SEM100 - MTAP100 - MLSCI 100 | MEDICAL LABORATORY SCIENCE INTERNSHIP

PRE- AND POST-ANALYTICAL PROCEDURES

Lorraine Mission, RMT and Neil John Maravilla, RMT August 13, 2021

OUTLINE Note
I. Pre-Analytical II. Post-Analytical ● When a specimen is rejected, it cannot be forwarded to
Procedures Procedures histopathology laboratory, not necessarily requiring
repeat collection
I. PRE-ANALYTICAL PROCEDURES
● Received specimens should always be prefixed before
● Size of container should be proportional to size of tissue sending it to the laboratory
sample ● Despite insufficient sample present, it may still be
→ Too large of a container for small samples can cause processed and sent to the pathologist for reading; it is up
tissue sample loss to the pathologist if they will read it
→ Skin punch biopsy: 0.5 cm (smallest container) ● 20:1 fixative to specimen ratio; refill formalin in spilled
→ 10% buffered formalin specimens
● ROC: Review of Case (second opinion)
→ If unsure about the diagnosis, samples can undergo
ROC to confirm or change the diagnosis
● Usually in laboratory setting, rules may be bent to accept
as many samples as possible
→ According to the book, sample must be rejected
regardless if they violate one of the criteria
● In cases of absent labels, contact the doctor or the
A. RECEIVING THE SPECIMEN watcher to inquire about the sample
● Make sure that the specimen has label
Step 2: Specimen Charging
Step 1: Check the documents
● In this process, this is the time that you can double check
● Check the documents received and correlate it with the the specimens received
specimens received ● Take note of the date and time and the person who
● Patient’s name up to clinician’s abstract received the specimen
● Specimens are usually placed inside a ziplock ● Fill out a claim stub to be given to the
● Contains initial diagnosis by physician, referring watcher/nurse/patient
department, operation performed, brief clinical data, pre- → inform patient to return at least 7 days (excluding
or post-operative findings, and additional requests or weekends) for the results
special stains to be done → claim stub has due date; date when result can be given
→ Inpatient documents are detailed; ● Example: outpatient > watcher goes to laboratory >
→ outpatient documents are not as detailed specimen is received > details encoded in system > print
transaction slip > give transaction slip to watcher >
watcher pays for the test > transaction slip is presented to
the laboratory > lab gives claim stub

Label includes:
● Full patient name
● Medical record number (optional)
● Age and sex of the patient
● Type of specimen (Anatomic site)
● Date and time of collection
● Location of the patient (optional) Additional Information
● Biopsy minimum processing time is 5 days, excluding
● Note: repeat collection in histopath may not be applicable weekends and holidays.
● Specimen rejection criteria: (but not totally rejected) ● If claim stub is lost, present receipt
→ Unlabeled or wrong label on the specimen → if no receipt, get the name of the patient, search in
→ Incomplete patient information/clinical history system and/or check logbook
→ Left unfixed or unrefrigerated for an extended period ● If watcher ask for the results, authorization letter is
→ Putrefied or autolyzed specimens required
→ Damaged specimen or broken slides ● FSB: specimen may be processed first before payment
→ Insufficient sample for processing for the test
→ Spilled or contaminated specimens
→ Failure of the requesting physician to enter the request
in the computer
→ Empty containers without the specimen or form
→ Referral Pathology consultation material without
Histopathology report of referring hospital
▪ refers to second opinions; review of case
▪ send the processed samples; tissue block & slide
▪ histopath request, biopsy result, tissue blocks, slides

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Step 3: Accessioning Step 4: Label the documents and the specimen
with its corresponding accession number
● Assign the laboratory number/accession number unique to
that patient ● No names are written, only accession number
● Choose the appropriate logbook → Write in masking tape; red color of marker used
→ Surgical Pathology → label container in both sides
→ IHC: immunohistochemistry ● Some laboratories use barcode but still utilize logbooks
→ Cytology/cell block ● Uppercase letters when writing
→ Pap’s smear
→ ROC (2nd opinion); review of case
→ FNAB (fine needle aspiration biopsy)
→ FSB (frozen section biopsy) → 15 mins
→ Rectal biopsy
→ PBS (peripheral blood smear)
→ BMA (bone marrow aspirate)
● Write the important details of the patient
→ accession number Step 5: Prepare a worksheet
→ patient’s name ● Not used by all laboratories
→ age and sex ● Place microscopic or gross description here
→ room number (or “OPD” if out-patient) ● Serves as a draft before writing the final results
→ attending physician ● Worksheet → draft paper
→ specimen
→ transaction number
→ patho-on-deck
→ date received/Due date
● Specimen Accessioning Format:

Step 6: Keep all documents in one folder

● Save all documentation for up to (?) 7 days
→ Doctors may need it to follow up on patient treatment
● Folders may be color-coded:
→ Green: Processing samples folder
▪ Gross examination papers
→ Yellow: IHC
→ Pink: miscellaneous tests (eg. pap smear, etc.)
II. POST-ANALYTICAL PROCEDURES
A. RELEASING OF RESULTS
● biopsy result is needed before performing IHC
● Check for additional tests
→ do not forget to read endorsement letters from your
colleagues
● IHC procedure is performed for further work-ups
→ Example: ER/PR HER2NEU
▪ Positive for ER/PR indicates need for hormonal
therapy
▪ Positive for HER2NEU requires chemotherapy
● Double check everything, remember to write legibly

● “For further evaluation” cases

Additional Notes
● Logbooks are kept in histopath lab.
● The logbooks you have will depend on the tests you
offer.
● Patho on deck → kung sino yung pathologist na duty for
that day
● Duty schedule → depende sa sabot ng mga patho
● Assign letter for multiple specimens of patient
● Write in the logbook the designation of each letter
● In log book, erasures may be made but add countersign
● SP-20-143-A1, A2, A3
→ 3 representative sections of the right ovary; note in
surgical pathology worksheet during gross description
→ three cassettes for specimen A
→ Cases in which the patho-on-deck prefers to have a
consultation or refer the case to other pathologists
● Note: Medical technologists can perform gross exam on
small biopsies; ideally, however, pathologists should
always perform gross examination
● Signed result for releasing
→ Recommended to place the final result in an envelope
to maintain patient confidentiality; encouraged
● Releasing logbook
→ Date today/released
→ Name of the patient
→ Accession number
→ Name and sign of the person who claimed the result
● Note: only one result is printed

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