Laboratory Medicine

Specimen types routinely processed by the Diagnostic Cytology Laboratory include:

Serous Fluids Cytology

Ascitic fluid, pericardial fluid, peritoneal washings and pleural fluid.

Respiratory Cytology

Bronchial aspirates, bronchial lavages, bronchial brushings and sputa.

Brushings Specimens

Pancreatic biliary, ureteric and common bile duct.

Fine Needle Aspiration (FNA) Cytology

Superficial FNA’s taken from thyroid, breast, lymph node, supraclavicular and submandibular. Endoscopic FNA’s including TBNAs (Transbronchial needle aspirations) from lymph nodes or masses, FNA from pancreas, stomach or oesophagus and fine needle biopsy (FNB) from pancreas/nodes.

Cerebrospinal Fluid (CSF)

CSF and other neuropathology fluids are processed by cytology and reported by the Neuropathology Consultants.

Synovial Fluids (NB: This test is not UKAS accredited)

Synovial fluids are examined for the presence of monosodium urate and calcium pyrophosphate crystals in cytology. Synovial fluids are also examined for microscopic assessment if septic arthritis, inflammation or infection is queried. Any Synovial fluid specimens where septic arthritis is suspected must have a separate additional specimen and request form being sent to Microbiology. Bursa fluid and ganglion fluid may be examined for the presence of crystals and microscopic cell evaluation.

Other Fluids

Cyst Fluids (e.g. ovarian cyst, parotid and Thyroid)

Urine

Urine, ureteric washings and renal pelvic washings. Cytology can test for the presence of casts in urine.

Certain specimens for Diagnostic Cytology can be transported by the previously listed normal specimen transport methods as well as the internal pneumatic tube system

Specimens from the Queen Elizabeth University Hospital may be sent via the internal pneumatic tube system. Only the following specimens may be sent via the internal pneumatic tube system: Fluids, FNAs which are fluids (Not slides), respiratory specimens and CSFs. Please do not send specimens with a danger of infection via the pneumatic tube system. Please ensure all specimens are sent in leak-proof containers (white lidded, screw top universal tubes are ideal).

The Diagnostic Cytology laboratory should be contacted on 89569 before a specimen is sent through the pneumatic tube system.  The pneumatic tube extension for cytology is 1616

The Diagnostic Cytology laboratory follows the same specimen acceptance criteria as the pathology department.

Specimens that are Mislabelled/Erroneous/Have Insufficient Information

In the event that a specimen received in diagnostic cytology where the specimen and/or the request form has been mislabelled or erroneous, the team leader or appropriate biomedical scientist will make every attempt to contact the sender and clarify what has happened.

This may be by email or by telephoning the clinician given on the request form.

If the event that there is insufficient information to contact the source regarding a specimen e.g. specimen sent with no request form. The specimen will be kept for 1 week, in the hope that the laboratory will be contacted. If no contact has been made at the end of this period, the specimen will be discarded.

A cytology trakcare request form should be sent for cytology tests not a histopathology trakcare request form. The cytology department does issue reports via trakcare.

Specimens taken specifically for the diagnosis of infectious diseases should NOT be sent to Cytology, but instead be sent directly to microbiology/virology as appropriate.

Specimens which are highly suspicious of, or from known Group 3 infectious diseases must be labelled as D.O.I

Examples of Group 3 Infectious Diseases

Coronavirus (COVID-19), Human Immunodeficiency Virus (HIV), Hepatitis C&D, Mycobacterium tuberculosis, and Creutzfeldt Jakob Disease (CJD)

CSF Cytology Specimens which are highly suspicious of CJD or known CJD should be labelled as D.O.I. A specimen should be sent directly to the Edinburgh CJD unit if there is a clinical suspicion of CJD.

Group 4 Infectious Diseases

Should not be sent to Cytology for processing. E.g. Viral haemorrhagic fever.

Specimens which pose a risk from infectious diseases must:

• Be placed in a D.O.I specimen bag (ONLY send D.O.I specimens in these bags)
• Have a D.O.I label on the Specimen Container
• Indicate there is a Danger of Infection by ticking the box on the request form
• Describe the nature of the risk (known or highly suspicious of) on the request form

Urgent specimens must be clearly labelled as urgent on the specimen request form.

