Histology

It is imperative when sending any specimen to the Histology Laboratory that it should be accompanied by a correctly filled out request form.  All sections of the form should be completed as shown on the provided example (see below). Failure to do so WILL result in rejection and the returning of the specimen to the requesting Clinic/ward/GP practice for amendment.

If Microbiology and/or cytology are required, separate specimens and separate forms MUST be submitted as the specimen(s) will be dealt with in different laboratories which are in different locations.

Request forms and specimen bags can be requested from The Royal Stoke Hospital Procurement and Supplies department (contact x72672).

It is vital that forms are correctly filled out and more importantly, legible. Clinical details are a vital part of the Histology request. Please provide legible and relevant information in this field along with any information regarding danger of infection status if known or suspected.

The minimum data set for completion of the request cards and specimen post must be followed. This can be found in UHNM Policy Number C49 – ‘Policy for Requesting Patient Investigations and Referrals and the Reporting and Interpretation of Results’.

Please note the following;

• County sourced specimens MUST have the NHS number noted on the form.
• Please ensure the resection or main specimen is labelled as “A” on the request card. The proceeding specimens should then be labelled as ‘B’, ‘C’, ‘D’ etc.
• Please note if the patient is on a cancer pathway.
• Reports may be delayed if notes have to be retrieved by pathologists in cases where clinical information provided on the requests card is deficient.

This zero tolerance approach is designed to ensure the correct and accurate receipt of specimens and request cards, to sufficiently fulfil the laboratory requirements for safe and reliable testing.

Failure to follow this procedure will result in delayed testing and ultimately delayed receipt the final report and results.

To ensure your request card is accurately filled out, please study and follow the template/s and example provided over page. The example test required is in blue text.

All patient and requestor details shown in red must be completed and correct to ensure acceptance.

Please ensure the name of the consultant is shown in the consultant field and not the requesting clinician. This will also cause rejection of the specimen.

Specimens for routine histology at The Royal Stoke Hospital must be submitted to the laboratory in 4% buffered formalin.

Please note the following dependant on where the specimens are sourced.

Specimens being sourced at The Royal Stoke for reporting at the Royal Stoke Hospital must be sent directly to The Royal Stoke Hospital Histology department for processing and reporting using internal portering services

Specimens being sourced at County Hospital for reporting at The Royal Stoke Hospital must be sent directly to the County Hospital specimen reception whereby they will then be transported to The Royal Stoke Hospital Histology department for processing and reporting.

Specimens being sourced at GP surgeries for reporting at The Royal Stoke Hospital must be sent directly to The Royal Stoke Hospital using either UHNM transport couriers or City Sprint (dependant on where you are situated). 

Specimen containers and formalin are available to The Royal Stoke Hospital users from the Pathology Stores (x 72672).

Specimen containers and formalin are available to the County Hospital users from County specimen reception.

Please ensure that the lids of specimen containers are properly secured to avoid leakage of formalin.

Histology specimens should be collected and handled with care.  If small specimens such as endoscopic biopsies, punch biopsies, small skin biopsies etc are crushed or allowed to dry out accurate histological diagnosis may be impossible. This may also lead to a degree of uncertainty of measurements within the result being provided.

Please note that it is the responsibility of the users to safely dispose of all materials used in the collection of specimens.

‘Fixation’ of specimens in formalin is the crucial first step in the histology process and should not be delayed unless necessary.

If a specimen is to be sent to the Histology laboratory dry (i.e with no formalin) please read the ‘Histology specimens sent 'dry'' in the FAQ section.Please note that here should not be any reason for County users to send any specimens dry to The Royal Stoke Histology laboratory.

Specimens should have a correctly filled out histology label attached to the side of the specimen container - not the lid. 

Specimens must be submitted to the laboratory in a sealed Histology specimen bag.

For The Royal Stoke Hospital users these can be requested from The Royal Stoke Hospital Pathology Stores ( x 72672).

For County Hospital users these can be requested from The Royal Stoke Hospital Procurement and Supplies department ( x 72672).

We strongly advise that a check of details on cards and specimens be made before specimens are bagged for dispatch to the laboratory.

Any unacceptable transcription errors (as noted under zero tolerance) which occur will give cause to the specimen being returned to the source. This will cause a delay in the report turnaround time for the specimen which may cause it to breach its target turnaround time.

If there is any known infection risk with the specimen e.g. HIV, Hepatitis and TB this should be clearly written on the request card.

Specimens for routine histology at The Royal Stoke Hospital must be submitted to the laboratory in 4% buffered formalin.

