Cellular Pathology

Specimen Delivery:

 SJUH: Histology specimens

It is preferable that all Histopathology specimens are delivered directly to specimen reception on level 5 of the Bexley Wing. Specimen reception is located close to ward 98 (follow the corridor around the corner from the entrance to ward 98).

SJUH: Cytology specimens and muscle & nerve biopsies

To be delivered to the pathology common reception area near Chancellor's Wing.

LGI: All Cellular Pathology specimens

Specimens should be delivered to the pathology common reception area in the Old Medical School.

High Risk Specimens:

To comply with national Health and Safety guidance and to alert laboratory staff that a 
specimen may require processing differently, some specimens must be labelled as ‘High Risk' (Danger of Infection).

Clinical judgement must be used to label specimens correctly, and the onus for this is on the requestor.
Specimens from the following require “Danger of Infection” labelling:

• Patients with proven infection with a Hazard Group 3 (HG3) pathogen eg: hepatitis B and C, HIV, tuberculosis and other mycobacteria, typhoid, brucella and anthrax
• Patients suspected of having a HG3 pathogen (information from clinical history and examination e.g. injecting drug user, haemophiliac, vCJD)
• Patients who are a part of an ongoing outbreak caused by a HG3 pathogen.
• Inmates of Her Majesties' Prisons

On no account should specimens be taken from patients suspected of having any pathogen in Hazard Group 4, e.g. viral haemorrhagic fever (Lassa, Marburg, Ebola and Congo-Crimean), or Hendra or Nipah viruses without prior consultation with the on-call medical microbiologist/virologist.

Handling “Danger of Infection” specimens:
“Danger of Infection” labels should have black print on a yellow ground, and should be self adhesive.
A label must be placed on the high-risk specimen container and its request form,
which must give sufficient clinical information to enable the experienced laboratory staff who will receive it to know what special precautions are necessary in the laboratory. The request form may be folded so that the information need not be conspicuous to other people, but the “Danger of Infection” label must be clearly visible.
The specimen container must be placed in an individual transparent plastic bag, which should then be sealed. High Risk specimens must not be transported to the laboratory via the air tube.
Further information is available from LTH Infection Control website: Infection Control Guidelines 

Requests for additional examinations:

Requests for additional examinations must be made as soon as possible, following the laboratory's receipt of the specimen. These requests must be made by telephone to the reporting pathologist. Depending on the nature of the specimen, and the request made, be aware that it may not be possible to accommodate your request although every effort will be made to do so, if clinically relevant.

Clinical advice and interpretation:

Clinical advice and interpretation is available via the multidisciplinary team meetings (MDTs), and from the reporting pathologist. If this pathologist is not available, other pathologists from the same specialty will provide this service.

Uncertainty of Results:

The majority of diagnostic services provided by Cellular Pathology are not numeric and therefore reports cannot be traced back or related to national or international standards of measurement. 
Uncertainty in reporting is minimised by:

• Pathologists / screeners / andrology BMS staff seeking a second opinion.
• Discussion of results at multidisciplinary team meetings.
• Reference to published descriptions of pathology.
• Internal quality control.
•  Participation in relevant external quality assurance (EQA) schemes and / or proficiency testing.
• Dual reporting for some specimen types including HER2 
• Equipment / reagents sourced from reputable suppliers, verified before use, serviced and calibrated as required.

Andrology and Her2  results are numeric, reliant upon the manual counting of specific entities. Uncertainty is minimised as described above.

Uncertainty may arise from many sources including:

• An inappropriate or inadequate specimen being taken.
• Inadequate fixation.
• Delayed transport to the laboratory.
• Inadequate storage of specimens.
• Inadequate training or supervision of staff.
• Malfunctioning equipment.
• Inadequate internal quality control of staining or screening results.
• Unresolved poor performance in EQA schemes.

The Department addresses these issues by:

• Compliance with standard operating procedures.
• Training and competency assessment for staff.
• Resolution of poor performance / non conformities.
• Equipment / reagents sourced from reputable suppliers, serviced and calibrated as required.

Results Server:

Results of LTH tests are available electronically on the LTH results server as soon as they are validated.
The LTH Results Server website address is available to authorised users Results Service