Laboratory of Pathology

Specimen Rejection

Flow Cytometry Specimen Rejection Approval Requests:

Specimen processing of rejected specimens requre flow cytometry pathologist approval.

• Processing poor quality specimens is at the discretion of the Flow Cytometry Head or Deputy Head pathologist.
• Processing approval may include rare specimens; specimens collected at significant risk or suffering to the patient i.e. clotted BM aspirates; or specimens that cannot be recollected i.e. a spleen cannot be removed again. 
• Results of poor quality specimens will be interpreted with caution. 
• Rejected specimen processing is delayed pending efforts to discuss with the pathologist by one of these methods:

• • Call the triage pathologist (301) 480-7179 or
  • Call direct to Dr. Hao-Wei Wang (301) 480-8043 or 
  • E-mail all Flow Cytometry pathologists:  FlowTriageNCI@mail.nih.gov 
    

 Flow Cytometry Specimen Rejection Examples: 

1. Unlabeled or mislabeled specimens will not be processed until the specimen label is corrected by knowledgeable staff in person. 
   
   
2. Specimens arriving after 1 p.m. may be held until the next day (if collected the same day received) or may be rejected if the schedule is full (or if the specimen was collected before the day received).
   
   
3. Improper collection or handling during transport (often detected during the gross specimen examination):
   
   
   • Coagulated, hemolyzed or frozen specimen may indicate non-ambient (freeze/heat) temperature conditions. 
   • Inappropriate collection containers include lithium heparin tubes or other non-approved anticoagulants. 
   • Specimens labeled radioactive or tuberculin hazard are rejected due to unavailable safety equipment in the testing area.
   • Inappropriate volume i.e. BM aspirate volume greater than 5ml (probable peripheral blood contamination unless needle repositioning noted). Note:  BM specimen volume 5 - 10ml are processed without prior pathologist approval; the BM aspirate volume is noted in the final report to interpret with caution.
   • Specimen clotting may be due to inadequate heparin.  Note:  Clotted BM aspirate samples with less than 50% clotting are processed without prior pathologist approval; presence of clots are noted in the final report to interpret with caution. 
     
     
4. Specimens with very low cellular content due to cell loss or disease conditions.
   
   
5. Fixed Specimen / Specimen in Fixative: Cells derived from blood, bone marrow, fluids and tissue must be viable for flow cytometry testing. Any specimen with fixative added for any length of time i.e. formalin, B5 fixative, alcohol, etc. will be rejected for flow cytometry testing. Fixation is not reversible. In addition, lithium heparin should not be used as it is toxic to cells. 
   
   
6. Low Viability / Non-Viable cells:  Viability less than 60% may be rejected. Cells derived from blood, bone marrow, fluids and tissue must be viable for flow cytometry testing. Cell death may be due to excessive age of specimen, poor handling, or patient therapy.
   
   

 Specimen Handling of Rejected Specimens:

1. The Flow Cytometry laboratory director or alternate will contact the clinician for recollection of rejected specimens.
    
2. The rejected specimen will be accessioned and finalized. 
   
   
3. In addition, the clinician will be notified and the specimen will be held at room temperature for retrieval by the sending service i.e. Hematopathology, Cytopathology or clinical group for alternate testing. 
   
   
4. Specimens remaining in the Flow Cytometry lab will be discarded the following work week.