Department Of Laboratory Medicine
CELLULAR PATHOLOGY AND MORTUARY
USERGUIDE
2014
Document number: CEL EXDO 612
Author: P Williams
Approved by:Dr M Perenyei
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CONTENTS
Page
HISTOLOGY
Key Personnel and Laboratory Telephone Numbers
5
The Cellular Pathology Request Form
(CELPTHY FRM-KPN-CEL-004)
6
Sample submission/Sample container
7
Histology Service
7
Routine Histopathology
8
Rapid Frozen section service
8
Rapid Processing and Urgent Histopathology
8
Skin Immunofluorescence
8
Lymph Node Analysis
8
MOHs Section
9
The Processing Of Foetuses, Retained Products And Placentas
10
Muscle Biopsies
11
Videoconferencing
12
Multidisciplinary Meetings
12
Digital Macro and Microphotography
12
CYTOLOGY
Key Personnel and Laboratory Telephone Numbers
13
Sample submission/Sample container
14
The LBC Request Form (HMR101)
15
Labelling the Cytology sample
16
Liquid Based Cytology Samples
17 -18
Uncertainty of Measurement
19
Effusions
19
Urines
19
Respiratory Tract Specimens
19
Document number: CEL EXDO 612
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Fine Needle Aspirations
20
Nipple Discharges
20
Aspirates of Breast Cysts
20
Cerebrospinal Fluids and Joint Aspirates
21
ANDROLOGY
Key Personnel and Laboratory Telephone Numbers
22
Semen Analysis for Subfertility
23
Requesting a Semen Analysis
23
Producing the Semen Sample
24
The Semen Analysis Test
25
Results
26
Interpretation of Results
26
Repeat Tests
27
Post vasectomy semen analysis
27
Requesting a Post Vasectomy Analysis
27
Producing the Semen Sample
28
Post Vasectomy Analysis
29
Results
30
Clearance
30
Special Clearance
31
MORTUARY
Key Personnel and Laboratory Telephone Numbers
32-34
General Information
34
Autopsies
34
Retained Products of Conception and Fetuses
35
Deaths
35
Death of a Patient
35-37
Document number: CEL EXDO 612
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Medical Certificate of Cause of Death
37
Post Mortem Examinations
37
Coroners Cases
38
To Report a Death to the Coroner
39
Circumstances when a Death Must be Reported to the
Coroner
39-42
Reporting Deaths Involving MRSA or other Infective Related
Deaths
42
Reporting Obstetric/Neonate Deaths to the Coroner
42
Cremation Certificates
42
Bereaved Relatives
43
List of Referral Centres
Document number: CEL EXDO 612
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INTRODUCTION
The department of Cellular Pathology is centralised on a single site at the William Harvey hospital,
Ashford. It provides diagnostic Histopathology and Cytopathology services.
KEY PERSONNEL & LABORATORY NUMBERS
Head of Service
Dr Miklos Perenyei
01233 616183 (Ext: 723-6183)
Head Biomedical Scientist
Mr Paul Williams
01233 616129 (Ext: 723-6129)
HISTOPATHOLOGY
Subspecialties
Dr Aminu Abdulkadir
Dr Kareem Aboualfa
Dr Salim Anjarwalla
Dr Nipin Bagla
Dr Nicola Chaston
Dr Matthias Koslowski
Dr Charles Lawson
Dr Brigid Maguire
Dr Miklos Perenyei
Dr Doraline Phillips
Dr Konstantinos Skendros
Dr Susanna Szakacs
Dr George Vittay
Dr Cate Wight
Consultants
Lung, Gynae, Soft Tissue,
Perinatal, Urology
Gynae, Lung, Skin, Urology
Upper and Lower GI,
Lung,Cytology, Urology
Lymphoreticular, Upper and Lower
GI,Skin
Upper & Lower GI, Liver, Head and
Neck, Urology, Endocrine
Urology, Gynae, Lower GI
Lymphoreticular, Breast, Head and
Neck, Soft Tissue, Upper GI
Skin
Endocrine, Breast, Upper & Lower
GI, Cytology, Lymphoreticular
Gynae, Breast,Cytology
Liver, Upper and Lower GI, Skin,
Urology
Head and neck, Skin
Upper and Lower GI, Breast,
Cytology, Endocrine
Gynae, Breast,Cytology
Phone number
01233 616184 (Ext: 723-6184)
01233 618058 (Ext: 723-8058)
01233 618034 (Ext: 723-8034)
01233 616605 (Ext: 723-6605)
01233 616015 (Ext: 723-6015)
01233 618035 (Ext: 723-8035)
01233 616014(Ext: 723-6014)
01233 616794 (Ext: 723-6794)
01233 616183 (Ext: 723-6183)
01233 616604 (Ext: 723-6604)
01233 616187 (Ext: 723-6187)
01233 616792 (Ext: 723-6792)
01233 616793( Ext: 723-6793)
01233 618942 (Ext 723-8942)
Chief Biomedical Scientist
Mr Brian Murphy
01233 616253 (Ext: 723-6253)
Results Enquiries
01233 616016 (Ext: 723-6016)
MDM Co-ordinator
01233 616235 (Ext: 723-6235)
Out of hours emergency services (including Bank holidays) are available via the hospital
switchboard
Laboratory
Opening hours
Document number: CEL EXDO 612
Author: P Williams
Approved by: Dr M Perenyei
8.00am – 8.00pm Monday - Friday
9.00am – 5.00pm Saturday – Sunday
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USE OF SERVICE
All specimens must be accompanied by a histology request form CELPTHY FRM-KPN-CEL-004
which is LEGIBLE AND PROPERLY COMPLETED. Essential information includes:-
NHS NUMBER
FULL NAME
DOB
SURNAME
FORENAME
NHS / HOSP NO
DOB
HOSPITAL / WARD
DATE / TIME
SPECIMEN
CONSULTANT/GP
MANDATORY
FIELDS *
SIGNATURE / INITIALS
ADDRESS
GP/SURGERY
SPECIMEN TYPES/SITES
CLINICAL
DETAILS
HIGH RISK STICKER
(IF APPLICABLE)
INSTRUCTIONS FOR SAMPLE SUBMISSION
Document number: CEL EXDO 612
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LABELLING INSTRUCTIONS FOR SAMPLE CONTAINER
Please note:- Accepted printed adhesive labels should never be placed on the container lid.
SAMPLE TYPE
Histology
REQUIRED CONTAINER
Labelled 10%formalin container showing
appropriate hazard warning
Sent to Histology ASAP in a dry labelled
container
Sent to Histology ASAP
One sample in a labelled histology container
One sample in Michels medium (cryotube to
be placed in a clean 60ml sterile container)
Histology - Frozen section
Histology - Skin samples for
immunofluorescence
Histology
MANDATORY Surname and at least one Forename
NHS* Number
Minimum mandatory criteria :-
Date of Birth
Two of these three patient identifiers
Patient's Address (including Postcode)
High Risk sticker (if applicable) - this must not cover patient details
Site of sample
Date/Time of collection
The importance of handwritten labels on specimen containers should be emphasised. Clinics
regularly dealing with multiple samples during a single procedure (i.e. endoscopy, colposcopy, and
prostate biopsy clinics) may consider printed labels which must be created at the time and location
of the procedure. Only data trace labels (or equivalent) are acceptable. Samples identified with
both acceptable printed labels and legible handwritten container labels must be clearly dated,
signed or initialled by the person who took the sample. Pre-printed labels such as addressograph
labels are unacceptable.
The department of Cellular Pathology will carry out site visits to clinics to audit and monitor
adherence to this policy. This activity is required by CPA (Clinical Pathology Accreditation) and the
aim is to standardise specimen labelling throughout the Trust minimising risk.
*NHS number in some cases (e.g. A&E, new born, unregistered, oversees visitors) may not be
available. In these cases hospital number/emergency number may be substituted.
Some patients’ identity may be anonymous (e.g. GUM clinic, blind clinical trials): these patients will
have a coded identifier, and will not have name, address nor NHS/hospital number.
Please ensure that the tops of bottles etc. are securely fastened and not cross threaded to prevent
leakage. High risk specimens should be clearly labelled double bagged and labelled Biohazard.
Any samples failing to meet these acceptance criteria will result in delay and possibly the return of
the sample to the requesting clinician for appropriate labeling.
The range of services offered by the department are as follows:
Document number: CEL EXDO 612
Author: P Williams
Approved by: Dr M Perenyei
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Routine diagnostic Histopathology
Rapid Frozen sections
Rapid processing for urgent histopathology
Skin Immunofluorescence
Lymph node analysis
Mohs sections
Muscle Biopsies
The Processing Of Foetuses, Retained Products And Placentas
Videoconferencing
Multidisciplinary meetings
Digital macro and microphotography
Referral centres
High Risk Specimens e.g. HIV, Hepatitis, TB, nv CJD including all specimens suspected of being
high risk or from patients in a high risk category such as immuno compromised patients must be
clearly labelled with a DANGER RISK OF INFECTION sticker. The nature of the risk MUST BE
CLEARLY stated on the request form. The specimen MUST be sent to the laboratory double
bagged.
Routine Histopathology
Specimens must be placed in an appropriate container with sufficient 10% Formalin to submerge
the specimen. Certain specimens are best preserved with alternative fixatives e.g.
Phaeochromocytoma, testicular biopsies. For information about alternative fixatives contact the
laboratory. Turnaround time for reporting the result:
Diagnostic biopsies 80% expected within 7 working days from collection date.
All histology specimens 80% expected within 10 working days from collection date.
Results are electronically available after authorisation by Pathologist.
Cases for further opinion are always sent to a CPA accredited laboratory.
Rapid Frozen section service
This service offers an immediate diagnosis on specimens from patients who are under anaesthetic
and must be booked at least 24 hours in advance with a Pathologist.
When booking a frozen section with a Pathologist on extn 86016 it is essential to give all patient
details and an indication of the expected time of arrival of the sample.
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The Cryostat is used to cut sections from fresh (unfixed) frozen tissue. Tissue debris collected in
the cryochamber is potentially contaminated with pathogens from any hazard group (see ACDP
guideline).
There is a risk samples will be sent to the laboratory from patients known to be infected
with hazard group 3 pathogens. These samples are not cut as frozen sections in this
laboratory.
Specimens must be sent immediately in a dry container with a properly completed request form.
Please inform the laboratory when the specimen has been despatched.
If at the time of surgery, it is decided not to proceed with the frozen section, please inform the
laboratory.
Urgent specimens including rapid access (other than frozen sections)
A report can be issued on biopsies on the same day if the specimen is received before 11.30am.
This service is by prior arrangement with the Subspecialist Pathologist on extn 86016.
Skin Immunofluorescence
Biopsies for immunofluorescence should be sent to the laboratory in Michels medium which can be
obtained from Histology.
Please inform the laboratory if such specimens are being sent on 01233 616016 ext: 86016
Samples must be received on the same working day.
Lymph Node analysis
Lymph nodes biopsy may be required to establish a diagnosis in cases of:

Infection or Pyrexia of Unknown Origin (PUO)

Unresolved lymphadenopathy

Suspected lymphoma or haematological malignancy

Metastatic disease
In cases of suspected infection or PUO, a full serological work up should be instituted prior to
biopsy. The sample should be divided and part sent fresh to the Microbiology department.
(Typical sample size 0.5 cm³). The remainder of the node should be divided in half and placed in
formalin.
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Appropriate serological work up should be completed before biopsy of unresolved
lymphadenopathy typically to exclude EB virus (monospot), toxoplasma, viral screening and HIV if
appropriate. A fresh sample may be sent if appropriate.
In other cases especially suspected lymphoma or haematological malignancy the sample should
be divided in half along the longest axis and placed in 10% formalin for histological analysis.
Dividing the node allows for better fixation and cell preservation.
Mohs Sections
This service is provided by the laboratory in co-operation with the Consultant Dermatologist and
should always be arranged at least one week in advance at KCH Dermatology unit between 0830
and 1700 hrs. Requirement for service beyond this time requires arrangement with Head BMS
The Processing Of Foetuses, Retained Products And Placentas.
The clinician / midwife should discuss with the Guys Hospital Regional Genetics Centre, the
appropriate samples required from a foetus for cytogenetics investigation. The samples usually
e.g. cord blood and skin must be taken by the clinician / midwife and dispatched to the regional
genetics centre.
The foetus can then be sent to the appropriate department as defined below according to
gestation.
In the case of suspected infection the clinician / midwife must take a swab of placenta and send
promptly to microbiology. Depending on gestation age the foetus and placenta should promptly be
sent via porter to the appropriate department as defined below. Terminations of pregnancy must be
taken from the EAPU or Gynaecology Ward via porter directly to the hospital site mortuary.
Foetus, retained products (suspect or clinical diagnosed products of conception labelled POC) and
placentas not requiring post mortem or foetuses <16 weeks
Send directly from the EPAU or gynae ward in an appropriate sized specimen container with
sufficient 10% formalin to the histology department at the William Harvey Hospital via the
pathology specimen reception at each site. It must be accompanied by a completed histology
request form clearly stating whether an external examination of the foetus is required, and / or
histopathological examination of the placenta. The form must clearly state:
Patient’s Name
NHS/Hospital Number
Time event took place and Date
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Signature Of Doctor
Ward
Consultant Name
Date of Specimen
Clinical Details
The Method and Date of Disposal
The pot must also bear a completed label included patient’s name, DOB, hospital number, what
the specimen is (labelled POC if retained products), the date the event took place. A certificate
must accompany the specimen that includes:
Name of Patient
NHS/Hospital Number
Time event took place and Date
Signature of Nurse or Doctor certifying products of conception < 24 weeks gestation
This certificate must accompany the specimen until final collection for disposal. If the specimen
consists of retained products from a live birth it should be stated in the clinical details as ‘’post
partum’’ and therefore does not require a certificate. Inform the porters who will transfer the
specimen in a pot with formalin to pathology reception. Specimens from QEQM and KCH will be
transported to the histopathology department at the William Harvey site in a secure transport
container via the pathology specimen transport system.
The laboratory staff will allocate a histology specimen number to the request form and specimen
pot(s). A signed duplicated POC certificate should accompany products of conception.
Please refer to: East Kent Hospitals NHS Trust Procedure For The Management Of Early And MidTerm Pregnancy Loss (Under 24 Weeks Gestation) Policy which is available on Sharepoint.
Muscle Biopsies
Protocol for sending to Neuropathology department, King’s College Hospital, London.
Tel no: 9020 3299 1951 or 020 3299 1957
This protocol applies to both open and needle biopsies. The Neuropathology department at
King’s College Hospital, London should be contacted to arrange mutually suitable times for
the biopsy to be taken. Tel no: 9020 3299 1951 or 020 3299 1957
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On removal from the patient, the muscle tissue should be placed in a dry specimen pot. A piece of
dampened gauze should be placed in the pot also to create a humid atmosphere. This should not
actually touch the tissue.
(Open muscle biopsies may be stretched by applying sutures at either end and attaching them to
dental wax, but this is not essential).
The biopsy and relevant patient data should then be urgently dispatched to Neuropathology, King’s
College Hospital, London with a request form noting of the time that the biopsy was taken.
Neuropathology, King’s College Hospital, London should then be contacted to be told the
estimated arrival time of the biopsy. Tel no: 9020 3299 1951 or 020 3299 1957
Videoconferencing
This service provides microscope images from the Cellular Pathology Department at the WHH site
to remote stations including Queen’s Centre for Clinical Studies, QEQM Hospital, Margate, Kent
and Canterbury Hospital and also Oncology at Maidstone Hospital. Use of this equipment is
arranged at least one week in advance with the multidisciplinary meetings secretary on ext: 84235
Multidisciplinary Meetings
The list of patient cases to be discussed is compiled one week in advance by co ordination with
Meeting Secretary on ext: 84235. Pathologist representation at every meeting is provided via
videoconferencing or by a Pathologist attending in person. Late inclusion of patient cases is
possible up to midday two working days prior to a forthcoming meeting by arrangement with the
departments MDM coordinator on ext: 84235
Digital Macro and Microphotography of Surgical Specimens.
This facility is available to clinicians for clinically important cases. This can be arranged through
the multidisciplinary meeting, sub specialist Pathologist or stated on the Histology request form
Document number: CEL EXDO 612
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CYTOLOGY
INTRODUCTION
The department of Cellular Pathology is centralised on a single site at the William Harvey hospital,
Ashford. It provides diagnostic Histopathology and Cytopathology services.
KEY PERSONNEL & LABORATORY NUMBERS
Head of Service
Dr Miklos Perenyei
Diagnostic Cytopathologists Dr George Vittay
01233 616183
(Ext: 723-6183)
01233 616793
(Ext: 723-6793)
Dr Miklos Perenyei
01233 616183
(Ext: 723-6183)
Dr Salim Anjarwalla
01233 618034
(Ext: 723-8034)
Dr Doraline Philips
01233 616604
(Ext: 723-6604)
Dr Cate Wight
01233 618942
(Ext: 723-8942
Head Of Gynaecological
Cytology
Dr Matthias Koslowski
01233 618035
(Ext: 723-8035)
Chief Biomedical Scientist
Mrs Shirley Moses
01233 616016
(Ext: 723-6016)
Cytology Office For Results /
Enquiries
01233 633331
(Ext: 723-8628 or 723-4233)
Out of hours emergency services (including Bank holidays) are available via the hospital
switchboard
Laboratory
Opening hours
Document number: CEL EXDO 612
Author: P Williams
Approved by: Dr M Perenyei
8.00am – 8.00pm
9.00am – 1.00pm
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Monday – Friday
Saturday