Please note the following dependant on where the specimens are sourced.

Specimens being sourced at The Royal Stoke for reporting at the Royal Stoke Hospital must be sent directly to The Royal Stoke Hospital Histology department for processing and reporting using internal portering services

Specimens being sourced at County Hospital for reporting at The Royal Stoke Hospital must be sent directly to the County Hospital specimen reception whereby they will then be transported to The Royal Stoke Hospital Histology department for processing and reporting.

Specimens being sourced at GP surgeries for reporting at The Royal Stoke Hospital must be sent directly to The Royal Stoke Hospital using either UHNM transport couriers or City Sprint (dependant on where you are situated). 

Specimen containers and formalin are available to The Royal Stoke Hospital users from the Pathology Stores (x 72672).

Specimen containers and formalin are available to the County Hospital users from County specimen reception.

Please ensure that the lids of specimen containers are properly secured to avoid leakage of formalin.

Histology specimens should be collected and handled with care.  If small specimens such as endoscopic biopsies, punch biopsies, small skin biopsies etc are crushed or allowed to dry out accurate histological diagnosis may be impossible. This may also lead to a degree of uncertainty of measurements within the result being provided.

Please note that it is the responsibility of the users to safely dispose of all materials used in the collection of specimens.

‘Fixation’ of specimens in formalin is the crucial first step in the histology process and should not be delayed unless necessary.

If a specimen is to be sent to the Histology laboratory dry (i.e with no formalin) please read the ‘Histology specimens sent 'dry'' in the FAQ section.Please note that here should not be any reason for County users to send any specimens dry to The Royal Stoke Histology laboratory.

Specimens should have a correctly filled out histology label attached to the side of the specimen container - not the lid. 

Specimens must be submitted to the laboratory in a sealed Histology specimen bag.

For The Royal Stoke Hospital users these can be requested from The Royal Stoke Hospital Pathology Stores ( x 72672).

For County Hospital users these can be requested from The Royal Stoke Hospital Procurement and Supplies department ( x 72672).

We strongly advise that a check of details on cards and specimens be made before specimens are bagged for dispatch to the laboratory.

Any unacceptable transcription errors (as noted under zero tolerance) which occur will give cause to the specimen being returned to the source. This will cause a delay in the report turnaround time for the specimen which may cause it to breach its target turnaround time.

If there is any known infection risk with the specimen e.g. HIV, Hepatitis and TB this should be clearly written on the request card.

Formaldehyde

Histological fixative is a 4% solution of formaldehyde in water (4% buffered formalin).  Formaldehyde at this concentration is classified under COSHH regulations as harmful. It is sensible to avoid all contact with skin and inhaling fumes.  Repeated exposure to formaldehyde can lead to sensitisation and may cause an allergic reaction. Formalin is now classified and it is noted that it ‘may cause cancer’.

Please note below the main ‘hazard warnings’ and ‘label elements’ for Formalin

Users of Formalin - please see additional information on the safe handling and disposal of 10% formalin,  as listed below.

• Material Safety Data Sheet for Formalin (10%)
• Policy to Control Substances Hazardous to Health (COSHH)

Spillage advice

In the event of a small spillage ventilate the area, put on gloves and apron and dilute the spill with water and mop up the fluid with tissue paper.  Put the tissue into a polythene bag and seal it and then double bag.  This can be disposed of into normal waste.  Keep the area ventilated until the spillage site is dry.

In the event of a large spillage of formalin, warn others to keep away from the area.  Ventilate the area well; wear a respirator if necessary along with other protective clothing. Use spillage absorption granules to soak up the spillage (special formalin neutralising granules are available).  Collect up the granules and double bag them and wash the area well with water and then mop this up.  Used spillage granules should be incinerated with clinical waste. Keep the area well ventilated until the spill area is dry.

If a spillage occurs in a public area or in a theatre, the spillage response team should be alerted. The team have been trained to deal with spillages of formaldehyde.

With any UNHM formalin spillage, a Datix incident form must be submitted.

All histology reports, once authorised are available immediately electronically via the EPR or ICE system (dependant on the site you are working at).

Hard copies of all reports are issued for insertion into the patients notes. It is the responsibility of the user to perform this action. Hard copy reports are provided daily through Monday to Friday 9am – 5pm except for when bank holidays occur and no service is provided.

Turnaround time (TAT) that can be expected by users (from receipt of specimen to a report being available on the EPR or ICE system) is as follows.

The departments aim is to report 80% of all Histology and Non Gynae cases received within 10 calendar days.

There will be however, times during which this turnaround time may not be achieved due to fluctuations in demand to capacity ratio within the department.

