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Pathology Handbook

Pathology User Handbook

Section 4: Department of Cellular Pathology

Table of Contents

4.1 Department Telephone Numbers and General Information

Dr Chris Meehan

Head of Department and Consultant

01225 825716

Dr Leigh Biddlestone

Consultant Histopathologist

01225 825624

Dr Simon Rose

Consultant Histopathologist

01225 824716

Dr Paul Kitching

Consultant Histopathologist

01225 826414

Dr Pinias Mukonoweshuro

Consultant Histopathologist

01225 825677

Dr John Mitchard

Consultant Histopathologist

01225 824719

Dr Sarah Johnson

Consultant Histopathologist

01225 824722

Mrs Lucinda Payne-Johns

Laboratory Manager

01225 825717

Mrs Jackie Price

Chief BMS Histopathology

01225 824718

Mr Simon Blight

Chief BMS Cytopathology

01225 824746

Mr Bill Minchin

Chief Mortuary Technician

01225 824062

Results Enquiries

 

01225 824700

Booking of Frozen Sections

 

01225 824720

The Histopathology and Cytology Laboratories are open from 09:00h to 17:30h from Monday to Friday. The mortuary is open from 0800h to 16.30h Monday to Friday. A Consultant Pathologist is available on call, out of normal hours, through switchboard. Please feel free to contact any one of the consultants and members of laboratory staff for advice about any aspect of our service.

Collection containers and slides:

Items available from Pathology stores include:

Please Fax stores requests to : 01225 824765

Items available from Histology Laboratory (ext 4750) include:
(Any items ordered directly from the laboratory will have to be collected)

Items available from Cytology Laboratory (ext 4721) include :

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4.2  General Safety Precautions

All histological and cytological specimens are potentially hazardous.  They must be collected and transported in appropriate, well-sealed containers.  Small specimens containers must be placed leak-proof plastic bags supplied by the laboratory .  High risk specimens should be placed in a suitable container, sealed against leakage with tape, and labeled with a "HIGH RISK" or "DANGER OF INFECTION" label.  The completed request form must also bear the appropriate biohazard label.

The following conditions are considered particularly hazardous and all specimens from patients with these conditions should bear the appropriate biohazard labels:

HIV, brucellosis, typhoid, leptospirosis, rabies, tuberculosis, viral hepatitis, Creutzfeld Jacob disease (or any other prion disease), septicaemia of any type.

Please consult Microbiology or the Department of Cellular Pathology if there are any queries regarding any of these, or other infective conditions you may encounter in clinical practice.

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4.3  Labelling of Specimens and Completion of Request Form

Every specimen that is sent to the Cellular Pathology Department must be accompanied by a fully completed Histopathology or Cytopathology request form.  The specimen container must also bear a fully completed label.  The details on the specimen container must correspond with those on the request form.  Any specimen arriving in the laboratory without a completed request form, in an unlabelled container or with details that do not correspond, will not be processed until the specimen has been correctly identified and labeled by the submitting clinician. 

There are priority tick boxes on the right hand side of the request form to allow appropriate triaging of specimens through the laboratory. Any small specimen eg endoscopic biopsy ticked as urgent will be fast tracked and we expect to report 90% of these within 2 working days of receipt.

Inadequately labelled cervical cytology specimens, use of out of date LBC containers, and out of screening samples ( women not due a sample) will be rejected and returned to the sender.

If an urgent result is required, the sender must indicate a contact extension or bleep number to allow the delivery of an oral report.

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4.4  Histopathology Specimens

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Routine specimens

All specimens for routine histological examination should be placed in buffered formalin, into a container of appropriate size.  Please do not force large specimens into small pots.  Please ensure that the specimen is completely covered by formalin to allow adequate fixation (at least twice the volume of the specimen is recommended).  Incomplete fixation will delay processing and impair histological assessment. Please keep histology specimen buckets upright when transporting them to the laboratory.

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Immediate diagnosis/Frozen sections

If possible please notify the laboratory at least one day in advance by contacting the laboratory On Ext 4720/4750. We will need to know full patient details, the time of the operation, the surgeon and the theatre extension. Please inform the laboratory if the frozen section is cancelled

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Urgent specimens

We can provide a report on urgent specimens in 24 hours if the tissue is small and adequately fixed. Please remember to put a bleep or contact number on the request form.