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GENERAL INFORMATION
The following information although comprehensive may not cover all eventualities, and when any
doubt exists as to the optimum way in which a sample should be collected and sent to the
laboratory please telephone the laboratory for instructions BEFORE THE SPECIMEN IS
OBTAINED.
Fixative, special containers and transport boxes, if required are obtainable from the laboratory on
request.
INSTRUCTIONS FOR SAMPLE SUBMISSION
SAMPLE TYPE
Gynae cytology(Liquid based Cytology)
Non gynae fluids
Non gynae slides
REQUIRED CONTAINER
LBC container labelled prior to leaving the
patient using the information confirmed during
the positive patient identification process
Labelled sterile container(25ml or 60ml)
Slides labelled with patient Name, Date of
Birth and site of specimen
LABELLING INSTRUCTIONS FOR REQUEST FORM
Non Gynae Cytology and Andrology.
Complete the request form CELPTHY FRM-KPN-CEL-004 for The same acceptance criteria
applies as in the Histology section. Please see page 5
Gynae Cytology. Complete the request form HMR101. In addition to the above the request form
must state Smear Taker’s ST No and signature and also indicate Source of Smear, Reason for
Smear, LMP, Last Smear Date, Previous History,
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FULL NAME, ADDRESS
DOB
NHS NUMBER
NAME AND ADDRESS OF SENDER IF NOT
GP
PRACTICE NAME AND ADDRESS
PLEASE COMPLETE BOXES 13-20. HIGH RISK
STICKER MUST BE APPLIED (IF APPLICABLE)
BOX 20 – ST NUMBER
BOX 20 – ST NUMBER AND SIGNATURE MUST BE
INCLUDED
BOX 21 – 24 FOR LABORATORY USE ONLY
BOXES 8 AND 9 - PLEASE USE THIS BOX FOR LOCAL CODES
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LABELLING INSTRUCTIONS FOR SAMPLE CONTAINER
Please note:- Accepted printed adhesive labels should never be placed on the container lid.
LBC Samples and Non Gynae Cytology Fluids
MANDATORY Surname and at least one Forename,
NHS* Number
Minimum mandatory criteria :-
Date of Birth
Two of these three patient identifiers
Patient's Address (including Postcode)
High Risk sticker (if applicable) - this must not cover patient details
Sign/Initial
Date/Time of collection
Site of sample (Non Gynae Cytology Fluids)
Criteria for Sample Acceptance – Non Gynae Slides
Minimum mandatory criteria:- All patient identifiers
Surname and at least one Forename,
Date of Birth
Site of Sample
Criteria for Sample Acceptance – Non Gynae Slide Boxes
MANDATORY Surname and at least one Forename,
NHS* Number
Minimum mandatory criteria :-
Date of Birth
Two of these three patient identifiers
Patient's Address (including Postcode)
High Risk sticker (if applicable) - this must not cover patient details
The importance of handwritten labels on specimen containers should be emphasised. Clinics
regularly dealing with multiple samples during a single procedure (i.e. endoscopy, colposcopy, and
prostate biopsy clinics) may consider printed labels which must be created at the time and location
of the procedure. Only data trace labels (or equivalent) are acceptable. Samples identified with
both acceptable printed labels and legible handwritten container labels must be clearly dated,
signed or initialled by the person who took the sample.Pre-printed labels such as addressograph
labels are unacceptable.
The department of Cellular Pathology will carry out site visits to clinics to audit and monitor
adherence to this policy. This activity is required by CPA (Clinical Pathology Accreditation) and the
aim
is
to
standardise
Document number: CEL EXDO 612
Author: P Williams
Approved by:Dr M Perenyei
specimen
labelling
throughout
the
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Trust
minimising
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*NHS number in some cases (e.g. A&E, new born, unregistered, oversees visitors) may not be
available. In these cases hospital number/emergency number may be substituted.
Some patients’ identity may be anonymous (e.g. GUM clinic, blind clinical trials): these patients will
have a coded identifier, and will not have name, address nor NHS/hospital number.
Any samples failing to meet these acceptance criteria will result in delay and possibly the return of
the sample to the requesting clinician for appropriate labeling.
*NHS number in some cases (e.g. GUM, A&E, new born, unregistered, oversees visitors) may not
be available. In these cases hospital number/emergency number/special code may be used.
Please ensure that the tops of bottles etc. are securely fastened and not cross threaded to prevent
leakage. High risk specimens should be clearly labelled double bagged and labelled Biohazard.
Each specimen must be accompanied by the correct completed request form, CLEARLY
LEGIBLE.
For all gynae specimens the request form HMR101 must be used
For all non gynae specimens the Kent and Medway Cellular Pathology request form must be
used.
In the case of cervical samples each request must include the full postal address of the woman
and the full postal address of her GP. The smear takers number and signature must be
included on the request form. Samples will be rejected by practitioners who do not hold a
valid sample taker number
Request form HMR101 must be used and all demographic, clinical and personal details must
be completed on the form and include previous smear report if abnormal.
The request form accompanying a High Risk specimen must show a biohazard sticker and the
precise hazard must be clearly stated (e.g. Hepatitis B etc)
Cervical Samples (LBC)
Sample taking kits are available from the laboratory including request forms, vials of fixative,
sample bags and sample taking devices (cervex brush).
The brush should be rotated 5 times through 360º in the cervical os. Add the sample to the fixative
by agitating the brush against the bottom of the vial 10 times. DO NOT detach the brush head into
the vial. Secure the lid firmly. Ensure the vial is labelled with the patients details in ink.
All samples must be accompanied by a fully completed cytology request form signed by the
sample taker and indicating their sample taken number.
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Indicate on the request form if the cervix was not visualised, also mention whether a vault or
vaginal sample was taken.
In some instances an endocervical brush may be used. It is important to state clearly if a specimen
has been obtained using an endocervical brush rather than a cervical brush. For routine smears
when both cervix and endocervical brushes are used the cervical brush sample should be taken
first. Material from both devices should be placed in the same vial. Non- water based lubricants
must not be used as they can lead to an inadequate sample report. Contact the laboratory for
further details on the use of lubricants if required.
Dispatch to laboratory without delay.
The patient’s GP and/or sample taker are informed of the result by the laboratory. The patient is
informed of the result by the Kent Primary Care Agency.
98% of results are available within 14 days.
Human Papilloma Virus (HPV) Testing
The aetiological role of Human Papilloma Virus (HPV) in the development of cervical cancer is well
established. The NHSCSP has therefore introduced additional High Risk (HR) HPV testing on
selected cervical cytology samples which has the benefit of fast tracking women at risk for
treatment and also reduces unnecessary repeat tests.
HPV Triage
The HPV triage test is performed on routine cervical samples showing a low grade cytological
abnormality. This includes borderline changes and mild dyskaryosis. A negative (not detected)
