Ordering Guidance

For a pathology consultation on paraffin embedded tissue and slides only (ie, no wet tissue being sent to be processed), order PATHC / Pathology Consultation.

Additional Testing Requirements

Shipping Instructions

Vitreous fluid/aqueous humor specimens: ship overnight; Attention: Ophthalmic Pathology Working Group. Call 800-533-1710 to request an Expedite on this order since vitreous fluid will have no fixative and needs to reach the laboratory as quickly as possible.

Attach the green "Attention Pathology" address label (T498) to the outside of the transport container before putting into the courier mailer.

Necessary Information

All requisition and supporting information must be submitted in English.

Each of the following items is required:

1. All requisitions must be labeled with:

-Patient name, date of birth and medical record number

-Name and phone number of the referring pathologist or ordering provider

-Anatomic site and collection date

2. A preliminary or final pathology report and brief patient history are essential to achieve a consultation fully relevant to the ordering provider's needs.

3. Additional information by case type

Cardiac explant: Include the last pretransplantation echocardiogram with report and images as well as all other relevant clinical documents (eg, family history of cardiac events, cardiac laboratory testing results)

Iris, conjunctiva, cornea, and other small biopsies from eye: Clinical/surgical notes should be included if available.

Specimen Required

Submit 1 of the following specimens:

Specimen Type: Lung biopsy

Supplies:

-Pathology Packaging Kit (T554)

-Formalin, 10% Buffered Neutral for Tissue (T118)

-Michel's Transport Media for Immunofluorescent Testing on Tissue (T321)

Specimen Volume: Biopsy specimens as delineated below

Collection Instructions:

For testing to be performed, both of the following must be submitted:

a. For light microscopy:

Preferred: A portion of lung tissue in 10% neutral buffered formalin. Specimens submitted in formalin needs to be fully submerged with the optimal approximate specimen volume of 10:1 or higher.

Acceptable: A representative hematoxylin and eosin (H and E)-stained slide

b. For immunofluorescence, a portion of the unfixed lung tissue in Michel's transport media

Specimen Type: Cardiac biopsy

Supplies:

-Pathology Packaging Kit (T554)

-Formalin, 10% Buffered Neutral for Tissue (T118)

-Gluta (Trumps) (T130)

Specimen Volume: Biopsy specimens as delineated below

Collection Instructions:

1. Collect 4 to 6 biopsy specimens and submit all in 10% neutral buffered formalin. Specimens submitted in formalin needs to be fully submerged with the optimal approximate specimen volume of 10:1 or higher. If formalin biopsy specimens are not available, light microscopy slides would also be acceptable.

2. If electron microscopy (EM) is also requested, submit at least 1 biopsy into 2.5% to 3% buffered glutaraldehyde preservative (Trumps) along with the formalin biopsy specimens.

Additional Information: If the question is drug toxicity, storage disease, or if the patient is younger than 25 years, send at least 1 biopsy specimen in 2.5% to 3% buffered glutaraldehyde (Trumps) in case EM is needed for diagnosis.

Specimen Type: Cardiac explant

Supplies: Pathology Packaging Kit (T554)

Specimen Volume: Entire explant specimen

Collection Instructions:

1. Fix entire explant specimen in formalin for a minimum of 24 hours.

2. Following fixation, lightly wrap specimen in formalin-soaked paper towel, place in a biohazard bag with a small amount of formalin, seal, place in another biohazard bag, and seal.

Specimen Type: Enucleated eye

Supplies:

-Pathology Packaging Kit (T554)

-Formalin - 10% Histo Prep, 45 mL (T117)

Specimen Volume: Entire eye specimen

Collection Instructions:

1. Immediately after removal, place specimen in approximately 300 mL of 10% neutral buffered formalin and fix for 48 hours.

2. Enucleated eye should not be opened or punctured.

3. After the 48-hour fixation, the specimen should be transferred from the larger, 300 mL container to a smaller container with fixative (Formalin - 10% Histo Prep, 45 mL) for shipping.

Specimen Type: Iris, conjunctiva, cornea, and other small biopsies from eye

Supplies:

-Pathology Packaging Kit (T554)

-Formalin - 10% Histo Prep, 45 mL (T117)

Specimen Volume: Entire biopsy specimen

Collection Instructions:

1. Place iris, conjunctiva, cornea, and other small biopsies on a paper mount (a piece of filter paper or other porous paper). This helps to keep the specimen from curling when it is fixed.

2. Immediately, gently place paper-mounted specimen into 10% formalin (Formalin - 10% Histo Prep, 45 mL).

3. In cases where margins are important, placing sutures at the margins of resection with accompanying explanatory draft will help orientation of the specimen in the lab.

Specimen Type: Vitreous fluid/Aqueous humor

Supplies:

-Pathology Packaging Kit (T554)

-Sarstedt Aliquot Tube, 5 mL (T914)

Container/Tube: Plastic screw-top vial

Specimen Volume: Entire specimen

Collection Instructions:

1. Place the liquid (vitreous or aqueous) concentrate (preferred) or washing (diluted, acceptable) into a small tube with a screw-top cap.

2. Refrigerate the specimen immediately (do not freeze).

Specimen Stability Information: Refrigerated