The request form must also have the contact information of the clinician who requires the urgent result e.g.  telephone number or page of the clinician. If a specimen is required urgently for a Multi-disciplinary Meetings (MDT), please put this on the specimen request form and the date of the MDT.

The pathology department offers a service for immunofluorescence testing on skin, renal, conjunctival and oral biopsies.

Skin, Renal, Oral and Conjunctival Biopsies requiring immunofluorescence should be placed in Michel’s fixative immediately after collection.

Michel’s fixative is capable of preserving fresh tissue for up to 5 days before there is any deterioration in the sample. The request form is checked for the date a sample is taken, to ensure that it has been received within time. Michel’s fixative is available from the pathology department upon request. The fixative should be stored between 2-25⁰c and not be used after it has reached its expiry date.

COVID-19

Fresh samples are processed routinely for immunofluorescence analysis. However, if the patient is known to be COVID Positive, please can this be indicated clearly on the form so the laboratory will be able to take the appropriate precaution when processing these samples.

Danger of Infection

Specimens that are suspected or are known to contain blood borne viruses (e.g. HIV, Hep B, and Hep C) are classified as Category 2 and can be dealt with using the appropriate safety precautions.

Specimens suspected or known to have Category 3 organisms (e.g. TB, Leprosy, and Anthrax) or Category 4 organisms (e.g. Ebola, Lassa Fever and Haemorrhagic Fever) or CJD are not suitable for analysis via immunofluorescence.

For further information regarding immunofluorescence or danger of infection samples, please contact the Immunocytochemistry Department of the pathology laboratory (0141 354 9518 or 89518).

CHI/Unique identifier, Surname & Forename or if no CHI/unique identifier, the Surname, Forename and Date of Birth must be provided.

A minimum of 3 matching patient identifiers across both the specimen pot labels and forms are required to accept a specimen and meet legislative requirements.

Only Specimen containers and Forms that satisfy the essential criteria listed below can be accepted into the department.

Request Form

Essential:-

• CHI Number or a temporary unique identifier (e.g. ZP number)
• Patient’s Full Name or unique coded identifier
• Date of Birth
• Nature of Specimen including qualifying details (Any Danger of Infection information is essential)

Desirable:-

• Patient’s Address including Postcode (essential if no CHI number)
• Clinical Information/history including risk/danger of infection (essential for fresh tissue and frozen section)
• Date and time of sampling
• Practitioner’s contact number (bleep or extension)
• Gender
• Location and destination of report
• Requesting Practitioner
• Investigation Required

Sample Container

Essential:-

• CHI number or a temporary unique identifier (e.g. ZP number)
• Patient’s Full name or unique coded identifier
• Date of Birth
• Nature of Specimen or identifier including qualifying details
• Labelling to indicate if there is a risk/danger of infection

Desirable:-

• Date and Time of Sampling

Other Essential Information

The full address to which the report should be sent must also be included.

N.B: Pre-printed labels do not indicate the address to which the report should be sent.

A short clinical history must also be provided.

A brief clinical history is invaluable in the interpretation of the histological findings and should be given in every case.

As many pathology cases require considerable clinico-pathological discussion before a diagnosis can be reached, it is essential that the name of the patient’s consultant, the name of the requesting doctor and the contact telephone or page numbers are put on the request form where asked.

If the report is required urgently this should be stated on the request form along with a contact telephone number or page number.

The laboratory cannot supply a report on unlabelled specimens or specimens received without request forms.

Failure to provide the required information may result in delays in processing specimens and/or in the provision of a Pathology report to the appropriate location.

Normally, specimens should be transferred in a sealed container with 10% neutral buffered formalin, which prevents tissue decay, ideally the volume of formalin should be at least 10 times the volume of the specimen, but for major resections this may not be possible. Please ensure that containers are properly sealed before dispatch as leaking specimens will not be picked up by Transport/ Facilities staff. If you have a Formalin spill, follow your own spill procedures. 

No fixative should be added if:

• a frozen section is requested (including: brain biopsies taken mid surgery for smear analysis, muscle biopsies and paediatric rectal biopsies – see individual sections for more information)
• the specimen is thought to be a lymphoma – whole lymph nodes only
• there is a need to collect and process fresh surplus tissue for medical research purposes
• The sample is for Cytology
• The sample is for Immunofluorescence 

Sending Fresh Tissue

All fresh tissue must be delivered to the Pathology Department immediately and Pathology Specimen Reception should be notified that fresh tissue has been sent.