HPV test allows a woman to return to normal recall whereas a positive (detected) HPV test initiates
a referral to colposcopy.
HPV Test of Cure
The HPV Test of Cure (ToC) is performed on samples taken following large loop excision of the
transformation zone (LLETZ) treatment for an abnormality. Negative samples and those showing
low grade abnormalities (borderline changes and mild dyskaryosis) are tested. A negative (not
detected) HPV test allows a woman to have a repeat test in 3 years before her return to normal
recall. A positive (detected) HPV test returns the woman to colposcopy for further investigation.
Histologically proven CGIN and women with invasive or micro invasive disease are excluded from
the ToC protocol.
Document number: CEL EXDO 612
Author: P Williams
Approved by:Dr M Perenyei
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Uncertainty of measurement
In cervical cytology the examination of the sample is used to indicate the presence or absence of
disease. Where biological variation in samples occurs, this can lead to difficulties in interpreting
results. Where there is genuine doubt as to whether cells changes are abnormal an equivocal
report ‘Borderline changes’ is issued. This report will initiate either an HPV test on the original
sample to aid patient management or a repeat test.
Within the NHSCSP the sensitivity and specificity of the test is well understood and documented.
All laboratories and screening individuals are monitored and expected to achieve sensitivities in
excess of 90% for all abnormalities and more than 95 % for high grade abnormalities
Diagnostic (Non-gynaecological) Samples
Effusions
Fluid should be sent to the laboratory in a labelled sterile container.
DO NOT send the specimen in a catheter drain bag.
Ideally 20ml of fluid should be collected particularly where malignancy is suspected so that
immunohistochemistry, if necessary, can be performed. The specimen should be sent to the
laboratory immediately. If collected at the weekend, the specimen should be kept in a refrigerator
at 4ºC.
Urines
Voided urine should be sent from the second urine of the day, a catheter specimen or mid stream
specimen is not satisfactory for cytological investigation.
If the only specimen which can be obtained is a catheter, post cystoscopic or ileal conduit, it must
be clearly stated on the request form.
Urine must be collected into a labelled 25ml sterile container (not boric acid preservative) and sent
to the laboratory immediately whilst fresh as cell morphology deteriorates rapidly in voided urine
and specimens more than a few hours old maybe unsatisfactory for cytological assessment.
Refrigerate if a delay in transportation is anticipated.
Respiratory Tract Specimens
Sputum: Early morning specimens should be sent fresh to the laboratory. Specimens should be
collected on three consecutive days if carcinoma is suspected. Check the quantity is adequate
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and sputum is not contaminated with food, saliva, tobacco or toothpaste. A specimen after
physiotherapy or postural drainage is very useful
Bronchial Brush/Touch Preparation: Smears made from bronchial brushing/biopsies should be
spread evenly and quickly on clean glass slides clearly labelled in pencil with the patient details
shown in the table on page 13. The slides should be immediately air dried and placed into the slide
transport box.
Broncho alveolar lavages / induced sputum: These specimens should be taken into a labelled
sterile containers and sent immediately to the laboratory (double bagged if known as a High Risk
specimen). .
Fine Needle Aspirates (FNA)
Appropriate for palpable lumps in breast, thyroid, salivary gland and superficial lymph nodes,
subcutaneous skin nodules and for imaging guided non palpable lesions. The sample must be
spread onto clean slides that have been clearly labelled with the patient details shown on page 13.
These labelled slides should be air dried, put into plastic slide mailer boxes and sent to the
laboratory with completed accompanying request form. There are “one stop” breast and head and
neck clinic sessions provided at Kent and Canterbury Hospital, Queen Elizabeth the Queen Mother
Hospital (QEQM) and William Harvey Hospital (WHH) sites.
Nipple Discharge
The discharge should be smeared on to a slide clearly labelled with the patient details shown in the
table on page 13, and air dried immediately.
Aspirates of Breast Cysts
The aspirate should be transferred to a labelled sterile container, or if less than 0.5 ml placed
directly onto a glass slide labelled in pencil with the patient details shown in the table on page 13,
then air dried. Fixative is not necessary.
CSF
Send as much of the specimen as can be spared to the Cytology and Microbiology laboratory, in a
labelled sterile container.
If there is unavoidable delay in sending a fresh specimen to the laboratory, it should be stored at
4º C. CSF investigations for Leukaemia should be suitably marked.
Joint Aspirates
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Joint aspirates requiring crystal identification should be collected into a clearly labelled sterile
container.
Results:
Urgent samples: from sample receipt 24 hours (excluding weekends)
Non urgent samples: from sample receipt 7 days (excluding weekends)
Document number: CEL EXDO 615
Author: S Moses
Approved by:P Williams
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ANDROLOGY
INTRODUCTION
Andrology in East Kent and Maidstone is carried out in the Cytology Department of the William
Harvey Hospital (WHH), Ashford and at Queen Elizabeth the Queen Mother Hospital (QEQM),
Margate.
KEY PERSONNEL & LABORATORY NUMBERS
Clinical Lead
Dr Matthias Koslowski
01233 618035
Chief Biomedical Scientist
Mrs Shirley Moses
01233 616016
Results Enquiries
01233 633331 (Ext: 723-1857 or
723-4233)
Availability of Service for Post Vasectomy Samples
This service is available on any weekday Monday – Friday (excluding Bank Holidays)
Samples can be taken to Pathology Reception at any of the following hospitals at the times
indicated:
William Harvey Hospital, Ashford
8.30 – 17.00
Queen Elizabeth the Queen Mother Hospital, Margate
8.45 - 15.45
Kent and Canterbury Hospital, Canterbury
8.30 - 16.00
Availability of Service for Subfertility Samples:
Please note that patients with High Risk samples (Hepatitis, HIV) must go to the William
Harvey Hospital for their semen analysis.
Please ensure that the patient is aware that they can take samples to Pathology Reception at the
following hospitals at specified times only (excluding Bank Holidays).
Queen Elizabeth the Queen Mother Hospital – Wednesday 8.30am to 2pm by appointment
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SEMEN ANALYSIS FOR SUBFERTILITY
Approximately 1 in 6 couples have difficulty conceiving and are referred for infertility investigations.
The single most common cause of infertility is sperm dysfunction, which is apparent in
approximately 30% of the men referred for analysis. A high quality Andrology service is therefore
essential for correct management of the male patient. Staff in the East Kent Hospitals University
Trust are fully trained scientists and are highly proficient in performing quality diagnostic semen
analyses in line with current World Health Organisation and Association of Biomedical Andrologist
guidelines. Currently we perform some 1200 semen analyses a year for infertility investigation. The
laboratories conduct regular internal and external QC and participate in the National External Quality
Assurance scheme for Andrology.
REQUESTING A SEMEN ANALYSIS
Please provide the patient with the following:

