Basingstoke and north hampshire hospital pathology user handbook

HISTOPATHOLOGY

Outline of service

The Histopathology Department offers a routine histology service including immunohistochemistry, Her-2, non-gynaecological cytology and a rapid service for frozen sections. It also liaises with the mortuary service who perform post mortem examinations.

Normal hours of service

Histology - Monday to Friday 0900 to 1715 hrs

Mortuary - Monday to Friday 0800 to 1600 hrs
Samples and labelling

Interpretation of a specimen is highly subjective and dependent upon the information supplied with the specimen. The request card must be completed fully and legibly. The absence of clinical details may prevent the issuing of a meaningful report. Incorrect or inadequate patient details will result in a delay as the specimen will be returned to the sender for verification or alteration. As part of obtaining informed consent for surgery and histology investigations, your patient must be aware that blocks and slides are archived for future review should this be necessary and may contribute to good laboratory practice procedures such as quality control, audit and teaching.

It is an essential requirement for Histopathology investigations that the requesting clinician signs and dates the request card to indicate that informed consent has been given.
Where several specimens are sent from one patient, the specimens must be clearly identified together with the request card. All specimen labelling MUST BE on the container, NOT on the lid.
If there is a danger of infection, e.g. TB, hepatitis, HIV, the specimen and the request card must be clearly labelled.
Routine Histology Specimens

Specimens for routine histology should be placed in at least three times their volume of 10% buffered formalin.

Routine Cytology Specimens

Non-Gynae Cytology specimens including Joint fluids, urines and sputum should be collected in 30-60ml non sterile universal white top containers

All cervical smears (Gynae Cytology) are examined at RHCH Winchester.
Where there is a Danger of Infection (e.g. tuberculosis, hepatitis B, HIV positive), the specimen container and the request card must be so identified. Specimens and request cards will normally be transported in the plastic bags provided, but special care to ensure that this is so will be needed where there is Danger of Infection. Please discuss such cases with the Consultant Pathologist before such specimens are sent - a risk assessment will need to be made before the work is carried out.
Pleural, ascitic fluid and cyst aspirates:-

A small amount (20 to 30 mL of the fluid) should be sent to the laboratory as quickly as possible. Please do not send the whole drain bag to the laboratory. Where delay is likely, e.g. over the week-end, store in a 4^o C refrigerator.

FNA sample requirements:-
Slides – Slides MUST be labelled with TWO points of patient identification as a minimum (Full name and NHS/Hospital number or DOB). This should be written on the slide in pencil prior to applying fixative.
Aspirates – 30/60ml non-sterile universal container with patient information written in pen as above.
Training in FNA slide preparation is available by contacting the Histopathology Department manager on ext 3280.
Urgent Specimens

Urgent specimens should be clearly marked as URGENT and delivered to the laboratory as soon as possible. For small specimens a report will normally be issued the next working day.

The sample must arrive in the laboratory by 5pm at the latest for next day results.

Same-day reporting may be possible on small biopsies provided this is discussed with the Consultant Pathologist prior to sending the specimen and the specimen is received in the laboratory before 1100 hrs.

Frozen Sections

Specimens for frozen sections must be placed into a suitable container without formalin or any other preservative or liquid.

Frozen sections must be booked at least 24 hours in advance to ensure a Consultant Histopathologist is available. The nature of the clinical problem should be discussed with the Pathologist at the time of booking to ensure optimum interpretation. The case should be first on the operating list and the laboratory MUST be informed if the frozen section is cancelled.
Where possible, unplanned frozen sections will be accommodated, but the laboratory must be telephoned prior to sending the specimen. The Consultant Histopathologist may wish to discuss the nature of the problem briefly with the surgeon/anaesthetist concerned at this time.
The specimen MUST be handed to a member of staff within the Histology Laboratory. It must not be left at Pathology Reception or elsewhere within the laboratory. Please write the extension number to which the report is to be phoned clearly on the request card.
Where there is a danger of infection, frozen sections will not normally be performed in order to reduce the risk of exposure of laboratory staff to infectious material and to avoid the withdrawal of the frozen section service for 24 hours whilst the cryostat is decontaminated.
Direct Immunofluorescence (Skin Biopsies)
A fixative solution is available from the laboratory for these samples. Once collected they should be sent to the laboratory as soon as possible.
Post Mortems

See 'Mortuary'.

