Pathology & Mortuary Services

Post-Mortem Authorisation Form

In September 2006 the Scottish Government introduced a national authorisation form for post-mortem examinations. By law this is the only “consent form” that can be accepted. The authorisation form, together with two types of information leaflets and a summary form are contained within a distinctive dark blue sleeve for adults and a pale green one for children and infants.

The forms are available online through the Scottish Pathology Network.

Guidance for completing these forms can be found here: Hospital PM authorisation process

Current guidelines recommend that only senior medical staff should obtain authorisation. Junior doctors or ward staff should act as witnesses.

It is important that the authorisation form is completed correctly; otherwise the post mortem may not be carried out.

The nearest relative, or a nominated person must be given the top (white) copy and the other two copies (pink and blue) are retained.

The form is a legal document and must not be altered without the relatives consent. Any changes must be made by having all three copies together and only writing on the top white copy to ensure that all the forms are identical.

Post-Mortem Examination

Small samples of tissue, for histological purposes only, will be retained in every post-mortem to confirm macroscopic findings unless consent for this is withheld.

Detailed neuropathological examination of the brain is best done if the organ is first immersed in formalin for three weeks. If the patient has died due to a complex neurological disorder (e.g. MS, dementia, Parkinson’s disease) and it is considered that examination of the brain is very important, then specific permission to retain the brain after the post-mortem should be obtained and noted in section 2A and 2B of the authorisation form.

In cases where there is an infectious risk to those handling the body after death (i.e. pathologists, mortuary technicians, undertakers) e.g. deaths from tuberculosis, AIDS, hepatitis B or C etc. the body must be transported to the mortuary in a cadaver bag with “danger of infection” stickers attached and clearly visible.

In cases of “bodies donated to medical science” or any other issue, please contact the mortuary staff.

Authorisation forms are available from the mortuary offices during working hours and from the booking in areas in every mortuary.

Wards should arrange for collection/delivery of authorisation forms together with the summary and case records. Do not use internal mail.

All post mortems will be carried out within the mortuary at the Queen Elizabeth University Hospital, with all adult NHS post mortems being carried out on Tuesdays and Thursdays only.

On completion of the autopsy the pathologist will contact the requesting clinician and where practical invite them to come and discuss the findings in the mortuary at their earliest convenience. If the requesting clinician is unable to attend the mortuary, then a summary of the finding is provided via email.

A preliminary autopsy report is dispatched to the Consultant in charge of the patient within three working days of the autopsy. Case notes are normally returned with the full PM report within 3-4 weeks.

Copies of the final report, which includes histological findings, are sent to the patient’s GP and hospital consultant usually within two weeks (this can be longer if additional tests are required) of the autopsy.

Deaths must be discussed with the procurator fiscal under the following circumstances:

1. Uncertified death
2. Any death which was caused by an accident due to the operation of a vehicle, or which was caused by an aircraft or rail accident.
3. Any death associated with employment, by accident, industrial disease or poisoning.
4. Any death due to poisoning (coal gas, barbiturate, etc.).
5. Any death where the circumstances would seem to indicate suicide.
6. Any death where there are indications that it occurred under an anaesthetic.
7. Any death resulting from an accident in the home, hospital or institution or any public place.
8. Any death following abortion.
9. Any death apparently caused by neglect (malnutrition).
10. Any death occurring in prison or a police cell where the deceased was in custody at the time of death.
11. Any death of a new-born child whose body is found.
12. Any death (occurring not in a house) where the deceased’s residence is unknown.
13. Death by drowning.
14. Death of a child from suffocation (including overlaying).
15. Where a death occurred as a result of smallpox or typhoid.
16. Any death as a result of fire or explosion.
17. Any sudden and unexplained death.
18. Any other death due to violent, suspicious or unexplained cause.
19. Deaths of foster children.
20. Any complaint concerning care or treatment of the deceased noted by nursing or medical staff.

Do not issue a death certificate until the case has been discussed with Fiscal.

If the Fiscal decides to instruct a post mortem, the body will be removed to QEUH Mortuary. Fiscal post mortems are carried out 5 days per week.

A pacemaker or other metal containing cardiac device must be removed from a body prior to cremation. This can be done by the technical staff in the mortuary at the QEUH provided that written consent from relatives for removal and retention has been obtained and delivered to the QEUH mortuary prior to the body being released to the funeral director. This service is not generally available at other mortuaries. If the pacemaker has not been removed the MCCD must indicate that a pacemaker is in situ.

Clinicians wishing to view remains should phone the mortuary staff to arrange a time to visit the mortuary and conduct a viewing.