Request form containing Patients full name, address with postcode, date of birth, partners
name, NHS number (if known) clinical information and reason for request (infertility/ reversal
of vasectomy). Please indicate requesting clinician’s name and location.
Patients that are known to be an infection risk must have their forms clearly labelled.
Please note that due to a change in facilities in the laboratory at Queen Elizabeth the
Queen Mother Hospital samples from known High Risk (Hepatitis, HIV) patients can no
longer be handled. These patients will need to go to the William Harvey Hospital for
their semen analysis.
Patients should be advised that they must bring the request form with them
when
delivering the specimen pot to the laboratory.

Patient instruction sheet. Please ensure that the patient is aware of the different
opening times for the following laboratories:
Queen Elizabeth the Queen Mother Hospital – Wednesday 8.30am to 2pm
An appointment must be booked for this test by ringing the blood test appointment
line on 01843 23500 (It is essential to ask for a semen test). Appointments are
available at 45 minute intervals.
William Harvey Hospital - Monday and Wednesday 8.30am to 1pm
- Friday 8.30am to 5pm.
No appointments are needed at the William Harvey Hospital
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A wide mouthed 60ml specimen pot that has a CE mark (This is marked on the label by the
manufacturer to indicate that it is fit for purpose). Please ensure that the patient is aware
that they must label the pot in ink with their full name and date of birth as well as
indicating the date and time of emission.

Specimen bag.
PRODUCING THE SEMEN SAMPLE
PLEASE NOTE THAT FACILITIES ARE NOT AVAILABLE TO PRODUCE SEMEN SAMPLES AT
HOSPITALS WITHIN THE EAST KENT HOSPITALS UNIVERSITY TRUST

Prior to producing the sample the patient must have abstained from sexual intercourse/
masturbation for at least 2-3 days and no more than 7 days.

He must be hygienic and wash his hands and genital area. Make sure that all soap is
washed off as this will kill sperm.

Check that the pot is free of cracks as leaking samples will be rejected.

He must only use the pot supplied by his GP/Clinic as inappropriate pots will be rejected.

The sample must be produced by masturbation directly into the clean plastic pot supplied by
his doctor/consultant. It is important that the entire sample is collected in order that an
accurate analysis can be carried out. The use of lubricants such as K-Y jelly must be
avoided. Samples produced by the withdrawal method or into an ordinary condom are
unsuitable for analysis.

Ensure that the pot lid is tightly screwed up as if the pot leaks in transit it will not be analysed.
Labelling the pot and completing the patients section of the request form.
It is essential that the following information is written in ink on the label of the pot.

Full name of patient (first name and surname).

Date of birth

Date of collection

Time of collection

Home postcode (as a patient identifier)

Please add your initials at the bottom of the label to indicate that the information is correct.
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Fill in the patients section at the back of the instruction sheet to confirm that the complete
sample has been collected and that the appropriate period of abstinence (sexual intercourse
/ masturbation) has been carried out.

This section should be torn off and attached to the request form.
What if the patient has problems collecting the sample?
Be re-assured that when most men get over the initial embarrassment they usually manage to
provide a specimen. However, for those who still can't, or have some religious or cultural objection,
we can provide a non-spermicidal condom for specimen collection. If the patient needs to request
one of these condoms please ask them to ring 01233 616016 and ask for Shirley Moses or
Josephine Coglan
Delivery of the Specimen

Sperm are sensitive to temperature and the semen sample must therefore be protected from direct
sunlight or extremes of cold. In order to keep the sample as close to body temperature as possible
it is best to carry it close to the body, ideally in an inside pocket.

The sample must reach the laboratory as soon as possible after production. Ideally this should be
within 1 hour, but patients travelling greater distances are allowed up to 2 hours from the time of
production.
Rejection of Specimens for Infertility Investigation
The laboratory will reject any specimen that is:

Not produced into an appropriate container.

Produced into an unlabelled container.

Found to have leaked in transit.

Delivered to any hospital other then the William Harvey Hospital or sent via the hospital or GP
transport.

Delivered at a time/day other than those specified.

Received without a request form.
THE SEMEN ANALYSIS TEST
We examine the semen sample for a number of important factors according to the World Health
Organisation Guidelines 2010.
Document number: CEL EXDO 615
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Sperm Concentration
Sperm count in millions per ml of semen. Normal samples have over 15 million per ml or 39 million for the
whole ejaculate.
Sperm Motility
Sperm are graded according to their ability to swim. Sperm that swim in a progressive manner are graded
as having rapid or sluggish motility.
Normal samples should contain at least 32% progressive sperm and
at least 40% motile sperm (progressive and non progressive) at 1 hour.
Sperm Morphology
The shape and size of the sperm are assessed on a stained preparation. The normal value in a fertile
population is 4% or above.
Vitality Test
This test is included in results where the number of immotile sperm are greater than 60%. It is a
staining technique that will identify if the immotile sperm are dead or just immotile and is reported
as a percentage vitality. The normal value is 58% or above
RESULTS
A written report is sent back to the referring practitioner within 7 – 10 working days. If further copies are
needed to forward onto other practices/ clinics please make a note on the original request form.
Patients should be made aware that they cannot receive the result directly from the laboratory.
If a report is required for a specific appointment date, this should be stated on the request form to allow
the report to be fast tracked.
INTERPRETATION
Although there are strict guidelines for the measurement and quality control of semen variables they are
not an absolute guide to a man’s fertility and no one parameter should ever be considered in isolation
unless he has no sperm at all. Procedural errors are minimised by standardised methods of collection,
analysis and reporting, therefore it is essential that the patient understands the instructions prior to
production of the sample.
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The overall balance of the sample is much more indicative of fertility potential and should be considered
alongside any investigations of the female partner. For example the term low sperm count is ambiguous
and is often misinterpreted by the patient. His count may be rather low but an increased motility may be
sufficiently high enough to compensate for any shortfall.
The following table shows the distribution of values for semen parameters from men whose
partners became pregnant within 12 months of discontinuing contraceptive use. WHO 2010
Parameter (units)
1941
1859
2.5
1.2
9
5
1.5
15
10
2.0
22
25
2.7
41
Centile
50
3.7
73
75
4.8
116
90
6.0
169
95
6.8
213
97.5
7.6
59
1859
23
39
69
142
255
422
647
802
928
1780
1778
1863
1851
428
28
1
19
3
53
32
1
22
4
58
39
2
25
5.5
64
47
3
31
9
72
55
5
39
15
79
62
9
46
24.5
84
69
15
54
36
88
72
18
59
44
91
75
22
65
48
92
N
Semen volume (ml)
6
Sperm concentration (10 per ml)
6
Total sperm number (10 per
ejaculate)
Progressive motility (PR, %)
Non-progressive motility (NP, %)
Immotile spermatozoa (IM, %)
Normal forms (%)
Vitality (%)
REPEAT TESTS
If any of the factors tested are below the normal range it is advisable to repeat the semen analysis test.
Abnormalities in the sample can occur for a number of reasons eg patient did not collect the whole
sample. In addition illness, stress or medication can also affect sperm quality. Confirmation of a true
sperm problem may require a second test.
POST VASECTOMY SEMEN ANALYSIS
Sperm tests to confirm the success (or otherwise) of a vasectomy operation are absolutely essential.
Patients are required to produce a sample of seminal fluid at 18 WEEKS, 22 WEEKS and possibly
an additional test at 28 WEEKS following vasectomy.
REQUESTING A POST VASECTOMY SEMEN ANALYSIS
Please provide the patient with the following:

Request form containing Patients full name, address with postcode, date of birth, NHS
number, reason for request and date of vasectomy. Please indicate requesting clinician’s
name and location.

(Patients that are known to be an infection risk must have their forms clearly labelled).
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Patients should be advised that they must bring the request form with them when delivering the
specimen pot to the laboratory. The patient declaration section at the end of the instruction sheet
must be completed to indicate whether the complete sample was collected. This must be attached
to the request form

Patient instruction sheet. This will give details of the times that samples can be delivered to
the nearest hospital to the patient.

