UNIVERSITY HOSPITAL
DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE
LABORATORY HANDBOOK
Version No: 004
Date Issued: August 27, 2013
Date Approved: August 27, 2013
Approved By: Pathology and Laboratory Medicine
Revised By: Michele S. Burday,Ph.D., D(ABMM)
Director of Clinical Laboratories
Replaces: Version No: 003 of Feb 2012
TABLE OF CONTENTS
DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE STAFF
LABORATORY TELEPHONE NUMBERS
2-4
GENERAL INFORMATION
Ordering Laboratory Tests
Collection of Blood Specimens
Biohazard Specimens
Labeling, Packing and Transport of Specimens to Laboratory
Specimen Delivery
Laboratory Reports
Rejection of Request Forms and Specimens
Reference Values
Emergency and STAT Tests
Critical Values
Retesting of Specimens
Phlebotomy
Use of Outside Laboratories
Point of Care Testing
Problems
Blood Bank/Transfusion Medicine Services
Clinical Microbiology
Molecular Diagnostics
Autopsy Service
Cytopathology
Neuropathology
Surgical Pathology
5
6
7
8
9
10
11
12
28
37
40
43
50
SPECIAL FUNCTION LABORATORIES
Blood Gas Laboratory
52
GENERAL TEST LIST
Body Fluids
Test Requirements & Reference Ranges – Blood, Serum, Plasma
53
2013 Laboratory Handbook Final 56
Page 1
UNIVERSITY HOSPITAL
DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE
PROFESSIONAL, ADMINISTRATIVE AND SUPERVISORY STAFF
Extension
INTERIM CHAIR, DEPARTMENT OF PATHOLOGY &
LABORATORY MEDICINE:
Seena Aisner, M.D.
4520
CHAIR FOR DIAGNOSTIC SERVICES, DEPARTMENT OF
PATHOLOGY & LABORATORY MEDICINE:
Seena Aisner, M.D.
5726
VICE CHAIR FOR EDUCATION:
Nicholas Ponzio, Ph.D.
5238
DEPARTMENTAL ADMINISTRATION:
Jeong-Sook Yoo
4451
ANATOMIC PATHOLOGY:
Stephen Peters, M.D., (Interim) Director of Surgical Pathology
Debra Heller, M.D., (Interim) Vice Chair, Department of
Pathology and Laboratory Medicine
5714
5715
CLINICAL PATHOLOGY / LABORATORY MEDICINE:
Michele Burday, Ph.D., D(ABMM), Director, Clinical Pathology
Patricia Adem, M.D., Assistant Director, Clinical Pathology
0604
4086
MOLECULAR AND BIOPHYSICAL PATHOLOGY:
Helen Fernandes, Ph.D., Director, Molec. & Biophys. Pathology
Ada Baisre, M.D., Medical Director, Molec. & Biophys. Pathology
6555
2624
DIVISION DIRECTORS:
Patricia Adem, M.D., Director, Immunology & Serology
Michele Burday, Ph.D., Director Clinical Microbiology
Helen Fernandes, Ph.D., Director, Molecular Diagnostics
Anthony E. Grygotis, M.D., Director, Chemistry and Informatics
Debra Heller, M.D., OB/GYN Pathology & Pediatric Pathology
Ranie Koshy, M.D., Director, Blood Bank/Transfusion Service
Qing Wang, M.D., Director, Hematology
Neena Mirani, M.D., Director, Cytopathology, ENT and Ocular
Pathology & Immunohistochemistry;
Vice-Chair for Clinical Coordination
Leroy R. Sharer, M.D., Director, Neuropathology
2013 Laboratory Handbook Final 4086
0604
3339
4092
0751
5231
4619
5715
4770
Page 2
ATTENDINGS:
Ada Bairse, M.D., Attending, Neuropathology
Valerie Fitzhugh, M.D., Attending, Surgical Pathology
Kenneth M. Klein, M.D., Attending, Surgical Pathology
W. Clark Lambert, M.D., Ph.D., Attending, Autopsy Pathology
& Dermatology
Neena Mirani, M.D. Attending, Surgical Pathology & Cytology
Mark Galan, M.D. Assitant Professor, Surgical Pathology
4145
5712
4716
4405
5715
0182
LABORATORY ADMINISTRATION:
Jonathan Bodnar, Administrative Director
Vacant, Assistant Administrative Director
Vacant, Manager of Clinical Sections
Flora Johnson, Office Manager
Juliette Collins, Office Manager (Anatomic Pathology)
Nana Achampong, Senior Revenue Cycle Analyst
3350
4088
6243/6676
3198
5713
6509
LABORATORY INFORMATION SYSTEM:
Vacant,
LIS System Manager
5954
CHIEF TECHNOLOGISTS:
Rabindra Sharma, MLS (ASCP)CM SBBCM, Interim Blood Bank
Chief Tech
Ahmed Kheir, MT(ASCP), Chief Tech Shift
Silvia Trainor, MHS, MT-H(ASCP), Hematology
Rama Sood, M.S., M(ASCP), Microbiology
Catherine Susan Delia, B.S., HT (ASCP) Histology,
Immunohistochemistry and Autopsy Services
6061
4081
4090
3453
5717
TRANSFUSION MEDICINE SAFETY OFFICER:
Rabindra Sharma, MLS (ASCP)CM SBBCM
6061
SUPERVISORS:
Lorraine Karst, Accession and Phlebotomy
Pamela Vercillo, B.S. MT (ASCP) Night and Weekend Shift
Seyed Hashemi Sohi, B.S. MT(ASCP) Shift Supervisor
Anjali Seth, Ph.D. CLSp (MB) Molecular Diagnostics
Timothy Momah, Shift Supervisor
Kent Ahmad, Shift Supervisor
Polina Klozner, B.S., CT(ASCP), Cytology
6045, 4081
4080
4080
3339/6885
4080
4080
5716
SECTION HEADS:
Bhavana Patel, B.S. MT(ASCP) Hematology
Asha Dave, B.S, MT(ASCP), Chemistry
Juliana Eng, B.S. MT(ASCP), Chemistry
Darshini Shah, B.S., M(ASCP), Microbiology
Raksha Naik, B.S., MT(ASCP), Serology & Immunovirology
9172/4096
6676/4130
6676/4130
3452/3124
6242/4087
2013 Laboratory Handbook Final Page 3
COORDINATOR POINT OF CARE TESTING:
Octavio Balza, MT (ASCP)
4078
LABORATORY TELEPHONE NUMBERS
ANATOMIC PATHOLOGY
Autopsy Reports
Cytopathology
Neuropathology
Surgical Pathology Reports
5709
5713
7167
5708, 5709
UH – E 156
UH – E 149
UH – MSB 525
UH – E 156
LABORATORY MEDICINE
Accession Area
Blood Bank
Chemistry
Flow Cytometry
Hematology
Immunovirology
Microbiology
Molecular Diagnostics
4079, 4080, 4081, 4082
4093, 4094
6676, 6175, 4130
0293
4096, 8814
4087
3455
3339, 6544
UH – C 118
UH - C 109
UH – C 119
UH – C110
UH – C 117
UH – C461
UH – B 111
UH – C 112
MSB – C 553
UH – C 461
UH - C 117
UH – E 118 – B
Serology
Urinalysis
Blood Gas Lab
2013 Laboratory Handbook Final 4087
4096, 8814
5753
Page 4
GENERAL INFORMATION
I.
SERVICES AVAILABLE
The Department of Pathology & Laboratory Medicine provides services in Anatomic and
Clinical Pathology. Pathologists are available for consultation and may be reached at any time
through a posted and distributed on-call Schedule.
II.
ORDERING LABORATORY TESTS
1. ELECTRONIC CLINICAL ORDER ENTRY
a. The majority of laboratory testing is available, and orderable, through the Epic Hospital
Information System (HIS), by utilizing Clinical Order Practice Management (CPOM).
b. For miscellaneous tests ordered using CPOM, through Epic, the test should be ordered as
MSO (Miscellaneous Send-Out) and a comment should be added stating the test
requested.
2. ELECTRONIC ORDER ENTRY ADD-ON REQUESTS
a. Before placing the order call the laboratory accession area to determine if there is a
specimen available in the laboratory on which the test can be performed.
b. If there is an available specimen the test order should be placed as for any other
electronic laboratory order, with the one exception that the test order should be placed
with the “frequency” of “ADD-ON”.
c. For orders placed as ADD-ON, the requisition will print in the laboratory. The
laboratory staff will review the order and verify that there is an adequate sample
available onto which to add the test.
d. If the re is adequate specimen for testing the original ADD-ON request will be cancelled
and the requested test will be added on to the accession number of the existing specimen
in the lab.
e. If there is not an adequate sample, the ADD-ON order will be cancelled and the
ordering location will be notified to re-order the requested test as per the usual process.
3. MANUAL REQUISITION ORDERS
a. For any area not utilizing CPOM, a manual laboratory requisition must be completed
and submitted to the Laboratory’s Accessioning department.
b. Press firmly with a ball point pen so that all copies of multiple part requisitions are
legible.
c. Make sure all entries are fully legible.
d. Use the proper requisition form in ordering each laboratory test.
e. The miscellaneous form should be used only for those uncommonly performed tests not
named on other forms.
f. All requisitions must be completely and accurately filled out.
The following information must be present:
 patient name (properly spelled)
 hospital number
 ordering location (using approved hospital codes).
 date and time specimen was obtained
2013 Laboratory Handbook Final Page 5
g. On all outpatient requests include the following:
 ICD – 9 code for all tests ordered
 physician’s hospital number
 ordering physician telephone number
h. Surgical and Cytology Specimens
Must be accompanied by the manual requisition.
The Epic Claim Check/Order Document will not be accepted in place of the manual
requisition
The specimen will not be processed until all paperwork/requests are supplied.
4. VERBAL ADD ON ORDERS
a. Verbal Add On orders will only be accepted when accompanied by a faxed or paper
requisition form
b. Make sure there is an order in the chart to document the request.
c. Send the requisition to C118, or FAX to 973-972-4083.
d. Please call the laboratory to make sure the sample is sufficient to run the additional test.
III.
COLLECTION OF BLOOD SPECIMENS
Depending on a patient’s location, patient’s clinical situation or specimen type (blood versus
non-blood specimen types), tests are designated by the electronic order entry system as either
laboratory or unit collections.
1. Unit Collect Orders
a. It is the responsibility of the nurse, or PCT to collect all specimens designated as “Unit
Collect”.
b. Once a “Unit Collect” specimen has been collected, the nurse/PCT must log on to Epic
and mark all samples as collected utilizing the “Collect” function.
NOTE: “Unit Collect” orders will not appear as orders in the Laboratory Information
System (LIS) unless the “Collect” step has been completed.
c. All tests ordered with a STAT collection priority will default to “Unit Collect”. Once
collected the floor should contact Logistics for transport of the specimen to the
laboratory.
NOTE: STAT specimens are not to be collected or transported by the Phlebotomy Team.
d. All orders qualifying for collection between 12am and 4am will default to “Unit Collect”
2.. Lab Collect Orders
a. It is the responsibility of the laboratory Phlebotomy Team to collect all specimens
designated as “Lab Collect”.
b. The Phlebotomy team makes routine rounds throughout the day according to the
following schedule:
4:00 AM
9:00 AM
12 noon
2:00 PM
5:00 PM
9:30 PM
2013 Laboratory Handbook Final Page 6
IV.
BIOHAZARD SPECIMENS – Universal Precautions
All specimens are treated as potential biohazards.
NOTE: Any specimens which contain blood, urine or other body fluid on the outside of the
container will be rejected. Request slips similarly contaminated will also be rejected.
V.
LABELING, PACKING AND TRANSPORT OF SPECIMENS TO PATHOLOGY
1. Each patient specimen must be labeled with the following:
 patient’s name
 date of birth
 hospital number
 specimen type if other than blood or serum
2. Each specimen (or group of specimens from one patient) must be placed securely in its own
“zip lock” biohazard plastic bag for transport.
FOR MICROBIOLOGY there should only one specimen per bag.
3. Place requisition in the pocket of the bag, NOT in the bag with the specimen.
4. Bags must be closed prior to transport to the laboratory.
5. All requisitions must be time stamped into the laboratory upon delivery to the laboratory
utilizing the time clock found in the accessioning area.
VI.
SPECIMEN DELIVERY
1. Chemistry, Hematology, Clinical Microscopy (Urinalysis, other fluids), Microbiology,
Toxicology, Molecular Diagnostics and Serology tests should all be delivered to the
Accession Area (C-118)
2. Specimens for the Blood Bank must be taken directly to the Blood Bank (C-109).
3. Blood bank specimen delivered through pneumatic tube must be taken to the blood bank
immediately.
4. Surgical specimens and Cytology specimens must be taken directly to the E level, E-161 and
E-149, respectively
5. For specimens types or tests which may have special instructions which differ from any of
the previous instructions the specific test instructions should be followed
VII.
LABORATORY REPORTS
1. Laboratory results are available in EPIC and Logician as soon as the test has been completed
by the technologist.
2. Reference laboratory reports which are not available in EPIC or Logician will be available
in Sovera..
3. Test results may not (or will not) be available when the following obstacles are
encountered:
a. The specimen is not obtained.
b. The specimen is not sent to the laboratory.
c. The specimen submitted is unsuitable.
d. The patient’s name, medical record, financial number, or location is not provided to the
laboratory or is not correct.
2013 Laboratory Handbook Final Page 7
VIII. REJECTION OF REQUEST FORMS AND SPECIMENS
Request forms and specimens may be rejected by the laboratory resulting in the requested test(s)
not being performed. Rejection may occur for any of the following reasons:
1. Patient I.D. on the specimen does not agree with patient I.D. on the request slip.
2. Patient’s I.D. is not legible, is incomplete, or incorrect.
3. For outpatients, the doctor’s identification number is missing.
4. No diagnosis or ICD 9 code is indicated for outpatients.
5. Wrong request form is used.
6. Date or time is missing or incorrect.
7. Specimen is delayed in transport to lab.
8. Test requested is not legible.
9. Specimen is damaged, deteriorated or otherwise unsuitable for the test requested.
10. Specimen is incorrect for the test requested.
11. Specimen amount insufficient for the test (QNS).
12. Specimen is unlabeled or incompletely identified.
13. Request form or specimen is otherwise inappropriate.
14. For Blood Bank specimens - More than one label is applied to a specimen tube submitted
for crossmatch (ONLY THE TYPENEX LABEL MAY BE APPLIED TO THIS TYPE OF
SAMPLE TUBE).
15. The person drawing a specimen for crossmatch has not signed and dated the sample tube
label.
16. There is no verifier signature on requisition slip for type and crossmatch specimen.
IX.
REFERENCE VALUES
Current reference values are available on EPIC, Sovera and Logician
2013 Laboratory Handbook Final Page 8
X.
AVAILABLE EMERGENCY TESTS
Results of most emergency tests are normally available within one hour or less of receipt of the
specimen.
THE AVAILABLE STAT TESTS
BLOOD BANK
1. ABO group and Rh type
2. Antibody screening and identification
3. Crossmatch
4. Direct Coombs test
5. Issuance of blood and components
6. Transfusion reaction work-up
CHEMISTRY
1. Acetaminophen
2. Acetone, serum
3. Albumin
4. Alcohol
5. Amylase, serum, urine, and body fluids
6. Bilirubin, total and direct (babies)
7. Calcium
8. CO2 content
9. Chloride
10. Creatinine
11. Glucose
12. Lactic acid
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
HEMATOLOGY and COAGULATION
1. CBC
2. Sickledex
3. Platelet count
4. Reticulocyte count (Pediatrics only)
5. Fibrinogen
6.
7.
8.
9.
Magnesium
Osmolality, urine and serum
Parathyroid hormone (PTH), intact
Phenobarbital
Phenytoin (Dilantin)
Phosphorus
Potassium, urine and serum
Salicylates
Sodium, urine and serum
Total protein
Urea nitrogen
aPTT
Prothrombin time / INR
D-dimer
Thrombin time
SPINAL AND BODY FLUIDS
1. Cell count and differential
2. Glucose
3. Lactic acid
4. Total protein
5. Cell count on DPL (diagnostic peritoneal lavage fluid)
OTHER
1. HIV
2. Urinalysis
3. Pregnancy test – qualitative, urine or blood
4. CSF Gram Stain
2013 Laboratory Handbook Final Page 9
XI.
CRITICAL VALUES
It is the policy of the laboratory to telephone to the patient care units certain laboratory test
results that are considered to be life-threatening. These critical values will be communicated to
the patients’ care provider (i.e. Doctor, nurse, etc.) within 15 minutes of confirmation of the
critical result. To verify the accuracy of the verbally communicated report the care provider
receiving the report will be requested to identify themselves and to read back the report
including the following information: the patient name, medical record number and result
Critical Laboratory Values for University Hospital are:
CHEMISTRY
Acetone
Alcohol
Bilirubin (newborns)
Calcium
Digoxin
Glucose
Glucose (newborns)
Lithium
Phenobarbital
Potassium
Potassium (newborns)
Salicylates
Sodium
LOW
---<6.0 mg/dL
-<40 mg/dL
<30 mg/dLl
--<2.5 meq/L
<2.5 meq/L
-<120 meq/L
HEMATOLOGY and COAGULATION
LOW
Hematocrit
<15%
Hemoglobin (blood)
<5 gm/dL
WBC count
≤2000/L
Platelets
≤20,000/L
INR
-aPTT
-Fibrinogen
≤100 mg/dL
HIGH
Positive
>350 mg/dL
≥12.0 mg/dL
>13.5 mg/dL
≥2.6 ng/mL
>600 mg/dL
>300 mg/dL
>2.0 meq/L
>60 mg/mL
>5.8 meq/L
>7.0 meq/L
>70 mg/dL
>160 meq/L
HIGH
>65%
-≥50,000/L
≥1,000,000/μL
>5.0
>70 sec.
OTHER
Blood smear positive for Parasites
Positive blood cultures
Positive CSF gram stain
Positive CSF culture
Positive Transfusion Reaction Work-up
Urines positive for ketone bodies in newborns
Urines positive for glucose in newborns
Urines positive for Reducing Substance (patients ≤2 years)
2013 Laboratory Handbook Final Page 10
XII.
RETESTING OF SPECIMENS
1. General
a. If a test result is questioned, the physician may contact the section Supervisor or a
Laboratory Medicine physician and request a repeat test on the same specimen.
b. The ability of the laboratory to comply with this request will depend on:
 the stability of the particular analyte
 availability of the original specimen
 if there is sufficient quantity of the original specimen to repeat the testing
2. Length of time specimens are saved
a. Chemistry specimens are saved for seven days.
b. Hematology specimens are saved for two days
c. Serology specimens are saved for four days
d. Molecular Diagnostics are saved for 2 weeks.
XIII.
PHLEBOTOMY
See the online laboratory handbook for proper procedure for venipuncture.
XIV.
USE OF OUTSIDE LABORATORIES
1. Specimens received by the laboratory for tests not performed in-house are sent by the
laboratory to referral laboratories under contract to us.
2. Tests sent to outside laboratories may need approval by a pathologist.
NOTE: submission of a specimen directly to a referral laboratory by any party other than the
U.H. Laboratory is not authorized. The cost of any test performed through such a channel will
be paid for by the sender.
XV.
POINT-OF-CARE TESTING
Prior authorization by the Department of Pathology and Laboratory Medicine must be
obtained before point-of-care testing of any type is performed at any site in University
Hospital. No point-of-care testing may be done without this authorization.
XVI.
PROBLEMS
1. Should a problem arise, a supervisor is on duty in the laboratory at all times and
pathologists are on call in both Anatomical and Clinical Pathology.
2. If it becomes apparent that the turnaround time (TAT) for testing will be exceeded by an
interval greater then three times the TAT benchmark, the ordering physician will be
notified.
2013 Laboratory Handbook Final Page 11
BLOOD BANK
ROOM C109
EXT. 4093, 4094, 4095, 6061
1. REQUEST FOR TYPE & CROSSMATCH OR TYPE-AND-SCREEN
o Complete the Blood Component Order form (UH-1230). Staff completing the order form should
confirm the Physician order in the patient chart for the test ordered and the type and components
requested. Specify the number of units of blood component or red cells being requested for
transfusion and the indication.
o Prepare the transfusion request form using the patient’s addressograph plate or Bar coded label
in the Emergency room. Ensure all information is legible. In an emergency, when the plate or
bar coded label is not available, the information may be handwritten [Print]. The patient’s full
name, (last name. first name, middle initial) medical record number, date of birth, location,
name of ordering Physician, Diagnosis, History of previous transfusion and or history of
pregnancy, if applicable, must be included. Include if patient is in the BLOODLESS program.
o Check the patient’s name and medical record number on the Blood Component Order form
against the hospital-issued wristband. If the patient is lucid, ask the patient his/her name.
o When requesting type-and-screen for potential red cell transfusion, requests require transfusion
bands (TYPENEX bands). TYPENEX bands used by the Trauma Unit are yellow; all other
TYPENEX bands are red. (Green TYPENEX for disaster).
2. TO DRAW BLOOD SAMPLE FOR THE BLOOD BANK:





At the patient bedside, the phlebotomist must complete the information required on the
TYPENEX band before proceeding to draw the blood sample. Information must be legible.
PRINT the patient’s name (last name, first name, middle if used), medical record number, and
date of draw in the blank space on the TYPENEX band. Sign or initial the blank space for
signature.
Peel the completed ID label from the typenex band and attach it to the pink top tube for sample
collection. DO NOT write on the blank label on the tube
Peel a TYPENEX number from the band and apply it to the component request form
With the sample tube still attached, snap the TYPENEX band securely around the patient’s
wrist. Cut the free end of the TYPENEX band and attach to the sample tube.
Verification of Patient identification by a second person takes place at this
time at the patient side. Second person must check all information on TYPENEX banded
tube, TYPENEX band and wrist band for the patient name, MR # and date of draw. All
information must match. Second person, must sign and date the Blood Component order form
attesting that all information was verified and accurate.
Note: Second person may leave the patient bedside at the initiation of the veni-puncture by the
phlebotomist.
Phlebotomist; Draw 6 ml of blood in the TYPENEX labeled PINK top tube.
 Sign and date the Component order form after checking all information match on the typenex
band, blood sample label and the component request form.
 Place the properly labeled sample and signed blood component order form in a zip lock bag and
deliver it directly to the Blood Bank.
2013 Laboratory Handbook Final Page 12







All requisitions must be clocked in at the time of arrival in the blood bank by the person
responsible for delivery
Do NOT label the tubes after you leave the patient’s bedside.
Specimen tubes will be rejected if:
 the label is incomplete, inaccurate, illegible or missing on the tube
 double labeled,
 there is write-over,
 Incorrect medical record #
 first and last names are reversed or misspelled, middle initial is missing when applicable
For major elective procedures for which more than six (6) units of red cells or irradiated blood
products are requested and/or if red cell antibodies are present, the request and sample must be
sent to the Blood Bank at least one full day in advance of surgery.
Blood samples used for cross-match is good for 72 hours. Requests for additional transfusions
beyond the 72 hours must be accompanied by a fresh specimen. Use a new TYPENEX
wristband each time a fresh specimen is submitted. The old band must be removed when a new
one is attached to the patient.
The sample and requests for Type-and-Screen will be held 72 hours. In the event blood is
needed, call the Blood Bank. Blood will be available within 10 minutes provided the sample
drawn within the 72 hours was typed and screened. [Exception; Patients with red cell antibodies
or for special blood types that are not in inventory]
NOTE: TYPENEX band is not required for routine blood typing or anti body screening as done
in an out patient setting. Patient’s name, medical record number, date and location must be on
the label (addressograph label may be used) and Routine Blood Studies form #6 (UH 0102).
Label on blood sample and request form must carry the date and signature of the person
drawing the sample.
If patient does not have a prior record at the UH blood bank, the blood bank will request a
second sample to confirm the blood type. A labeled pink top tube will be provided by the blood
bank for the second sample draw. If the initial TYPENEX banded specimen is hemolyzed,
clotted or unacceptable for any reason, the blood bank will request a second TYPENEX banded
specimen.
Pre Admission Testing (PAT):
 Blood sample may be drawn at the time of the PAT testing. Request Type and screen.
Indicate the date of surgery.
 If blood is needed for surgery (see Maximum surgical blood order schedule MSBOS)
request cross match and number of units required and indicate date of surgery. Follow
the MSBOS for the indicated number of RBC units
 If sample submitted is more than 72 hours before surgery and the patient does not have
any red cell antibodies, the patient should be admitted 2 hours before surgery and a pink
top 6 ml blood sample must be sent to the Blood Bank ASAP. Follow TYPENEX
wristband procedure.
 Patients who have antibodies (surgeon will be notified) and those with a history of blood
transfusion or pregnancy in the past three months must have a blood specimen drawn 4872 hours before the scheduled surgery. For blood samples drawn less than 72 hours
before surgery, follow TYPENEX and wrist band procedure. No additional sample is
required at the time of surgery.
2013 Laboratory Handbook Final Page 13
REQUEST FOR EMERGENCY BLOOD TRANSFUSION
 Send a properly labeled blood sample and a request form indicating the number of
units needed. Mark the request “STAT”. Notify the Blood Bank by telephone or
intercom in advance that an emergency exists.
 In life-threatening situations, a physician may direct the Blood Bank to immediately release
uncross matched type O red cells or Type specific red cells. The ordering physician must
follow this with an Emergency Transfusion Request Form (which states that he/she directed
such release and that he/she accepts full responsibility for the transfusion).
BLOOD COMPATIBILITY TABLE
PATIENT BLOOD TYPE AND COMPATIBILITY
BLOOD
O
A
B
AB
COMPONENT
*RBC
O
YES
YES
YES
YES
A
NO
YES
NO
YES
B
NO
NO
YES
YES
AB
NO
NO
NO
YES
**PLATELET
O
YES
YES
YES
YES
A
YES
YES
YES
YES
B
YES
YES
YES
YES
AB
YES
YES
YES
YES
***PLASMA
O
YES
NO
NO
NO
A
YES
YES
NO
NO
B
YES
NO
YES
NO
AB
YES
YES
YES
YES
CRYOPRECIPITATE
YES
YES
YES
YES
POOL, O, A, B, or AB
*RH NEGATIVE WOMEN OF CHILD BEARING AGE, CHRONICALLY TRANSFUSED PATIENTS AND IN
THE PRESENCE OF RH ANTIBODIES SHOULD RECEIVE RH NEGATIVE RBC. OTHER RH NEGATIVE
PATIENTS MAY BE SWITCHED TO RH POSITIVE RBC WHEN APPROVED BY THE BLOOD BANK
MEDICAL DIRECTOR OR DESIGNEE WHEN RH NEGATIVE BLOOD IS NOT AVAILABLE.
**IT IS PREFERABLE TO GIVE TYPE SPECIFIC WHEN AVAILABLE.
*** IN MASSIVE BLEEDING AND IN THE ABSENCE OF IMMEDIATE AVAILABILITY OF TYPE
SPECIFIC PLASMA, A SINGLE UNIT OF PLASMA THAT IS NOT COMPATIBLE MAY BE TRANSFUSED
IN THE FOLLOWING PREFERRED ORDER, TYPE SPECIFIC, AB, A, B, O.
SAMPLE FOR NEONATAL TRANSFUSION
 Send a cord blood sample and the mother’s blood sample for typing and for neonatal
compatibility testing.
 Compatibility testing is done once/hospital stay on infants less than four months old provided
that there are no irregular antibodies present in the mother’s serum.
 A TYPENEX labeled microtainer sample is also required for any neonate requiring Red Blood
Cell Transfusions.
2013 Laboratory Handbook Final Page 14
3. ISSUANCE OF BLOOD & BLOOD PRODUCTS



Individuals picking up blood and components must present a request for pick up (UH-2390)
showing the patient’s full name, medical record number, date, and type and number of
components requested. The identifying information on the pick up form, transfusion record and
blood unit must be checked. If all information matches, the pick-up person must sign a receipt
for the blood (transfusion record UH1230).
Individuals may pick up blood for only one patient at a time. Only one unit will be issued at one
time, with the exception of blood for the operating room, emergency room, dialysis and medical
and surgical ICU.
Blood should not be picked up until the transfusion is to be actually started. Never store blood
in refrigerators on the patient care units.
4. RETURN & STORAGE OF UNUSED BLOOD
 Blood taken from the Blood Bank and not used must be returned within 30 minutes of issue.
Blood issued in portable coolers and not used must be returned within four hours of issue.
 Once an infusion set is connected, the unit of blood cannot be returned.
5. CANCELLATION OF TRANSFUSION REQUEST
 Notify the Blood Bank immediately if transfusion or surgery is canceled so that the blood may
be used for other patients.
 Cross-matched blood will be kept on reserve for 24 hours from the time of intended transfusion.
Blood will then be released for issue to other patients, unless the physician requests that it be
held for a longer time.
6. PROCEDURE FOR ADMINISTRATION OF BLOOD:
Please refer to UH Patient Care Services Policy #601-100-1215 Handling and Administration of
Blood and Blood Components at http://uhpolicies.umdnj.edu/live/





The crossmatch sticker or applicable blood component sticker will be applied to the top or
bottom of the blood or blood component bag and two copies of the Blood Transfusion Record
form rubber banded will accompany blood released from the Blood Bank. Infusion should be
started within thirty (30) minutes after release of blood from the Blood Bank.
Only a physician or an IV certified nurse may start infusion of blood.
Matching Identification – TO BE DONE AT PATIENT’S BEDSIDE by two people.
The identity of the patient receiving the blood and the information on the blood or blood
component must be matched. Two individuals are required to check that all of the information
matches. Both individuals must sign the transfusion record form to document that two
individuals checked for all information and all information of the patient and blood unit matches
before starting the transfusion.
In addition, the patient, if lucid, should be asked his/her name. Ask what is your name, not “
are you Mr. Smith”
2013 Laboratory Handbook Final Page 15
The following items (a through f) must be checked by two individuals (physicians or nurses) prior to
transfusion:
PROCEDURE FOR ADMINISTRATION OF BLOOD
Patient’s Hospital
Typenex
Chart
Wristband Band*
a. Patient’s Full
X
X
X
Name
b. Patient’s
X
X
X
Hospital Number
c. Donor Blood
Unit Number
d. Patient & Donor
X
ABO and Rh
e. Typenex
X
Wristband
Number
f. Acceptable
Expiration Date
* For Red Blood Cell transfusion only






Donor Blood
Unit
X
Transfusion
Record Form
X
X
X
X
X
X
X
X
X
X
X
Do NOT transfuse if any discrepancy is noted. Resolve any discrepancies immediately. Notify
the Blood Bank immediately should any discrepancy be found.
If all information matches and is found acceptable, the two persons doing the pre-transfusion
check will certify by signing the Cross matched Blood Transfusion Record that all required
criteria match before starting the transfusion.
Take and record the baseline vital signs (temperature, BP, pulse, respirations) immediately
before starting the transfusion.
No drugs or solutions may be added to the blood. When a “Y” recipient set is used, the only
solution, which may be infused through the other arm of the set, is normal saline (0.9% sodium
chloride). [Exception: FDA approved solutions such as PLASMA-LYTE 148 Injection and
PLASMA-LYTE A Injection pH 7.4 are compatible with blood and blood component
administration and available for use in the OR for trauma patients].
USE OF FILTERS in Administering Blood and Blood Products
1. For Routine administration of blood components or red cells use a standard 170 filter.
2. All cellular blood products such as red cells and platelets are pre storage leuko-reduced. In
the rare instance if leuko-reduced red blood cells are not available in the Blood Bank inventory,
a leuko-reduction filter to be used at the bedside will be provided.
Indications for the use of leuko-reduced blood: (Indicated for cellular components only)
1. When the patient has a history of multiple nonhemolytic febrile reactions
2. H/O chronic blood transfusions
3. Reduce the risk of alloimmunization. (HLA)
4. CMV negative blood. Pre storage leuko-reduced units are also CMV safe. When CMV
negative blood or cellular components are requested, pre-storage leuko- reduced CMV
safe blood will be provided.
5. Bedside leuko-reduction filter: use one leuko-reduction filter per red cell unit.
 If everything is in order, start the transfusion.
2013 Laboratory Handbook Final Page 16


During the first 15 minutes of blood administration in non-emergent cases the blood should
be given slowly (25 drops/min.). The physician or a designated registered nurse must be in
the immediate vicinity to observe the patient for untoward reactions. Adjust to the desired
rate of flow after the first 15 minutes if no adverse event noted. The time allowed for
transfusion of a unit of blood must not exceed 4 hours. For transfusions, which are to be
given more slowly, the units may be split. Arrange through the Blood Bank. (Units may
also be split for pediatric patients.)
Obtain and record the patient’s vital signs (Blood Pressure, Pulse, Temperature and
Respiratory rate) before starting a transfusion, after 15 minutes from starting a transfusion,
hourly and post transfusion (when the transfusion was completed) and hourly thereafter for 6
hours post transfusion. Document on the transfusion record form.
NOTE:
 Patients should be monitored for Transfusion related acute lung injury (TRALI).
Symptoms of respiratory distress commonly occur within 6 hours post transfusion. It is
self limiting and early diagnosis and respiratory support will reverse the condition.
7. SIGNS AND SYMPTOMS OF AN ADVERSE REACTION
Chills/Rigors
Pruritis/Itching/
Rash
Urticaria
Jaundice
Elevated Temp.
>1° C or >2 F
Decrease in BP
<30mm Hg or shock
Increase in BP
>30mm Hg
Diffuse Hemorrhage
Hematuria
Pain: Abdominal, chest, flank, IV
site, or headache
Dark Urine
Oliguria in <72
hrs.
(<500cc/24hrs.)
Nausea/
Vomiting
Hypoxemia: (PaO2/FiO2 >300
mmHg) or O2 saturation <90% on
room air ( < 6hrs.)
Shortness of breath new or
worsening or increased RR <24hrs.
8. SHOULD AN ADVERSE REACTION OCCUR:
 Stop the transfusion, but keep the needle open with a slow drip of 0.9% saline.
 Notify the patient’s physician and the Blood Bank.
 Repeat the matching identities step given above. Determine that there is no discrepancy.
 Taking care to avoid hemolysis, draw a full pink top tube of blood from the opposite
arm. Samples must be drawn as soon as possible. Label as above.
 Immediately send the tube to the Blood Bank along with a completed Request for
Investigation of Transfusion Reaction form within 30 minutes of an adverse suspected
reaction.
 Send the blood bag and infusion set to the Blood Bank. [Note: For hives, itching or
urticaria, clamp the blood tubing, administer 0.9% saline to keep vein open. Resume
transfusion when patient is asymptomatic following Benadryl administration.] Note: Do
not exceed the 4 hour limit from originally entering the unit.
 A post transfusion urine sample must be obtained to examine for hemoglobinuria.
2013 Laboratory Handbook Final Page 17
9. POST-TRANSFUSION PROCEDURE
 When the transfusion is completed, the Cross matched Blood Transfusion Record should
be completed indicating the date, time and amount of the transfusion, (One RBC unit is
350 mL as validated by the blood bank or as noted by infusion pump and other
component volume as indicated on the bag), whether or not the blood was warmed, and
the type of filter (if leukoreduction filter or microaggregate filter used), vital signs at the
time the transfusion is complete and signed by the RN completing the transfusion.
 One copy (Chart copy) of the completed Transfusion Record form must be charted
on the mounting sheet (UH 1232) and the second copy returned to the Blood Bank
NOTE:
 All suspected adverse events to blood transfusions must be promptly reported to the
blood bank
 All suspected infectious complications suspected due to blood transfusions must be
reported to the blood bank. [viral, bacterial, prion and other diseases]
10. SPECIAL REQUIREMENTS
 Warming Of Blood
Blood may be warmed by using an approved blood warmer. (Baxter, Fenwal)



