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PIP-62

Cellular Pathology - Handbook 

Contacts

Basildon Hospital (01268 524900):

    Consultant (Clinical Lead): Dr Peter Ozua extn 8219

Consultant :Dr Abdel-Kadir Abdulla extn 8216

Consultant: Dr Kingsley Osayi extn 8220

Consultant: Dr Nazar Alsanjari extn 8218

 

Consultant: Dr Andrew Prodromou extn 1665

CTC Consultant: Dr Filomena Medeiros extn 8211

Operations Manager Cellular Pathology : Matt Jeffery extn 8209

  Office: General enquiries extn 8212
   
Southend Hospital (01702 435555):
    Consultant: Dr Simon Payne (Head of Department) ext 5205
    Consultant: Dr Konrad Wolfe extn 5202
    Consultant: Dy Maryse Sundaresan extn 5634
    Consultant (Cytology Lead): Dr Anu Malhotra extn 5201
    Office enquiries: extn 5198
Cytology:
    Cytology Consultant BMS: Sarah Hemingway: 01268 968238
    Cytology Lab Enquiries and Orders: 01268 968231


Clinical advice is available from the consultants listed above.

 

General Information

This department provides a diagnostic Histology, Cytology and Andrology service. 

Histology

The Histopathology Laboraotries are open between 8.30 and 5.00pm Monday to Friday. At Basildon Hospital it is located on Level C just past phlebotomy and the office reception is opposite the Rheumatology clinic rooms. At Southend Hospital Histopathology is located on level 1 of the Tower Block and the Essential Services Laboratory is on the 2nd Floor in the pink zone.

Specimens from Theatres and 'urgent' specimens for Histology should be brought directly to the laboratory and handed to a member of staff.  Porters may deliver non-urgent Histology from hospital clinics directly to the laboratory or to the Pathology Reception area.  Regular courier deliveries are made to the Pathology Reception areas. 

All specimens should be sent to the department as soon as possible. A fully completed and legible request form must accompany all specimens. Clinical details are essential. Failure to do so will delay the result as the specimens will be returned to source.

Specimens should only be marked URGENT if there is a clinical need to do so or if the results are required within 24 - 48 hours. Specimens from target patients should also be marked clearly in red with a large T.

The Department reports 80% of diagnostic biopsies in 3 working days

   
  Andrology
Special arrangements are in place for receipt of Andrology specimens and patients should read the information sheet.
   

Request Forms





































Incomplete details on request forms result in delay in processing and reporting requests. It also increases the chances of specimen mix up and poor quality reports. The request form must have the following details clearly written, and must be signed by the requesting clinician, otherwise the specimen will be rejected:

  • Surname
  • First Name
  • Date of Birth
  • Hospital Number (for Hospital patients)
  • Full address
  • NHS number
  • Requesting Consultant and/or GP
  • Ward/Clinic for Hospital patients.

 

For cervical samples the patient’s surname, first name and date of birth must be written in ink on the vial.

 

Failure to do so will result in the specimen being returned to the sender with a subsequent delay in reporting. 

Please ensure that telephone calls enquiring about already posted reports and/or requesting them to be faxed are kept to an absolute minimum. Our secretaries are finding it very difficult to cope with the large numbers of calls they receive and these cause severe disruption to their daily work.

Limitations

1.    Incorrect Request forms - delay in transit as sample may go to another department. This may affect the cell preservation (Non-Gynae and andrology) and hence the diagnosis

2.     Sample and form incorrectly/incompletely filled in - sample may be for incorrect patient or the report may go to the incorrect consultant/GP

3.     Incorrect/missing clinical details - may result in incorrect interpretation of results or not all relevant tests being carried out.

4.     Delay in transit/failure to refrigerate - sample may deteriate (non gynae)

5.     Large sample - returned to originator for aliquot - delay in processing sample may deteriate.

6.     Sample in inappropriate  container - may not be possible for sample to be processed.

   

Routine Tests

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Routine Histology

 

1. 

     Specimens are to be sent in 10% buffered formal-saline.  Please ensure that the container is large enough not to squash the tissue, and that it contains sufficient fixative.  (approximately ten times the volume of the specimen is recommended). 
The specimen container must be clearly labelled with the patient's details. This should be written on the side of the pot not the top.

2.

80% of diagnotic biopsies will be reported within 3 days after receipt in the laboratory.  Larger specimens and specimens requiring special stains or tumour markers will take longer.