Please ensure that the patient is aware that they must label the pot in ink with their full
name, date of birth and home post code as well as indicating the date and time of
emission.
Please note that the service is available Monday to Friday (excluding Bank Holidays)

Samples can either be brought directly to Pathology Reception at the William Harvey
Hospital, Ashford between 8..45am and 5.00pm or taken to Pathology reception at the times
specified for each of the other hospitals:

Queen Elizabeth the Queen Mother Hospital, Margate
8.45am- 3.45pm
Kent and Canterbury Hospital, Canterbury
8.30am- 4.00pm
A wide mouthed 60ml specimen pot that has a CE mark (This is marked on the label by the
manufacturer to indicate that it is fit for purpose)

Specimen bag
.
PRODUCING THE SEMEN SAMPLE
PLEASE NOTE THAT FACILITIES ARE NOT AVAILABLE TO PRODUCE SEMEN SAMPLES AT
HOSPITALS WITHIN THE EAST KENT HOSPITALS TRUST

He must be hygienic and wash his hands and genital area. Make sure that all soap is
washed off as this will kill sperm.

Check that the pot is free of cracks as leaking samples will be rejected.

He must only use the pot supplied by his GP/Clinic as inappropriate pots will be rejected.

The sample must be produced by masturbation directly into the clean plastic pot supplied by
his doctor/consultant. It is important that the entire sample is collected in order that an
accurate analysis can be carried out. The use of lubricants such as K-Y jelly must be
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Approved by:Dr M Perenyei
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avoided. Samples produced by the withdrawal method or into an ordinary condom are
unsuitable for analysis.

Ensure that the pot lid is tightly screwed up as if the pot leaks in transit it will not be analysed.
Labelling the pot and completing the patients section of the request form.
It is essential that the following information is written in ink on the label of the pot.
Full name of patient (first name and surname).
Date of birth
Date of collection
Time of collection
Home postcode
Please add your initials at the bottom of the label to indicate that the information is correct.
Fill in the patients section at the back of the instruction sheet to confirm that the complete sample
has been collected. This section should be torn off and attached to the request form.
Delivery of the Specimen
Sperm are sensitive to temperature and the semen sample must therefore be protected from direct
sunlight or extremes of cold. In order to keep the sample as close to body temperature as possible it is
best to carry it close to the body, ideally in an inside pocket.
The sample must reach the laboratory as soon as possible after production. This should be on the day of
production.
Rejection of Specimens for Post Vasectomy Investigation

The laboratory will reject any specimen that is:

Not produced into an appropriate container.

Produced into an unlabelled container.

Found to have leaked in transit.

Received without a request form.

Produced earlier than 16 weeks after vasectomy.
POST VASECTOMY ANALYSIS
Document number: CEL EXDO 615
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The semen sample is initially examined as a direct wet preparation and any spermatozoa present in a
10ul aliquot are counted and the result per ml of sample is calculated. Due to the delays between time of
emission and examination there is no comment for non- motile sperm. There is no guarantee that nonmotile sperm were always non- motile and therefore a comment is only made if there are motile sperm
present.
If sperm are not seen in the original preparation a portion of the sample is centrifuged at high speed to
produce a pellet and this provides a concentrate of the original sample. An aliquot of this concentrate is
analysed for the presence of sperm and if any sperm are counted the result per ml of original sample can
be calculated. Samples found to have very high counts and motile sperm will be analysed as infertility
specimens.
The test will be based on the numbers of spermatozoa. The presence of large number of
spermatozoa may indicate a failed surgical procedure/ recanalisation. This is an infrequent event
which will need to be confirmed by a sample delivered to the laboratory within 2 hours. The
laboratory will advise the need for a repeat sample or re referral to the surgeon.
RESULTS
Reports will record the absence of sperm as:NO SPERMATOZOA SEEN IN A CENTRIFUGED DEPOSIT
Reports will record the presence of sperm as:SPERM CONCENTRATION – ie Number of sperm per ml
TOTAL COUNT – ie Number of sperm per ml x volume of semen
Only sperm concentrations greater than 10,000 spermatozoa per ml are significant.
CLEARANCE
Will require either 2 samples with ‘No spermatozoa seen’ or 1 sample with ‘No spermatozoa seen’
and another with ‘Less than 10,000 spermatozoa per ml
This will be adequate to confirm vasectomy. The laboratory will include in the report that no further
samples are required.
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SPECIAL CLEARANCE
Evidence based studies have shown that in a small minority of men non-motile spermatozoa persist
after vasectomy. In such cases special clearance may be given if less than 10,000 spermatozoa per
ml are seen in a sample examined at least 28 weeks after vasectomy.
If all three samples (at 18, 22 and 28 weeks) show the presence of non motile sperm in
concentrations of less than 10,000 spermatozoa per ml special clearance should be given to the
patient by the doctor/ surgeon who performed the vasectomy.
In these cases the report will read:–
PERSISTENT RARE (< 10,000 spermatozoa/ml) SPERMATOZOA PRESENT. ADVISE SPECIAL
CLEARANCE. NO FURTHER SPECIMENS REQUIRED.
If you have any further queries or have any problems regarding the production and delivery of your
semen sample please contact us on 01233 633331 (Ext: 88628 or 84233
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MORTUARY
INTRODUCTION
The department of Cellular Pathology currently provides a hospital and public mortuary service on
three East Kent hospital sites. These include Kent and Canterbury, Queen Elizabeth the Queen
Mother, and William Harvey hospitals.
KEY PERSONNEL & LABORATORY NUMBERS
Lead Pathologist/
Designated Individual
Dr Miklos Perenyei
01233 616183
(Ext: 723-6183)
Deputy Lead
Dr Nicola Chaston
01233 616793
(Ext: 723-6793)
Lead Anatomical Pathology
Technician
Mr Adam Berry
01233 616606
(Ext: 723-6606)
Lead Pathologist for perinatal
Investigations
Dr Aminu Abdulkadir
01233 616184
(Ext: 723-6184)
Head Biomedical Scientist
Mr Paul Williams
01233 616129
(Ext: 723-6129)
Opening hours
William Harvey Hospital
7.30 am – 4.00pm
Monday-Friday
Queen Elizabeth the Queen Mother Hospital
7.30 am – 4.00pm
Monday-Friday
Kent and Canterbury Hospital
8:00 am – 4.00pm
Monday-Friday
(Access outside these hours covered by portering services)
Advice may also be obtained from the Consultant Histopathologists
Contacting the On Call Mortuary Technicians out of normal working hours is done via the hospital
switchboard.
Viewings/ID’s by Police and/or Next of Kin will require prior arrangement with Mortuary staff or the On
Call Technician.
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Contacts
Kent and Canterbury Hospital
Relative Support Office
01227 766877
(Ext: 722-4112)
Queen Elizabeth the Queen Mother Hospital
Relative Support Office
01843 225544
(Ext: 725-3459)
William Harvey Hospital
Relative Support Office
01233 633331
(Ext: 723-8206)
Senior Chaplain Rev. Christopher White
01843 225544
(Ext: 725-2578)
07717540972
Alternatively
Coroner’s Office
Ashford, Dover and Folkestone telephone:
01233 896242
Alternatively
07876356620
01233 896172
Alternatively
07879481594
01233 896171
Alternatively
07740185247
Canterbury and Margate telephone:
03000 410 603
Maidstone telephone:
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General Information
The three mortuaries each provide cold body storage. Autopsies are presently performed at Queen
Elizabeth the Queen Mother Hospital and William Harvey Hospital mortuaries.
Identification of deceased in the mortuary
Identification of the deceased with the Notification of Death sheet must accompany the deceased.

Patient identification labels should have been placed onto the deceased by the ward and must
have at least two identification means i.e. full name, date of birth and ward or first line of
address.

Any property and valuables must be checked and recorded.
A body that is known to be at risk of infection of a category 3 or 4 disease, must be treated with
extra precaution.

The body must be placed in a sealed body bag.

