Chapter 016

Specimen Handling,
Transport, and Processing
Chapter 16
Copyright © 2020 by Elsevier Inc. All Rights Reserved. 1

Learning Objectives
Lesson 16.1: Specimen Handling,
(Slide 1 of 3)
1. Discuss what might happen to a sample that is not

properly handled and processed.
2. Describe four ways in which samples can be safely
transported to the laboratory.
3. Explain why tubes should be transported in an
upright position.
4. State the acceptable time between specimen
collection and separation of cells from plasma or
serum, and explain why this is necessary.

Learning Objectives
(Slide 2 of 3)
5. List two exceptions to time constraints, and state the

maximum time that each may be held.
6. List two tests for which the samples must be kept warm,
and explain how to do this.
7. Describe how to handle samples that must be chilled.
8. List at least three analytes that are light sensitive, and
explain how to protect them.
9. Describe the safety equipment that must be used when
processing samples.

Learning Objectives
(Slide 3 of 3)
10. Explain why samples must be allowed to clot fully

before processing, and state the average time for
complete clotting to occur in a red-topped tube and
when clot activators are used.
11. Explain the principle and proper operation of a
centrifuge.
12. Describe the proper procedure for removing a stopper.
13. List at least five reasons for specimen rejection.

Proper Handling of Specimens
 Critical to ensure accuracy of test results obtained

from them
 Analytes may change in composition and
concentration over time and with temperature

changes or exposure to light

General Guidelines for
Specimen Transport
(Slide 1 of 3)
 Tubes with additives should be inverted gently

and completely 5 to 10 times immediately after
being drawn
 Thorough mixing allows the additives to be evenly
distributed throughout the sample

Specimen Transport
(Slide 2 of 3)
 An efficient and safe way to transport

samples is in a leak-resistant bag with
zip closure
 Specimen bags are marked with a
biohazard symbol and have a separate

front pouch for requisitions to prevent
contamination of the requisition should
the specimen leak

Specimen Transport
(Slide 3 of 3)
 Tubes should remain upright during transport

 This accomplishes several purposes:
 It promotes complete clot formation when there is no
additive present
 It prevents sample contamination due to prolonged
contact with the stopper
 It reduces the likelihood of aerosol formation during
uncapping, as there is no residual blood clinging to the
stopper

Time Constraints
(Slide 1 of 2)
 The quality of test results depends heavily on the

time between when the sample is drawn and when it
is analyzed: The longer the interval, the more likely
the results will be inaccurate
 Ongoing glycolysis (metabolic sugar breakdown
within cells) within the specimen is a primary cause

of inaccurate test results
 As a general rule, an uncentrifuged blood sample
should be delivered to the laboratory within 45

minutes of being drawn

Time Constraints
(Slide 2 of 2)
 A few sample types can wait longer before

processing without loss of viability
 Because fluoride inhibits glycolysis, glucose
samples collected in gray-topped tubes can be held

for 24 hours at room temperature and for 48 hours
at 2º to 8º C
 Blood smears made from such samples must be
done within 1 hour of collection because

ethylenediaminetetraacetic acid (EDTA) will
eventually distort cell morphology

Temperature Considerations: Keeping
Specimens Warm
 Specimens that must be maintained at 37º C
during transport and handling include cold
agglutinins, cryoglobulins, and cryofibrinogen
 The tubes for these specimens should be warmed
using a heel-warmer packet before collection, and

the sample should be transported wrapped in a
heel-warmer packet as well
 Specimens for cold agglutinin testing and
cryofibrinogen must also be kept warm

Specimens at Room Temperature
 Some specimens must be kept at room
temperature
 If the specimen is being delivered outside the
facility by courier, it may be placed in an insulated

container to protect it from extreme heat or cold

Specimens Cool
 Chilling a specimen slows metabolic processes
and keeps analytes stable during transport and
handling
 Samples that need to be chilled include pyruvate
and lactic acid

 To chill a sample, place it in a slurry of chipped
or shaved ice and water

 This promotes complete contact between the
sample and the ice bath

Specimens Frozen
 Some specimens must be kept frozen, because
some analytes are stable only in extreme cold
 Require storage at temperature ranging from -20º
C down to -70º C before testing

 Clotting factors and complement factors

Protecting Specimens from Light
 Exposure to light can break down light-sensitive

analytes
 Bilirubin is the most common light-sensitive
analyte; others include vitamin B12, carotene,

folate, and urine porphyrin
 To prevent light exposure, samples are collected in
amber-colored microtubes, wrapped in aluminum

foil, or an amber/brown biohazard bag, and placed
inside a brown envelope or heavy paper bag

Protecting Specimens from Light

Transporting Specimens
to the Laboratory
(Slide 1 of 2)
 In many institutions, samples are hand-carried by

the phlebotomist or another member of the
laboratory team
 Samples may be dropped off at designated areas
within the hospital for transportation and delivery

by the laboratory staff
 Minimum information should include the patient’s
name, hospital number and room number, specimen

type, date and time of delivery to the drop-off area,
and name of the person depositing it

