Submitting a Specimen

OC Lab
Submitting a Specimen.

Criteria for Acceptability Acceptable Specimen Types Delivery Information Specimen Flow Chart The Referral Form

Specimen must be sterile
Contamination may be suspected if container is cracked or leaking. If gross contamination is evident, notify physician and inquire about the possibility of obtaining a repeat specimen. Peripheral blood may be submitted as an alternative specimen if blood contains approximately blasts 30%. If a repeat specimen is not available, attempt to obtain results from original specimen. Immediately discard contaminated specimens using proper disposal techniques. Notify physician of culture contamination.

Proper anticoagulant must be used.
Sodium heparin is the anticoagulant of choice. Sodium citrate may also be used. EDTA and lithium heparin have been shown to impair culture growth. If either of these two anticoagulants are used, notify physician that culturing will be attempted, but growth failure is possible. A repeat bone marrow specimen (or peripheral blood if blasts are present) may be indicated.

Specimen should be free from clots.
Clotting reduces the number of WBC's available for culture inoculation. If specimen is clotted, perform WBC count immediately. If there are sufficient cells for culture inoculation, proceed with culture set up as usual. If there are insufficient cells for culture inoculation, disperse clot mechanically. Place entire specimen (including clots) in one culture. A repeat bone marrow specimen (or peripheral blood if blasts are present) may be indicated.

Completed referral form must accompany all specimens.
Call physician's office to obtain missing information before accessioning specimen. Oral test requests are discouraged; however in the event of such a request, a written test request must follow within 24 hours of specimen receipt.

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Acceptable Specimen Types

The following specimen types can be used for cytogenetic analysis. The procedures for each are listed beside the type.

Bone Marrow Bone Marrow is the specimen of choice for most hematologic malignancies. Collect bone marrow according to the following procedure:

Aspirate 0.5 ml of preservative-free sodium heparin, 100 units/ml, into a sterile syringe. Rinse walls of syringe and expel all but 0.1 ml heparin.
Aspirate 2 ml bone marrow into heparinized syringe. Invert syringe to mix bone marrow with heparin.
Immediately transfer marrow to a sterile 3 ml green top (pediatric size) vacutainer tube containing sodium heparin (BD#6387 with 45 units of sodium heparin). Invert tube to mix well.
Deliver or ship heparinized marrow at room temperature to Room FG03, Emory University Hospital, as sson as possible.

Peripheral Blood Peripheral blood may be used for oncology cytogenetic analysis when bone marrow aspiration is not possible and if peripheral blood contains a minimum of 30% blasts. The laboratory will accept a peripheral blood specimen if fewer blasts are present but results may not be obtained.
Collect 5 mL of blood by venipuncture in a sterile 7 mL green top vacutainer tube containing sodium heparin (BD# 6483 with 100 units sodium heparin).
NOTE: Do not use the green/gray top tubes which contain separating gel and lithium heparin. (Lithium heparin is toxic to cells and may inhibit culture growth.)

Bone Core Biopsy Pre-arrange for delivery of sterile media tube to physician performing tap. Collect 1 to 3 separate bone core biopsies, each 2 to 3 cm long. For multiple samples, the biopsy cannula can be redirected within the same cortical site without complete withdrawl. Immediately place specimen(s) in sterile media tube.

Lymph Node Pre-arrange for delivery of sterile media tube to physician or pathologist. Obtain and 1 cm of tissue if possible. Immediately place specimen in sterile media tube. Sterile, normal saline solution (without preservatives) may be used in place of media, if necessary. If the specimen cannot be immediately delivery to the Oncology Cytogenetics Laboratory, DO NOT refrigerate it. Keep the specimen at room temperature and make arrangements for delivery.

Solid Tumor Pre-arrange for delivery of sterile media tube to physician or pathologist. Obtain and 1 cm of tissue if possible. Immediately place specimen in sterile media tube. Sterile, normal saline solution (without preservatives) may be used in place of media, if necessary. If the specimen cannot be immediately delivered to the Oncology Cytogenetics Laboratory, DO NOT refrigerate it. Keep the specimen at room temperature and make arrangements for delivery.

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Delivery Information

Arrange for immediate delivery of all specimens to Emory Oncology Cytogenetics Laboratory.
Make certain that the following steps are followed:

Specimen container is properly labeled
Specimen container is properly capped and sealed
Outer packaging protects delivery personnel from accidental leakage
Properly completed referral form accompanies specimen
Specimen is maintained at room temperature and protected from extremes of temperature (During the summer months, if ambient temperature is above 80F, a cold pack may be necessary during transport. During the winter months, do NOT allow specimen to freeze. Use proper insulation.)

All specimens should be shipped to:

Oncology Cytogenetics Laboratory
Emory University Hospital
1364 Clifton Rd, NE, Room FG03
Atlanta, Georgia 30322

Delivery Options

For Atlanta area specimens, the submitting institution may wish to use their own courier service.
The Oncology Cytogenetics Laboratory uses Courier Express. Please call us at 404-712-5833 to arrange for pick-up or send us an electronic message.
For out-of-town specimens that need overnight delivery, please call us at 404-712-5833 to arrange for Federal Express delivery or send us an electronic message.

Weekend / Holiday Delivery

If specimens are obtained sterilely and maintained at ROOM TEMPERATURE, they are stable and cell viability will be preserved for 2 to 3 days. DO NOT refrigerate; DO NOT freeze. If the laboratory is closed, please deliver the specimen to:

Specimen Depository - Emory University Hospital
First Floor - Room D140 Telephone (404) 712-4376

Please leave a message on the Oncology Cytogenetics voice mail (404-712-5833) indicating that a specimen has been delivered to Specimen Depository or send us an electronic message. If you require information or would like to speak with one of the members of our staff to personally communicate that a specimen has been delivered to Specimen Depository, please feel free to page us at 404 864-1465. (Enter your call back number and press #).