Autologous and Directed Blood Donations
o NJ State law requires that, when blood transfusion is anticipated during an elective
surgical procedure, the patient must be offered transfusion options such as autologous
and/or directed donation (Blood from patient selected donors)..
o Arrangements must be made through the Blood Bank, preferably four to six weeks prior
to the anticipated date of transfusion
o All blood donations are collected at a blood center accessible to the donor(s). Consult the
Blood Bank for more information
Pre Storage, Leukocyte reduced Cellular Blood Components
o These products are CMV safe
o Indicated in reducing Febrile non hemolytic Transfusion reactions
o Prevent Alloimmunization to white cells such as HLA
o All platelets provided at the UH are single donor platelets that are leukocyte poor and
tested negative for bacterial contamination
Irradiation of cellular Blood Components to prevent graft-vs-host disease (GVHD)
(Acellular components such as fresh frozen plasma or cryoprecipitate have not been
implicated in GVHD).
o Indications;
1. Allogeneic bone marrow or peripheral-blood-progenitor-cell transplantation
recipients or potential recipients.
2. Ablative therapy in preparation for an autologous marrow transplant;
3. Congenital immunodeficiency syndrome;
4. In uteri transfusion or a neonate who has had a previous intrauterine transfusion, a
neonate undergoing exchange transfusion or use of extracorporeal membrane
oxygenation;
5. Premature infant weighing less than 1200 grams;
6. HLA matched platelets.
7. Component to be transfused has been donated by a blood relative of the recipient;
2013 Laboratory Handbook Final Page 18



8. When the recipient has Hodgkin’s disease;
9. Marrow suppression with an absolute lymphocyte count of less than 500/l.
NOTE: Allow 24-48 hours for availability of irradiated products
Massive Transfusion Protocol (MTP);
o SERVICE AVAILABLE to Department of TRAUMA, OBSTETRICS AND
GYNECOLOGY and OPERATING ROOM. Policy and Procedure available at these
locations only
o May be only initiated by UH Attending Staff Physicians Trained in the MTP policy
and procedure.
o Available for acute massive blood loss exceeding 50% of estimated blood volume in
1-3 hours or blood loss at 150ml/minute
Protocol involves rapid replacement of RBC, plasma, platelets and fibrinogen in prepackaged
blood component packs issued from the blood bank at 15 minute intervals to when the MTP is
called off.
o Once initiated, the blood bank will provide RBC, plasma, platelets and
cryoprecipitate in packs at 15 minute intervals to enable transfusions to
approximate a 1:1:1 mix of RBC, plasma and platelets.
Note: Blood Bank must be notified immediately when an MTP is stopped to prevent
blood product wastage.
Massive Transfusion Support
o Differs from MTP in that it is Clinician driven. The blood bank issues the requested
number of components for rapid transfusion. Massive Transfusion Support is
indicated in acute blood loss where rapid transfusion of multiple blood components
may be necessary as evaluated by the UH Attending MD. Example; SICU, Recovery
Room, ICU, Operating room, Obstetrics and Gynecology or other areas where acute
blood loss is encountered.
TRANSFUSION SERVICE PRODUCTS
BLOOD/COMPONENT
Red Blood Cells (RBC)
2013 Laboratory Handbook Final INDICATIONS & DOSE
 Symptomatic anemia
 Large volume blood loss.
(>15% of total blood volume)
One unit RBC raises the Hb
one gram and the Hct 3%
TIME REQUIRED
Non-emergency: If type & screen
done and negative for antibodies available in 10 min.
Pre-operative: Request by noon on
the day before surgery.
Same day surgery: 2 hr. from the
time specimen is received, if
previously tested in PAT.
Emergency: O blood type or type
specific or one hr. 15 min. required
for complete testing and crossmatch compatible unit.
Page 19
BLOOD/COMPONENT
RBC leukoreduced
*RBC irradiated and/or
leukoreduced
*Washed RBC
*Frozen, thawed RBC
Fresh Frozen Plasma
(FFP)
Platelets: available as one
adult dose ( single donor
plateletpheresis, SDP)
(All Plateletpheresis
units are leukoreduced,
and CMV safe)
Platelets
*Plateletpheresis,
irradiated
Cryoprecipitate
One unit has 80 IU of
Factor VIII & 150 mg of
fibrinogen
2013 Laboratory Handbook Final INDICATIONS & DOSE
Repeated febrile, nonhemolytic transfusion
reactions and as CMV safe
when CMV negative blood is
requested.
Irradiated to prevent GVHD.
Immune suppressed bone
marrow transplant recipients.
Potential bone marrow
recipients, family members
who are directed blood donors
to the patient, neonates.
IgA deficiency with anti-IgA
TIME REQUIRED
< 2 hours
Patients with rare antibodies.
Need 24 hr. notice
Massive transfusion, coumadine reversal with bleeding.
Bleeding with PT & APTT at
1½ times reference range.
TTP, delayed Vit. K reversal
(one ml of FFP provides one
unit of coagulation factor
activity in adults).
Thrombocytopenia <10,000
without bleeding, pre surgery
or post-op with bleeding and
platelet count <50,000,
platelet dysfunction
DOSE: one adult therapeutic
dose = one plateletpheresis
unit or up to 6 platelet
concentrates provides
40,000 - 60,000 platelets/adult
dose
To prevent GVHD.
See RBC, irradiated for
indications
Fibrinogen deficiency with
bleeding, factor XIII & vWF
deficiency, hemophilia A.
Source of fibrinogen & labile
clotting factors
30 min for thawing. Call ahead to
cut waiting time for thawing.
Need 24-48 hr. notice; in an
emergency 4-6 hr notice.
Need 24 hr. notice
10-15 min if in Blood Bank stock.
Need 24 hr. notice
Emergency 4-6 hr. notice
15 min for thawing. Call ahead to
cut waiting time for thawing.
Page 20
BLOOD/COMPONENT
Rh immune globulin (IM
injection)
INDICATIONS & DOSE
TIME REQUIRED
Prevent Rh immunization.
5 min .after RHIG work-up is
Submit an Rh immune
complete.
globulin request form.
Arrangements must be made through the Blood Bank, preferably
four to six weeks prior to the anticipated date of transfusion. All
donations are collected at a local blood center. State law requires
that, whenever it is anticipated that blood transfusion may be needed
during an elective surgical procedure, the patient be offered the
options of autologous and directed donations. Autologous donation
is not recommended for patients who are not likely to need
transfusions.
Autologous and
Directed (Designated)
Donation
Products Available through the Blood Bank/Transfusion Service:
*NOTE: The time required for blood products that are not routinely stored in the Blood Bank depends
on product availability and travel time from our suppliers.
Specimen Requirements: All Blood Bank tests require a 6 ml pink top tube
that is properly labeled.
UH GUIDELINES FOR MAXIMUM SURGICAL BLOOD ORDER
SCHEDULE FOR ELECTIVE SURGICAL PROCEDURES [RBC]
Please note that the indicated number of units of red cells will be issued for the procedure listed unless the Blood Bank is
notified by the requesting attending, by phone or on the request form with justification for additional units requested.
[NSR: No specimen required. T&S: Type and Screen. Numbers in Cross match column indicates units cross matched]
Service
Procedure
Cross match
General and Vascular
Surgery
Amputation of limb (A/K OR B/K)
T&S
Aneurysm, abdominal
5
Appendectomy
T&S
Breast: Biopsy
NSR
Mastectomy, simple or modified
NSR
Mastectomy, radical
NSR
TRAM
2
Bypass, vascular: Aorta-iliac or aorta-femoral
5
Femoral-popliteal
3
Carotid endarterectomy
2
Cholecystecomy, with or without CBDE
T&S
2013 Laboratory Handbook Final Page 21
Service
Procedure
Cross match
General and Vascular
Surgery
Colectomy: Subtotal
2
Total or abdominal-perineal (AP)
Colostomy, revision or closure
T&S
Embolectomy
2
Esophagectomy
4
Gastrectomy, subtotal or total, with or without vagotomy
2
Gastroplasty, Mason (Gomez)
T&S
Gastrostomy
T&S
Hemorrhoidectomy
NSR
Hepatectomy
6
Liver Transplant
Neurosurgery
3
10
Hernia repair, all types
T&S
Hodgkins or Lymphoma staging
T&S
Laporatomy, exploratory
T&S
Pancreatectomy, partial or radical
6
Parathyroidectomy
T&S
Parotidectomy
NSR
Pilonidal cyst or sinus resection
NSR
Procedure
Cross match
Renal transplant
2
Shunt (portal hypertension)
6
Skin Graft, split thickness
T&S
Splenectomy
1
Sympathectomy
T&S
Thyroidectomy
T&S
Tracheostomy
T&S
Vagotomy and pyloroplasty
T&S
Varicose vein stripping
T&S
Aneurysm, cranial
2
Anterior cervical diskectomy, with or without fusion
T&S
Carotid endarterectomy
2
Carpal tunnel release
NSR
Cordotomy
T&S
2013 Laboratory Handbook Final Page 22
Service
Procedure
Cross match
Neurosurgery
Crainectomy for synostosis (child)
1
Craniotomy: For AV malformation
2
For STA MCA or PICA bypass
2
For intracranial hematoma
2
For tumor
2
Hypophysectomy
2
Laminectomy, lumbar for disk
T&S
Laminectomy, cervical thoracic or lumbar for decompression
2
Anterior thoracolumbar decompression and/or fusion
4
Laminectomy, cerivcal, thoraic or lumbar, for tumor
4
Lumbar or cervical fusion, posterior
2
Lumbar peritoneal shunt
2
Child
T&S
Meningomyelocele repair
1
Peripheral nerve surgery other than carpal tunnel, tarsal tunnel
and ulnar nerve transposition
Stereotactic brain biopsy
T&S
Syringoperitoneal shunt
2
Child
Otorhinolaryngeology
NSR
1
Tarsal tunnel release
NSR
Ulnar nerve transposition
NSR
Procedure
Crossmatch
Ventriculoarterial shunt
T&S
Ventriculoperitoneal shunt
T&S
Acoustic tumor resection
2
Angiofibroma, resection
2
Brachial cleft cyst, resection
T&S
Caldwell-Luc procedure
NSR
Carotid body tumor resection
4
Cleft palate repair
NSR
Ethmoidectomy
2
Glomus jugular tumor excision
4
Laryngectomy: Simple
2
With radical neck
2013 Laboratory Handbook Final 3
Page 23
Service
Procedure
Cross match
Otorhinolaryngeology
Mandibulectomy, hemi or total
2
Mastoidectomy, partial or total
NSR
Maxillectomy
2
Orbital exploration
NSR
Parotidectomy
NSR
Pharyngeal flap
T&S
Radical neck dissection
2
Retrolabriyinthine vestibular nerve resection
T&S
Rhinoplasty
NSR
Temporal bone resection
T&S
Tonsillectomy-adenoidectomy
T&S
Tracheostomy
NSR
Aneurysm, thoracic, resection
4
Atrial septal defect repair
3
Arterial switch operation
3
Blalock-Tussig Shunt
1
Coarctation of aorta repair: Child
1
Adult
3
Cardiac and Thoracic
Surgery
Coronary bypass graft (CABG)
4
CABG Redo
4
Embolectomy
2
Esophagectomy
4
Procedure
Crossmatch
Fontan Procedure
4
Hernia repair, all types including primary hiatus
T&S
Recurrent hiatus
2
Lobectomy pulmonary
2
Patent ductus arteriosus repair
1
Pericardectomy
4
Peumonectomy
2
Tetraology of Fallot Repair
3
Tracheostomy
T&S
Valve replacement
4
2013 Laboratory Handbook Final Page 24
Service
Procedure
Cross match
Cardiac and Thoracic
Surgery
Ventricular Septal defect repair\
3
Wolf-Parkinson white Procedure
2
Yag Laser Bronchoscopy
2
Amputation (A/K or B/K)
T&S
Arthrotomy
T&S
Arthroscopy
NSR
Cervical fusion
2
Cervical laminectomy (disk)
T&S
Fracture, open reduction: Hip
2
Orthopedic Surgery
Femur
2
Tibia
T&S
Forearm
T&S
Fusion, lumbar or thoracolumbar
2
Hand surgery
NSR
Hip arthroplasty first operation
2
Subsequent operations
Plastic Surgery
4
Hip disarticulation
4
Hip pinning
2
Knee arthroplasty
T&S
Laminectomy, lumbar
T&S
Meniscectomy
NSR
Osteotomy or bone biopsy: Femur
2
Tibia
T&S
Removal of knee pin
T&S
Cleft palate repair
T&S
Debridement and skin graft
2
Mammoplasty: Augmentation
NSR
Reduction
T&S
Mastectomy, subcutaneous, with implants
T&S
Otoplasty
NSR
Rhinoplasty
NSR
Skin flap
T&S
2013 Laboratory Handbook Final Page 25
Service
Procedure
Cross match
Obstetrics-Gynecology
Abortion, spontaneous, or termination during first or second
trimester
Cervical conization
T&S
NSR
Cesarean section
Uncomplicated
T&S
Known or suspected placenta previa
4
After trial of forceps
T&S
Cesium implant
T&S
Deliveries, multiple (vaginal or abdominal)
T&S
Delivery accompanied by marked anemia (Hb <10 gms) or
shock
Ectopic pregnancy
2
Examination under anesthesia (EUA) for known or suspected
placenta previa
High risk labor
2
Hysterectomy: Vaginal
T&S
2
T&S
Vaginal with pelvic floor repair
T&S
Abdominal
T&S
Abdominal with salpingo-oophorectomy
T&S
Radical
4
Laparoscopy
T&S
Malpresentation of fetus
T&S
Maternal Hemolgobin <8mg/dl
T&S
Oophorectomy and ovarian wedge resection
NSR
Pelvic lymph node dissection
3
Placental abnormality, acreta, increta, percreta, placenta previa,
vasa previa
Salpingo-oophorectomy
4
Procedure
Crossmatch
Sickle Cell Anemia & Gestation
T&S
Trauma
T&S
Tubal ligation
NSR
Tuboplasty
NSR
Vaginal birth after C section
T&S
2013 Laboratory Handbook Final T&S
Page 26
Service
Procedure
Cross match
Obstetrics-Gynecology
Vaginectomy
2
Vulvectomy, total or radical
2
Adrenlaectomy
2
Cystectomy
4
Cystolithotomy
NSR
Cystoscopy
NSR
Ileal Loop
T&S
Kidney biopsy, open
T&S
Meatotomy
NSR
Nephrectomy
2
Urology
Nepyhrolithotomy or pyelolithotomy
First operation
2
Subsequent operations
4
Orchiectomy
NSR
Penile implant
T&S
Prostatectomy: Transurethral
T&S
Suprapubic
2
Perineal
2
Radical
4
Renal artery repair
5
Retroperitoneal lymph node dissection
2
TUR (Bladder Tumor)
T&S
Ureterolithotomy
T&S
Ureterostomy
T&S
Uretero-vaginal or vesical-vaginal fistula repair
T&S
Urethroplasty
NSR
Vesicopexy (All)
T&S
Vesicostomy (All)
T&S
01/25/06 RK, BP
2013 Laboratory Handbook Final Page 27
CLINICAL MICROBIOLOGY LAB
ROOM B111
EXT. 3455
ROUTINE MICROBIOLOGY LABORATORY HOURS: Daily 8:00 AM to 11:00 PM.
EMERGENCY (STAT) GRAM STAINS: AVAILABLE 24 HOURS DAILY
DELIVER SPECIMENS (Routine and STAT including emergency Gram stains): to C118.
QUESTIONS & SPECIAL REQUESTS (e.g., prior approvals, STAT requests, etc.):
Between 8:00 AM to 4:00 PM call Microbiology supervisor at EXT. 3455
Between 4:00 PM to 8:00 AM call Night supervisor at EXT. 4080
CONDITION OF SPECIMENS: Under no circumstances will specimens arriving in an unsanitary
condition in leaking containers or with gross exterior contamination (e.g., with infectious material on
the outside of the container, on the plug, etc.) be accepted in the Microbiology Lab. All specimens
must be submitted in containers with tight fitting, securely closed lids.
LABELING OF SPECIMENS AND LABORATORY REQUEST FORMS: All specimen containers
must be labeled with the patient's name, hospital number, clinical unit, source and date. The manual
Microbiology request slips must be COMPLETELY FILLED OUT including time specimen was taken
and physician's signature and beeper number. A provisional diagnosis is of utmost importance. Often
extra procedures can be employed to more fully assist in confirming the diagnosis when the laboratory
knows, at least roughly, what to look for. An important diagnosis may be missed without this
information.
Do not include requests for non-microbiological tests with specimens for microbiology. For example,
stool guaiac or fats must be requested on a Urine, CSF, and Body Fluids Order Form (UH-0141) with a
separate specimen; pneumocystis must be requested on a Cytopathology request with a separate
specimen and sent to Cytology (E-149).
GRAM STAINS:
 Aerobic, anaerobic, fluid, tissue or non-gel swab specimens are all acceptable for Gram stain.
 Swab collected specimens must be in aerobic (non-gel) transport media
 Two aerobic transports (2 swabs each) are required for STAT Gram stain requests received between
10 PM and 8 AM.
 Dry swabs are not acceptable for Gram stain or culture.
2013 Laboratory Handbook Final Page 28
GRAM STAIN CATEGORIES & SPECIMEN CONTAINERS
SPECIMEN
SOURCE
GRAM STAIN
CATEGORIES
GRAM STAIN ALWAYS INCLUDED
WITH CULTURE REQUESTS and
GRAM STAIN ALWAYS PERFORMED
STAT
All positive results will be called to floor
NONSTAT GRAM STAIN ROUTINELY
PERFORMED WITH CULTURE
REQUEST (no prior approval for
non-STAT necessary);
STAT GRAM STAIN PERFORMED
ONLY ON PHONE REQUEST FROM
CLINICAL UNIT (exception: written
requests from operating rooms are
accepted)
GRAM STAIN NOT ROUTINE BUT
MAY BE PERFORMED ON PHONE
REQUEST FROM DOCTOR;
STAT GRAM STAIN REQUEST MUST
BE CALLED IN BY DOCTOR WHEN
GRAM STAIN FIRST REQUESTED