Contacts:
Mortuary Operations Manager	0141 451 5815
Mortuary Post Mortem Manager Mortuary Scheduling and Performance Manager	0141 451 5795 Vacant
Mortuary Contact Numbers:
Queen Elizabeth University Hospital (QEUH)	0141 354 9357
Glasgow Royal Infirmary (GRI)	0141 201 3186
Gartnavel General Hospital (GGH)  – Enquiries should be directed to QEUH mortuary	0141 354 9357
Royal Alexandra Hospital (RAH)	0141 314 6648
Inverclyde Royal Hospital (IRH)	01475 504 301
Vale of Leven (VOL)   – Enquiries should be directed to QEUH mortuary	0141 354 9357

NHS Greater Glasgow and Clyde Pathology Department is undergoing a digital transformation whereby glass slides are digitised and are able to be viewed on digital workstations, rather than microscopes.  This change is being undertaking in partnership with Philips Healthcare. 

The transformation will take several years to complete for histology (and longer for cytology where the technology is less mature).  We are following national guidelines and best practice recommendations from the Royal College of Pathologists (RCPath) and pathologists reporting digitally are following the RCPath validation process.  Digital Pathology is being incorporated into our quality management system and we are working towards UKAS extension to scope. 

We fully believe that this development will deliver both quality and safety benefits to our service users. 

Intra-Operative Frozen Section Requests

Pre-Booking a Frozen Section

 The requesting clinician must ensure that:

• Pathology Duty Consultant is notified of frozen section request 24 hours in advance of sample collection, via Pathology Specimen Reception on 0141 354 9513 or 0141 354 9514 (89513 or 89514)
• As per national guidance, the department will routinely process requests for frozen section analysis unless the clinician or request form indicate the patient potentially being COVID positive.
• On the day of surgery, theatre staff notify Pathology reception that the frozen section is on its way to the Laboratory.

Failure to pre-book an intra-operative frozen section may result in delays in reporting and in exceptional circumstances the request being declined.

When pre-booking an intra-operative frozen please provide the following details:

• Patient’s name and CHI number
• Requesting clinician
• Theatre name/number including hospital
• Likely time of operation
• Contact number
• Specimen type

The Consultant Pathologist will phone the result to the requesting clinician on the contact number given.

Queen Elizabeth University Hospital (QEUH)

An intra-operative frozen section service is available Monday to Friday from 9:00am to 5:00pm

Golden Jubilee National Hospital (GJNH)

An intra-operative frozen section service is provided, on site at GJNH, Monday to Thursday from 9:00am to 1:00pm. Any cases requiring a frozen section should be recorded on the GJNH theatre lists.

To arrange an intra-operative frozen section out with these times please contact the Duty Pathologist via Pathology Specimen Reception at QEUH on the telephone number below.

These specimens will be transferred to Pathology Department at QEUH for processing and should be sent by taxi to:

Specimen Reception (L3/B/021),

NHSGGC Pathology Department

Level 3, Laboratory Medicine and Facilities Management Building

Queen Elizabeth University Hospital

Tel:  0141 354 9513 (89513) or 0141 354 9514 (89514)

It is the responsibility of staff at GJNH to arrange rapid transfer of these specimens to QEUH as per local protocol.

Glasgow Royal Infirmary (GRI)

An intra-operative frozen section service is available Monday to Friday within normal laboratory working hours, from 9am to 5pm.

This Laboratory is only manned for pre-booked requests. It is, therefore, imperative that frozen section requests for onsite analysis at GRI are received by the Pathology Department more than 24 hours in advance, by phone call.

From time to time an urgent frozen section is required due to an unexpected finding at surgery. The department provides this service, but for intra-operative frozen section requested on site at GRI, a short delay is inevitable to allow staff to travel.

Alternatively the specimen can be sent to QEUH urgently by courier by telephoning:

01412113734 or 01412113674 (Transport Hub) and following the information below for Transporting Urgent Fresh Specimens.

Labelling Frozen Section Specimens

The normal requirements for labelling specimens and request forms apply to frozen sections in addition to the following criteria on the request form:

• Hospital
• Theatre
• Date and time of request.
• Requesting clinician
• Alerts to known or suspected danger of infection
• Clinical History
• Theatre contact number

Transporting Urgent Fresh Specimens

QEUH site:

Fresh (unfixed) specimens should be sent directly to:

Specimen Reception (L3/B/021),

NHSGGC Pathology Department

Level 3, Laboratory Medicine and Facilities Management Building

Queen Elizabeth University Hospital

Tel:  0141 354 9513 (89513) or 0141 354 9514 (89514)

Other Sites

Fresh (unfixed) specimens taken at other sites out with stated service provision at GJNH and GRI should be sent directly to the Pathology laboratory at QEUH by courier.

The courier should be telephoned by theatre staff, telephone Eagle Couriers on 08451231230 at least 30 minutes before the specimen is available on the day of the operation.

