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Andheri Diagnostic Centre

Fully Automated & Computerised

On Panel of : AIR INDIA, ALLIANZ BAJAJ , INDIA GOVT.MINT & INDIAN HEALTH ORGANIZATION


GUIDELINES

DEAR DOCTORS,


The quality of any laboratory test result is majorly dependent on the correct specimen , which can be ensured by following simple specimen collection instructions and guidelines.
Here we attempt to provide a few GUIDELINES for the same.

PATIENT PREPARATION :

Many tests require that the patient be prepared in some specific way to ensure useful results.
For most of the tests performed on serum, plasma or whole blood, a fasting specimen is preferred since this provides information that reflects the physiological baseline of the patient.
Also, non fasting samples are often lipemic, containing high triglycerides from food, which can interfere with many analytical procedures.
An ideal fasting period would be for 12-14 hours especially for triglyceride estimations.

PROPER LABELLING OF SPECIMENS :

Each submitted specimen must be labeled with the patients name (as it appears on the requisition slip) and the tests to be conducted.

BLOOD,SERUM AND PLASMA SPECIMENS :

Collect the blood using routine phlebotomy techniques.
Gently mix the samples within the appropriate container (if anticoagulant is required).Do not mix vigorously as it may cause hemolysis.
If serum is required, then do not shake the container after collection. Allow the tube / vacutainer to stand for a while before transport.

URINE SPECIMENS :

  • For routine urine analysis – The first morning voided (concentrated) specimen is always the best.
  • For urine culture analysis – A midstream early morning sample is preferable since there are increased bacteria in the bladder after overnight incubation.
  • For urine pregnancy test – The first morning sample is preferable since it is concentrated.
  • For urine chemistry tests – A 24 hour collection is the usual standard. For some of these tests, there are dietary restrictions. For some there are drugs that must be avoided prior to collection. For tests like VMA, Metanephrines, Catecholamines,17 Ketosteroids - patient must abstain from ice cream, chocolates, bananas, drugs containing gentisic acid and homogentisic acid products for 3 days prior to the test. A container having 30ml of HCL is given to the patient.
    For all other urinary assays like albumin, creatinine, uric acid, calcium, phosphorous, spot test – no preservatives in the urine container are required.

  • Sample collection instructions:

  • The sample is to be collected in the container provided by ADC along with the required preservative. Instruct the patient not to discard the preservative.
  • On the day of collection, ask the patient to empty the bladder in the toilet and not include this sample in the collection container. The date and time of voiding should be noted on the container. All the subsequent voidings should be added to the container. The last sample to be collected should be the first specimen voided the following morning at the same time as the previous days first morning void.
    Mix the contents of the container thoroughly but gently.
  • When referring from another lab – measure the total volume of urine and transfer only the required amount of urine to a plain container

STOOL SPECIMENS :

  • For general screening/ parasites : Collect the stool specimen in the plain containers provided by ADC.
    Many parasites are intermittently passed and hence it is recommended that at least 3 specimens collected at 1-3 days intervals should be submitted to increase the probability of detecting parasites. Barium, antibiotics, antimalarials, mineral oil and other laxatives interfere with parasite detections. Specimens submitted from patients treated with the above must be collected at least 7 days post treatment.
  • For occult blood :
    Any clean dry container can be used.
    Strict adherence to a special diet is crucial for reliable results- Patients should be instructed to eat a well balanced diet including fiber such as bran, cereal, fruits and vegetable.
    The following items should be avoided for at least three days before the test:
    Red meat (beef , lamb, liver)
    Vitamin C in excess of 250mg/day from supplements, citrus fruits, juices.
    High peroxidase containing fruits and vegetables including turnips, radishes, broccoli, cauliflower and melons.
    Non steroidal anti-inflammatory drugs such as Ibuprofen, naproxen, Indomethacin or aspirin (>325mg/day)
    Iron supplements containing>250mg of vitamin C.

COAGULATION TESTING :

  • Citrated plasma is the only acceptable sample. All other anticoagulants are NOT acceptable.
  • The proper 9:1 blood to anticoagulant ratio must be strictly followed. No extra blood must be forced into the tubes.
  • Mix gently by inverting the tube several times. Do not shake the tube as this will breakdown fibrinogen in the sample.

MICROBIOLOGY :

Specimens for aerobic cultures should be submitted under aseptic conditions in the sterile container provided by ADC.