Danger of Infection must be clearly marked on the outside of the bag
Autopsies
When an autopsy (Hospital Post Mortem) is requested for a patient dying in hospital, where there is no
Coroner’s involvement, the documentation required is:
a) A completed, signed informed consent form (available from the Bereavment office)
b) The patient’s notes
c) A concise summary of the case
d) Medical Certificate of Cause of Death completed
e) Completed cremation form where relevant
These documents should then be taken to the Relative Support Office who will then make contact with
the Mortuary & the Duty Pathologist to arrange a suitable time and day to carry out the autopsy.
In certain circumstances deaths must be reported to the Coroner. Please refer to the guidelines issued
by the Coroner, (Guidelines for Hospital Doctors on Reporting Deaths to Her Majesty’s Coroner). In
these cases the Coroner will decide if an autopsy is required and make appropriate arrangements.
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Telephone Numbers
Kent and Canterbury Hospital
Relative Support Office
Ext
722-4006
Mortuary
Ext
722-4352
Relative Support Office
Ext
725-4452/725-3127/725-4233
Steve Burr
Deputy Lead Anatomical Pathology
Technician
Ext
725-5079/725-3182
Relative Support Office
Ext
723-8206 / 723-6887
Adam Berry
Lead Anatomical Pathology Technician
Ext
723-6606
Rev. Christopher White
Trust Chaplain
Ext
725-2578
Paul Williams
Head Biomedical Scientist
Ext
723-6129
Queen Elizabeth the Queen Mother Hospital
William Harvey Hospital
RETAINED PRODUCTS OF CONCEPTION AND FOETUSES
All Retained products of conception, fetuses will be stored and disposed of in accordance with
departmental Standard Operational Procedures.
DEATHS
Relative Support Office, see above for contact details.
Death of a Patient
A subject that is never very easy to deal with, even as you become more used to it. Continue to keep
a healthy respect for the dead.
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Practical Points
Confirm death.
Talk to the relatives, should they request it.
TRY NOT TO KEEP THE WARD WAITING
Confirm:
I.
Pupils are fixed.
II.
Patient is un-responsive to a painful stimulant
III.
There are no palpable cardiac pulsations.
IV.
No heart or breath sounds, heard over one minute.
Write all the information below in the notes:
I.
Date/Time.
II.
Circumstances.
III.
Declaration of Death.
IV.
Can certificate be issued? If so, what is the cause of death?
V.
Have the relatives been informed? If so, what were they told?
VI.
Sign the entry in the notes, clearly.
Legal Certification of Death
Can you issue a Medical Certificate of Cause of Death?
Q: Were you in clinical attendance during the last illness and had you seen the patient during the 14
days prior to death. NB: See “24 hour rule”.
Q: Do you know the Cause of Death (or think you do)?
Q: Was death wholly due to NATURAL CAUSES with no unnatural event which has contributed to
death?
If the answer to ALL THREE of these questions is “yes”, then you MUST issue a certificate. Medical
Certificate of Cause of Death are available through the Relative Support Office (or if death has
occurred in ITU or A&E then certificates are available there) Once complete, the Relative Support
Office (or ITU/A&E) liaises with the Next of Kin regarding the collection of the Medical Certificate of
Cause of Death. Discuss any concerns with the Relative Support Officer or the Coroner.
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Informing the GP
When patients die the Relative Support Office are responsible for informing the GP. Please liaise with
them on this.
Medical Certificate of Cause of Death
The Medical Certificate of Cause of Death will normally be completed by a member of the medical
team, who has been attending the Deceased patient. This must be completed as soon as possible to
avoid unnecessary delay and therefore distress to the relatives.
If there is any doubt what to write on the Medical Certificate of Cause of Death or whether to report the
case to the
Coroner, the Consultant in charge must be consulted.
If the case needs to be reported to the Coroner this must be done as soon as possible. Do not
complete the Medical Certificate of Cause of Death in these circumstances unless the Coroner
instructs otherwise.
Once the ‘Cause of Death’ certificate has been handed to the relatives and registered it CANNOT BE
CHANGED in relation to the stated cause of death
Blank Medical Certificate of Cause of Death are kept by the Relative Support Office, also ITU & A&E.
Medical Certificate of Cause of Death must be completed before 10 am on the morning following a
death if the Doctor is working nights, any other time the Doctor will be contacted by the Relative
Support Office to complete the paperwork.
Post Mortem Examinations
Coroner’s Post Mortems – once the case is accepted by the Coroner no further responsibility is
devolved to the House Officer.
Hospital requested Post Mortems – once it has been agreed that the Coroner is not involved, a
Hospital Post Mortem may be requested. In this event the informed consent of the immediate Next of
Kin is required. Before this is sought a Medical Certificate of Cause of Death must be completed.
When consent has been obtained, a member of the medical team should fill in a Post Mortem request
form and hand this, the consent form, and the full hospital notes to the Mortuary.
Doctors are expected to attend the Post Mortem, and to contact the Consultant Pathologist to discuss
the case beforehand.
A Hospital Post Mortem examination must never be a substitute for, or a means of avoiding, one
instructed by the Coroner, and Consultant Pathologists will refer any doubtful cases to the Coroner.
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Coroners Cases
The duty of the Coroner is to investigate sudden or unexpected deaths in which the cause is
uncertain. Deaths in the circumstances described below must be reported to the Coroner via the
Coroner’s Office. The Coroner’s Officer’s can be contacted between 8:00am & 4:00pm Monday to
Friday to obtain advice or report a death. Remember also to seek advice on difficult or urgent issues
such as organ donation in respect of cases referred to the Coroner. In regards to tissue/organ
donation, it’s usually the donation team that will contact the Coroner directly once they have been
informed about a potential donor.
To report a death to the Coroner
Ring the number relevant to the site where the death occurred, Monday to Friday between 8:00am –
4:00pm, details of this number is available in the Relative Support office. If contact is made to the
Coroner’s Officer’s and they are not available, follow the instructions on the answer phone.
Ashford, Dover and Folkestone telephone:
03000 410804
Alternatively
07876356620
Alternatively
07879481594
Alternatively
07740185247
Canterbury and Margate telephone:
03000 410603
For Maidstone telephone:
01622 – 820412
Advice may also be obtained from the duty Consultant Pathologist.
Write “Referred to the Coroner” on the patient’s notes to assist the Coroner’s Office and the Relative
Support office.
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Circumstances when death must be reported to the Coroner
If the Medical Officer in attendance on the patient is sure of the Cause of Death and it is natural they
should complete a Medical Certificate of Cause of Death and need not report the case to the Coroner.
If there is any doubt whatsoever regarding the Cause of Death, the case must be reported to
Coroner.
Deaths are reportable to the Coroner if they are sudden and unexpected, if the doctor is uncertain
of the Cause of Death, and if it has been caused as a result of an accident or unusual
circumstances or industrial disease (e.g. asbestos related)
In no circumstances must relatives be offered the option of agreeing to allow a Hospital Post Mortem
to be performed as an alternative to reporting the death to Coroner.
Deaths in the following circumstances must be reported to the Coroner:
ABORTION
If the death is linked with an abortion
ACCIDENTS
If in any way it is thought that an accident may have contributed to the death.
ALCOHOLISM
Acute alcoholic poisoning
ANAESTHETIC DEATHS
Whether a patient dies during a procedure or afterwards, irrespective of the length of time involved
after anaesthesia e.g. a cerebral anoxia case dying 6 months later. If you are in any doubt report the
case to the Coroner.
BLOOD TRANSFUSIONS
Deaths thought to be due to a blood transfusion.
COMPLAINTS
If there is any suggestion that the relatives of the deceased are dissatisfied for any reason (this may
be a valuable safeguard for the doctor in attendance).
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DELAY IN DIAGNOSIS
If there is any possible delay in making a correct diagnosis, the death should be reported to the
Coroner, e.g. meningitis
DRUGS
Deaths thought to be due to any drug, whether therapeutic or related to any form of abuse, including
overdose, reaction, poisoning or addiction. Deaths related to solvent abuse