 The information required by Eagle couriers includes:

• Hospital site
• Theatre collection point
• Advise that this is an “Emergency Pathology Specimen”.
• Codes used for each location should be as per local protocols.
• Please telephone Pathology Specimen Reception on 01413549513 or 01413549514 (89513 or 89514) when the courier is on the way

Fresh/Urgent Paediatric Specimens

Paediatric Rectal biopsies for diagnosis of Hirschsprung’s disease via Acetylcholinesterase histochemistry must be sent fresh (not fixed) as is done for frozen sections (see above).

Please ensure that for all specimens indicative of paediatric neoplasia/cancer/tumour that the paediatric team are notified (89531) in advance of submission and the specimens are submitted fresh/unfixed as is done for frozen sections (see above).

Fresh Lymph Nodes for Suspected Lymphoma

Excised lymph nodes, for suspected lymphoma should be bisected alone their long axis at the time of removal.

Half of the specimen should be placed into a sealed container with buffered formalin. The second half of the specimen should be placed in dry container, without formalin and sent “fresh” to the Pathology Department to allow ancillary testing to be undertaken.

It is particularly important that any Danger of Infection is recorded on the request form.

Follow the instructions above for Transporting Urgent Fresh Specimens.

Orthopaedic Amputations

The orthopaedic theatre should contact Pathology Specimen Reception at least 24hrs before procedure is scheduled on 01413549513 or 01413549514 (89513 or 89514) to request that a dedicated large amputation specimen container is sent to relevant theatre.

Specimens such as amputations that have a high ratio of surface area covered by skin should be sent unfixed. If there is a surgical stocking, leave in place.

Reasons for this are:

• Poor penetration of skin by formalin
• Moving and handling considerations

To contain potential leakage, put the amputation into a large plastic bag or wrap in drapes as appropriate and then put into the amputation container.  Never use yellow or orange bags or containers as this corresponds to the code for waste incineration.

Please follow the instructions for transporting urgent fresh specimens above. It is important to advise the courier that this is a large specimen (requires van rather than motorcycle courier).

Paediatric rectal biopsies for diagnosis of Hirschsprung’s disease do not need to be sent fresh. These specimens may be sent in formalin. There is no requirement to discuss these cases with the duty pathologist.

Paediatric tonsils do not need to be sent fresh unless there is a high clinical suspicion of malignancy. These specimens may be sent in formalin. There is no requirement to discuss these cases with the duty pathologist unless there is a high clinical suspicion of malignancy.

Please ensure that for all specimens indicative of paediatric neoplasia/cancer/tumour that the day duty pathologist is notified in advance of submission and the specimens are submitted unfixed as specified by the day duty pathologist’s instructions. All fresh specimens including frozen sections must be discussed directly with the day duty pathologist in advance of submission.

Urgent Paediatric Specimens

The following procedures must be followed for all urgent paediatric fresh specimens including frozen sections, fresh tumour biopsies and fresh tumour resections.

Any queries regarding urgent specimens should be directed to the duty Paediatric pathologist by telephoning the paediatric office on 89478 and asking to speak to the duty paediatric pathologist. If advice/assistance is urgently required out of hours, please contact switchboard who can contact a paediatric pathologist. The paediatric laboratory team may be contacted on 89531.

Discussion with the duty pathologist – All Cases

All cases must be booked in advance (ideally the day before) by telephoning 89478 and discussing the case and your requirements with the duty paediatric pathologist. Please provide patient details, including name and CHI number, date of surgery, approximate time of surgery and a contact number for theatre.

The surgeon or interventionalist performing the biopsy / resection must speak directly to the duty Paediatric pathologist prior to the procedure in every case to establish the specimen requirements.  Failure to follow this procedure may render the biopsy un-interpretable.

The instructions below are general instructions and must not replace a case by case discussion with the duty pathologist.

• Tissue for frozen section should be kept dry and placed in a suitable container labelled with the patient’s details (ideally a small plastic dish wrapped in a yellow plastic bag). Do not place small biopsies on paper or wrap them in gauze or paper.
• Unless indicated otherwise by the day duty pathologist, all fresh tumour biopsies should be placed in pink tissue culture fluid for transport to the laboratory.
• Unless indicated otherwise by the day duty pathologist, all fresh tumour resections should be kept dry and placed in a suitable container labelled with the patient’s details.

Transport to the Laboratory – All Cases

All fresh paediatric specimens must be conveyed immediately in person or by porter to pathology (3^rd floor, Laboratory Medicine Building). It is the responsibility of the surgical team to arrange urgent transport of the specimen to pathology. The sample must not be sent via the POD system and must not be placed in a purple bag. It must be taken directly to pathology specimen reception on the 3^rd floor. The specimen should be marked as “Urgent. Frozen section.” Staff transporting the specimen must inform specimen reception staff that it is an urgent fresh specimen for frozen section.