Reports
Reports are available from the Ward Enquiry System. Printed reports, where necessary, are sent out on the same day that the report is available on the computer.
The Consultants preliminary findings may be discussed prior to the issue of the final report if clinically required.
Turnaround times
The departments Turnaround time targets are as follows:

• 
  Diagnostic Biopsies – 90% in 5 days
  
• 
  All other Histology – 90% in 10 days
  
• 
  FNA Cytology – 90% in 5 days
  
• 
  All other Cytology – 90% in 5 days
  

Specimens requiring decalcification will take longer, possibly up to several weeks. Larger or more complex specimens may take longer.
HISTOLOGY routine reference laboratories
HER2, EGFR and KRAS testing are referred to Source Bioscience, 1 Orchard Place, Nottingham Business Park, Nottingham. NG8 6PX. TAT 14 DAYS
Lymphoma referrals are sent to Cellular Pathology, Level E, Southampton General Hospital, Tremona Road, Southampton. SO16 6YD. TAT 28 DAYS

MORTUARY

Deaths in hospital

You will normally be asked to certify death promptly, whether by day or night. If relatives are present you should see them with the nurse in charge who will support you and will then know what has been said. The body is then laid out, with hands placed by the patients’ sides, eyes and mouth closed where possible and all drains, catheters lines and cannulas left in situ. The Notification of Death form is then filled out with the blue copy attached to the patients shroud and the green to the sheet they are wrapped in. A wristband with the patients details must be placed on both the wrist and the ankle. Where there is a danger of infection (Hepatitis B, HIV, Tuberculosis etc.) the body is placed in a leak-proof body-bag, and marked with a 'Danger of Infection' label attached to the outside of the body-bag. For a list of infections that require body-bags please see the trust infection control policies. Please note that both MRSA and C. Difficile Patients DO NOT require body-bags. For reasons of confidentiality the nature of the infection is not stated. On receipt of the patient in the Mortuary, the Pathology Technicians will contact the ward to ascertain the nature of the infection, this is necessary as Exposure Prone Procedures may need to be undertaken. The precise nature of the infection is not passed to the Funeral Director; however they are informed a danger of infection is present and that embalming should not be carried out.

Having recorded the fact of death you must decide whether you can accept "jurisdiction" over the death and can complete a Death Certificate. This means that you have treated the patient within the last fourteen days, that death has not been from an industrial cause, from an accident or overdose or is unexpected as from unknown causes or has occurred during an operation or before recovery from an anaesthetic. Such deaths must be referred to the Coroner. See Deaths to be reported to the Coroner (p45).
Death Certificates

Please deal with death certificates before you start on other work in the morning. It is the policy of the Hospital that when relatives arrive following a death, all personal items, together with the Death Certificate are ready and waiting. Relatives will normally be seen by the Patients & Relative Support Manager, extension 4777, bleep 1100. Relatives must not be asked to return later to collect the death certificate.

Death Certificates for infants dying within 28 days of birth are to be issued from the book entitled "Medical Certificate of the Cause of Death of Live born Children Dying within the First 28 days of Life".
Cremation Papers
The Patient & Relative Support Managers also handle cremation papers. Please complete promptly and do not leave them in the Information Room. It should be remembered that the forms have to be at the Crematorium 24 hours before the actual cremation takes place. For a Cremation paper to be completed, two parts must be filled out by two different Doctors. The first doctor will need to be one who treated the patient during their last illness. This will usually, but not always, be the doctor completing the death certificate. The second doctor must be on a different team to the first and have at least five years registration with the GMC. Both Doctors will need to have performed an external examination of the patient after death. This usually takes place within the Mortuary but can be undertaken on the ward. To make an external examination in the Mortuary, the department must be contacted on ext.4749 to arrange a suitable time.
Pacemakers

Should a pacemaker be fitted, this must be removed before cremation. This will be done at the Funeral Directors. If you are completing a Cremation Paper it must be indicated that a Pacemaker is in situ but that it has not been removed. Please ask The Patients & Relative Support Manager (ext 4777, bleep 1100) or the Mortuary (ext.4749) for further advice if necessary.