  • Urine Cultures :
    Obtain early morning samples whenever possible. Symptomatic patients may have lower colony counts if specimens are collected late in the day.
    Obtain a midstream clean catch specimen within the sterile containers, to avoid contamination by normal vaginal, perineal and anterior urethral flora.
  • Urethral sample (male):
    Patient should not urinate for one hour prior to the test. Insert the swab 2-4cms into the urethra and rotate for 3-5seconds.
  • Endocervical samples (Female):
    Remove excess mucus from the ectocervix with a separate swab and discard it. Rotate a fresh swab in the endocervix for 15-30 seconds, avoiding the vaginal wall.
  • Conjunctival samples :
    Firmly stroke the lower conjunctiva with a swab 2-3 times.
  • Blood Cultures (AEROBIC) :
    To be collected in the blood culture bottles provided by ADC.
    Completely decontaminate the skin at the site of sampling.
    Draw the required quantity of blood as specified on blood culture vial. Inject the same amount, directly and gently, into the blood culture vial.
    For optimal recovery of microorganisms, obtain the blood culture before the use of systemic antimicrobials, when there is a fever combined with significant leucocytosis / leucopenia.
    Prior to pickup – store the bottles and tubes at room temperature away from direct sunlight and/or ventilation sources. The sample is stable for upto 24 hours.
  • Blood Cultures ( Mycobacterial / Fungal ) (BACTEC) :
    Collect in SPS tubes. Gently mix the tubes after innoculation.

SPUTUM AND LOWER RESPIRATORY TRACT SPECIMENS :

  • The preferred sputum sample is an early morning expectorated sample obtained after a deep cough. The patient should rinse the mouth with water before collection and must avoid adding saliva or nasopharyngeal discharges, to avoid contamination with indigenous microorganisms.
    The lower respiratory tract samples are obtained by bronchoscopy or transtracheal aspiration.
  • For mycobacterial cultures , it is recommended that 3 separate sputum samples be collected over three consecutive days and submit them separately, not pool them.

SEMEN ANALYSIS :

  • Abstinence (no ejaculation) ideally for 3 days prior to sampling is advised.

  • Specimen should be obtained by masturbation only.
  • The patient is instructed to urinate first, then wash the genital area using warm water only (no soap),wash hands with soap and warm water & dry thoroughly , ejaculate directly in the specimen container and the entire ejaculate should be collected without spillage.
  • The exact time of collection should be noted and the sample should reach the lab within ½ hour of collection. Ideal would be collection at the main lab only.

DRUG ASSAYS

  • For lithium levels collect blood after 12 hrs after intake of medicine.
  • For all other drug assays collect blood after 4 hrs of intake of medicine or as per the clinicians instructions.

TRIPLE MARKER STUDIES

  • The following details should be mandatorily provided : Date of birth, weight, LMP, USG findings of patient, H/O diabetes, Smoking and H/O Downs syndrome in mother or family.

HORMONAL ASSAYS :

  • Avoid having thyroid medicines prior to blood collection unless instructed by the clinician.
  • For PSA testing avoid the test for 7 days after rectal examination, UTI, per rectal USG as this may give falsely elevated readings.

CYTOPATHOLOGY

Cytopathology requests should mandatorily include the following information:

  • Patient’s name, age , sex and telephone number.

  • Submitting physicians name and telephone number.

  • Date of specimen collection.

  • Source of the material submitted (cervical , endocervical, vaginal or other gynaecologic / non-gynaecologic sites.
  • For GYNAECOLOGIC specimens – Date of LMP and pertinent clinical information of routine examination findings,hormone therapy,OC pills intake,hysterectomy etc)
  • For NON GYNAECOLOGIC specimens – Source and specific site , Nature of lesion (solid/cystic, mobile/fixed etc) , Pertinent clinical history & Radiological findings

  • Patient preparation for Gynaecologic specimens :

  • Patient should abstain from sexual intercourse, vaginal medications/contraceptives or douches for 24-48 hours prior to examination.
  • Optimal time for a PAP test is mid cycle. Menses may interfere with the interpretation.

    IMMEDIATE FIXATION WITH CYTOSPRAY OR EHTYL ALCOHOL IS THE MOST IMPORTANT STEP, since inconclusive reports follow poorly fixed samples. Kindly ask for the “PAP JAR” from ADC.

HISTOPATHOLOGY :

For routine histopathology submissions, the request form should include all the details as enlisted under Cytopathology.
Instructions for specimen handling :

  • Immediately immerse the complete specimen in 10% neutral buffered formalin. Do not allow the specimen to dry.
  • Do not force a large specimen into a small container. Formalin volume to specimen ratio should be 10:1
  • Do not crush the specimen with forceps or any other instruments.

  • Use separate containers for each separately identified specimen.

  • Label each container wall with the patients name and source of specimen.

CYTOGENETICS :

The blood chromosomal analysis test is used to determine the genetic cause for mental retardation , congenital anomalies, infertility , miscarriage , still birth and ambiguous genitalia , to confirm or exclude the diagnosis of chromosomal syndromes.
Kindly prefix appointments with the laboratory before sampling, for instructions.

ENDOCRINE AND METABOLIC ASSAYS :

Kindly contact the lab for specific instructions.

FLOW CYTOMETRY :

Indicated for various Immune deficiency panels, Leukemia/lymphoma panels, Obstetric flow panel and DNA ploidy , HLA B-27 and S phase fractions.

Kindly prefix appointments with the lab for specific instructions.