When the specimen leaves theatre, theatre staff must inform the laboratory by telephoning 89531.

Paediatric Renal Biopsies

The following procedures must be followed for all paediatric renal biopsies:

Discussions with the Duty Pathologist and the Laboratory

All Renal biopsies must be discussed with the Duty Paediatric Pathologist on 89478 as well as with laboratory staff on 89531 (see below).

These specimens will be collected in theatre by a biomedical scientist who will separate the sample for immunofluorescence and electron microscopy.  Notification of such biopsies to the laboratory must be done as far in advance of the biopsy as possible by telephoning 89531. Failure to do so may result in delay since staff will have to be available to attend theatre to undertake this procedure.

The placental request form is linked here

Criteria for Examination

The local criteria for placental examination are:

Stillbirth

Miscarriage > 14/40

Birth weight < 3rd centile

Drop in fetal growth of > 2 quartiles or > 50 percentiles

Absent or reversed EDF on umbilical artery Dopplers

Spontaneous preterm delivery or prolonged preterm rupture of membranes less than 32/40

Iatrogenic preterm delivery less than 32 weeks

Severe early onset (less than 32/40) pre-eclampsia requiring iatrogenic delivery

Massive abruption with retroplacental clot

Fetal hydrops

Severe fetal distress defined as: pH<7.05 or base Excess > -12 or scalp lactate >4.8mmol/l

Severe maternal sepsis requiring adult ICU admission

Severe fetal sepsis requiring ventilation / level 3 NICU admission

Caesarean hysterectomy for morbidly adherent placenta and

Monochorionic twins with twin to twin transfusion.

Required Data Terms

Listed below are the data items that are required for pathological examination of placentas. Obligatory data items are in bold and the remainder should be added as required. Please include these data items on the pathology request form accompanying the placentas.

Please write clearly on the forms

· Mother’s name

· Mother’s date of birth

· Address

· Hospital Number and CHI number

· Date of delivery

· Date placenta sent for pathology examination

· Referring Hospital

· Referring consultant

· Midwife or trainee doctor’s name and contact extension / bleep number

· Gravida and Parity

· Gestation

· Indication for examination (see below)

· Livebirth (Y/N):

· Birth Weight and Centile:

· Mode of delivery:

In cases of stillbirth / late miscarriage, page 2 of the placenta form must be completed by a doctor of ST7 or consultant level. Please provide the following information:

Presence or absence of maceration

Interval between IUD diagnosis and delivery

Additional clinical details including any relevant antenatal history

Placentas not Requiring Pathological Examination

Any placentas not indicated for placental examination by our local protocol do not need to be sent for pathology. If sent to pathology, they will be stored with no initial examination. A brief report indicating the placenta has been stored will be issued shortly after the placenta is received (generally within a fortnight). These placentas will be retained for 3 months in the pathology department prior to disposal. Full macroscopic examination with histology will only be performed on request with additional clinical details indicating why such examination is required.

Placentas with the following are not indicated for examination and do not need to be sent to pathology unless there are additional relevant indications:

• Pre-eclampsia with onset after 32/40 and not requiring iatrogenic delivery
• Maternal sepsis not requiring adult ICU admission
• Maternal pyrexia
• Possible abruption
• Fetal distress not fulfilling the following criteria: pH<7.05 or base Excess > -12 or scalp lactate >4.8mmol/l
• Maternal Group B streptococcus
• Maternal diabetes or other maternal disease with normal pregnancy outcome
• Known trisomy 13, 18, 21 / Turners
• Congenital anomaly
• Uncomplicated twin pregnancy
• Twin placentas for assessment of chorionicity
• “Gritty” placenta
• Placenta praevia
• Post-partum haemorrhage
• Polyhydramnios
• History of previous molar pregnancy
• Cholestasis
• Hepatitis B/C, HIV
• Single umbilical artery
• Uncomplicated velamentous cord
• Placenta with accessory lobe
• Normal pregnancy

Test Name	Specimen/Container Requirements	Further Information:
Electron Microscopy	Specimens for electron microscopic analysis should ideally be no larger than 1-2 mm3 and placed into a vial of fresh 2% Glutaraldehyde fixative as soon as possible after specimen retrieval. Blood/Fluid Specimens should be discussed with the EM unit directly. (0141 3549420 or 01413549422). If specimens are sent through the post they must comply with post office regulations. EM sampling from a histology wax block must be accompanied by a representative light microscopy slide.	Freshly prepared glutaraldehyde has a 7 day shelf life and must be stored to 4-80c prior to use. This fixative is available with advance notice from: Electron Microscopy Unit, Pathology Department, Level 2, Laboratory Medicine and Facilities Management Building, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF (0141 3549420 or 01413549422). All unused Glutaraldehyde should be returned to the EM unit for disposal. Samples to be placed in a purple specimen bag.
Primary Cilial Diskenesia Service	Specimens are only accepted in the laboratory if taken from the clinic Specimens should be placed into M199 media with penicillin-streptomycin added – supplied by the EM laboratory.	Contacts for more info about the service and clinic.:  Paul French Jennifer Sweeney Anne Devenny

Specimens for EM analysis should ideally be no larger than 1-2mm³ and placed into a vial of fresh 2% Glutaraldehyde fixative as soon as possible after specimen retrieval apart from blood/fluid specimens which must be discussed with EM unit directly.

