for placental examination

Concerning Placental Examinations

The placenta should be sent to Surgical Pathology for examination by the Pathologist under any of the following circumstances:

1. It is removed by Caesarian section.
2. Any gross abnormality of the placenta, it’s membranes, or the umbilical cord.
3. Any case in which there is reason to suspect an abnormal pregnancy, abnormal delivery, abnormal infant, or Potential for litigation.
4. The existence of certain maternal conditions:
   1. diabetes mellitus ( or glucose intolerance)
   2. hypertension (pregnancy-induced)
   3. pre-maturity (32 weeks or less gestation)
   4. post-maturity (pregnancy longer than 42 weeks gestation)
   5. maternal history of reproductive failure (defined as one or more previous spontaneous, still birth, neonatal deaths, or premature births)
   6. oligohydramniosg. fever or infection
   7. maternal history of substance abuse
   8. repetitive bleeding (other than minor spotting in the first trimester)
   9. abruption placenta.
5. The existence of certain fetal and neonatal conditions:
   1. stillbirth or perinatal death
   2. multiple birth
   3. congenital abnormalities
   4. fetal growth retardation
   5. pre-maturity (32 weeks or less gestation)
   6. fydrops fetalis
   7. viscid/thick meconium
   8. admission to a neonatal intensive care unit
   9. severe depression of the CNS (Apgar score of 3 or less at 5 minutes)
   10. neurologic problems, including seizures
   11. suspected infection

Specimen handling and media requirements:

1. Use the specimen container displayed on barcode label when collecting specimen.
2. Adhere to specimen handling when necessary.(e.g. DO NOT FREEZE). 
3. Viral Culture Media- Universal Culture Media. Store at refrigerated temperatures between 2-8 C. The transport media does not need to come to room temperature prior to use.
4. Coagulation- If unable to collect coagulation specimen and specimen must be drawn through an indwelling catheter, the line should be furnished with 5ml of saline and the first 5 ml of blood or six dead space volumes of the catheter discarded.
5. Surgical Pathology specimen handling conditions. Specimens submitted should be either in:
   1. Container with 10% NBF (Neutral Buffered Formalin fixative solution), 4% Buffered Glutaldehyde Fixative – supplied by Surgical Pathology - or in sealed leak-proof plastic bag for specimens requiring immediate (frozen section) diagnoses, Scrape & touch Preps.
   2. Leak-proof, Biohazard bag – for large unfixed tissue. Attached patient specimen label and #SP-1 form (Blue) with specimen delivery log book to verify and confirming the accuracy of document to prevent any possible error.
   3. Large, double, red-bag – for amputated limbs.
   4. OR – Leak-proof plastic bag attached patient specimen label and #SP-1 form with specimen delivery log Book to verify and confirming the accuracy of document to prevent any possible error.
   5. Labor and Delivery - Leak-proof plastic bag attach patient specimen label and #SP-2 form (Green)
   6. Clinics - 10% Neutral Buffered Formalin filled container- attach patient specimen label and #SP-1 form.
   7. Nursing Stations - 10% Neutral Buffered Formalin filled container- attach patient specimen label and SP-1 form.
   8. Endoscopy – 10% Neutral Buffered Formalin filled container- attach patient specimen label and SP-1 form.
   9. Satellite Labs - 10% Neutral Buffered Formalin filled container- attach patient specimen label and SP-1 form.
   10.  Oral - 10% Neutral Buffered Formalin filled container- attach the patient specimen label and Requisition form.( Folded small White)
   11. For renal biopsies – tissue for immunofluoresent studies portion should be submitted in Zeus’ Fixative.
   12. Delivery of specimens – it is important that all specimens are delivered to Surgical Pathology at room A2-467 and notify to the secretaries ASAP to insure proper handling and the need for immediate fixation.

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All specimens delivered after normal duty-hours (Mon-Fri. from 8:00am to 6:00pm) and Holiday, Weekend are stored in the designated specimen refrigerator located in the Clinical Pathology Suite near room #A2-428