Tel:  0141 354 9513 (89513) or 0141 354 9514 (89514)

If you are unsure of the correct procedure, contact Pathology Specimen Reception for advice on the telephone numbers above.

Delay in receipt of a “fresh” specimen may make diagnosis impossible.

Fixatives and specimen jars are available from:

Specimen Reception (L3/B/021),

NHSGGC Pathology Department

Level 3, Laboratory Medicine and Facilities Management Building

Queen Elizabeth University Hospital

Tel:  0141 354 9513 (89513) or 0141 354 9514 (89514)

Requests for urgent results should be clearly marked on the request form and contact telephone or page number provided.

The consultant pathologist should be notified before the specimen is sent if an urgent result is required.

It is the responsibility of the clinical team to ensure that emergency/urgent specimens are transported urgently to the Pathology Laboratory.

In practice, these are specimens that carry the risk of transmitting Hepatitis B virus, Hepatitis C virus, HIV, M. tuberculosis and other category III pathogens.

The Clinical Microbiology Department should be contacted where there is any uncertainty.

Such specimens, include those from confirmed or suspected cases of the disease, known carriers (e.g. those known to be hepatitis antibody or antigen positive), as well as patients from an ‘at risk’ group (e.g. drug abusers).

‘Danger of infection’ (DOI) stickers must be put on the specimen bag, the request form and the specimen container.

If the nature of the DOI is known please include this in the clinical details.

Specimen bags should be sealed so that they can be opened without the use of sharp or pointed instruments.

For large specimens, containers should be enclosed in individual plastic sacks tied at the neck. The request form should be placed in a plastic envelope which is then securely tied to the neck of the sack.

“Danger of Infection” specimens should always be sent in an adequate volume of buffered formalin.

If a specimen is received in Pathology and the specimen and/or request form has been mislabelled, is unlabelled or there are discrepancies between the request form and specimen container, the Laboratory staff will make every attempt to contact the sender to clarify the error, including telephoning the source and contacting requesting clinician etc. identified from any information that has been supplied.

If the Laboratory staff are unable to rectify the problem by telephone, a “Non-conformance letter” will be sent to the requesting clinician.

This letter is accompanied by the request form and identifies the nature of the non-conformance with a request that this is rectified, and the requesting clinician takes responsibility for the changes.

Specimens will not be returned but will be kept in Pathology Specimen Reception labelled with the appropriate non-conformance number, until the non-conformance has been resolved.

The laboratory cannot supply a report on unlabelled specimens or specimens received without request forms. Failure to provide the required information may result in delays in processing specimens and/or in the provision of a pathology report to the appropriate location.

In the event of an urgent specimen being received in diagnostic cytology, where the specimen and/or request form has been mislabelled, the technical staff in the lab will make every attempt to contact the sender and clarify the mislabelling error, including telephoning the source and contacting the requesting clinician etc. identified from any information that has been supplied.

In the event of there being insufficient information to allow cytology to contact the sender, the specimen will be kept refrigerated for one week, in the hope that the lab will be contacted. If no contact has been made at the end of this period, the specimen will be discarded.

NHSGGC Pathology User Manual

NHSGGC Pathology Request Form

NHSGGC Placenta Request Form

NHSGGC Muscle Biopsy Request Form

NHSGGC Pathology Specimen Dispatch Note

NHSGGC Transport & Disposal of Specimen Containers & Specimens Policy

NHSGGC Confidentiality and Data Protection Policy

The pathologist named first in each team, is the designated specialty representative.

We invite all our users to complete our user survey form. Please return via email to the quality manager. The information obtained from this survey will allow us to develop and improve the service we offer. We greatly appreciate the time and effort taken to complete this.

For general complaints/compliments/comments on the service please contact:

Dr Sylvia Wright (Head of Service) 

Tel: 0141 354 9558

Mrs Nicola Small (Compliance Manager)

Tel: 0141 354 9461

Please click here for further information about the NHSGGC Complaints policy

NHSGGC Biochemistry GP Handbook

The Scottish Trace Element and Micronutrient Diagnostic and Research Laboratory (STEMDRL) is in part centrally funded by the National Services Division of NHS Scotland to provide a specialist analytical and advisory service for trace elements and vitamins.