Freshly prepared glutaraldehyde has a seven-day shelf life and must be stored between 4-8⁰c prior to use. This fixative is available with advanced notice from the Electron Microscopy Unit, NHSGGC Pathology Department, Level 2, Facilities Management and Laboratory Medicine Building, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF (0141 3549422).

Each specimen must be accompanied by a request form with the minimum of 3 matching patient identifiers.

Due to the small size of the specimen container, there is limited space for patient’s details but at least the patients CHI and first and surname must be provided on the specimen container.

Requests for urgent results should be clearly marked on the request form and contact telephone or bleep numbers provided. The consultant pathologist should be notified first by telephone, if an urgent result is required.

Specimens should be sent for EM analysis in the same manner as routine histopathology specimens.

If specimens are sent through the post they must comply with post office regulations. EM sampling from a histological wax block must be accompanied by a representative light microscopy slide.

All unused Glutaraldehyde should be returned to the EM unit for disposal.

EM Analysis should normally be available within 5-12 days once the sample has been received by the department for processing. This may change due to service provision. If appropriate any samples marked as urgent will have an accelerated turnaround.

Sample results are affected by a number of factors including delay in fixation, use of inappropriate fixative/old fixative and incorrect sample size (1-2mm³ is recommended; if a sample is too big this can cause sub-optimal fixation, if too small will not give a good representation of morphology).

Name Of Test	Specimen/Container Requirements:	Further Information:
Respiratory: Sputum Bronchial Aspirates, Washings, Lavages, Brushings	Do not fix sample in formalin, please use saline. Please use a 30 ml white topped universal container or trap without the tubing See below for specimens requiring a differential cell count. Please send the specimen immediately. If this is not possible, the specimen(s) can be refrigerated overnight but must be delivered at the earliest opportunity the next day.	Samples to be placed in a purple specimen bag.   Brushings should be sent in preservcyt vial available from the laboratory: Cytology Department, Level 3, Laboratory Medicine and Facilities Management Building, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF (0141 354 9569).
Bronchial Differential Cell Counts	Specimens requiring a differential cell count must be clearly described/marked on the request form. Please use a 30 ml white topped universal container or trap without the tubing. Specimens for bronchial differential cell counts must be lavages in saline (the test requires mucoid material). Please send the specimen immediately. If this is not possible, the specimen(s) can be refrigerated overnight but must be delivered at the earliest opportunity the next day.	Differential cell counts cannot be performed on patients who are positive for COVID-19   Samples to be placed in a purple specimen bag.
Pancreatic Brushings	Do not fix sample in formalin, please use Preservcyt solution. Please send the specimen immediately. If this is not possible, the specimen(s) can be refrigerated overnight but must be delivered at the earliest opportunity the next day.	Preservcyt solution is available with advance notice from: Cytology Department, Level 3, Laboratory Medicine and Facilities Management Building, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF (0141 354 9569). Samples to be placed in a purple specimen bag.
Fine Needle Aspirate (FNA): Head & Neck, Breast, Lymph Node etc.	FNA specimens should be sent on 4 glass slides: 2 slides air dried and 2 slides treated with Cytofixx solution. Please send us 2 alcohol fixed and 2 air dried slides. More information can be found in the document: Fine Needle Aspirate Labelling Guide for Cytology Users FNA specimens do not need to be refrigerated Please contact Dr Van Der Horst (01413549553) if FNA demonstration s required (Head & Neck) For FNA of Breast, please send 2 air dried slides	Cytofixx solution is available with advance notice from: Cytology Department, Level 3, Laboratory Medicine and Facilities Management Building, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF (0141 354 9569). Samples to be placed in a purple specimen bag.
Endobronchial Ultrasound Guided Transbronchial Needle Aspirate (EBUS-TBNA) Endoscopic Ultrasound Guided Fine Needle Aspirate (EUS FNA): Pancreas, Liver	Do not fix sample in formalin, please use Preservcyt vials.	Preservcyt vials are available with advance notice from: Cytology Department, Level 3, Laboratory Medicine and Facilities Management Building, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF (0141 354 9569). Samples to be placed in a purple specimen bag.
Joint (Synovial) Fluid Analysis Gout Crystal Analysis	Do not fix sample in formalin, please send fresh and with no additives. Please use a 30 ml white topped universal container Please do not add EDTA	This test has been fully validated within the cytology department but is not UKAS accredited. Samples to be placed in a purple specimen bag.
Serous Effusions	Do not fix sample in formalin, please send fresh and with no additives. The volume of sample sent should be a minimum of 75ml if possible, but preferably no more than 150ml. Unless the sample is a peritoneal washing, for these a larger volume is required, we recommend at least 300 ml. Please send the specimen immediately. If this is not possible, the specimen(s) can be refrigerated overnight but must be delivered at the earliest opportunity the next day.	Samples to be placed in a purple specimen bag.
Urine Samples	Do not fix sample in formalin, please send fresh and with no additives. Do not send a urine sample taken early in the morning or shortly after waking (midstream, not first in the morning). The volume of sample sent should preferably be 50ml Please send the specimen immediately. If this is not possible, the specimen(s) can be refrigerated overnight but must be delivered at the earliest opportunity the next day.	Samples to be placed in a purple specimen bag.
Cerebrospinal Fluid (CSF)	Do not fix sample in formalin, please send fresh and with no additives. A volume of at least 2ml is required. Please send the specimen immediately.	Samples to be placed in a purple specimen bag.
Flow Cytometry	Do not send to Cytology Department. Send to Haemato-Oncology, Gartnavel. Samples need to be analysed by the lab within 72 hours of sample collection-This is especially important for patients with a clinical history including Lymphoma	Samples to be placed in a purple specimen bag. Samples should be sent directly to Flow Cytometry laboratory by porter/courier: Haemato-Oncology, Gartnavel General Hospital, Paul O’Gorman Building, 21 Shelley Road, Glasgow, G12 0XB (0141 3017729)