CSF
Spinal fluid kit tube #2

STERILE BODY
FLUIDS except
blood (eg, joint,
pleural, peritoneal,
pericardial, etc.)
Sterile tube
(red top vacutainer);
fluid preferred, nongel transport swabs
accepted

LOWER
RESPIRATORY

TISSUE
Transport Jar or
Transport vial

WOUNDS

GC ONLY
In Transport Media
(fluid preferred, nongel swabs accepted)
Transport swabs

STOOL
Stool in white plastic
container or Rectal
swab in transport
media

UPPER
RESPIRATORY
(e.g., ear, eye, nose,
throat)
Swab in transport
media
URINE
GRAM STAIN CAN NOT BE
PERFORMED
2013 Laboratory Handbook Final CONTAINER





Sterile container
Vacutainer Urine
Collection System
BLOOD
BONE MARROW
CATHETER TIPS
GRP B STREP SCRN (vag/rectal)
SPECIMENS COLLECTED IN BROTH
(e.g. blood culture bottle)
Page 29
BACTERIOLOGY GRAM STAIN AND / OR CULTURE
SPECIMEN TRANSPORT CONTAINERS & SPECIAL INSTRUCTIONS
CULTURE and / or
CONTAINER
GRAM STAIN
SOURCE or TYPE
ANAEROBES
Aspirate material with
(includes aerobic culture & needle & syringe, then
Gram stain)
gently inject material into
anaerobic transport vial
or collect using swab
transports (both aerobic
double swab non-gel plus
anaerobic single swab gel
transport required).
TISSUE / BIOPSY
Transport Jar or Transport
(includes Gram stain,
vial
aerobic & anaerobic
bacteriology, fungal and
AFB culture)
BLOOD
Blood culture bottles
(Always includes recovery Adults & children > 2yrs.
of routine yeast [fungus] ).
Aerobic & Anaerobic
Neonates & children 2yrs.
Pediatric bottle only
Fungus culture done only
when filamentous mould
suspected – must call
Micro supervisor for
approval.
Isolator tube
Pediatric isolator 2yr
BODY FLUIDS
except CSF
Sterile tube
(red top vacutainer) or
anaerobic transport vial
Pediatric Isolator tube
BONE MARROW
(includes aerobic
bacteriology, fungal and
AFB culture)
BORDETELLA
PERTUSIS (includes
culture & PCR)
2013 Laboratory Handbook Final Collect 2 nasopharyngeal
swabs.
1st swab - inoculate plate
2nd swab into VTM
SPECIAL INSTRUCTIONS
Aspirate preferred over swabs
Not done on specimens where
anaerobes are part of the normal flora
or superficial skin source.
Do not expose to air.
Take promptly to Microbiology lab;
when microbiology is closed deliver
directly to laboratory supervisor C118).
Transport immediately
Friction cleanse venipuncture site with
chlorhexidine gluconate
rubbing vigorously with back and
forth motion for 30 sec;
allow to air dry, then draw blood.
Adults and children > 2yrs.:
Use aerobic and anaerobic bottles
Patients > 80 lbs 8-10 mL bld / btl
< 80 lbs 4-5 mL bld / btl
Neonates and children 2 yrs.
Use 1 pediatric bottle; 1-3 mL bld
Draw 2 sets of bottles,
from 2 separately prepared sites.
Do NOT draw more than 2 sets of
Blood cultures in any 24 hr period.
Sterile tube (red top vacutainer)
DO NOT USE BLOOD CULTURE
BOTTLE
Obtain Regan-Lowe & VTM media
from Micro lab prior to specimen
collection.
Deliver STAT directly to Micro.
Page 30
CULTURE and / or
GRAM STAIN
SOURCE or TYPE
CSF
(STAT Gram stain routine
for all culture requests)
DIRECTIGEN
(Always includes bacterial
culture)
EAR
FUNGAL STUDIES
Cryptococcal Antigen
(Positive specimens
will be titered;
Cryptococcal Antigen
will be substituted for
all India Ink requests)
GENITAL
STREP GRP B SCREEN
GRAM STAIN FOR BV
GC Culture
LEGIONELLA URINE
ANTIGEN TEST
CONTAINER
Spinal Fluid Kit tubes,
set of 3 tubes.
Spinal Fluid Kit tubes,
set of 3 tubes.
Swab(s) in aerobic
transport media
Consult laboratory
Director
1 mL spinal fluid in spinal
fluid tube
SPECIAL INSTRUCTIONS
Tube #2 containing minimum of
5 ml. Deliver as soon as possible;
DO NOT REFRIGERATE.
Smears consistent with possible
pneumococcus, meningococcus,
haemophilus, Group B strep,
Escherichia coli or Cryptococcus will
be confirmed by antigen testing when
appropriate
Tube #2 containing minimum of
5 ml. Deliver as soon as possible;
DO NOT REFRIGERATE.
Indication of diagnosis on request is
extremely important
If spinal fluid can not be obtained send
a red top tube of blood.
DO NOT send spinal fluid in a
vacutainer tube.
2 swabs in transport media
swab in gel transport
Indicate if for:
STREP GRP B SCREEN
BACTERIAL VAGINOSIS
GC ONLY
OTHER
Urine in leak proof
container
MYCOBACTEROLOGY
TESTING
See separate table
PARASITOLOGY
TESTING
See separate table
SPUTUM
(INDUCED SPUTUM –Adult:
processed for Gram stain
only, no culture)
5-10 ml sputum in Sputum
Collection System.
STREPTOCOCCUS
PNEUMONIAE
ANTIGEN TEST
Urine or CSF in
leak proof container
2013 Laboratory Handbook Final A specimen with >25 epithelial
cells/lpf is considered a Poor Quality
specimen, contaminated with saliva,
unacceptable for culture and will be
rejected. Floor will be notified.
Page 31
CULTURE and / or
GRAM STAIN
SOURCE or TYPE
STOOL & RECTAL
SWABS
Routine Enteric
Pathogens
CONTAINER
Stool in white plastic
container
Rectal swab - transport
media
Clostridium difficile
THROAT
Culture
Swab in transport media
Rapid A Antigen
[all neg will be cultured]
URINE
Non-gel transport media
with double swabs
Vacutainer Urine
Collection System
WOUND
(Gram stain routine for all
culture requests)
Swab(s) in aerobic
transport media.
When anaerobic culture
requested add swab in
anaerobic gel transport
2013 Laboratory Handbook Final SPECIAL INSTRUCTIONS
GRAM STAIN: not routine, contact
supervisor for all requests
(Gram stains on these specimens
performed to determine the presence
of neutrophils.)
ROUTINE SCREEN includes Shigella,
Salmonella & E coli O157:H7 culture;
Campylobacter antigen and Shiga
Toxin detection assays. Culture for
any other suspected pathogens must be
specifically ordered e.g. Yersinia or
Vibrio
Only soft or liquid stools accepted.
No repeat testing for five days.
Screen done for group A, C & G
beta hemolytic Strep only.
Contact the laboratory for unusual
requests.
Deliver immediately to micro lab.
GRAM STAIN: not routine, contact
supervisor for all requests
MIDSTREAM CLEAN CATCH:
Instruct patient on proper cleansing of
genitalia.
SUPRAPUBIC or STRAIGHT
CATHETER: indicate on the request
slip if the specimen has been obtained
in this way; the presence of any
colony count is significant in these
specimens.
FOLEY CATHETER TIP - not
accepted for culture.
Urine - Not acceptable specimen for
GC culture
The specimen should be taken in a
manner so that surface contamination
does not occur.
Page 32
MYCOBACTERIA TESTING *
SPECIMEN TRANSPORT CONTAINERS & SPECIAL INSTRUCTIONS
MYCOBACTERIA
STUDIES
Blood
CONTAINER
Myco/F Lytic Broth
Bone Marrow
Pediatric Isolator tube
CSF
5-10 mL if possible in
spinal fluid tube
Sterile Container
Gastric Lavage
Feces
Stool specimen in white
plastic container
Pleural Fluid
100 mL if possible in
sterile drainage bottle
Sputum Collection
System 5-10 ml volume
Sputum
Tissue
Urine
Sterile container with
small amount of added
sterile saline
Sterile container, 40 mL
minimum
SPECIAL INSTRUCTIONS
Available only from Microbiology
Lab 8A.M. to 4 P.M.
Patient must be suspected HIV pos
Same tube used for bacteriology,
fungal and AFB cultures
Less than 1 mL is unsatisfactory.
DO NOT use vacutainer tubes.
Collect upon awakening.
Transport immediately to laboratory.
Specimen must be neutralized since
gastric acid can destroy AFB.
Adults: Only AFB smear positive
specimens will be cultured.
Pediatrics: All specimens will be
processed for smear and culture.
Less than 10 mL is unsatisfactory.
Collect 3 specimens no closer than 8
hours apart, at least 1 early morning.
Volume not more than 10 mL each
(5 mL minimum recommended).
Only 3 smear positive specimens will
be cultured.
All further specimens the 1st month
will only be processed for smears for
monitoring therapeutic response.
Subsequent specimens will only be
accepted for processing once every 4
days until smear negative.
Deliver immediately to laboratory.
Store in frig if possibility of delay in
transport of greater than 1 hr.
Deliver immediately to the
laboratory.
Collect 3 to 5 first morning total
voided urine specimens
(40 mL minimum each).
Smears are not done.
24 hr. collection is not accepted.
*Amplified nucleic acid probe for Mycobacterium tuberculosis complex is routinely performed
the first time lower respiratory specimens are positive for acid-fast organisms.
2013 Laboratory Handbook Final Page 33
PARASITOLOGY TESTING *
SPECIMEN TRANSPORT CONTAINERS & SPECIAL INSTRUCTIONS
PARASITOLOGY
TESTS
PARASITES
Amebiasis and
Giardiasis
Cestodes and
Helminths
Cryptosporidium
Pinworm
Trichomonas
CONTAINER
Fresh stool in white
plastic container
Fresh stool in white
plastic container
Fresh stool in white
plastic container
Pinworm Paddle
(sticky paddle)
Sterile tube with 0.5 mL
sterile saline
SPECIAL INSTRUCTIONS
Parasitology examinations are sent to a
referral laboratory.
Specimens containing oil, barium, or
urine will not be accepted for
examination.
Consult lab.
Two to three fresh stools on
consecutive days
Collect early morning prior to bathing.
Two to three specimens on
consecutive days.
Collect with sterile swab or speculum.
Transport immediately.
Deliver directly to microbiology lab
(B-111).
Testing only available 8am-10pm.
SPECIMENS WITH SPECIAL CRITERIA FOR PERFORMANCE:
(conditions when microbiology tests WILL NOT BE DONE)
 Specimen not in transport container appropriate for test request, examples follow:
o Any specimen for culture or Gram stain not in sterile container or culture transport device (with
the exception of stool).
o Dry swabs for Gram stain.
o Request for anaerobic culture from swab sent in non-anaerobic transport system
o Bordetella pertussis - culture not received on Regan-Lowe media; PCR not received in VTM
media
o Urine in urinalysis tube (with preservative)
o Tissue biopsy in formalin
o Request for Rapid Strep A from swab specimen where only a gel-transport swab is received.
 Foley catheter tip.
 Repeat Test Requests [the following applies to inpatients only - Patient Type “I” ]: Repeat test
request within 24 hour period of any identical specimen type with the exception of sterile body
fluids and blood cultures.
 CSF - Latex agglutination tests for bacterial antigens in spinal fluid are done ONLY when the CSF
WBC count is elevated or organisms are seen on Gram stain. (This restriction does not apply to
neonates.)
2013 Laboratory Handbook Final Page 34
SPECIMENS WITH SPECIAL CRITERIA FOR PERFORMANCE (continued):
 Gram Stains:
o Stat Gram stain for swab specimens received between 10PM and 8AM which do not come with
2 swabs
o Gram stain from swab specimen where only a gel-transport swab is received.
o Gram stain only requests from the following specimens: blood, bone marrow, catheter tips,
vaginal/rectal swabs for Group B Strep screen, or any specimen collected in broth (e.g. blood
culture bottle).
 Sputum culture with specimen Gram stain criteria indicating specimen salivary in nature
 Trichomonas specimen collected between 10PM and 8AM and/or >1hour old.
 Stool
o Routine culture for enteric bacterial pathogens, or diarrheic specimens for parasites in patients
who have been hospitalized for more than three days.
o More than 2 specimens for enteric bacterial pathogens
o Stool for Ova & Parasites containing barium, mineral oil, bismuth, or any other non-absorbable
anti-diarrheal compound.
o Request for VRE culture within 6 days of previous VRE culture from identical specimen type.
o Formed stool for Clostridium difficile toxin assay.
o Repeat stool request for Clostridium difficile toxin assay within five days of previous testing.
 AFB Rejection Criteria
o Catheter tips for AFB culture (request a blood specimen for AFB instead)
o Swab collected specimens (except laryngeal) for AFB testing.
o 24 hour urine specimen for AFB, instead of first morning, total voided specimen.
o 1 mL minimum of CSF for AFB culture
o 40 mL minimum of urine for AFB culture
o 5 mL minimum and 10 mL maximum for sputum specimen for AFB.
 Maximum of 3 smear positive AFB lower respiratory specimens for culture in 1st month.
Additional specimens the 1st month will only be accepted for processing every 5 days and will only
be processed for smear.
Exceptions to these rules must be approved by the Director or a supervisor in Microbiology
RESISTANT ORGANISMS ALERTS
All methicillin resistant Staphylococcus aureus (MRSA) strains, vancomycin resistant enterococci
(VRE), ESBL producing Enterobacteriaceae or MDR Gram negative rods are:
 flagged on the culture report
 reported to Infection Control via direct report prints
 called to Infection Control on weekdays
 called to the nursing units on weekends
2013 Laboratory Handbook Final Page 35
TURN-AROUND TIME FOR MICROBIOLOGY REPORTS
1. Routine Gram stain and routine KOH: 1 day
2. Routine specimen (e.g. sputum, throat, urine): incubated 2 days before final negative report.
3. Abscess, wound or tissue specimens: incubated 5 days before final negative report
4. Cystic fibrosis lower respiratory specimen: incubated 5 days before final negative report
5. Cornea specimen: incubated 10 days before final negative report
6. MRSA culture: 1 day.
7. Anaerobic cultures: incubated 3 days before final negative report
8. Blood cultures and all sterile body fluid specimen (e.g. spinal fluid) results are called to the floor as
soon as positive.
 Spinal fluid cultures are kept 3 days before declaring them negative.
 All other sterile body fluid specimens are kept 5 days before declaring them negative.
 Blood cultures are checked on a continual basis. All negative blood cultures are discarded on
the fifth day.
9. AFB specimens are processed daily (7 days a week and holidays included)
 For AFB specimens with AFB smears the smears are prepared and reported the same day as the
day the specimen is processed.
 All positive AFB smears are called to the floor.
 Amplified nucleic acid probe are performed on all 1st time positive smears of lower respiratory
specimens, of patients not yet on anti-tuberculosis therapy, with a turnaround of 48 to 72 hours.
 AFB cultures take 2-6 weeks to grow. Positive cultures are tested by DNA probe for
Mycobacterium tuberculosis, M. avium and M. gordonae within a few days of positivity.
 All other Mycobacteria spp. are sent to an outside reference laboratory for identification.
M. tuberculosis susceptibility testing usually takes an additional 1-2 weeks after the isolate
identification.
10. Fungus cultures are kept for four weeks before declaring them negative.
11. Feces for Salmonella, Shigella, Escherichia coli O157:H7 and Yersinia may take from two to five
days before results can be reported.
12. Bordetella pertussis cultures are held 5 days before declaring them negative.
13. Direct Antigen tests (e.g. Directigen Bacterial CSF, Legionella Urine Antigen, Streptococcus
pneumoniae Antigen, Urine or CSF) depending on time of specimen receipt and hours of operation
turnaround time 4 – 24 hours.
14. Trichomonas: 2 hours
15. Pinworm: depending on time of specimen receipt and hours of operation turnaround time 6- 24
hours.
16. Routine Ova and Parasite, Giardia and Cryptosporidium testing is sent to an outside reference lab.
Results may take up to 5 days.
17. Any result considered to be life-threatening or important epidemiologically will be called to the
floor.
2013 Laboratory Handbook Final Page 36
MOLECULAR DIAGNOSTICS
ROOMS : MSB C- 553 UH C – 112 EXT. 3339 and 6544
Laboratory Hours: Daily 8.00 a.m. to 4.00 p.m.
All tests performed in the Molecular Diagnostic Laboratory are Nucleic Acid based tests that
use DNA and/or RNA as test material. Testing is performed on a variety of sample types
over a wide range of diseases including Infectious Diseases, Oncology and Genetics The tests
are useful for both qualitative and quantitative analysis as well as genotyping and subtyping
of pathogens. Rapid (daily) testing is available for MRSA and Clostridium difficile.
1. Each specimen must be accompanied by the Molecular Diagnostics lab requisition
form #3 (UH 0146) and the appropriate test box must be checked.
2. Requests must have all relevant information filled in. Tests sent for HIV
genotyping must have the specific information on the form.
3. Please call the lab for information on “special collection tubes”.
INFECTIOUS DISEASES:
TYPE OF TEST
Chlamydia Trachomatis and/or
Neisseria gonorrhoeae Qualitative
(by PCR)
SPECIMEN REQUIRED
Female specimen: Endocervical or
Vaginal swab in Special collection tube.
Urine poured in special collection tube.
Male specimens: Urine, or urethral swab
collected in special collection tube.
Clostridium difficile Qualitative
Stool (Only liquid stools will be
accepted)
Cytomegalovirus Quantitative
5 – 7 ml. blood in Lavender-top (EDTA)
(by PCR)
tube, Broncho-alveolar lavage, spinal
fluid
Enterovirus Qualitative
Spinal fluid, nasopharyngeal, throat, or
rectal swab collected in special tube,
tissue
Hepatitis B Virus Quantitative range 20- 5-7 ml. Blood in Lavender-top (EDTA)
10,00000 IU/mL (by Ampliprep/Taqman tube.
realtime PCR)
Hepatitis C Virus Quantitative/Qualitative 5 – 7 ml. blood in Lavender-top (EDTA)
range 43-10,000,000 IU/mL
tube, must reach the lab within 4 hours
of collection
Hepatitis C Virus Genotype
5 – 7 ml. blood in Lavender-top (EDTA)
(by PCR & Line Probe Genotyping
tube, must reach the lab within 4 hours
assay)
of collection
Herpes Simplex Virus I and II qualitative Swab of lesion collected in special
(by realtime PCR)
collection tube, biopsies, spinal fluid
2013 Laboratory Handbook Final TURNAROUND
TIME (days)
5-7 days
Page 37
Daily
10-14 days
5-7 days
7-14 days
7-14 days
10-14 days
7-10 days
TYPE OF TEST
SPECIMEN REQUIRED
Human Papilloma Virus, subtyping of
High risk only
Cervical swab in Special collection tube,
biopsies, preserve-cyto specimen sent for
Pap smear.
Human Papilloma Virus - Identification Performed when requested on HPV high
of subtypes 16 & 18
risk positive specimens
Human Immunodeficiency Virus (HIV-1) 5 – 7 ml. blood in Lavender-top (EDTA)
RNA Quantitation
tube, must reach the lab within 4 hours
Range 40-10,000,000 viral copies
of collection
(Roche Ampliprep/Taqman and Abbott
m2000 realtime assays-40-10,000,000
viral copies/mL)
Human Immunodeficiency Virus
5 – 7 ml. blood in Lavender-top (EDTA)
(HIV-1) proviral DNA
tube, must reach the lab within 4 hours
Qualitative (by PCR)
of collection
Human Immunodeficiency Virus
5 – 7 ml. blood in Lavender-top (EDTA)
Genotype and viral load for
tube, must reach the lab within 4 hours of
Antiretroviral drug resistance
collection.
SPECIFIED PATIENT INFORMATION
MUST BE INCLUDED ON THE
REQUEST FORM
JCV Polyoma Virus
5 – 7 ml. blood in Lavender-top (EDTA)
Qualitative (by realtime PCR)
tube, CSF, urine
Methicillin Resistance for
Done as a reflex test for all blood
Staphylococcus aureus from
cultures found to have gram positive
Positive blood cultures (by realtime PCR) cocci in clusters.
Methicillin Resistance for
This test is limited to patients in the
Staphylococcus aureus from
medical ICU (IY1)at this time.
Nasopharyngeal swabs (by realtime
PCR)
Respiratory Viral Panel for identification Nasopharyngeal swab collected in
of RSV, Influenza A& B, Parainfluenza, special collection tube, nasopharyngeal
Adenovirus and human metapneumovirus washes
TURNAROUND
TIME (days)
10-14 days
10-14 days
5-7 days
10-14 days
10-21 days
7-10 days
Daily
Daily
3-7 days
For information on special collection tubes please call ext. 6544 or 3339
ONCOLOGY
TYPE OF TEST
Deletions in Chromosome 1p and 19q for
oligodendrogliomas
(by PCR/loss of heterozygosity)
2013 Laboratory Handbook Final SPECIMEN REQUIRED
Fresh tumor, paraffin block. MUST
BE ACCOMPANIED BY 5-7 ML
OF PERIPHERAL BLOOD IN
LAVENDER TOP (EDTA), and A
HISTOLOGY SLIDE.
TURNAROUND
TIME (days)
7-14 days
Page 38
TYPE OF TEST
Microsatellite Instability (MSI)
For colorectal cancer (by capillary
electrophoresis)
Mutations in the KRAS gene for colorectal
cancer (seven mutations detected by
Pyrosequencing)
B cell – Immumnoglobulin Heavy Chain
(IgH) Clonality
T cell – T cell Receptor
Gamma (TCRG) Clonality
Mutations in the BRAF gene (V600E/K) for
colorectal & lung cancer and melanoma
(detected by Pyrosequencing)
Mutations in the EGFR (EGF receptor) for
lung cancer and melanoma (detected by
Fragment analysis / Pyrosequencing)
Mutations in the IDH1 / IDH2 genes for
Glioblastomas (detected by realtime PCR)
MGMT Methylation analysis in brain tumors
SPECIMEN REQUIRED
Fresh tumor or paraffin block
MUST BE ACCOMPANIED BY 57 ML OF PERIPHERAL BLOOD
IN LAVENDER TOP (EDTA), and
A HISTOLOGY SLIDE.
Fresh tumor or paraffin block
MUST BE ACCOMPANIED BY A
HISTOLOGY SLIDE
Fresh tumor or paraffin block
MUST BE ACCOMPANIED BY A
HISTOLOGY SLIDE
Fresh tumor or paraffin block
MUST BE ACCOMPANIED BY A
HISTOLOGY SLIDE
Fresh tumor or paraffin block
MUST BE ACCOMPANIED BY A
HISTOLOGY SLIDE
Fresh tumor or paraffin block
MUST BE ACCOMPANIED BY A
HISTOLOGY SLIDE
Fresh tumor or paraffin block
MUST BE ACCOMPANIED BY A
HISTOLOGY SLIDE
Fresh tumor or paraffin block
MUST BE ACCOMPANIED BY A
HISTOLOGY SLIDE
TURNAROUND
TIME (days)
7-14 days
7-14 days
7-14 days
7-14 days
7-14 days
7-14 days
7-14 days
7-14 days
GENETICS
TYPE OF TEST
Cystic Fibrosis (CF) Carrier Screening< For
identification of CF mutations performed by
PCR and bead hybridization.
Factor V Leiden (FVL) G506A mutation
detection. Performed by real time PCR
Factor II (Prothrombin)
G20210A mutation detection. Performed by
real time PCR.
Detection of the Interleukin 28 (IL28)
polymorphism in patients infected with
Hepatitis C Virus (detected by realtime PCR)
SPECIMEN REQUIRED
5-7 ml. blood in Lavender-top
(EDTA) tube
TURNAROUND
TIME (days)
14-21 days
5-7 ml. blood in Lavender-top
(EDTA) tube
5-7 ml. blood in Lavender-top
(EDTA) tube
7-10 days
5-7 ml. blood in Lavender-top
(EDTA) tube
7-10 days
7-10 days
For information on special collection tubes please call ext. 6544 or 3339.
2013 Laboratory Handbook Final Page 39
AUTOPSY SERVICE
POSTMORTEM EXAMINATION
At NJMS and University Hospital house staff are particularly encouraged to seek autopsy consent for
the following cases:
 Deaths in which autopsy may help to explain unknown and unanticipated medical complications
 All deaths in which the cause of death is not known with certainty.
 Cases in which autopsy may help to allay the concerns of the family regarding the death and to
provide reassurance to them regarding same.
 Deaths of patients who have participated in clinical trials (protocols) approved by institutional
review boards.
 Natural deaths that are subject to but waived by a forensic medical jurisdiction such as:
 All obstetric deaths. (Deaths occurring within 24 hr. of delivery must be cleared by the medical
examiner.)
 Deaths resulting from high-risk infectious or contagious diseases.
 All neonatal and pediatric deaths.
 Deaths of patients of any age where it is believed that autopsy would disclose a known or suspected
illness that also may have a bearing on survivors or on recipients of transplant organs.
Autopsies are usually performed during the ordinary working day upon receipt of a legal autopsy
consent. Autopsies can and will be performed at any time necessary to meet the legitimate
requirements dependent upon a particular case. Arranging for an autopsy at odd hours will require
certain procedural changes; therefore, please inform the Pathology Autopsy Service as soon as possible
of the specific case and problem. The Pathology Autopsy Service will notify the attending physician
responsible for the case as to the time when the autopsy will begin so that arrangements to attend it may
be made. It must be emphasized that an autopsy represents a major consultation to the requesting
service. As such, although the Pathology Autopsy Service will have read the chart before performing
the autopsy, the most advantageous situation will be when a responsible and informed attending
physician discusses the case with the responsible pathologist. At such time particular areas of concern,
whether of major or minor importance, can be ascertained before the autopsy and accordingly sought
for in a proper fashion.
PROCEDURE RELATING TO COUNTY MEDICAL EXAMINER’S CASES
All deaths occurring within 24 hours after admission or 24 hours after surgery are reportable to
the Office of the Medical Examiner. Permission for autopsy is not to be sought until said cases are
released by the Medical Examiner.
All deaths due to homicide, suicide, accident, poisoning, intoxication and those occurring under
suspicious and doubtful circumstances, regardless of the length of hospitalization, must be immediately
reported to the Medical Examiner’s Office (Telephone No. 643-6554).
2013 Laboratory Handbook Final Page 40
PROCEDURE RELATING TO PERMISSION AUTOPSIES
When a request for autopsy is obtained by the attending physician, the completed authorization will be
affixed to the patient’s medical record. The nurse or designee will contact Bed Management at 24050/4051 to inform them that an autopsy is requested and the nurse or designee will deliver the patient
medical record with the authorization for autopsy to the Bed Management office. Bed Management will
in turn contact the Morgue Assistant via pager (973-259-2080) to inform him/her of the request for
autopsy. No autopsy will be performed without availability of the patient medical record.
If it becomes necessary for an autopsy to be performed after 3 PM, Bed Management will contact the
Pathology resident on call.
PERMISSION FOR AUTOPSIES
Consent for the performance of an autopsy may only be granted in the following order of relationship:
1. The spouse (even if legally separated but not divorced)
2. *Children (over 18 years of age) of the patient
3. *Grandchildren (over 18)
4. *Parents of the patient
5. *Brothers or sisters
6. *Nieces or nephews
*All relatives of equal rank must give consent (i.e., both father and mother, all living children).
If there are no surviving relatives, a permit may be signed by a friend, lodge officer, or other person
assuming responsibility for burial.
A maximum period of 24 hours after death is allowed under the New Jersey State Law for a death
certificate to be signed. If autopsy permission is still being sought in a particular case, the death
certificate should still be signed to comply with this state law. Since the person or persons authorizing
a funeral director to remove a body are almost always the same individuals who can grant the autopsy
permission, there should be no inadvertent losing of an autopsy authorization. Bed Management is
fully prepared to handle the administrative problems in such a case and to assist the doctor in
preventing such a loss.
Bodies may be removed between the hours of 8:00AM and 4:00PM, with the exception of Medical
Examiner cases and removals for Religious purposes/.
REGULATIONS FOR SIGNING THE DEATH CERTIFICATE
1. Generally, the physician who was charged with the patient’s care must sign the death certificate.
2. When a certificate requires a signature at a time when the regular physician is off duty, it must be
signed by the covering physician.
3. In permission autopsy cases, the house staff physician is responsible for signing the death
certificate. The final diagnosis may be obtained from the pathologist.
4. Death certificates will be signed by the Medical Examiner in those cases involving the Office of the
Medical Examiner.
2013 Laboratory Handbook Final Page 41
POLICY ON FETAL EXAMINATION
FETUS 20 WEEKS GESTATION AND OVER:
A fetus 20 weeks gestation or over is considered a stillbirth, and must have a fetal death certificate
filed. Additionally, the fetal death certificate is required for burial purposes. If the fetus is the product
of an outside delivery, the mother has a positive toxicology, or the pregnancy meets other reporting
requirements for the medical examiner, the medical examiner must be called. If the case is released
back to the hospital by the medical examiner, this must be documented in the records. An autopsy
consent must be obtained if the fetus is to have an in-house autopsy; Pathology will not perform an
autopsy without the consent. However, the placenta may be examined. All fetuses 20 weeks gestation
and over should be sent to the morgue and are handled as any other death in terms of burial. In cases
with poorly documented clinical dates, a cutoff maximum foot length of 3.4 cm will be applied to
determine gestational age.
All live births require Death Certificate completed online in the Electronic Death Registration System
(EDRS).
FETUS UNDER 20 WEEKS GESTATION:
A fetus that is under 20 weeks gestation does not require a fetal death certificate, should be sent to
Surgical Pathology and can be examined as a surgical specimen without consent required. Fetuses of
under 20 weeks are disposed of as surgical tissues. Fetal age is determined by good clinical
documentation, i.e. a reliable last menstrual period date or ultrasound confirmation. The gestational
age and method of determining such should be stated on the requisition to surgical pathology. If the
clinical dating is unreliable, foot length is the best determinant of age. (Weight, is not used in NJ.)
Foot length should be performed and recorded prior to submission of the fetus. A maximum foot length
of 3.4 cm is acceptable for Surgical Pathology examination, assuming no contradictory clinical
evidence suggests a fetus is 20 weeks or more.
2013 Laboratory Handbook Final Page 42
CYTOPATHOLOGY
ROOM E-149 EXT 5713 / 5718
LABORATORY HOURS: Monday-Friday, 8 AM – 4 PM.
 CPOM order form is not accepted in Anatomic Pathology department!
Criteria for Acceptance of Specimens (GYN and Non-gyn):



The Cytopathology laboratory will only accept specimens for processing from physicians or
other persons authorized by law. An attending M.D. or Resident M.D. must sign any
Cytology laboratory request.
- Name and address, and contact information (e.g. phone or beeper number) of authorized
person requesting the test must be written on the cytology requisition.
- Specimens will not be accepted from unauthorized person such as medical students or from
the nursing staff.
NOTE: Patients are not authorized persons.
All specimens received by the laboratory (containers or slides) must be adequately labeled with
two patients identifier (e.g. patient’s first and last name; MR# or DOB)
All specimens must be accompanied by a properly completed cytology requisition form.
FEMALE GENITAL TRACT
Use the Cytopathology Requisition form “REQUEST FOR CYTOLOGY EXAMINATION”.
The Gynecologic area of the form should be completed by the physician and must include:










Patient’s name, address, and other unique identifier (e.g., Medical Record number), and location.
Patient age and/or date of birth
Test(s) ordered
Date of the specimen
Menstrual history (date of LMP, hysterectomy, pregnant, postpartum, hormone therapy).
Clinical findings and diagnosis.
History of previous abnormal PAP smears.
Patient risk status for developing cervical cancer, e.g. “high risk”
History of previous treatment, particularly hormonal therapy, cautery, surgery, radiation,
chemo-hormonal therapy, etc., even if not applied to the genital tract.
Source – cervical/vaginal, or vaginal.
Patient instruction:

Schedule the examination 2 weeks after the first day of the last menstrual period. Avoid
examination during menses.
 Do not use vaginal medication, vaginal contraceptive or douches for 48 hours before the
appointment.
 Intercourse is not recommended the night before the appointment.
Specimen collection:
2013 Laboratory Handbook Final Page 43




Specimen should be obtained after a non-lubricated speculum (moistened only with warm water
if needed) is inserted. Do not use lubricant.
Excess mucus or other discharge should be removed gently with ring forceps holding a folded
gauze pad.
The sample should be obtained before the application of the acetic acid of Lugol’s Iodine.
An optimal sample includes cells from ectocervix and endocervix.
PROCEDURE FOR LIQUID-BASED PAP TEST SPECIMEN COLLECTION
Endocervical brush/Spatula Protocol:
1.
2.
3.
4.
5.
6.
7.
Obtain an adequate sample from the ectocervix using a plastic spatula.
Put the spatula into the PreservCyt Solution vial and swirl the spatula ten times.
To obtain an adequate sampling form the endocervix use an endocervical brush
and insert the brush into the cervical os until only the bottommost fibers are
exposed. Slowly rotate 1/4 or 1/2 turn in one direction. DO NOT
OVER-ROTATE.
Put the brush into the same PreservCyt Solution as was used for the spatula.
Rotate the brush ten times while pushing the brush against the vial wall. Swirl the brush
vigorously to further release material.
Tighten the cap of the vial so that the torque line of the cap passes the torque line
on the vial.
Label the vial with the patient’s full name and medical record number. Place the
vial and the corresponding requisition form in a biohazard specimen bag.
Deliver the vial and the completed cytology request form to the Cytology
Laboratory (UH E-149).
Broom-Like Device Protocol:
1.
2.
3.
4.
5.
To obtain an adequate sampling from the cervix using a broom like device insert the
central bristles of the broom into the endocervical canal deep enough to allow the shorter
bristles to fully contact the ectocervix. Push gently and rotate the broom in a clockwise
direction five times.
Rinse the broom in the PreservCyt Solution vial by pushing the broom into the bottom of the
vial ten times forcing the bristles apart. Swirl the broom vigorously to further release
material.
Tighten the cap of the vial so that the torque line of the cap passes the torque line on the vial.
Label the vial with the patient’s full name and medical record number. Place the vial and the
corresponding requisition form in a biohazard specimen bag.
Deliver the vial and the completed cytology request form to the Cytology Laboratory (UH E149).
NON-GYNECOLOGICAL SPECIMENS:
Use the Cytopathology Requisition form “REQUEST FOR CYTOLOGY EXAMINATION”.
The Non-Gyn area of the form should be completed by the physician and must include:
2013 Laboratory Handbook Final Page 44







Patient’s name, address, age and/or date of birth, and other unique identifier (e.g., Medical
Record number) and location.
Test(s) ordered
Source of specimen
Date of the specimen
All specific clinical information and radiology or other tests findings
Name of attending physician and/or resident physician.
Attach the form to the specimen container.
Label the container with the patient’s name and medical record number.
During laboratory working hours, immediately deliver all the specimens, without any fixative added
unless otherwise instructed, to the Cytology Laboratory (UH E149).
Note: Specimens sent to Cytopathology are for cytology ONLY.
If tests other than Cytopathology are required, please divide the specimen accordingly and send
it with a corresponding requisition for each department.
If Microbiology testing is required, the specimen must be sent there first.
Specimens obtained when the laboratory is closed should be collected as instructed below.
PROCEDURE FOR CEREBROSPINAL FLUID SPECIMENS
1. The collection procedure should be performed in a way to avoid a bloody tap or the aspiration of
solid material.
2. The second or third tube collected should be sent to the Cytopathology Laboratory.
The CSF specimen should be delivered to the lab immediately. Containers must be securely
tightened to eliminate any leakage.
3. Indicate specimen source (CSF and i.e. lumbar puncture, shunt, EVD).
4. Ensure all required information is complete; include pertinent clinical history.
5. For Flow Cytometry study use another tube with RPMI media and send it to Hematology Laboratory.

If specimen collected after 4:00 pm and on weekends or holidays, add an equal volume of fixative
(Carbowax solution or 50% alcohol) to the specimen and refrigerate until delivered to the laboratory.
PROCEDURE FOR BODY FLUID SPECIMENS
1. Submit fresh specimen; 100 to 200 cc of fluid is placed in a clean specimen container. Containers
must be securely tightened to eliminate any leakage.
2. Immediately deliver the specimen to the Cytopathology Laboratory (UH E-149). If more than a 24hr delay is anticipated between collection and receipt in the laboratory, please refrigerate specimen.
3. If specimen collected after 4:00 pm and on weekends or holidays, place the fluid in the
refrigerator until it can be delivered to the laboratory and processed.
Do not add any fixative to body fluid specimens.
2013 Laboratory Handbook Final Page 45
Note:

DO NOT SEND FLUIDS IN SYRINGES (WITH OR WITHOUT NEEDLES ATTACHED).

DO NOT SEND FLUIDS IN TRANSFUSION BAGS, OR I.V. BOTTLES.