3.

Please telephone for results only when absolutely necessary.  If the report is required by a given date, please indicate this fact on the request form.

4.

Special arrangements are required for muscle biopsies:

Basildon Hospital - please telephone the Rheumatology Department on 0845 155 3111 x8461

Southend Hospital - Please contact Shelley Kjernsholen or Glenn Tovell at Queen's Hospital on 01708 435000 ext 399.

5.

Renal biopsies at Basildon Hospital – please telephone and give the department as much advance notice as practicable (ext. 8214).
The trolley with the dissecting microscope may be collected between 8:30 and 17:00. It must be returned in the same condition as itv was when taken. Without return of the trolley specimen cannot be sent to the Royal London Hospital for processing, this will delay the result

A fully completed consent form must be sent in addition the the Cellular Pathology request form any possible pregnancy loss including ?ectopic pregnancy, products of conception or non viable foetuses.

Frozen Sections

Please telephone the department at the relevent Hospital site in advance to enable the Consultant Pathologists and the histology staff to be ready. If possible, please give a minimum of 24 hours notice.

If the need for a frozen section should arise during surgery, please contact a Consultant Histopathologist immediately.

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Andrology: Semen analysis

Synonyms
Male Fertility Test
Vasectomy sample
Clinical Indications
Infertility / subfertility
Reversal of vasectomy
Post vasectomy
Test Includes
Male Fertility Test includes estimation of volume of ejaculate, viscosity, sperm motility, sperm concentration
Vasectomy testing detects presence or absence of sperm
Request Form
Three patient identifiers including the NHS number are required on the container AND form. Basildon Hospital forms are available here: Basildon Request Form.
Availability of Infertility tests:
Basildon Hospital: Weekdays, by appointment only. Phone 01268 524900, ext 8888 to make an appointment. Phone between the hours of 08:30-17:00.

Southend Hospital: Weekdays, by appointment only. Phone 01702 435555, ext 7726 to make an appointment. Phone between the hours of 08:30-17:00.
Specific Criteria
Clinical information, date and time of ejaculation is required
Patient Preparation
Complete semen sample to be collected by masturbation directly into container.
The sample should be collected between 2 and 7 days of sexual abstinence.
Please note that the patients must produce sample at home as there are no suitable facilities on the hospital site for sample collection.

Cellular Pathology at Southend Hospital is located on level 1 of the Tower Block.

See below for how to find the department at Basildon Hospital:
   
  See patient Information leaflet (available from Pathology reception, GP surgeries and community clinics) for full details.
Turnaround Time
Post-vasectomy samples: 3 working days
Infertility samples: up to 10 working days
Specimen
Semen (complete sample)
Container
Squat red top container labelled 'Semen Analysis' available from Pathology Reception and Path Stores order form.
Please state that it is for a male fertility test/post vasectomy sample .
 
Collection
For Infertility tests samples must be kept warm and delivered to the laboratory within 1 hour of collection.
These samples MUST NOT be delivered by GP courier.
Lab Handling
Sample processed upon receipt.
Causes for Rejection
• Unlabelled / inadequately labelled
• Leaking
• Received without an appointment
• 3rd patient identifier missing
Reference Range
For Infertility test:
• Volume 1.5 ml or more
• Sperm concentration 15 x 10^6 / ml or more
• Motility 32% or more
• Normal morphology is 4% or greater

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Cytology

The Cytology department is located at the Pathology First Laboratory, Bentalls, Basildon SS14 3BY. Routine laboratory hours and general enquiries: 08:30-17:00 Monday to Friday.

Cervical samples  

 

 

Request Forms

Pre-printed A5 HMR101 (2009) cervical cytology request forms should be produced via Open Exeter where possible for all cervical smears taken in GP surgeries and clinic. A blank cervical cytology request form may be used if Open Exeter is not available.  The request form must include the following:

 

·         Surname

·         First name

·         Date of Birth

·         NHS number

·         Hospital Number (for Hospital patients)

·         Patients full address

·         GP and sender (clinician and location if sender is not GP)

·         Smear taker code

Please also include the date of test, LMP and any relevant clinical details.  Please clearly label all urgent samples with ‘urgent’.

 

Sample Container

ThinPrep vials and brushes must be used. The prepared vial should be clearly labelled in ink with:

·         Surname

·         First name

·         Date of birth

·         NHS number (desirable)

Any missing details may lead to a delay in reporting or may lead to the sample being rejected. Please place labelled vial with the completed request form in a transport bag with absorbant paper. If a sticky label is used please do not place over the clear area on the vial as this is needed for processing.