Specimen types routinely processed by the Diagnostic Cytology Laboratory include:

Serous Fluids Cytology

Ascitic fluid, pericardial fluid, peritoneal washings and pleural fluid.

Respiratory Cytology

Bronchial aspirates, bronchial lavages, bronchial brushings and sputa.

Brushings Specimens

Pancreatic biliary, ureteric and common bile duct.

Fine Needle Aspiration (FNA) Cytology

Superficial FNA’s taken from thyroid, breast, lymph node, supraclavicular and submandibular. Endoscopic FNA’s including TBNAs (Transbronchial needle aspirations) from lymph nodes or masses, FNA from pancreas, stomach or oesophagus and fine needle biopsy (FNB) from pancreas/nodes.

Cerebrospinal Fluid (CSF)

CSF and other neuropathology fluids are processed by cytology and reported by the Neuropathology Consultants.

Synovial Fluids (NB: This test is not UKAS accredited)

Synovial fluids are examined for the presence of monosodium urate and calcium pyrophosphate crystals in cytology. Synovial fluids are also examined for microscopic assessment if septic arthritis, inflammation or infection is queried. Any Synovial fluid specimens where septic arthritis is suspected must have a separate additional specimen and request form being sent to Microbiology. Bursa fluid and ganglion fluid may be examined for the presence of crystals and microscopic cell evaluation.

Other Fluids

Cyst Fluids (e.g. ovarian cyst, parotid and Thyroid)

Urine

Urine, ureteric washings and renal pelvic washings. Cytology can test for the presence of casts in urine.

Certain specimens for Diagnostic Cytology can be transported by the previously listed normal specimen transport methods as well as the internal pneumatic tube system

Specimens from the Queen Elizabeth University Hospital may be sent via the internal pneumatic tube system. Only the following specimens may be sent via the internal pneumatic tube system: Fluids, FNAs which are fluids (Not slides), respiratory specimens and CSFs. Please do not send specimens with a danger of infection via the pneumatic tube system. Please ensure all specimens are sent in leak-proof containers (white lidded, screw top universal tubes are ideal).

The Diagnostic Cytology laboratory should be contacted on 89569 before a specimen is sent through the pneumatic tube system.  The pneumatic tube extension for cytology is 1616

The Diagnostic Cytology laboratory follows the same specimen acceptance criteria as the pathology department.

Specimens that are Mislabelled/Erroneous/Have Insufficient Information

In the event that a specimen received in diagnostic cytology where the specimen and/or the request form has been mislabelled or erroneous, the team leader or appropriate biomedical scientist will make every attempt to contact the sender and clarify what has happened.

This may be by email or by telephoning the clinician given on the request form.

If the event that there is insufficient information to contact the source regarding a specimen e.g. specimen sent with no request form. The specimen will be kept for 1 week, in the hope that the laboratory will be contacted. If no contact has been made at the end of this period, the specimen will be discarded.

