HSL Special Coagulation: Specimens

Guidance on specimen collection

A properly collected specimen is critical to quality test results.

• When collecting blood samples for Platelet Studies, it is recommended that you use 10ml green cap Sarstedt S-Monovette® Citrate 0.107M (3.2%) tubes.
• When collecting blood samples for all other special coagulation tests:
  • For RFH and Barnet Hospital patients, prepare the patient and collect the samples following the Royal Free Trust ‘Taking blood (venepuncture)’ guidelines (https://freenet2.royalfree.nhs.uk/documents/ preview/94650/Taking-Blood-March-2022) which provides information on blood collection tubes, order of draw to avoid cross contamination of additives between tubes (coagulation samples must be collected first), and mixing of tubes following collection.
  • Collect the blood sample into light blue capped sodium citrate vacutainer tubes which contain 0.109M (3.2%) sodium citrate as anticoagulant.
  • Immediately and gently mix the blood inside the tube 3–4 times to form the plasma. Note: insufficient sample collection or too vigorous mixing can result in inaccurate test results and the need to re-draw.
  • For all other locations prepare the patient and collect the venous blood samples for special coagulation tests according to local guidelines on venepuncture.

Specimen labelling

Each specimen container must be labelled:

• At the time of collection i.e., next to the patient when the sample is taken.
• With the correct barcode label (pre-printed label with accession numbers generated by an information system). With a single label placed on it.
• With a label whose information matches the information on the accompanying request form. See Sample rejection / acceptance criteria for essential and desirable sample labelling requirements.

Note:

• NEVER label the specimen bag.
• NEVER wrap the request form around the specimen bottle as a specimen label.

For requests made using EPR (Royal Free Hospital) or EPR2 (Barnet Hospital, Edgware Community Hospital)

Place the EPR specimen label along the length of the tube, as straight and as far up as possible without touching the cap of the tube, so that the analysers can read the label.

It is imperative that the label quality is checked prior to labelling the specimen bottles as poor-quality barcodes cause delays and introduce the risk of errors in the laboratory.

Request forms

A completed request form (electronic or manual) must accompany each patient sample with the details on the specimen label matching the details on the corresponding request form.

Either complete:

• Royal Free London users
  • EPR or EPR2 request (Royal Free London NHS Foundation Trust internal electronic order comms system)
  • A manual request form in the event of downtime. The form can be accessed at https:// freenet2.royalfree.nhs.uk/sites/menu/group-clinical- services/SitePage/88305/downtime-forms
• GPs – tQuest request (GP order comms system)
• External Users – local request forms

All requests should be completed with all relevant information, including:

• NHS number (or Hospital number)
• Patient name (last name and first name)
• Date of birth
• Gender
• Ward or clinic
• Requesting doctor with contact number – the signature, bleep and/or contact number of the requesting doctor must also be completed.
• Clinical details
• Tests requested
• Date and time sample taken
• Consultant
• Consent (where appropriate)
• Paper request forms should include the signature/ initial of the person collecting the samples, confirming that they have verified the patient details on the label matches the patient details on the test requisition and that the specimen has been drawn.

Specimen packing and transport

• Place the labelled specimen container in a plastic specimen mini-grip bag, which is available on the wards, in the clinics and from central stores, and seal.
• Each specimen bag must only contain samples from one patient (DO NOT mix patient samples).
• Place the matching requisition in the outside pouch of the bag.

Royal Free Hospital requirements

Send the specimen promptly to the laboratory or to the collection point. For guidance on the most appropriate means of transporting specimens please see below.

Delivery using the RFH pneumatic air chute system

• Where samples can be sent using the pneumatic air chute system, place the specimen bag into a pod. This will prevent any breaks or leaks. In the event the pod is visibly defective (e.g., the lid will not close, or the housing is cracked), please DO NOT remove any defective pods from circulation and inform the Estates Team so that they can organise for replacement carrier(s) to be obtained for the relevant clinical area.
• Close the pod securely and place in the station.
• Enter destination code 591 when transporting samples during normal working hours and code 885 when sending samples out-of-hours.
• Press: Send (PTT).

Note: Samples for Platelet studies (aggregometry, lumiaggregometry and platelet nucleotides) and whole blood assays – IMPACT R, PFA-200 and ROTEM – MUST NOT be sent via the air chute. These must be hand-delivered to the laboratory as soon as possibleafter collection (within 2 hours of venepuncture).

Delivery in person (including RFH hospital porters)

Place the specimen in a leak-proof sealed plastic biohazard bag designed for specimen transport and drop off at the collection point or deliver as soon as possible to the laboratory.

Note: When transporting samples for PAI-1 antigen levels, place the specimen container in crushed ice and deliver to the laboratory.

See the table below for collection times during routine working hours from the Royal Free Hospital Trust wards / departments / clinics.

Note: Samples transported out of hours are to be delivered to the Rapid Response Laboratory Specimen Reception.

GPs and community clinics 

Blood samples to be collected and placed in a biohazard bag which will be delivered to Royal Free Hospital Pathology Reception (Floor 1) or directly to the Haemophilia and Thrombosis Laboratory (Floor 1) via courier.

External users (excluding GPs, community clinics, etc.) 

• If a delay is expected with transportation of citrated blood samples to the laboratory, the sample should be double-spun, separated, frozen within 4 hours of collecting the sample from the patient and transport frozen.

• Frozen plasma should be sent in polystyrene boxes with dry ice, sealed, placed into specimen bags and delivered by courier.

• By post: Blood samples which are considered to be Category B Biological Substances are assigned to UN3373 and must be packaged according to the Dangerous Goods ADR (Road) Packing Instruction 650 for transport.

• If there is any concern that the material being sent does not meet UN3373 (including most category 3 and 4 pathogens), the laboratory must be contacted for advice before sending.

• Place the labelled primary specimen container into a plastic specimen mini-grip bag together with sufficient absorbent material (e.g., tissue paper or cotton wool), to absorb the blood in the event of a leak, and seal.

• Each specimen bag must only contain samples from one patient (DO NOT mix different patient samples in the same specimen bag).

• Place the matching requisition in the outside pouch of the bag and place this into the secondary packaging with sufficient cushioning material to secure the primary container within the secondary container.

• Close / seal the secondary container. Note: Where multiple primary receptacles need placing in single secondary packaging, they must be separated using cushioning material to prevent contact between them.

• The transport of pathology samples from external locations to the Royal Free Hospital is provided by City Sprint Ltd. When the courier presents you with a diagnostic substances UN3373 transport bag or box (i.e., outer packaging), place the secondary container into the transport bag/box.

• Where single or multiple secondary containers are placed into the UN3373 transport bag ensure that these are cushioned to secure the secondary packaging within the outer packaging – thus preventing movement during transportation.

• Ensure the outer packaging is sealed before it leaves your premises.