 

Transport

Basildon Hospital: Ward and clinic samples should be taken to the Pathology Reception Specimen hatch on Level C. Cervical samples DO NOT need to be refridgerated.

 

Southend Hospital: Ward and clinic samples should be taken to Pathology Reception in the Essential Services Lab on the 2nd Floor in the Pink Zone. Cervical samples DO NOT need to be refridgerated.

 

All GP work is collected by the courier service and brought to the hub.

Sample requirements

In patients with a LMP, it is preferable that the sample should be taken mid-cycle. If the patient is pregnant it is preferable to take the sample 3 months post-delivery.

 

Factors Affecting Examination Results/Limitations

Samples will be rejected and NOT processed if the vial is unlabelled, out of date or is sent to the laboratory with the broom head within it. Samples where there is a major miss-match between the request form and the vial will also be rejected (we will endeavour, wherever possible to contact the sample taker first).

Vault samples should not be taken routinely post total abdominal hysterectomy, guidance should be supplied by the Consultant Gynaecologist or please contact the laboratory BEFORE taking a vault sample if there is any doubt.

'Out of programme’ samples (e.g. age under 24 and a half, over 64, and earlier repeat than indicated on Open Exeter e.t.c.). These will be rejected. Please see local and national guidance for symptomatic women, under 25s etc.

The reason for rejection will be stated on the report.

Certain cases with low grade abnormalities or patients who have had previous treatment for an abnormal smear may require an High Risk Human Papilloma Virus (HR HPV) test. These are requested by the Cytology department when necessary amd the test is carried out on the original sample. The Cytology Department will indicate the appropriate management of these patients in accordance with the HR HPV results and NHSCSP guidelines.

 

Reports

The report will be sent electronically to the patient’s GP and paper copies of the reports will be sent to all hospital clinics (e.g. Colposcopy). If a smear is taken at a Family Planning Clinic, paper copies of the reports are issued to the FPC and the patient’s GP. The result will be sent electronically to call and recall, who will send a letter to the patient advising her of her smear result and recommended recall. Patients referred to Colposcopy clinic or attending appointments at the Colposcopy clinic will receive both their appointment letter and result directly from the clinic.

The laboratory staff do not issue results directly to the patient.

Turn Around Times

Cervical samples taken as part of the national screening programme in GP surgeries and Family Planning Clinics are normally reported within 7-10 days of receipt of the smears in the laboratory, as recommended in the National Health Service Cervical Screening Programme guidelines.

Non Gynae cytology samples

 

Request Forms

Please use Cellular Pathology request forms for all non gynae cytology samples. The request form must include the following:

 

·         Surname

·         First name

·         Date of Birth

·         NHS number

·         Hospital Number (for Hospital patients)

·         Patients full address

·         Consultant/GP

·         Ward/Department

·         Nature and Source of Specimen

·         Clinical History

·         Date and time sample taken

Please clearly label all urgent samples with ‘urgent’. Please ensure all details are clearly written to prevent delays in reporting.

 

Sample Container

 

Please use white topped universal containers or ThinPrep Cytolyt containers as appropriate. The sample pot should be clearly labelled in ink with:

·         Surname

·         First name

·         Date of birth

·         NHS number (desirable)

·         Date and time sample taken

Any missing details may lead to a delay in reporting or may lead to the sample being rejected. Please place labelled vial with the completed request form in a transport bag with absorbent paper.

 

 

ThinPrep CytoLyt Container             White-topped universal

         

Transport

Basildon Hospital: Ward and clinic samples should be taken to the Pathology Specimen reception hatch on Level C as soon as possible after collection to prevent delays in transit and reporting.

If there is a delay between collection and transport, fresh samples need to be refridgerated. Samples collected in CytoLyt must be left at room temperature.

 

Southend Hospital: Ward and clinic samples should be taken to Pathology Reception in the Essential Services Lab on the 2nd Floor in the pink zone as soon as possible after collection to prevent delays in transit and reporting.

If there is a delay between collection and transport, fresh samples need to be refridgerated. Samples collected in CytoLyt must be left at room temperature.