A cytology trakcare request form should be sent for cytology tests not a histopathology trakcare request form. The cytology department does issue reports via trakcare.

Specimens taken specifically for the diagnosis of infectious diseases should NOT be sent to Cytology, but instead be sent directly to microbiology/virology as appropriate.

Specimens which are highly suspicious of, or from known Group 3 infectious diseases must be labelled as D.O.I

Examples of Group 3 Infectious Diseases

Coronavirus (COVID-19), Human Immunodeficiency Virus (HIV), Hepatitis C&D, Mycobacterium tuberculosis, and Creutzfeldt Jakob Disease (CJD)

CSF Cytology Specimens which are highly suspicious of CJD or known CJD should be labelled as D.O.I. A specimen should be sent directly to the Edinburgh CJD unit if there is a clinical suspicion of CJD.

Group 4 Infectious Diseases

Should not be sent to Cytology for processing. E.g. Viral haemorrhagic fever.

Specimens which pose a risk from infectious diseases must:

• Be placed in a D.O.I specimen bag (ONLY send D.O.I specimens in these bags)
• Have a D.O.I label on the Specimen Container
• Indicate there is a Danger of Infection by ticking the box on the request form
• Describe the nature of the risk (known or highly suspicious of) on the request form

Urgent specimens must be clearly labelled as urgent on the specimen request form.

The request form must also have the contact information of the clinician who requires the urgent result e.g.  telephone number or page of the clinician. If a specimen is required urgently for a Multi-disciplinary Meetings (MDT), please put this on the specimen request form and the date of the MDT.

https://www.nhsggc.scot/download/fna-labelling-guide

Name of Test	Specimen/Container Requirements:	Further Information:
Cervical Cytology/HPV Screening LBC Smears	The specimen should be taken following the normal smear taking protocol. The collected specimen should then be rinsed out into a Hologic™ Thin Prep Pap Test (LBC) specimen vial Please ensure the vial is within the date specified. If it is out of date then it must NOT be used.	Each LBC sample should be placed in a clear polythene bag and sent to the laboratory in the appropriate white cervical cytology samples only (LBC) bag and accompanied with a Specimen Dispatch Note. For general/technical enquiries please contact: Gillian Collins: 0141 354 (8)9501 Lab: 0141 354 (8)9524

The pathology department offers a service for immunofluorescence testing on skin, renal, conjunctival and oral biopsies.

Skin, Renal, Oral and Conjunctival Biopsies requiring immunofluorescence should be placed in Michel’s fixative immediately after collection.

Michel’s media is capable of preserving fresh tissue for up to 5 days before there is any deterioration in the sample. The request form is checked for the date a sample is taken, to ensure that it has been received within time. Michel’s media is available from the pathology department upon request. The fixative should be stored between 2-25⁰c and not be used after it has reached its expiry date.

COVID-19

Fresh samples are processed routinely for immunofluorescence analysis. However, if the patient is known to be COVID Positive, please can this be indicated clearly on the form so the laboratory will be able to take the appropriate precaution when processing these samples.

Danger of Infection

Specimens that are suspected or are known to contain blood borne viruses (e.g. HIV, Hep B, and Hep C) are classified as Category 2 and can be dealt with using the appropriate safety precautions.

Specimens suspected or known to have Category 3 organisms (e.g. TB, Leprosy, and Anthrax) or Category 4 organisms (e.g. Ebola, Lassa Fever and Haemorrhagic Fever) or CJD are not suitable for analysis via immunofluorescence.

For further information regarding immunofluorescence or danger of infection samples, please contact the Immunocytochemistry Department of the pathology laboratory (0141 354 9518 or 89518).

CHI/Unique identifier, Surname & Forename or if no CHI/unique identifier, the Surname, Forename and Date of Birth must be provided.

A minimum of 3 matching patient identifiers across both the specimen pot labels and forms are required to accept a specimen and meet legislative requirements.

Only Specimen containers and Forms that satisfy the essential criteria listed below can be accepted into the department.

Request Form

Essential:-

• CHI Number or a temporary unique identifier (e.g. ZP number)
• Patient’s Full Name or unique coded identifier
• Date of Birth
• Nature of Specimen including qualifying details (Any Danger of Infection information is essential)

Desirable:-

• Patient’s Address including Postcode (essential if no CHI number)
• Clinical Information/history including risk/danger of infection (essential for fresh tissue and frozen section)
• Date and time of sampling
• Practitioner’s contact number (bleep or extension)
• Gender
• Location and destination of report
• Requesting Practitioner
• Investigation Required

Sample Container

Essential:-

• CHI number or a temporary unique identifier (e.g. ZP number)
• Patient’s Full name or unique coded identifier
• Date of Birth
• Nature of Specimen or identifier including qualifying details
• Labelling to indicate if there is a risk/danger of infection

Desirable:-

• Date and Time of Sampling

Other Essential Information

The full address to which the report should be sent must also be included.