PLEASE NOTE: While Oncology Cytogenetics is "officially closed" on weekends and holidays, the laboratory is always staffed for a portion of the weekend/holiday. The person covering weekends/holidays will pick up all specimens delivered to Specimen Depository.

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Specimen Flow Chart

Specimen arrives in laboratory
Review intake; obtain missing information
Accession of specimen on computer, assign lab number, enter patient and specimen information in database.
Perform cell count
Determine correct number and incubation time
Inoculate flask with appropriate number of cells
Incubate specimen for appropriate number of days
Harvest specimen
Prepare slides
Stain slides according to analysis required: routine, molecular, heteromorphism, etc.
Microscope analysis
Photograph pertinent metaphases
Prepare preliminary report
Chart review
FAX preliminary report
Develop film
Prepare prints
Prepare karyotypes
Prepare final report
Chart review
Mail final report and Xerox of pertinent karyotypes to physician and other medical personnel as indicated in chart.
Prepare labels for chart
File complete chart
Store slides in slide file

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The Referral Form

Any specimen must be accompanied by a completely filled out Specimen Referral Form. The information requested on this form will enable us to determine which culturing times and techniques to use as well as to ensure proper distribution of clinical findings. This form can be downloaded in the following ways:

Please either include the form with the specimen or fax the completed form to the lab at 404-712-4349. As an alternative, you can also e-mail all of the necessary information to our electronic address.

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Introduction Administration Testing Services Submitting a Specimen Other Lab Links

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Specimen must be sterile	Contamination may be suspected if container is cracked or leaking. If gross contamination is evident, notify physician and inquire about the possibility of obtaining a repeat specimen. Peripheral blood may be submitted as an alternative specimen if blood contains approximately blasts 30%. If a repeat specimen is not available, attempt to obtain results from original specimen. Immediately discard contaminated specimens using proper disposal techniques. Notify physician of culture contamination.
Proper anticoagulant must be used.	Sodium heparin is the anticoagulant of choice. Sodium citrate may also be used. EDTA and lithium heparin have been shown to impair culture growth. If either of these two anticoagulants are used, notify physician that culturing will be attempted, but growth failure is possible. A repeat bone marrow specimen (or peripheral blood if blasts are present) may be indicated.
Specimen should be free from clots.	Clotting reduces the number of WBC's available for culture inoculation. If specimen is clotted, perform WBC count immediately. If there are sufficient cells for culture inoculation, proceed with culture set up as usual. If there are insufficient cells for culture inoculation, disperse clot mechanically. Place entire specimen (including clots) in one culture. A repeat bone marrow specimen (or peripheral blood if blasts are present) may be indicated.
Completed referral form must accompany all specimens.	Call physician's office to obtain missing information before accessioning specimen. Oral test requests are discouraged; however in the event of such a request, a written test request must follow within 24 hours of specimen receipt.

Bone Marrow	Bone Marrow is the specimen of choice for most hematologic malignancies. Collect bone marrow according to the following procedure: Aspirate 0.5 ml of preservative-free sodium heparin, 100 units/ml, into a sterile syringe. Rinse walls of syringe and expel all but 0.1 ml heparin. Aspirate 2 ml bone marrow into heparinized syringe. Invert syringe to mix bone marrow with heparin. Immediately transfer marrow to a sterile 3 ml green top (pediatric size) vacutainer tube containing sodium heparin (BD#6387 with 45 units of sodium heparin). Invert tube to mix well. Deliver or ship heparinized marrow at room temperature to Room FG03, Emory University Hospital, as sson as possible.
Peripheral Blood	Peripheral blood may be used for oncology cytogenetic analysis when bone marrow aspiration is not possible and if peripheral blood contains a minimum of 30% blasts. The laboratory will accept a peripheral blood specimen if fewer blasts are present but results may not be obtained. Collect 5 mL of blood by venipuncture in a sterile 7 mL green top vacutainer tube containing sodium heparin (BD# 6483 with 100 units sodium heparin). NOTE: Do not use the green/gray top tubes which contain separating gel and lithium heparin. (Lithium heparin is toxic to cells and may inhibit culture growth.)
Bone Core Biopsy	Pre-arrange for delivery of sterile media tube to physician performing tap. Collect 1 to 3 separate bone core biopsies, each 2 to 3 cm long. For multiple samples, the biopsy cannula can be redirected within the same cortical site without complete withdrawl. Immediately place specimen(s) in sterile media tube.
Lymph Node	Pre-arrange for delivery of sterile media tube to physician or pathologist. Obtain and 1 cm of tissue if possible. Immediately place specimen in sterile media tube. Sterile, normal saline solution (without preservatives) may be used in place of media, if necessary. If the specimen cannot be immediately delivery to the Oncology Cytogenetics Laboratory, DO NOT refrigerate it. Keep the specimen at room temperature and make arrangements for delivery.
Solid Tumor	Pre-arrange for delivery of sterile media tube to physician or pathologist. Obtain and 1 cm of tissue if possible. Immediately place specimen in sterile media tube. Sterile, normal saline solution (without preservatives) may be used in place of media, if necessary. If the specimen cannot be immediately delivered to the Oncology Cytogenetics Laboratory, DO NOT refrigerate it. Keep the specimen at room temperature and make arrangements for delivery.