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Special requirements

Small gastrointestinal mucosal biopsies
Place biopsies  on acetate paper strips.  The use of the paper strips allows the site of series of biopsies to be identified during reporting.  These strips are marked with black ink at one end and if a series of biopsies are taken please place the most proximal biopsy nearest the mark e.g. the caecal biopsy in a complete colonoscopic series. and the remaining biopsies  in order .  Do not put more than 6-7 biopsies on one strip.  If more than this number of biopsies are taken please use more than one acetate strip placing each strip in a separate formalin filled container labeled appropriately.

Muscle and nerve biopsies
Please contact one of the pathologists for advice since     some of these specimens must be sent fresh and unfixed to Frenchay Hospital.      Alternatively contact a Neuropatholgist at Frenchay Hospital direct on 0117 970 1700.

Renal biopsies
These specimens are sent directly to Southmead Hospital by the Referring Clinician.

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General Practitioner biopsies

Please complete full history including site of lesion and method of removal, e.g. curettage, shave or excision biopsy.

How Long Does a Report Take?

From the time of removal, the lesion will usually require 24-48 hrs of fixation. Blocks are then taken and processed overnight so that thin sections can be cut the following day for microscopy. Slides are available in the afternoon with a typed report usually available the next day. Cases requiring further levels or special stains take longer.

Small simple urgent specimens: 90% are reported with 2 working days of receipt.

Simple small soons and routines: 90% are reported within 6 working days after receipt

Urgent small biopsies can be processed much more quickly and other specimens can be expedited by prior arrangement. Results can be telephoned through for appropriate clinical reasons, also speeding up this process. Clearly this can only be done for a small number of cases.

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Cytology specimens

Please telephone the Cytology Laboratory on 4721 if the specimen you are sending is urgent and you require an immediate result.

All specimens must be labelled with the correct patient idenifiers and accompanied with a completed cytology request form.

Sputum
One early morning specimen is required from each of 3 consecutive days; each should bear the date of production on the label.  Specimens should be produced early in the morning before the patient has eaten and should be from a deep cough.  Please note that multiple specimens from the same day are not satisfactory and will not be processed.  Specimens should be brought to the laboratory on the day of production.

Bronchial brushings
Send to laboratory in Cytolyt Solution. Please telephone Cytology lab on ext 4721 for supplies of solution.

Bronchial washings/lavage specimens
Send to the laboratory in a sterile universal container as soon as possible

Fluids from body cavities (e.g. pleural, peritoneal, pericardial and hydrocoele fluid)
Send to lab in a labelled, plain, sterile universal container without fixative as soon as possible.

Urine
Freshly voided urine, the SECOND sample of the day should be sent in a plain sterile container (without formalin).  The first specimen of the day is not suitable as this contains degenerate cells which have been lying in the bladder overnight and which are unsuitable for assessment.

Fine needle aspirates
Smear lengthwise directly onto slides labelled in pencil with correct identifiers on frosted end of slide, ensuring that the specimen is on the same side as the labelling. Spread well (do not leave a dense mass on a small area in the centre of the slide), air-dry rapidly and place in plastic slide box. Then send directly to the laboratory.

Cerebrospinal fluid  (min volume of 1 ml required wherever possible)  
Place in a labelled sterile universal container without fixative and send to the laboratory immediately.

Synovial fluid
Place in a labelled sterile universal container without fixative and send to the laboratory immediately.

Breast cyst fluid
Send in a labelled sterile, universal container without fixative.

Cervical Samples
Thin prep Liquid Based Cytology samples are only accepted from registered smear takers, submitted with a fully completed gynaecological cytology request form.

Thyroid aspirations from Endocrinology and needle washings from Ultrasound
Material obtained for cytology should be placed in a universal container containing RPMI culture medium. Please note that RPMI medium is highly susceptible to contamination and so these tubes are only supplied in small numbers. Please call Cytology Office ext 4721 to arrange for further supplies.

Semen Samples for Fertility Analysis
These tests are carried out by appointment only and are available Tuesdays and Thursdays only. The patient should telephone the Cytology Laboratory office on 01225 824721 to make the appointment and should bring the sample to the laboratory on the day of the appointment in sufficient time that it may be analysed within one hour of production. Further details are provided in the patient instruction sheet (see below).

At consultation please supply the patient with the following

Instructions for the collection of semen

Post Vasectomy samples: These are done by prior on arrangement with CASH clinic at St Martins Hospital

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Turnaround Times

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4.5  Autopsies

After the death of a patient, please inform the mortuary as soon as possible if a post mortem examination is required.