DO NOT SEND LARGE VOLUMES OF FLUID. POUR INTO APPROPRIATE CONTAINERS OR
CONTACT LABORATORY FOR DIRECTION.
PROCEDURE FOR SPUTUM SPECIMEN
1.
2.
3.
4.
ORAL CLEANLINESS IS A PREREQUISITE.
Instruct patient to EAT NO FOOD after midnight prior to obtaining specimen.
Collection of early morning specimen is preferred.
Immediately before specimen collection, the patient must clean his teeth (remove dentures) and
rinse mouth thoroughly.
5. Have the patient relax, cough deeply without drawing from nasal passages, and expectorate material
into sputum cup containing cytology fixative (Carbowax/alcohol solution). If fixative is not
available, deliver the specimen to cytology lab promptly.
6. Containers must be securely tightened to eliminate any leakage.
7. A Twenty-four hour sputum specimen is not acceptable.
A total of three SATISFACTORY specimens should be obtained on three different days if
malignancy is suspected (consecutive, if possible).
NOTE: Only induced sputum specimens will be processed for Pneumocystis carinii.
Transport each specimen to the laboratory as soon as possible. The specimen should be refrigerated if a
delay in transporting the specimen is anticipated.
PROCEDURE FOR FINE NEEDLE ASPIRATION AND PREPARATION OF CYTOLOGIC
MATERIAL
1. Make thin smears from the aspirated material and fix immediately in 95% alcohol (for PAP stain).
2. If there is enough material air dry at least 1 to 2 smears (for Romanowsky stain).
3. Flush the syringe and needle with saline or carbowax and empty into a clean specimen container for
a cell block. Containers must be securely tightened to eliminate any leakage.
4. Promptly send the specimen(s) and a cytology requisition form to the cytology laboratory.
NOTE: Please call 2-5713/ 2-5718 with questions regarding FNA preparation.
The Cytopathology Department staff may be available to assist during Fine Needle Aspiration
procedures upon request of the physicians:
 Call the Cytology laboratory at least 24 hours prior to the scheduled FNA procedure.
Short notifications will be subject to the staff availability.
 Any changes to the procedure schedule must be called in to the Cytology Lab promptly. This
includes procedures which are added on, delayed, canceled and re-scheduled.
 It is suggested, the Physicians should call for the Cytotechnologist after the patient prepped.
 As much as possible, Fine Needle Procedures should be scheduled for the morning hours.
2013 Laboratory Handbook Final Page 46
The cut-off time for FNA procedures that requires Cytotechnologist assistance is 4pm.
Note: The cytotechnologist may assist at only one procedure at a time.
The Cytotechnologists will determine the specimen adequacy only. The pathologist, in addition to
specimen adequacy may render a preliminary diagnosis.
PROCEDURE FOR BRUSHING SPECIMENS
(Bronchial, esophageal, bile duct, etc.)
1. The cellular material is obtained by vigorously brushing the lesion.
2. The brush is used to spread the sample onto glass slides which have the patient’s name printed
on the frosted end in pencil. Press the brush against the slide and roll across the slide only once.
Fully frosted slides may be used but extreme care must be used not to be overly aggressive with
the brush on the slide; use the frosted side of the slide.
3. Fix the slides IMMEDIATELY in a Coplin jar in 95% ethyl alcohol.
4. Wash the brush well in carbowax fixative.
5. Deliver the vial and completed cytology request form to the Cytology Laboratory (UH E149)
NOTE: All other smears made for cytology studies such as direct breast smears, oral smears, etc. must
be immediately fixed either by adding fixative (spray) or by placing smears into a jar in 95%
ethyl alcohol. Written instructions for the collection and preparation of bronchial, gastric,
colonic, urine, body fluids, etc. are available from the CYTOLOGY LABORATORY.
Criteria for Rejection of Specimens (GYN and Non-gyn):
A. Unlabeled specimen or label did not contain minimum required information or the information
differs from that on the requisition.
B. Incomplete or inaccurate patient identification (patient name, MR# and/or DOB missing).
C. No request form was received with the specimen.
D. Incorrect container or specimen type submitted for the requested test.
E. Specimen sent to the Laboratory in the Syringe with Needle Attached.
F. Specimen container/slide broke or container leaked
NOTE: The laboratory will promptly contact the appropriate clinical area if a specimen
has been rejected.
A. Unlabeled specimen (submitted with a properly completed requisition).
No unlabeled specimens shall be accepted. An attending M.D. or a Resident M. D. responsible
for that specimen shall be notified and must return to the laboratory to identify that specimen, or in
some circumstances, the specimen will be returned to its origination/sender
B. Mislabeled Specimen or Requisition.
Under no circumstances will laboratory staff change specimen labels or requisition information. An
Attending M.D. or a Resident M.D. must come to the laboratory and make the proper correction (s),
or in some circumstances, the specimen will be returned to its origination/sender
2013 Laboratory Handbook Final Page 47
In situation where the specimen is perishable or in similar extenuating circumstances, processing
will be initiated, but results will not be reported until the specimen identification has been clarified.
C. Specimen will not be processed without properly filled out cytology requisition form. In addition, no
test requests are to be added to specimens already in the laboratory without authorization from
Attending M.D. or a Resident M.D. and clearance by supervisor to assure that the specimen is
adequate for added tests in regard to quantity, type and time collection.
D. All Specimens are to be received in appropriate containers (with fixative when appropriate) or as
smears prepared on glass slides.
E. Specimen sent to the Laboratory in the Syringe with Needle Attached.
In compliance with the Federal Needle Stick Prevention and Safety Act 2001 and The New
Jersey Needle Safety Act 2001 “No Needle shall be recapped”. Therefore, no specimen in a
syringe with the needle attached will be accepted.
2013 Laboratory Handbook Final Page 48
NEUROPATHOLOGY
ROOM C-525
EXT. 7167
The division of neuropathology is responsible for muscle biopsies and nerve biopsies. For either of
these specimens the following general procedure should be followed:
1. It is recommended that the clinician discuss the case with the neuropathologist, Dr. Ada Baisre (Ext.
4145) or Dr. Leroy Sharer (Ext. 4770), before the biopsy is taken. This allows the pathologist to
inform the laboratory of any special procedures needed for that specimen.
2. The clinician should notify the Neuropathology Laboratory of the date and time of the biopsy at
least one day prior to the procedure. Contact the Neuropathology Laboratory (Ext. 7167). ONLY
with pre-arrangement, muscle and nerve specimens will be obtained directly from the operating
room. In no case are specimens to be delivered to either the Accession Area (C118) or to the
Surgical Pathology Laboratory. NOTE: Specimens will be accepted only between 9 AM and 2 PM
Monday through Wednesday.
3. A written clinical history must accompany the specimen. This should include the results of
pertinent laboratory work-up and the name and telephone number of the physician responsible for
the case.
Detailed protocols giving guidelines for muscle and nerve biopsy sampling can be
obtained from the neuropathology division.
2013 Laboratory Handbook Final Page 49
SURGICAL PATHOLOGY SERVICE
ROOMS E-156 (Secretaries), 157, 161 (Lab.), 163 (Sign out)
Ext 5707, 5709
All tissue or foreign material removed from patients in the hospital must be sent to the Surgical
Pathology Laboratory for examination, confirmation and diagnosis. A Surgical Pathology Examination
request form must accompany each specimen. The completed request form must include the patient's
name, sex, age, location, hospital number, pre- and post-operative diagnostic impressions, source and
type of tissue submitted and a brief clinical summary. The specimen container must also have the
patient’s name, medical record number and source and type and tissue submitted. The request form
must be signed by the responsible physician and include a telephone extension or beeper number.
Containers with radioactive specimens should be appropriately labeled (for example. sentinel lymph
node #1,#2, #3 etc.,) with appropriate “radioactive labels” as per ORSS guidelines.
When the diagnoses of lymphoma, liposarcoma, renal cell cancer, Ewing’s sarcoma, synovial sarcoma
or any other tumor with a known cytogenetic abnormality is suspected, the tissue must be brought to
Surgical Pathology in the fresh, unfixed state.
Routine, small tissue specimens and biopsies (e.g. tonsils, skin biopsies, cervical biopsies, etc.) should
be submitted in a 10% solution of buffered formalin The containers with formalin may be obtained
from the Histology Laboratory (UH E-161). Small biopsies removed after 4:00 PM or on weekends,
may be brought to the Accession Area – C 118 Large tissue specimens and resected organs should be
submitted undissected, in the fresh state, placed in plastic bags and kept moist with saline soaked
sponges. Fresh specimens which cannot be sent immediately to Surgical Pathology (i.e. when removed
at night or on a weekend) should be placed in formalin in the operating suite. If the specimen cannot be
submitted within 24 hours, place the tissue in a large container of 10% buffered formalin. The proper
volume is 20 volumes of formalin to 1 volume of tissue. A 100 gm spleen, for example, should be
placed in a bucket with 2 liters of formalin. The tissue can then be stored at room temperature.
When a RUSH diagnosis is desired, print the word "RUSH" in large red letters on the front of the
Surgical Pathology Examination request form and this biopsy will be given priority. The laboratory
staff MUST be notified when the RUSH specimen is brought to Pathology. A special type of RUSH
processing is available for small biopsy specimens where same-day information is vital. Specimens of
this nature should be brought to Surgical Pathology before 11:00 AM. Make direct communication
with the pathologist in person or by telephone for RUSH cases. Slides will be available by 5:00 PM.
Rush processing of this type may compromise diagnosis and further study; and should only be
requested in emergent situations. The physician’s phone or beeper number must be on the request
form.
FROZEN SECTION - for rapid diagnosis, is available only on fresh tissue specimens. This service
should only be used where immediate operative decisions depend upon rapid diagnosis. The specimen
for Frozen Section must be immediately hand carried to Surgical Pathology (E-161) in the fresh state.
The request form must have the OR room number on it so that the surgeon can be notified of the
diagnosis. Whenever possible, the Surgical Pathology Laboratory or the Pathologist should be notified
before the tissue arrives.
2013 Laboratory Handbook Final Page 50
When a frozen section is needed at night or on weekends, the resident on call for surgical pathology
must be notified in advance, if known, or as soon as the situation arises to avoid delays. The surgical
pathology resident will notify the pathologist. The on-call roster for surgical pathology is available
from the page operator.
RENAL BIOPSIES – must be preceded by telephone notification (ext. 2-5710 or 5711) and must be
received in saline by 2:00 PM to insure appropriate handling. All renal biopsies must be accompanied
by a completed Surgical Pathology request form and a Clinical Data Guide Sheet (available in the
Histology Laboratory, E-157).
ELECTRON MICROSCOPY AND OTHER SPECIAL STUDIES. When EM or other special
studies (e.g. analysis of liver tissue for copper or iron content, etc.) are needed for clinical purposes, the
Anatomic Pathologist on call must be consulted in advance so that all necessary procedures that will
insure the maximum viability (and therefore the proper handling) of the involved tissues will be in
place. For EM studies specifically, fresh biopsy specimens must be placed into 4% paraformaldehyde
fixative (available from the Histology Laboratory, E-157) immediately after removal from the patient.
Tissues to be used for research purposes with approved IRB. MUST be sent to Surgical Pathology first
- the Pathologist will then make the determination as to what may be used in this regard so as to ensure
there is enough tissue left for diagnostic purposes. IMMUNOFLUORESCENT STUDIES (skin,
kidney, lung, etc.) - fibrinogen, C4, albumin and lambda and kappa light chains must be specifically
requested.
Place specimen in normal saline and deliver to room UH E161.
A Direct
Immunofluorescence Request Slip (UH-0123) specifying the presumptive diagnosis must be submitted
with the specimen. Request for IMMUNOHISTOCHEMICAL STUDIES (UH-E-153) must be
accompanied by a Surgical Pathology request form with appropriate patient and insurance information.
Chromosome 1 p deletions in oligodendrogliomas is done by PCR/loss of heterozygosity by Molecular
Diagnostics (MSB C-553). For this study 5-7 ml of peripheral blood collected in a lavender top tube
(EDTA) is needed. If microsatellite instability studies are needed, please indicate such on surgical
pathology requisition form.
OUTSIDE CONSULTATIONS: Blocks and slides from outside institutions to be reviewed at
UMDNJ must be accompanied by a Surgical Pathology request form with appropriate registration and
insurance information, and a copy of the Surgical Pathology Examination report from the outside
institution. The completed request form must include the patient's name, sex, age, location, hospital
number, pre- and post-operative diagnostic impressions, source and type of material submitted and a
brief clinical summary.
SURGICAL PATHOLOGY REPORTS
Reports are available in Logician and EPIC computer systems. If the report is not in the computer, you
may call the Pathology Office at Ext. 5709/5708.
.
2013 Laboratory Handbook Final Page 51
BLOOD GAS LABORATORY
ROOM E-432
EXT. 5753, 7137
SPECIMEN REQUIREMENTS:
a. A minimum of 1 ml of whole blood in a pre-heparinized syringe or capillary tube is required
in order to obtain blood gas analysis and co-oximeter results.
b. All samples must be clearly identified with the patient's full name and hospital number.
c. The blood gas request must be filled out completely.
d. Immediately after drawing, place all blood gas samples in ice.
SAMPLE TURNAROUND TIME:
a. Single sample (approximately 15 minutes) - The results appear in EPIC as soon as the test is
completed.
b. Multiple samples - As each sample is analyzed, the results appear in EPIC.
For detailed information regarding the blood gas sample collection and handling procedure, please call
the Blood Gas Laboratory.
2013 Laboratory Handbook Final Page 52
GENERAL TEST LIST
The general test list contains the majority of tests which are performed on serum, plasma, and whole
blood in the laboratories of University Hospital and New Jersey Medical School. Listed separately are
requirements for the collection of blood bank, microbiology and virology specimens, tests done on
urine, cerebrospinal fluid, and on body fluids, and specimens for special function laboratories. The
meaning of abbreviations used on the following pages will be found in the Appendix.
BODY FLUID TESTS
Use Urine, CSF, and Body Fluids Order Form (UH-0141)
FLUID TYPE
SYNOVIAL FLUID
Examination includes appearance,
WBC and RBC counts, differential
and microscopic examination
for crystals
Additional tests as needed.
PLEURAL, PERITONEAL, or
PERICARDIAL FLUID
Examination includes appearance
RBC count, WBC count and differential.
Additional tests as needed.
SPECIMEN CONTAINER(S) NEEDED
One 5 ml green-top tube and one 5
ml red-top tube. (Deliver specimen
as soon as obtained.)
Consult general test list for
amount and container.
Consult general test list for
amount and container.
SEMEN ANALYSIS
Must be scheduled. Prior consultation with pathologist is required.
CSF EXAMINATION
Use Urine, CSF, and Body Fluids Order Form (UH-0141)