N.B: Pre-printed labels do not indicate the address to which the report should be sent.

A short clinical history must also be provided.

A brief clinical history is invaluable in the interpretation of the histological findings and should be given in every case.

As many pathology cases require considerable clinico-pathological discussion before a diagnosis can be reached, it is essential that the name of the patient’s consultant, the name of the requesting doctor and the contact telephone or page numbers are put on the request form where asked.

If the report is required urgently this should be stated on the request form along with a contact telephone number or page number.

The laboratory cannot supply a report on unlabelled specimens or specimens received without request forms.

Failure to provide the required information may result in delays in processing specimens and/or in the provision of a Pathology report to the appropriate location.

Normally, specimens should be transferred in a sealed container with 10% neutral buffered formalin, which prevents tissue decay, ideally the volume of formalin should be at least 10 times the volume of the specimen, but for major resections this may not be possible. Please ensure that containers are properly sealed before dispatch as leaking specimens will not be picked up by Transport/ Facilities staff. If you have a Formalin spill, follow your own spill procedures. 

No fixative should be added if:

• a frozen section is requested (including: brain biopsies taken mid surgery for smear analysis, muscle biopsies and paediatric rectal biopsies – see individual sections for more information)
• the specimen is thought to be a lymphoma – whole lymph nodes only
• there is a need to collect and process fresh surplus tissue for medical research purposes
• The sample is for Immunofluorescence 

Sending Fresh Tissue

All fresh tissue must be delivered to the Pathology Department immediately and Pathology Specimen Reception should be notified that fresh tissue has been sent.

Tel:  0141 354 9513 (89513) or 0141 354 9514 (89514)

If you are unsure of the correct procedure, contact Pathology Specimen Reception for advice on the telephone numbers above.

Delay in receipt of a “fresh” specimen may make diagnosis impossible.

Fixatives and specimen jars are available from:

Specimen Reception (L3/B/021),

NHSGGC Pathology Department

Level 3, Laboratory Medicine and Facilities Management Building

Queen Elizabeth University Hospital

Tel:  0141 354 9513 (89513) or 0141 354 9514 (89514)

Requests for urgent results should be clearly marked on the request form and contact telephone or page number provided.

The consultant pathologist should be notified before the specimen is sent if an urgent result is required.

It is the responsibility of the clinical team to ensure that emergency/urgent specimens are transported urgently to the Pathology Laboratory.

In practice, these are specimens that carry the risk of transmitting Hepatitis B virus, Hepatitis C virus, HIV, M. tuberculosis and other category III pathogens.

The Clinical Microbiology Department should be contacted where there is any uncertainty.

Such specimens, include those from confirmed or suspected cases of the disease, known carriers (e.g. those known to be hepatitis antibody or antigen positive), as well as patients from an ‘at risk’ group (e.g. drug abusers).

‘Danger of infection’ (DOI) stickers must be put on the specimen bag, the request form and the specimen container.

If the nature of the DOI is known please include this in the clinical details.

Specimen bags should be sealed so that they can be opened without the use of sharp or pointed instruments.

For large specimens, containers should be enclosed in individual plastic sacks tied at the neck. The request form should be placed in a plastic envelope which is then securely tied to the neck of the sack.

“Danger of Infection” specimens should always be sent in an adequate volume of buffered formalin.

If a specimen is received in Pathology and the specimen and/or request form has been mislabelled, is unlabelled or there are discrepancies between the request form and specimen container, the Laboratory staff will make every attempt to contact the sender to clarify the error, including telephoning the source and contacting requesting clinician etc. identified from any information that has been supplied.

If the Laboratory staff are unable to rectify the problem by telephone, a “Non-conformance letter” will be sent to the requesting clinician.

This letter is accompanied by the request form and identifies the nature of the non-conformance with a request that this is rectified, and the requesting clinician takes responsibility for the changes.

Specimens will not be returned but will be kept in Pathology Specimen Reception labelled with the appropriate non-conformance number, until the non-conformance has been resolved.

The laboratory cannot supply a report on unlabelled specimens or specimens received without request forms. Failure to provide the required information may result in delays in processing specimens and/or in the provision of a pathology report to the appropriate location.

In the event of an urgent specimen being received in diagnostic cytology, where the specimen and/or request form has been mislabelled, the technical staff in the lab will make every attempt to contact the sender and clarify the mislabelling error, including telephoning the source and contacting the requesting clinician etc. identified from any information that has been supplied.

In the event of there being insufficient information to allow cytology to contact the sender, the specimen will be kept refrigerated for one week, in the hope that the lab will be contacted. If no contact has been made at the end of this period, the specimen will be discarded.