 

All GP work is collected by the courier service and brought to the Hub

 

Factors Affecting Examination Results/Limitations

Urine and sputum samples will be rejected and NOT processed if the sample or form are unlabelled. Other less easily repeatable unlabelled samples may be accepted but the clinician will be contacted to take responsibility for the sample and a disclaimer form will have to be completed. This will result in a delay in reporting so it is imperative that all sample and form are clearly and completely labelled. Samples where there is a major miss-match between the request form and the sample pot may also be rejected (we will endeavour, wherever possible to contact the clinician first). The reason for rejection will be stated on the report.

All samples should be taken to specimen reception as soon as possible for collection by a courier. If this is not possible place all fresh samples in a fridge to prevent deterioration. If sample is in CytoLyt please leave at room temperature.

Please send SEPERATE samples for Cytological investigation with the correct Cellular Pathology request form whenever possible rather than ‘sharing’ the sample with another department. This may lead to a delay in transit to Cytology and   deterioration of the specimen.

 

Reports

Reports are available to view on the Basildon intranet : Hub/Clinical Hub/Histology reporting. The laboratory staff do not issue results directly to the patient.

 

Turn Around Times

Non gynae normally be reported within 10 days from receipt of sample in the laboratory as recommended in RCPath guidelines : Key Performance Indicators in Pathology. April 2013.

 

Sample Requirements

Fluids
40ml is
the maximum volume for cytological investigations that can be accepted as large volumes are difficult for the laboratory to deal with. 
Dry 2oz containers, 1 or 2 white capped universal containers or a ThinPrepCytolyt’ container may be used. A fully completed request form must accompany the specimen with the date and time of collection recorded.  The clinical information provided must be sufficient and appropriate to aid the Pathologist reporting the case.

Urine
A full specimen of urine, preferably a mid-morning specimen, is required for cytology, Please advise patients to record the date and time of collection on the specimen container and ensure that the lids are firmly tightened to prevent leakage during transport to the laboratory. When catheter specimens are sent, please ensure these are clearly labelled as such on the specimen container and request form. Specimens should not be collected during the 14 days following cystoscopy. Unlabelled specimens will not be processed. 

Bronchial Brushings, Washings & Sputums

Material obtained by brushing should be spread along the length of the slide, and placed immediately in absolute alcohol. The slide must be labelled in pencil with the patients name, DOB and NHS number (hospital number is acceptable if the NHS number is not available). The slide must be sent to the laboratory in a slide box together with the fully completed request form.

Bronchial Washings and sputum samples should be collected into ThinPrep 'CytoLyt' containers, but a white capped universal container or a dry 2oz container is acceptable. Specimens should be collected on three consecutive days. These should be expectorated early in the day before eating, drinking or cleaning teeth. Specimens contaminated with food particles are not helpful to the assessment. Send the specimens daily. Do not save until all three are collected.

 

2oz container

Fine Needle Aspirates (FNA)

Material obtained by aspiration should be spread along the length of the slide, using another glass slide placed horizontally, pulling the slides apart. Prepared slides must be fixed immediately in alcohol or air dried (preferably one of each) before dispatch to the laboratory. Slides must be labelled in pencil with the patients name, DOB and NHS number (hospital number is acceptable if the NHS number is not available) and with an indication as to the method of fixation. The slides must be sent to the laboratory in a slide box. If there is material remaining after the slides have been prepared, this can be placed into a white topped universal or placed into a universal containing preservative fluid (CytoLyt).

 


Other specimens

Cytological investigation of a variety of specimens is available. These include bronchial brushings from biliary strictures. For any further information please contact the Cytology lab for guidance.

Please note:

  1. All fresh samples which cannot be sent to the laboratory immediately must be refrigerated and sent to the laboratory as soon as possible. Samples collected into CytoLyt must be left at room temperature.
  2. Please send SEPERATE samples for Cytological investigation on the correct Cellular Pathology request form whenever possible to avoid deterioration in the specimen, plus potential delays in transit and reporting.
  3. If a Cytological assessment is required on a sample which has been sent to another Pathology Department or a Cytology sample is required to be sent to another Department for analysis, please contact Cytology on 01268 968229.
  4. Further investigations (as above or e.g. clot creation) must be requested within 3 working days of the sample being taken or the cells may have deteriorated too much for analysis and a new sample will be requested.

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Handbook

Contacts

General Information

Routine Tests

Guidance

Clinical Information

Other Information

Policies

   

Version 1.3 / March 2017                                                                                         Approved by: Cellular Pathology Operations Manager