FALLS & FRACTURES (Including pathological fractures)
All deaths after a fall or a fracture which occurred in the last 3 months and all deaths where there
have been older fractures or falls unless they were clearly unrelated to the cause of death
HOSPITAL DEATHS
If the doctor in attendance considers that there is any possibility for serious complaint about the
treatment or otherwise of the Deceased, he should ensure the fact is mentioned in his report to the
Coroner who will decide if the body should be removed to a place for a post mortem other than the
hospital in which the patient died.
If the death is related to a medical procedure or treatment, whether invasive or not.
All deaths within 24 hours of
(a) Admission
(b) Any procedure
(c) Anaesthetic
(d) Discharge from hospital
All alleged medical or nursing mishaps or if you have any reason to believe that such an allegation
has been, or is likely to be made against any member of hospital staff.
For example:- where death occurs before a diagnosis is established or where some event occurs
which is unexpected and in which the doctor may think the death is not entirely natural, e.g. surgical
complications post anaesthetic, anaesthetic complications, or a fall from a bed or trolley.
Please Note: Deaths due to properly performed procedures are likely to be considered natural but are
still reportable.
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INDUSTRIAL DISEASES & DEATHS RELATED TO OCCUPATION
Deaths associated with industrial exposure, e.g. asbestosis, or suspected mesotheliomas,
pneumoconiosis, or any prescribed diseases or deaths which are thought to be due to any new
unscheduled industrial substance must be reported to the Coroner.
IN POLICE CUSTODY/VOLUNTARY ATTENDANCE AT A POLICE STATION
If the death has occurred whilst in Police custody, prison or after recent contact with a Police station or
prison.
INVESTIGATORY PROCEDURES
All deaths related to investigatory procedures, e.g. ECT, IVP, Biopsy, CV Lines, cardiac procedures,
endoscopy, etc.
MENTAL PATIENTS
Deaths where the Deceased was detained under the Mental Health Act 1983.
OPERATIONS
If the death occurs within 14 days of an operation it must be reported to Her Majesty’s Coroner. If it
is thought that the operation caused, accelerated, or in any way contributed to the death then it must
be reported to the Coroner irrespective of when it took place. If the operation has been performed
for an injury irrespective of how it was caused, please report the death to the Coroner.
SERVICE & DISABILITY PENSIONERS
Where the deceased was receiving any form of War Pension or Industrial Disability Pension, unless
the death can be shown to be WHOLLY unconnected.
STILLBIRTHS/INFANT DEATHS
Where there is any doubt whether the child was born alive or obscure, neonate and infant deaths.
Maternal deaths whilst pregnant or within 42 days of termination of pregnancy.
VIOLENT OR UNNATURAL DEATHS
If there is the slightest suspicion regarding the circumstances of the death, including violence or the
possibility of an unnatural death, it must be reported to the Coroner, e.g., want, exposure, neglect/self
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neglect, hypothermia, self injury or if the death could have occurred secondary to injuries from an
accident that occurred a long time ago.
Please Remember
If the doctor in attendance requires assistance in knowing whether to report the death to the Coroner,
please speak to the Coroner personally.
Please have the notes with you when you call.
The Coroner can, in many circumstances, support a Medical Certificate of Cause of Death with a
Form A, (where the Coroner notifies the Registrar of Deaths that the case has been reported to
him/her but it is unnecessary to perform a Post Mortem examination). This will overcome problems
with Cremation and Registration of the Death.
Reporting Deaths involving MRSA or other infection related deaths to the Coroner
Deaths should be reported if all the following conditions are fulfilled:The infection, including MRSA, was contracted by the patient whilst in hospital; and
The patient was subjected to a procedure whilst in hospital, whether a surgical intervention, the
insertion of an IV line or a naso-gastric tube or any similar procedure and the infection occurred as a
result; and
The infection is a contributory factor in the cause of death.
Reporting Obstetric/Neonate deaths to the Coroner
The following deaths should be reported to the Coroner:All sudden unexpected maternal deaths associated with pregnancy.
Deaths involving a non-viable foetus or a stillborn child are not reportable to the Coroner.
However, if there is any doubt whether the fetus or child achieved an independent existence of its
mother before death, no matter for how long, it must be reported to the Coroner.
Further, if it is clear that the fetus or child has achieved independent status of its mother, and
subsequently dies, it must be reported to the Coroner if the death appears to be violent or unnatural,
or sudden and the Cause of Death is unknown or occurs within 24 hours of admission to hospital.
Cremation Certificates
When a deceased patient’s relatives request Cremation, the Relative Support Office will contact an
appropriate member of the medical team. Complete the form and hand it back to the Relative Support
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Office who will obtain a second signature. The Relative Support Office coordinates collection of the
fee, and by custom this is shared between the two signatories. You are reminded that income from
this source is liable to tax, and a record should therefore be kept of all fees received so that it may be
declared to the Inland Revenue.
Bereaved Relatives
All medical staff are asked to communicate directly and sympathetically with the relatives of patients
who die in hospital, especially when the death has been unexpected. Do not delay in completing
Medical Certificate of Cause of Death. Also do not delay in reporting cases to the Coroner. A little
consideration at this time often prevents long-standing grievance.
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List Of Referral Centres
Histopathology Department
Royal Marsden NHS Trust
Fulham Road
London
SW3 6JJ
Royal Victoria Hospital
Department Of Pathology
Grosvenor Road
Belfast
BT12 6BA
Northern Ireland
Pathology
Western General Hospital
Crewe Road
Edinburgh
EH4 2XU
Department Of Histopathology UCLMS
Rockefeller Building
University Street
London
WC1E 6BJ
Royal National Throat, Nose & Ear Hospital
330 Gray’s Inn Road
London
WC1X 8DA
Department Of Cellular Pathology
Medical School
University Of Birmingham
Edgbaston
Birmingham
B15 2TT
South London Healthcare NHS
Queen Elizabeth Hospital
Stadium Road
Woolwich
London
SE18 4QH
Department Of Histopathology
Frenchay Hospital
Marlborough Street
Bristol
BS16 1LE
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Leeds Teaching Hospitals Trust
Department Of Histopathology
5th Floor Bexley Wind
St James’s University Hospital
Leeds
LS9 7TF
St John’s Institute Of Dermatology
3rd Floor, Southwark Wing
Guy’s Hospital
Great Maze Pond
London
SE1 9RT
Histopathology Department
Chase Farm Hospital
The Ridgeway
Enfield
Middlesex
EN2 8JL
Liver Pathology
King’s College Hospital
Denmark Hill
London
EE5 9RS
Institute Of Metabolic ScienceMetabolic Research Laboratories
Universtiy Of Cambridge
Box 289, Level 4
Cambridge
CB2 0QQ
Department Of Cellular Pathology
Northwick Park Hospital
Watford Road
Harrow
Middlesex
HA1 3UJ
Department Of Cellular Pathology
Southmead Hospital
Bristol
BS10 5NB
Histology Department
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Macclesfield District General Hospital
Victoria Road
Macclesfield
Cheshire
SK10 4BL
The Piccolo Laboratory
Gi Cancer Translational Research
Level 4 Wellcome-Brenner Building
St James’s University Hospital
Leeds
Royal National Orthopaedic Hospital
Histopathology Department
Institute Of Orthopaedics
Brockley Hill
Stanmore
Middlesex
HA7 4LP
Cellular Pathology
Royal Hampshire County Hospital
Romsey Road
Winchester
SO22 5DG
St Thomas’s Hospital
Westminster Bridge Road
London
SE1 7ET
Stoke Mandeville Hospital
Mandeville Road
Aylesbury
Buckinghamshire
HP21 8AL
Department of Histopathology
St George’s Hospital
Blackshaw Road
London
SW17 0QT
The Great Western Hospital
Marlborough Road
Swindon
SN3 6BB
South West Thames Regional Genetics Service
Medical Genetics Unit
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St George’s Hospital Medical School
Cranrner Terrace
London, SW17 0RE
Department Of Histopathology
St Mary’s Hospital NHS Trust
Praed Street
London
W2 1NY
Division Of Haematological Oncology
St. Bartholomew’s Hospital
West Smithfield
London
EC1A 7BE
Basildon University Hospital
Nethermayne
Basildon
Essex
SS16 5NL
Department Of Histopathology
Leeds General Infirmary
Great George Street
Leeds
West Yorkshire
LS1 3EX
Department Of Histopathology
Central Sheffield University Hospital NHS Trust
Royal Hallamshire Hospital
Glossop
S10 2JF
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