SPECIMEN for standard CSF examination (includes appearance, cell count, differential, protein,
glucose, and lactate): Submit 3 lumbar puncture tubes, each containing 2-3 ml of fluid. Each patient
care unit has lumbar puncture kits. The tubes included are usually prelabeled #1, #2, #3 (if not, label as
such). Use them in that order to collect the CSF.. Unless otherwise requested, tube #1 is used for
chemistry, tube #2 for microbiology (when ordered), and tube #3 for cell count and differential.
Microbiology requests must be on a separate microbiology form. Cytopathology requires an additional
sample and request form when ordered.
STOOL OCCULT BLOOD –
Use Misc. order form
Must be sent on occult blood card
STOOL WBC
Use Misc order form
Submit in plastic cup. Reference range = negative
2013 Laboratory Handbook Final Page 53
URINE CHEMISTRY TESTS
and URINALYSIS
TIMED COLLECTION OF URINE: Many of the analyses performed on urine specimens must be
carried out on 24 hr. urine collections. If the urine collection is less than 24 hr., please mark the
number of hours of urine collection on laboratory slip.
URINE CONTAINER: Urine containers for 24 hr. collections are available at the clinic or in Room
C119. Return complete urine collection to the laboratory promptly. Instructions for 24 hr. urine
collection accompany the 24 hr. urine collection container.
CODES FOR PRESERVATIVE used in 24 hr. urine collection:
(N) - no preservative
(H) - 10 ml. Of 6 N HC1
(B) - 2 gm. Of boric acid
RANDOM urine specimens do not require any preservatives.
URINE TEST
AMYLASE
CALCIUM
CHLORIDE
CREATININE
DRUG SCREEN 8
URINE TEST COLLECTION REQUIREMENTS
AVAILABLE CONTAINER COLLECTION
REQUIRED
REQUIRED
E
N
Random or
Timed 2 or 24 hr
D
N
24 hr
D
N
Random or 24 hr
D
N
Random or 24 hr
E
N
Random
FORM
UH-0141
UH-0141
UH-0141
UH-0141
Misc
This is a screen for clinical purposes; positives are not confirmed
by a second method.
Includes:
amphetamines
barbiturates
benzodiazephine
cannabinoids
cocaine
methadone
opiates
phencyclidine
GLUCOSE
D
2013 Laboratory Handbook Final (cut off for positive result =1000 ng/mL)
(cut off for positive result =200 ng/mL)
(cut off for positive result =200 ng/mL)
(cut off for positive result = 50 ng/mL)
(cut off for positive result =300 ng/mL)
(cut off for positive result =300 ng/mL)
(cut off for positive result =300 ng/mL)
(cut off for positive result = 25 ng/mL)
N
24 hr
UH-0141
Page 54
URINE TEST
AVAILABLE
MAGNESIUM
MICROALBUMIN
OSMOLALITY
D
D
E
PHOSPHORUS,
D
INORG.
POTASSIUM
E
PROTEIN
D
SODIUM
E
UREA NITROGEN D
URIC ACID
D
URINALYSIS
E
Includes: appearance of urine, pH,
specific gravity, protein, glucose,
ketone, bilirubin, blood, nitrite,
urobilinogen, leukocyte esterase,
reducing substance on children <2
years, and microscopic examination.
CONTAINER
REQUIRED
N
N
N
N
N
N
N
N
N
N
COLLECTION
REQUIRED
24 hr
Random or 24 hr
Random
specimen
24 hr
Random or 24 hr
Random or 24 hr
Random or 24 hr
24 hr
24 hr
5 ml random
Submit the
specimen in a
Kovac tube
FORM
UH-0141
UH-0141
UH-0141
UH-0141
UH-0141
UH-0141
UH-0141
UH-0141
UH-0141
Send specimens for urinalysis to the laboratory immediately, as the test should be done within 1-2 hr. of
specimen collection.
2013 Laboratory Handbook Final Page 55
TEST NAME
ACETAMINOPHEN
ACETONE
ACTIVATED PARTIAL
THROMBOPLASTIN
TIME (APTT)
ALBUMIN
ALCOHOL (ethanol)
ALKALINE
PHOSPHATASE
ALPHA-FETOPROTEIN
Tumor marker
ALT (ALANINE MINOTRANSFERASE,)
AMIKACIN
AMMONIA
AVAIL
ABLE
E
E
E
E
E
TUBE
SPECIMEN
FORM
REFERENCE RANGE
GG
GG
B or b
0.1 ml
0.1 ml
Fill tube
UH-0140
UH-0140
UH-0140
0-30 g/mL therap. range
Negative
24-39 min
D
GG
0.1 ml
UH-0140
GG
0.2 ml
UH-0140
Keep tube tightly stoppered.
GG
0.1 ml
UH-0140
D
GLD
D
GG
0.2 ml
0.1 ml
UH-0140
UH-0140
D
GG
0.1 ml
UH-0140
Draw peak 30 min. after IV dose is completed.
Draw trough immediately before next dose is to be
administered.
E
L
Fill tube
UH-0140
Specimen must be transported on ice
AMYLASE
E
GG
0.1 ml
UH-0140
ANTI-DNA ds
weekly R/GLD
UH-0140
ANTI-MITOCHONDRIAL weekly R/GLD
UH-0140
Ab
2013 Laboratory Handbook Final 3.5-5.2 gm/dL
Negative
40-130 u/L Male
35-105 u/L Female
0-15 ng/mL
0-41 u/l Male
0-33 u/l Female
Peak 20-25 g/mL
Trough 5-10 g/mL
16-60 mol/L Male
11-51 mol/L Female
28-100 u/L
Page 56
TEST NAME
ANTINUCLEAR
ANTIBODIES (ANA)
ANTI-SMOOTH
MUSCLE Ab
ANTI-THROMBIN III
ANTITHYROGLOBULIN
APTT
AST (ASPARTATE
AMINOTRANSFERASE)
b HCG
BILIRUBIN, DIRECT
AVAILA
BLE
weekly
weekly
Once/
wk
E
D
E
TUBE
SPECIMEN
FORM
R,
GLD
R/GLD
1.0 ml serum
UH-0140
REFERENCE RANGE
UH-0140
R
1.0 ml serum
UH-0140
B or b
GG
Fill tube
0.1 ml
UH-0140
UH-0140
See HCG, BETA
SUBUNIT
GG
0.1 ml
85-120%
0-60 u/mL
24-39 sec
0-40 u/L Male
0-32 u/L Female
UH-0140
UH-0140
0-0.3 mg/dL
UH-0140
0-1.0 mg/dL
Protect from light
BILIRUBIN, TOTAL
E
GG
0.1 ml
Protect from light
2013 Laboratory Handbook Final Page 57
TEST NAME
BMP – BASIC
METABOLIC PANEL
Includes:
Sodium
Potassium
Chloride
Carbon Dioxide
Glucose
Urea Nitrogen
Creatinine
Calcium, total
BNP
BUN
C3 COMPLEMENT
C4 COMPLEMENT
CA 125
CALCIUM, TOTAL
CARBAMAZEPINE
CBC includes:
Hemoglobin
AVAILABLE
E
TUBE
SPECIMEN
FORM
GG
0.2 ml
UH-0140
D
E
D
D
Twice/wk
E
L or l
GG
GG
GG
R
GG
Fill tube
0.1 ml
0.1 ml
0.1 ml
0.5 ml
0.1 ml
Misc
UH-0140
UH-0140
UH-0140
Misc
UH-0140
E
E
R or r
L or l
0.1 ml
Fill tube
UH-0142
UH-0140
Hematocrit
WBC
2013 Laboratory Handbook Final REFERENCE RANGE
133-145 meq/L
3.5-4.8 meq/L
97-110 meq/L
23-30 meq/L
70-109 mg/dL
8-23 mg/dL
0.7-1.2 mg/dL Male
0.5-1.0 mg/dL Female
8.2-9.6 mg/dL
0 -100 pg/mL
6-20 mg/dL
90-180 mg/dL
10-40 mg/dL
0 – 35 u/mL postmenopause
8.4-10.2 mg/dL
8-12 ug/mL
14-18 gm/dL Male
12-16 gm/dL Female
42-52 % Male
37-47 % Female
4,500-11,000/L
Page 58
TEST NAME
AVAILABLE
TUBE
SPECIMEN
FORM
REFERENCE RANGE
CBC cont’d
Platelet count
150,000-450,000/L
RBC, MPV, MCV,
On report
MCH, MCHC, RDW
CBCD includes all
E
L or l
Fill tube
UH-0140
On Report, see also CBC
components of CBC
plus complete
differential
CEA
D
L
0.5 ml
UH-0140
0-3.0 ng/ml
CHLAMYDIA
M-F
For cervical, urethral,
UH-0140
Negative
TRACHOMATIS and/or
and male urine.
NEISSERIA
Collection kits & instructions available in Chemistry C 119
GONORRHOEAE by
PCR
CHLORIDE
E
GG
0.1 ml
UH-0140
97-110 meq/L
CHOLESTEROL,
D
GG
0.1 ml
UH-0140
100-200 mg/dL
TOTAL
CMP D
GG
0.3 ml
UH-0140
See individual tests
(COMPREHENSIVE
METABOLIC PANEL)
Includes: Albumin, total protein, alk. phos, ALT, AST, total bili, calcium, Na, K, Cl, CO2, BUN, creatinine, glucose
CMV IGG ANTIBODY
CMV IGM ANTIBODY
CMV QUANTITATIVE
by PCR
weekly
weekly
Once/
2 wks
2013 Laboratory Handbook Final R / GLD
R / GLD
L
1.5 ml serum
1.5 ml serum
Fill tube
UH-0140
UH-0140
UH-0146
On report
Page 59
TEST NAME
CO2 CONTENT
COOMBS TEST
DIRECT & INDIRECT
CORTISOL
CK
CK-MB
C-REACTIVE
PROTEIN
C-REACTIVE
PROTEIN
High Sensitivity
CREATININE
AVAIL
ABLE
E
TUBE
SPECIMEN
FORM
REFERENCE RANGE
GG
0.1 ml
UH-0140
23-30 meq/L
D
R&L
Fill both tubes
UH-0102
Negative
Twice/
wk
D
D
D
GG
0.1 ml
UH-0140
On report
GG
GG
GG
0.1 ml
0.5 ml
1.0 ml
UH-0140
UH-0140
UH-0140
0-200 u/L
0-6 ng/L
0-5 mg/L
D
GG
1 .0 ml
UH-140
0-3 mg/L
E
GG
0.1 ml
UH-0140
0.7-1.2 mg/dL Male
0.5-1.0 mg/dL Female
CYCLOSPORIN
D
L
Fill tube
UH-0140
CYTOMEGALOVIRUS
Once/wk L
Fill tube
UH-0146
On report
By PCR
D-DIMER
E
B
Fill tube
UH-0140
90-500 ng/mL
DIGOXIN
D
GG
0.1 ml
UH-0140
0.8-2.2 ng/mL
DILANTIN
D
GG
0.1 ml
UH -0140
10-20 g /ml
DRUG SCREEN (urine) D
2 ml urine
UH-0141
Negative
This is a drug screen for clinical purposes; positives are not confirmed by a second method
Includes: amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, methadone, opiates, and phencyclidine
TEST NAME
AVAIL TUBE
SPECIMEN
FORM
REFERENCE RANGE
ABLE
2013 Laboratory Handbook Final Page 60
TEST NAME
EBV IgG & IgM
AVAILA
BLE
TUBE
SPECIMEN
FORM
weekly
R\GLD
1.0 ml serum
UH-0140
REFERENCE RANGE
ELECTROLYTE PANEL E
GG
0.1 ml
UH-0140
See individual tests – Na, K, Cl, CO2
ENTEROVIRUS,
UH-0146
Qualitative by PCR
Other specimens accepted: nasopharyngeal, throat or rectal swab collected in special collection tube.
FACTOR II
M-F
B
Fill tube
UH-0140
60-140%
FACTOR V
M-F
B
Fill tube
UH-0140
60-130%
FACTOR VII
M-F
B
Fill tube
UH-0140
60-150%
FACTOR VIII
E
B
Fill tube
UH-0140
50-166%
FACTOR IX
E
B
Fill tube
UH-0140
74-176%
FACTOR X
M-F
B
Fill tube
UH-0140
64-169%
FACTOR XI
M-F
B
Fill tube
UH-0140
54-198%
FACTOR XII
M-F
B
Fill tube
UH-0140
45-183%
All factor assays are subject to approval by Laboratory Director
FERRITIN
D
GG
0.1 ml
UH-0140
30-400 ng/mL Male
13-150 ng/mL Female 14-60 yr
30-150 ng/mL Female >60 yr
FETAL HEMOGLOBIN Once/wk
L
Fill tube
UH-0140
0.1-2.0%
FIBRIN
E
B or b
Fill tube
UH-0140
<5 µg/mL
DEGRADATION
PRODUCTS
FIBRINOGEN
E
B or b
Fill tube
UH-0140
145-490 mg/dL
FLOW CYTOMETRY
GN/Flo Fill tube/
MISC
See report
(Leukemia/Lymphoma)
D
w
tissue CSF
medium tube
(PNH)
D
L
Fill tube
Misc
See report
2013 Laboratory Handbook Final Page 61
TEST NAME
AVAIL
ABLE
TUBE
FLU A & B
D
FOLIC ACID (folate)
D
SPECIMEN
FORM
REFERENCE RANGE
Nasal washings or swab
MISC
NEGATIVE
GLD
0.1 ml
UH-0140
7.3-26.1 g/mL
0.5 ml
UH-0140
Follicular 3.0-8.1 miu/mL
Luteal
1.4-5.5 miu/mL
Midcycle 2.6-16.7 miu/mL
Postmenop 26.7-133.4 miu/mL
Male:
1.0-12.0 miu/mL
GLD
FOLLICLE STIMULATING HORMONE
(FSH)
M-F
FTA
weekly
R/GLD
1.0 ml serum
Done only on specimens with a positive RPR; lab will do automatically on positive RPR
F
L
Fill tube
UH-0140
Negative
G6PD SCREEN
GAMMA GLUTAMYL
TRANSFERASE
D
GG
0.1 ml
UH-0140
8-61 u/L Male
5-36 u/L Female
GENTAMICIN
D
GG
0.2 ml
UH-0140
Peak 5-10 g/mL
Trough 0-2 g/mL
GLUCOSE
Draw peak 30 min. after IV dose is completed
Draw trough immediately before next dose
E
GG
0.1 ml
UH-0140
Grey top tube for glucose order only
2013 Laboratory Handbook Final 70-109 mg/dL Fasting
Page 62
TEST NAME
TUBE
SPECIMEN
FORM
REFERENCE RANGE
HCG, BETA SUBUNIT
AVAILA
BLE
D
GG
0.1 ml
UH-0140
HDL CHOLESTEROL
D
GG
0.1 ml
UH-0140
HEINZ BODY STAIN
HEMOGLOBIN A1C
HEMOGLOBIN A2
M-F
M-F
Once/wk
L
L
L
Fill tube
Fill tube
Fill tube
UH-0140
UH-0140
UH-0140
Nonpreg female: < or = 5 mIU/mL
Post-men female: < or = 8 mIU/mL
Male: < or = 3 mIU/mL
Pregnancy – from start of LMP:
3 wk 6-71
4 wk 10–750
5 wk 220–7140
6 wk 160–31,800
7 wk 3700–164,000
8 wk 32,100–150,000
9 wk 63,800–151,000
10 wk 46,500–187,000
12 wk 27,800–211,000
14 wk 13,950–62,500
15 wk 12,000–71,000
16 wk 9040–56,500
17 wk 8175–55,900
18 wk 8100–58,200
20 – 23 wk 2200–45,200
36 – 39 wk 3900–43,500
Risk of CHD:
High risk < 40 mg/dL
Moderate risk 40–60 mg/dL
Lowest risk > 60 mg/dL
Negative
4-6%
1.3-3.5%
2013 Laboratory Handbook Final Page 63
TEST NAME
AVAILA
BLE
M-F
TUBE
SPECIMEN
FORM
REFERENCE RANGE
L
Fill tube
UH-0140
100% HbA (normal levels of Hb F &
Hb A2 are included with Hb A)
HEPARIN ASSAY
(Factor Xa)
D
B
Fill tube
Misc
Unfractionated & LMW heparin – 0.30.7 IU/mL
HEPARIN INDUCED
M-F
R
Fill tube
Misc
Negative
THROMBOCYTOPENIA
HEPATITIS A IgM
ANTIBODY
Twice/wk
GLD
0.5 ml
UH-0140
Negative
HEMOGLOBIN
ELECTROPHORESIS
HEPATITIS B CORE
ANTIBODY
HEPATITIS B
SURFACE ANTIBODY
HEPATITIS B
SURFACE ANTIGEN
HEPATITIS C
ANTIBODY
HEPATITIS C VIRUS
by PCR
QUALTITATIVE
HEPATITIS C VIRUS
by PCR
QUANTITATIVE
Done only when the AST is > 45 u/l
D
GLD
0.5 ml
UH-0140
Negative
D
GLD
0.2 ml
UH-0140
Negative
D
GLD
1.0 ml
UH-0140
Negative
D
GLD
0.2 ml
UH-0140.
Negative
Twice/wk
L
Fill tube
UH-0146
On report
Specimen must reach laboratory within 4 hours of collection.
Twice/wk
2013 Laboratory Handbook Final L
Fill
UH-0146
tube
Specimen must reach laboratory within 4 hours of collection.
Page 64
On report
TEST NAME
HEPATITIS C VIRUS
GENOTYPE by PCR &
reverse dot-blot hybridiz.
AVAILA
BLE
Once/
2 wks.
HERPES SIMPLEX –
IgG AB 1 & 2
HIV ANTIBODY
SCREEN
HIV GENOTYPE &
VIRAL LOAD for
antiretroviral resistance
HIV (HIV-1) PROVIRAL
DNA by PCR
QUALTITATIVE
HIV (HIV-1) RNA
QUANTITATION –
VIRAL LOAD
weekly
HIV (HIV-1) RNA
ULTRASENSITIVE
QUANTITATION –
VIRAL LOAD
HIV – Western Blot
Weekly
HOMOCYSTEINE
D
TUBE
SPECIMEN
L
Fill
tube
FORM
UH-0146
REFERENC
E RANGE
On report
Specimen must reach laboratory within 4 hours of collection.
R/Gold
1.5 ml.
UH-0140
M-F
R/Gold
3 ml serum
UH-0140
Western Blot is done automatically if HIV Ab is detected by the screening test.
Once/2 wks
L
Fill
UH–0146 Specified patient
On report
tube
information must be supplied.
Once/
2 wks
L
Twice/wk
L
Twice/wk
L
Fill
tube
UH-0146
On report
Fill
UH-0146
tube
Range: 400-750,000 viral copies
On report
Fill tube
UH-0146
Range: 50-75,000 viral copies
R/GLD/L
GG
UH-0140
1.0 ml
UH-0140
Specimen must be transported on ice.
2013 Laboratory Handbook Final Page 65
Male: 5.5-16.2 µmol/L
Female: 4.4-13.6
TEST NAME
AVAILABLE
TUBE
Once/ 2 wks.
D
D
Cervical swab in special
collection tube, biopsies,
PreservCyt specimen sent for
Pap smear
Cervical swab in special
collection tube, biopsies,
preservCyt specimen sent for
Pap smear
GG
0.1 ml
GG
0.1 ml
UH-0140
Misc
IgG
IgM
IMMUNOFIXATION
Serum
INHIBITOR SCREEN
INTERLEUKIN-2
RECEPTOR
IRON-BINDING
CAPACITY, TOTAL
(TIBC)
IRON
D
D
Twice/wk
GG
GG
GLD
0.1 ml
0.1 ml
1.0 ml
UH-0140
UH-0140
UH-0140
70-400 mg/dL
See report <16 yr.
0-100 Iu/mL (adults)
700-1600 mg/dL
40-230 mg/dL
On report
M-F
Once/wk
B
L
Fill 4 tubes
Fill tube
Misc
UH-0140
On report
1050-4830 pg/mL
D
GG
1.0 ml
UH-0140
250-400 g/dL
D
GG
0.1 ml
UH-0140
KLEIHAUER-BETKE
STAIN
LACTIC ACID
D
L
Fill tube
UH-0140
59-158 g/dL Male
37-145 g/dL Female
≤ 1%
E
GY
1.0 ml
UH-0140
Specimen must be transported on ice
HUMAN PAPILLOMA
VIRUS subtype of high
risk only (by
hybridization)
HUMAN PAPILLOMA
VIRUS subtype of high
and/or low risk groups (by
hybridization)
IgA
IgE
Once/ 2 wks.
2013 Laboratory Handbook Final SPECIMEN
FORM
UH-0146
REFERENCE
RANGE
On report
UH-0146
On report
Page 66
0.5-2.2 meq/L
LAP SCORE
(LEUKOCYTE
ALKALINE
PHOSPHATASE
STAIN)
LEAD
M-F
GN
Fill tube
UH-0140
Score of 32-182
D
TAN
Fill tube
Misc.
<10 g/dL
LDH, TOTAL
D
GG
0.1 ml
UH-0140
120-250 u/L
LDL CHOLESTEROL
D
GG
UH-0140
Calculated from Triglyceride, Cholesterol & HDL Cholesterol
Direct measurement if triglyceride is > 400 mg/dl
AVAILABLE TUBE
SPECIMEN
FORM
TEST NAME
LIPASE
LIPID PROFILE,
includes:
Cholesterol, HDL,
LDL and triglycerides
LITHIUM
LUTEINIZING
HORMONE (LH)
D
D
GG
GG
0.1 ml
0.2 ml
UH-0140
UH-0140
E
M-F
GLD
GLD
0.1 ml
0.2 ml
UH-0140
UH-0140
2013 Laboratory Handbook Final Page 67
<130 mg/dL
REFERENCE
RANGE
13-60 u/L
See individual tests
0.5-1.4 meq/L
Midcycle 9.1- 7.2
miu/mL
Follicular 2.4-6.6
miu/L
Luteal
0.9-9.3
miu/L
Postmenop 10.4-64.6
miu/L
Male
1.1-8.8
miu/L
LYME DISEASE
TOTAL ANTIBODY
LYMPHOCYTE
SUBSETS
MAGNESIUM
MALARIA SMEAR
MEASLES IGG AB
(RUBEOLA)
METHOTREXATE
MONOSPOT
OSMOLALITY
PARATHYROID
HORMONE (PTH),
INTACT
PHENOBARBITAL
PHENYTOIN
PHOSPHORUS
TEST NAME
PLATELET AGGREGATION STUDIES
PLATELET COUNT
POTASSIUM
weekly
R, GLD
1.5 ml serum
UH-140
M-F
L
Fill tube
Misc.
On report
E
E
weekly
GG
L
R, GLD
0.1 ml
Fill tube
1.5 ml serum
UH-0140
UH-0140
UH-0140
1.6-2.5 mg/dL
Negative
M-F
M-Sat
E
GG
R\GLD
GG
0.2 ml
1.0 ml serum
0.1 ml
UH-0140
UH-0140
UH-0140
280-295 mosm/k
E
GLD
0.1 mL
UH-0140
15-65 pg/mL
E
GG
0.1 ml
SEE DILANTIN
GG
0.1 ml
UH-0140
15-40 g/mL
UH-0140
2.5-4.5 mg/dL
TUBE
FORM
REFERENCE
RANGE
On report
E
AVAIL
ABLE
D
SPECI
Fill
UH-0140
tubes 4
Prior consultation with Laboratory Medicine physician required. MUST be scheduled.
Call Hematology lab to schedule patient for platelet aggregation study.
E
L or l
Fill tube UH-0140
150,000-450,000/L
E
GG
0.1 ml
UH-0140
3.5-4.8 meq/L
serum
2013 Laboratory Handbook Final B – four
+ 1L
Page 68
PREGNANCY TEST
Qualitative
E
urine or
R
UH-0141
UH-0140
Negative
GG
1.0 ml
urine or
1.0 ml
serum
0.1 ml
PROLACTIN
D
UH-0140
D
GLD
0.5 ml
UH-0140
4.6-21.4 ng/mL Male
6.0-29.9 ng/mL Female
0-4 ng/mL
PROSTATE SPECIFIC
ANTIGEN (ABBOTT)
PROTEIN C, functional
F
B
Fill tube
UH-0140
60-140%
PROTEIN
ELECTROPHORESIS
PROTEIN, TOTAL
PROTEIN S, functional
PROTHROMBIN TIME
(PT)
QUANTIFERON TB
GOLD
RAPID HIV
Tu, F
GLD
0.5 ml
UH-0140
On report
E
F
E
GG
B
B or b
0.1 ml
Fill tube
Fill tube
UH-0140
UH-0140
UH-0140
6.0-8.3 gm/dL
65-140%
11.7-15.2 sec
REPTILASE TIME
D
TEST NAME
RESPIRATORY
SYNCYTIAL VIRUS
ANTIGEN (RSV)
M-F
D
AVAIL
ABLE
E
2013 Laboratory Handbook Final 3 tubes
Fill tubes Misc.
* Specimens accepted only between 8 AM and 5 PM Monday – Friday
L
Fill
UH-0140
Non-Reactive
tubes
B
Fill
UH-0140
14-22 sec
tube
TUBE
SPECIMEN
REFERENCE
RANGE
1-2 ml nasal
Misc
Negative
washings.
Collect in sterile,
leak-proof container
on ice.
Deliver to lab immediately.
Page 69