If a report is required by a certain day/time this information must be stated on the request form.

Inevitably there will also be some cases, particularly complex cases, cases requiring prolonged decalcification or cases requiring tertiary referral will take longer.

For those cases which are referred out to an accredited external NHS Trust, external reporting body or specialist testing site, there may be an increased turnaround time seen and this can be between 2 and 8 weeks dependant on the reason for the referral and complexity of the case.

This delay in the final report will be nominated to the originating clinicians via the Histology report. The report will state that ‘a supplementary report will be issued’.

We do have contingency plans in place for major failures such as equipment failures, staffing capacity failures, utilities failures, etc. If any of these contingency plans have to be put into place, we will communicate this to our users through electronic interfaces in order to inform the user of the issue, effect on specimen turnaround time and the action plan.

The laboratory can provide on request, more speciality based turnaround time data if required by the user.

The diagram below shows the multi-step process involved in Histopathology;

Further Information

For clinical information on a specific case or report callers should speak to a Consultant Histopathologist. Please phone The Royal Stoke Hospital Histology Office (x 74289) and a secretary will put you through to the correct Consultant Histopathologist.

For inquires of a technical nature callers should contact a Biomedical Scientist or the Lead Biomedical Scientist at The Royal Stoke Hospital Histology laboratory

The Royal Stoke Mortuary and County Body Store’s opening hours are 08:00 to 16:00 Monday to Friday.

On Saturday’s and Sunday’s the mortuaries are not manned but can be accessed by non-Mortuary approved UHNM personnel for delivery of a deceased.

The Mortuary staff take part in an on-call system whereby they will attend at weekends and out of hours if requested. The on-call Mortuary personnel can also be contacted for urgent information as required. These on-call Mortuary staff can be contacted via phone via The Royal Stoke Hospital switchboard for clinical advice in emergencies only.

Coroners Post Mortems

The following deaths should always be reported to Her Majesty’s Coroner.

1. Deaths from unknown causes.
2. All cases seen only after death.
3. Deaths occurring within 24 hours of anaesthetic or operative/investigative procedure.
4. All deaths which occur within 24 hours of admission to hospital.
5. All violent or unnatural deaths related to:
   • Poisoning or drug mishap (recreational/therapeutic).  This includes alcohol related death.
   • Criminal abortions
   • Assault or accident – irrespective of time interval between the event and death.
   • Want, exposure or neglect.
   • Industrial disease e.g. pneumoconiosis, mesothelioma
   • Inmates of prisons.  
   • Any known suggestion of allegations of neglect or malpractice against hospital medical or nursing staff.
   • Suicide.
6. Deaths in custody or shortly after release.

The reporting clinician should fill in a “Clinical summary for cases referred to the Coroner” form prior to discussing the case with the coroner.

If the case is accepted by HM Coroner then this form together the clinical notes, and any x-rays should be sent directly to the mortuary.

The involved clinician will be invited to attend the Post Mortem.

The written report will be sent to the Coroner and copied to the General Practitioner and where appropriate the hospital consultant.

Non Coroner’s Post Mortems

Post Mortem Examination Requests

Post mortems are performed in the hospital mortuary situated at UHNM.  They are usually performed between the hours of 09:00 and 14:00 hours Monday to Friday.

The approximate time of autopsy can be determined by direct contact with the appropriate Consultant Pathologist or with the mortuary technical staff.

Consent

The procedure for obtaining permission for a post-mortem examination in those cases which are not reportable to HM Coroner is as follows:

At the time of filling in the death certificate the clinician seeks permission for an autopsy from the bereaved relatives.  A hospital post mortem consent form must be filled in and signed.  A clinical details form should be completed and submitted immediately with the case notes and x-rays to the mortuary.

High risk cases MUST be brought to the attention of the Pathologist and mortuary staff immediately after consent has been obtained.

Clinicians are encouraged to attend the post mortem.

A written report of post mortem findings is sent directly to the Consultant in charge of the case and to the patient’s General Practitioner.

Do not delay the death certificate until after the post-mortem.  If the cause of death is not known it should be referred to the coroner.

Attendance at autopsies

• Visitors must abide by the Health and Safety notes that apply within the Mortuary.  These will be explained by the mortuary staff.
• People under 18 years of age are not permitted to attend an autopsy.

Attendance by medical personnel and medical students is encouraged.

Non Gynaecological cytology is part of the Histology Department.

Table of Non- Gynaecological specimen types and information.

Click the above link to see types of specimens received into the Non-gynaecological cytology department.