If a hospital post mortem examination is to be performed:

  1. a death certificate must be completed
  2. signed consent from the next-of-kin must be obtained
  3. a clinical summary for the mortuary must be completed
  4. the patient's notes must also be sent to the mortuary with the clinical summary

Failure to comply with these requirements will lead to a delay in the post mortem examination.

If a death needs to be reported to the Coroner (see below - Notes for Guidance in connection with notification of deaths to HM Coroner), please inform the Coroner's Officer at Flax Bourton – 01275 461920 - as soon as possible. The Coroner's Officer is available between 0800h and 1600h.

If there is any doubt as to whether or not a death has to be referred to HM Coroner, please contact a Consultant Pathologist or the Mortuary for advice.

Please note that mortuary staff and pathologists must be informed of any post mortems with possible infective hazards, especially HIV, hepatitis B, C and tuberculosis and that all such bodies must clearly bear the appropriate biohazard labels.

Notes for guidance in connection with the notification of deaths to HM Coroner (Information for Medical Staff)

A death certificate should not be issued on a patient dying under the following circumstances.  HM Coroner or his/her deputy should be informed AS SOON AS POSSIBLE.

  1. Where a body is UNIDENTIFIED.
  2. Where NO DOCTOR HAS ATTENDED THE DECEASED during the last illness.
  3. When the DOCTOR attending the patient DID NOT SEE HIM OR HER WITHIN FOURTEEN DAYS OF DEATH.
  4. Death whilst under the influence of ANAESTHESIA (ON THE OPERATING TABLE or on the ward before recovering consciousness). The Anaesthetist should be informed before reporting the facts to the Coroner.
  5. Where the CAUSE IS NOT KNOWN.
  6. When the death was SUDDEN AND UNEXPLAINED or there were SUSPICIOUS CIRCUMSTANCES.
  7. Patients already dead on ADMISSION to hospital, or dying shortly after (within 24 hours of admission).
  8. Following an ACCIDENT (e.g. road traffic accident or domestic)  or injury, which is relevant to the cause of death, even if the accident took place many years before.  It is advisable to inform HM Coroner if a patient dies shortly after an ACCIDENT IN THE HOSPITAL even if the injury appears not to have contributed to the death.
  9. Deaths following abortions.
  10. Detention in hospital under an  ORDER of the  COURTS or of a PERSON ADMITTED TO HOSPITAL FOLLOWING POLICE OR PRISON DETENTION.
  11. DRUGS, Therapeutic mishaps, addition or abnormal sensitivity
  12. ILL TREATMENT including malnutrition and suspected baby battering.
  13. INFANT DEATHS if in any way obscure.
  14. LITIGATION - all cases where it is known or suspected that the relatives or executors intend to bring charges of negligence against any person.
  15. Patients from a LONG STAY HOSPITAL (Mentally handicapped hospitals, etc.)
  16. OCCUPATIONAL DISEASE. E.G. pneumoconiosis, asbestosis, (to be suspected in cases of mesothelioma), Weil's disease, carcinoma of the urinary tract in rubber workers, nasal carcinoma in wood workers, anthrax and all diseases covered by the FACTORIES ACT  malignant disease or anaemia resulting from exposure to radiations or radioactive active substances.

    The Coroner would be grateful if the Hospital reports to him deaths of ALL MINERS unless the presence of pneumoconiosis can be definitely excluded.
  17. PENSIONERS receiving war or disability pensions, where death might be connected with the disability.
  18. POISONING from any causes (including food-poisoning) and including the ACUTE EFFECTS OF ALCOHOL.
  19. RENAL TRANSPLANT DONORS.
  20. SEPTICAEMIA.
  21. SUICIDE.
  22. UNNATURAL DEATHS, e.g. drowning, electrocution, violence, hypothermia, choking.

Please Note:

The REGISTRAR OF BIRTHS AND DEATHS is unable to register a death when the certificate states that a FRACTURE has contributed to death. This may need to be qualified as osteoporotic or certainly demonstrated that the fracture was not a result of an accident. This would be an accidental cause of death rather than a natural cause of death.

Cases are referred to the Coroner by fax using the forms available in the Patient Affairs offices and faxed directly to the number. This means there is a written trail of evidence that can be stored in the casenotes and that there is no dispute about what information is given to the Coroner. Full details of the fax and contact numbers are available within the Patient Affairs office. The Patient Affairs extension is 4315. The opening hours of the Patient Affairs office are: 08.30am – 3.30pm Monday to Friday.

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