RETICULOCYTE
COUNT
RHEUMATOID
FACTOR
E
weekly
R\GLD
ROTAVIRUS ANTIGEN
M-Sat
Negative
RPR
M-Sa
RSV
D
RUBELLA SCREEN
(IgG)
RUSSELL'S VIPER
VENOM TIME,
DILUTED (DRVVT)
M- F
At least 2 gm. of
Misc
feces
Refrigerate until delivered to lab.
R or GLD 1.0 ml
UH-0140
serum
Nasopharyngeal washing, aspirate or swab. Deliver to
lab as rapidly as possible.
R/GLD
1.0 ml
UH-0140
serum
B
Fill
Misc
tube
SALICYLATES
SEDIMENTATION
RATE (ESR)
SICKLEDEX
E
E
GG
L or l
E
L or l
Negative
Male 0-10 mm/hr
Female 0-20 mm/hr
Negative
SIROLIMUS
M-F
L or l
D
2013 Laboratory Handbook Final L or l
Fill
tube
1.0 ml
serum
UH-0140
0.5-2.0%
UH-0140
0.1 ml
Fill
tube
Fill
tube
UH-0140
UH-0140
Fill
tube
Misc.
UH-0140
Page 70
Negative
28-44 sec
AVAIL
TEST NAME
ABLE
SODIUM
E
SUCROSE HEMOLYSIS M-F
TEST
SYPHILIS SEROLOGY
TUBE
SPECI
FORM
REFERENCE
RANGE
133-145 meq/L
No hemolysis
GG
0.1 ml
UH-0140
Call
UH-0140
Laborat
ory
See RPR (serum) or VDRL (CSF)
T3
(TRIIODOTHYRONINE)
T4 (THYROXINE)
FREE T4
TACROLIMUS
D
GG
0.2 ml
UH-0140
0.6-1.6 ng/mL
D
D
D
GG
GG
L
0.2 ml
0.2 ml
Fill
tube
UH-0140
UH-0140
UH-0140
4.5-12.0 g/dL
0.7-1.5 ng/dL
TEGRETOL
TESTOSTERONE
THEOPHYLLINE
THROMBIN TIME
See CARBAMAZEPINE.
Twice/wk
GG
E
GG
E
B
UH-0140
UH-0140
UH-0140
On report
10-20 g/mL
< 21 sec
TOBRAMYCIN
D
0.2 ml
0.1 ml
Fill
tube
0.5 ml
UH-0140
Peak 6-10 g/mL
Trough 0.5-2 g/mL
TOXOPLASMA
ANTIBODIES
IgG & IgM
TRANSFERRIN
TRIGLYCERIDES
TROPONIN I
GG
Draw peak 30 min. after IV dose is completed.
Draw trough immediately before next dose.
D
R
1.5 ml
UH-0140
serum
D
D
D
2013 Laboratory Handbook Final GG
GG
GG
0.1 ml
0.1 ml
0.5 ml
UH-0140
UH-0140
UH-0140
Page 71
200-360 mg/dL
0-200 mg/dL
<0.3 ng/mL
TEST NAME
AVAIL-ABLE
TUBE
SPECIME
FORM
TSH
UNSATURATED IRON
BINDING CAPACITY
UREA NITROGEN
URIC ACID
D
GG
0.2 ml
UH-0140
D
GG
0.1 ml
UH-0140
UH-0140
VALPORIC ACID
VANCOMYCIN
D
D
GG
GLD
0.1 ml
0.1 ml
UH-0140
UH-0140
VARICELLA IGG AB
VDRL
VERIFY NOW
Aspirin
Plavix
VIRAL CULTURE
VITAMIN B12
VITAMIN D 25
VON WILLEBRAND
AG
See BUN.
Draw peak 30 min. after IV dose is completed.
Draw trough immediately before next dose.
M,W,F
R/GLD
1.5 ml
UH-140
serum
M-Sat
CSF
0.5 ml CSF UH-0141
Done only on CSF; RPR done on serum
E
Special B tubes (2
Misc
+discard)
E
Special B tubes (2
Misc
+discard)
Contact Accession Area ext. 4080, 4081
D
GLD
0.2 ml
UH-0140
Weekly
R/GLD
Misc
D
B
Fill tube
Misc
2013 Laboratory Handbook Final Page 72
REFERENCE
RANGE
0.27-4.0 IU/mL
3.4-7.0 mg/dL Male
2.4–5.7 mg/dL Female
50-100 g/mL
Peak 25-40 g/mL
Trough 10-20 g/mL
Non-reactive
See report
See report
211-946 pg/mL
30-100 ng/mL
50-160%
ABBREVIATIONS
Listed are abbreviations used throughout the manual
VACUTAINERS USED FOR BLOOD COLLECTION
B - 7 ml Blue Top Tube - citrate anticoagulant
b - 3 ml Blue Top Tube - citrate anticoagulant
GLD – 3.5 ml Gold Top Tube – serum tube with gel separator
GG – 3 ml Green Top GEL Tube – lithium heparin anticoagulant
GN - 5 or 10 ml Green Top Tube – either sodium or lithium heparin anticoagulant,
Requirement of sodium or heparin is indicated.
sterile -
GY - 2, 4, or 10 ml Gray Top Tube – sodium fluoride glycolytic inhibitor, sterile
L - 5 ml Lavender Top Tube - EDTA anticoagulant
l - 2 ml Lavender Top Tube - EDTA anticoagulant
R - 4 ml Red Top Tube – no preservative, sterile
r - 2 ml Red Top Tube – no preservative
T - 3 ml Tan Top Tube – EDTA anticoagulant
AVAILABILITY
E - Test performed on an emergency (STAT) basis
D - Test is performed daily
S, M, Tu, W, Th, F, Sa - indicates day(s) of the week on which test is performed.
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2013 Laboratory Handbook Final Page 73