Specimen Collections

Specimen collection is the first critical step in diagnosis. All diagnostic information from the laboratory is contingent on the quality of the specimen received. Consequences of a poorly collected and/or poorly transported specimen include failure to isolate the causative microorganism and the possibility of recovering contaminants or normal flora, which can lead to improper treatment of the patient. Careful attention to the specimen source, method of collection and timing, storage, transport and handling of the specimen will result in the most relevant information available to the clinician in his decision making.
 
In addition, a completed request form with tentative diagnosis and relevant history is essential for optimal and efficient laboratory workup. Please use this as a guide in ordering, selecting, and collecting specimens from your patients.
 

specimen guidelines

Specimen Submissions

Laboratory tests contribute vital information about a patient’s health. Correct diagnostic and therapeutic decisions rely, in part, on the accuracy of test results. Adequate patient preparation, specimen collection and specimen handling are essential prerequisites for accurate testing. The accuracy of test results is dependent on the integrity of specimens.
 

Specimen Labeling

All specimens should be labeled in the presence of the patient with the patient’s name, specimen date, and time collected.
 

Specimen Requisition Forms

Please use the Laboratory Test Request Form for submissions. This form is also available upon request by submitting a Laboratory Supplies and Forms Requisition. For more information about laboratory testing, forms, reports, or supplies, please visit our Laboratory Testing, Reporting & Supplies webpage.
 
The Laboratory Test Request forms are double copy. The white original is returned to the lab. The yellow copy stays with the submitter. Laboratory Test Request forms are submitted for immunological evidence of infection from blood and CSF specimens and for isolation and/or identification of bacteria, fungi, parasites, or viruses.
 
Please follow these steps in filling out the forms. Please print all information legibly.

Specimen Collection Guidelines for Immunology

Collection & Storage Guidelines

A single aseptically collected whole blood specimen in a red top vacutainer is sufficient for any of the immunology tests on the Immunology Request Form. An aseptically collected spinal fluid specimen may be submitted for some serological tests. Blood, spinal fluid and serum specimens should be held refrigerated. Spinal fluid and serum/plasma specimens may be frozen if held for an extended period of time.
 
Specimens submitted for HIV viral load testing and CD4/CD8 must be submitted promptly in purple-topped EDTA anticoagulant tubes. Specimens for QuantiFERON testing are collected in 3 specialized tubes and must be submitted within 16 hours of collection.
 
Universal blood and body fluid precautions should be taken when handling these specimens. Specimens may be centrifuged, following standard practice, and the serum or plasma transferred to a sterile tightly capped tube before submitting to the laboratory. Alternately, blood tubes with serum or plasma separators may be centrifuged and transported in the original tube. Please contact the Laboratory with any questions regarding appropriate specimens.

Specimen Required

Any of the following may be used. Check individual test procedure for specific requirements.

  1. Most Serology Tests: Serum from whole blood, allowed to clot, in red top or serum separator vacutainer tubes, stored at 2-8ºC or –20ºC. May be transported at room temperature or refrigerated. Hemolysis may occur at high temperatures, making specimen unsatisfactory for testing.
  2. HIV-1 Viral Load PCR: 1) Plasma from whole blood with EDTA anticoagulant (purple top)– centrifuge at 2000rpm for 20 minutes and separate plasma within 24 hours of collection; or, 2) Plasma separator tubes with EDTA: centrifuge at 2000rpm for 20 minutes after blood draw. Store at 2-8ºC.
  3. CD4/CD8 Flow Cytometry: Whole Blood with EDTA anticoagulant (purple top)– Must be tested within 48 hours of collection time; or, Purple Tiger Top—can be tested up to one week after collection. Store at room temperature.
  4. QuantiFERON: Whole Blood in 3 test-specific low volume tubes (1ml) drawn in order, (1) Gray; (2) Red; (3) Purple. Shake vigorously for 5 seconds. Store at room temperature. Must arrive at lab within 16 hours of blood draw for incubation at 37ºC.

Turnaround Times

Syphilis RPR and HIV-1 EIA are run weekly. Expected turnaround time and availability of final reports on negative specimens is about five (5) working days from the day the specimen is received. Reports are then faxed to the secure fax line on file for that submitter. Other immunology tests, including confirmatory tests, are run once a week. Depending on when the specimen is received, turnaround time is 7-10 days. In cases of urgency or public health emergency, testing will be done as soon as practicable, after communication with the public health laboratory director or designee.

Specimen Transportation Guidelines

Use the following guidelines to properly transport specimens to the laboratory.
 
Temperature Requirements
Specific temperature transport requirements are provided under each assay description. Unless otherwise indicated specimens should be transported at 2-8ºC.
 
Diagnostic Specimens
Specimens that are transported in house or by courier should be placed in the appropriate resealable specimen bag. Make sure the specimen bag is tightly sealed to avoid leaking. Place paperwork in the outer pocket and NOT inside with the specimen. Important: The request form should not be wrapped around the blood tube itself or inside the transport container.
 
Other specimens should be sent in their appropriate specimen containers and placed inside the plastic resealable bag provided. The request form should be placed in the front pocket of the plastic resealable bag (if available) or wrapped around the resealable bag. Please do not place the request form inside the specimen compartment.
 
Any specimens sent through the US mail need to meet federal and postal regulations.
 
Biological Substance, Category B
Defined as any human material including, but not limited to excreta, secreta, blood and its components, tissue and tissue fluids being shipped for purposes of diagnosis. The following guidelines (IATA Packing Instruction 650) are to be utilized if transportation is by commercial carrier:
 

  1. Watertight primary receptacle.
  2. Watertight secondary receptacle.
  3. Absorbent material, sufficient to absorb the entire contents of all primary receptacles placed between the primary receptacle and the secondary receptacle.
  4. A sturdy outside packaging constructed of corrugated fiberboard, wood, metal or plastic.
  5. UN3373 label.

 
Infectious Substances
Substances known to contain or reasonably expected to contain, pathogens. Pathogens are microorganism (including bacteria, viruses, rickettsia, parasites, and fungi) or recombinant microorganisms (hybrid or mutant) that are known or reasonably expected to cause infectious disease in humans. The following guidelines (IATA Packing Instructions 620) are to be utilized if transportation is by commercial carrier:
 

  1. Watertight primary receptacle.
  2. Watertight secondary receptacle.
  3. Absorbent material, sufficient to absorb the entire contents of all primary receptacles placed between the primary receptacle and the secondary receptacle.
  4. Affix an Infectious Substance label.
  5. Attach the Shipper’s Declaration of Dangerous Goods.

 
Frozen (Dry Ice) Shipments
Be aware that dry ice is a dangerous good and must always be declared by marking, labeling and documentation. If there are no other dangerous goods in a shipment with dry ice, a Shipper’s Declaration is not required. Refer to IATA packing instruction 954.

Specimen Collection Guidelines for Clinical Technology

Fecal Occult Blood

Lab Test Request Form: CT9
 
Specimen Collection Kit available from Laboratory with pre-labeled postage-paid mailer for patient to collect specimen and mail from home. Following the directions on the Hemosure specimen collection kit, collect a small amount of fresh stool and replace in transport vial. Complete patient information on test request form and return the specimen vial and request form to the Public Health Laboratory in the pre-addressed postage-paid Tyvek envelope.