Transporting Specimens
to the Laboratory
(Slide 2 of 2)
 Some institutions use a pneumatic tube system, in

which samples are carried in sealed plastic carriers
that travel within a network of tubes
 Shock-absorbing foam inserts are placed in
carriers to reduce the shaking and agitation of the

sample during transport
 Special containers are used to protect the sample
and prevent contamination of other material

during transport

Pneumatic Tube System

Safety
 The Occupational Safety and Health

Administration (OSHA) requires personal
protective equipment (PPE) to be worn during
sample processing

Central Processing
(Slide 1 of 2)
 Specimens entering the laboratory are usually first

handled by central processing, an area devoted to
accessioning and sorting samples as they arrive
 The date and time of arrival are recorded, often
with a time- and date-stamping machine

 Each sample is marked with an accession number,
a unique identifying number used for cataloging

the sample in the laboratory

Central Processing
(Slide 2 of 2)
 Central processing is also usually responsible for

centrifuging samples, to separate plasma or serum
from cellular elements, and for preparing aliquots,
which are small portions of the specimen
transferred into separate containers for distribution
to a variety of laboratory departments
 Before centrifuging, the stopper should remain on
the sample to prevent its contamination or

alteration

Clotting
 Serum specimens must be completely clotted

before centrifugation
 Complete clotting may take 30 to 45 minutes at
room temperature
 Samples with clot activators (including serum
separator tubes) clot within 30 minutes

 If thrombin is used, complete clotting may occur
within 5 minutes

Centrifuging
 A centrifuge spins the sample at a very high speed,

separating components based on density
 Cellular elements, which are denser, move to the
bottom; the less dense plasma or serum is pushed

to the top

Blood after spun

Removing a Stopper
 The major risk of stopper removal is formation of

an aerosol, a microscopic mist of blood that forms
from droplets inside the tube
 Aerosols are especially likely if the tube or rim
has been contaminated by blood during collection

or transport
 Many automated instruments allow for testing
without stopper removal

Preparing Aliquots
 All tubes into which aliquots are placed should be

labeled before filling and then capped before
delivery to the appropriate department
 Aliquots are not poured off because this may
cause splashing and aerosol formation

 Instead, an aliquot is removed with any one of
several types of disposable pipetting systems

Transport and Processing
of Nonblood Specimens
 Microbiology samples must be transported to the
laboratory immediately to increase the likelihood
of recovering pathogenic organisms
 Most specimens are collected in transport media
and do not require additional processing after

collection
 Most samples are plated immediately on culture
media; often the phlebotomist is trained to

perform this task

Specimen Rejection
 Improper or inadequate identification

 Hemolysis
 Incorrect tube for the test ordered
 Tubes used past their expiration date
 Inadequate ratio of blood to additive
 Insufficient volume for testing
 Drawing a specimen at the wrong time
 Contaminated specimen
 Improper handling
 Bringing a sample to the laboratory outside the
appropriate time frame
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Specimen Handling,

Transport, and Processing

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 1

1. Discuss what might happen to a sample that is not

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 2

5. List two exceptions to time constraints, and state the

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 3

10. Explain why samples must be allowed to clot fully

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 4

 Critical to ensure accuracy of test results obtained

concentration over time and with temperature

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 5

 Tubes with additives should be inverted gently

distributed throughout the sample

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 6

 An efficient and safe way to transport

biohazard symbol and have a separate

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 7

 Tubes should remain upright during transport

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 8

 The quality of test results depends heavily on the

within cells) within the specimen is a primary cause

should be delivered to the laboratory within 45

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 9

 A few sample types can wait longer before

samples collected in gray-topped tubes can be held

done within 1 hour of collection because

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 10

using a heel-warmer packet before collection, and

cryofibrinogen must also be kept warm

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 11

facility by courier, it may be placed in an insulated

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 12

and lactic acid

or shaved ice and water

sample and the ice bath

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 13

C down to -70º C before testing

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 14

 Exposure to light can break down light-sensitive

analyte; others include vitamin B12, carotene,

amber-colored microtubes, wrapped in aluminum

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 15

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 16

 In many institutions, samples are hand-carried by

within the hospital for transportation and delivery

name, hospital number and room number, specimen

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 17

 Some institutions use a pneumatic tube system, in

carriers to reduce the shaking and agitation of the

and prevent contamination of other material

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 18

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 19

 The Occupational Safety and Health

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 20

 Specimens entering the laboratory are usually first

with a time- and date-stamping machine

a unique identifying number used for cataloging

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 21

 Central processing is also usually responsible for

the sample to prevent its contamination or

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 22

 Serum specimens must be completely clotted