MLS 301 Medical Technology PDF

MLS 301 Bachelor of Science in Medical Technology 1st Semester A.Y 2024-2025| Basanta, S.M. ○ If inadequate or “wrong” fixative: add or replace fixative...

MLS 301 Bachelor of Science in Medical Technology 1st Semester A.Y 2024-2025| Basanta, S.M. ○ If inadequate or “wrong” fixative: add or replace fixative COMMON CONCERNS IN RUNNING A HISTOPATHOLOGY SERVICE SPECIMEN COLLECTION AND CONTAINERS Large samples should placed in a wide mouth THE HISTOPATHOLOGY LABORATORY container or a thick plastic bag with 10% neutral Aims: buffered formalin immediately to process tissues adequately, to report a Volume of formalin is 20x the size of the complete and accurate histologic diagnosis, and specimen to provide safekeeping of tissue archives and Very large specimens such as leg are sent to the reports laboratory as it is immediately Requirements: If culture are also desired, put 1 part in sterile equipment/machines with technical support and container and send to the laboratory preventive maintenance immediately technically-skilled histotechnologist The other part of the specimen is immediately anatomic pathologists immersed in 10% neutral buffered formalin safety measures and a system of rational waste disposal LOGGING OF SPECIMEN Provide a unique histopathology accession RECEIVING OF SPECIMEN number per case Complete patient and conical data ○ S-07-000X for surgical and C-07-000X ○ ensures prompts evaluation and for cytology reporting ○ not good practice to use patient name ○ include patient/doctor contact as unique accession (confidentiality) information All samples from 1 surgery equals 1 specimen Out-patient referrals and slide review cases accession number requirements: ○ make for a homogenous single ○ tissue sample/s and/ or paraffin block/s, evaluation and reporting slide/s and histopathology report ○ doctor request (for clinical impression and/ or special preparation/fixation GROSS EVALUATION SPECIMEN required Ideally, tissue must be fixed for 6-48 hours and Assessment of charges sectioned in order for fixative to penetrate well Gross worksheet ○ accession number, number of sections SPECIMEN REJECTION and block taken per case, manner of Discrepancy between requisition and specimen embedding label Sample for gross description only Unlabeled or mislabeled specimens ○ specimen submitted for documentation Contaminated specimen/leaking container purposes No clinical data/history ○ no microscopic examination is ○ pathologist cannot accurately predict performed and no histopathologic clinical data from glass slides alone diagnosis issued Inappropriately identified specimen Special requests: ○ abortus or calculi to be returned to CHECKING OF SPECIMEN patient Check completeness of specimen ○ compare if type of sample and number TISSUE FOR GROSS DESCRIPTION ONLY of samples are compatible with surgery Prepuce/foreskin done laterality Vaginal mucosa Check for fixation Scars/cicatrix ○ If unfixed: put formalin (surgical) or Foreign bodies (e.g., bullets, ortho, medical alcohol (cytology) devices, silicone implants) MLS 301 Bachelor of Science in Medical Technology 1st Semester A.Y 2024-2025| Basanta, S.M. Hair, fingernails, and toenails removed for ○ to know if patient has previous surgery cosmetic reasons or diagnosis and to know his/her other Lens cataracts laboratory work-ups Nasal septum (rhinoplasty) Turn around time (from specimen receipt to case Calculi, stones reporting) Eyelid ○ Ideal: 24 hours for clear cut cases: 2-3 Placenta from normal spontaneous delivery days for cases of moderate complexity Teeth ○ Reasonable: 7-14 days Fetuses ○ Step sections appropriate for minute samples Diagnosis CUTTING AREA CONSIDERATIONS ○ Check for completeness typographical If specimen entirely submitted for processing, errors and specimen laterality save specimen containers in one area until case is signed-out ○ problems with labels laterality, lost NOTICE OF PENDING DIAGNOSIS sample Preliminary report addressed to the attending Save biohazard waste bag from grossing room physician of the patient for an extra day to allow for recovery of lost ○ to let the MD know that there will be a specimens or assets if needed (inadvertently) delay ○ to let the MD know the reason/s for the delay TISSUE PROCESSING CONSIDERATIONS 1. additional sections or deeper Tissue processing worksheet levels taken ○ to account for all sections/blocked 2. clinical and radiologic submitted information needed Section with staples should never br submitted 3. difficult case: needs referral to for tissue processing other pathologists ○ at least 2 levels of about 20-25 um apart 4. difficult case: needs special may unmask other pathology stains and/ or ○ tissue ribbon simply repeats adjacent immunohistochemistry studies histology the notice must have a working pathologic ○ step sections appropriate for minute diagnosis or differential diagnosis samples Floaters or pick-ups ○ clean tools and dissection area/case, CASE/SLIDE REVIEW wrap small fragments in filter paper, Requirements: change solution, periodically clean water photocopy of the histopath report baths paraffin block (submit all) and H&E slides of the ○ clean cutting face of paraffin block above paraffin block ○ check other cases for similar lesion type written request from the doctor, if available ○ additional sections from remaining fixed Previous report is necessary tissue or deeper levels from paraffin to verify that the item submitted (paraffin block block and slide) belongs to the patient ○ slide: circling and tagging as folder to determine the source as well as the gross ○ if floated disappears on slide from description of the specimen deeper cuts discard previous slide with to know the pathologist who read the previous floater report ○ need not include floater in the final Screening of material by trainee/consultant report pathologist ○ in cases wherein there is discrepancy on the specimens submitted and the CASE EVALUATION AND REPORTING report, the matter should be discussed Ideal to have laboratory information system well to the bearer MLS 301 Bachelor of Science in Medical Technology 1st Semester A.Y 2024-2025| Basanta, S.M. ○ inform him or her what is lacking and still ○ name of the slide/s and block/s need to be submitted, write it on the submitted request form ○ number of submitted Ideally, one's official report is released, a copy of ○ unclaimed materials will be subject for it should be mailed to the pathologist who read disposal after 1 year the histopath report Item are filed in designated drawers, arrange in alphabetical order, and kept in a cool dry place ARCHIVING Paraffin blocks, histopathology slides and reports are important materials that have to be kept for future reference Paraffin blocks ○ kept in a transparent plastic bag (prevent access of pests) indicating the beginning and ending numbers on the contents ○ it should be kept in a cool dry place (avoid melting of paraffin) Histopathology slides ○ arrange according to the year and sequence of accession numbers in designated drawers ○ it should be kept in a cool dry place RECORDS AND SPECIMEN RETENTION Request forms and log books: 1-2 years Gross specimen and blood smears (routine): 714 days after report issued Body fluids (specimen): 48 hours Surgical pathology reports: 10 years or indefinitely Autopsy/forensic reports: indefinitely Cytogenetics report/diagnostics images: 20 years Cytogenetic slides: 3 years Surgical pathology slides: at least 10 years Paraffin blocks: at least 10 years or BORROWING OF SLIDES AND BLOCKS indefinitely It is the prerogative of the patient and his or her Instrument maintenance: 2 years doctor to borrow slides and blocks for outside Quality control: 2 years review For histopathology: STORAGE BLOCKS/SLIDES FOR REVIEW/SPECIAL ○ obtain recuts for laboratory's own file in PROCEDURE case materials borrowed are not return ○ additional slides must be The requesting party should be informed of the For cytology: laboratory policy regarding storage and disposal ○ if > 1 slide has lesion, retain one or two of these items slides for filing A copy of consent form the disposal is signed by the requesting party: PACKAGING OF SAMPLES, SLIDES AND BLOCKS ○ name of the patient, specimen, and Sliding and blocks accession number ○ place material in sturdy plastic/reinforced box MLS 301 Bachelor of Science in Medical Technology 1st Semester A.Y 2024-2025| Basanta, S.M. ○ “pakidala” — patient, relatives are friends carry the material to the laboratory MAINTENANCE ○ don't put too much mountain medium on Proper documentation of maintenance charts slide Monitoring of temperature ○ allow the mountain medium on slides Proper labeling of coplin jars used for special ○ allow the mountain medium on stains slideshow dry before putting the slides Standard of labeling of shelves, hanging in containers cabinets, filing cabinets, and log book Tissues: Appropriate use of handling reagents ○ if we'd fixatives, ensure that leakage will “First in first out” policy should be observed be prevented during transport Develop a more organized and effective filing system for paraffin system for paraffin blocks and slides COSTING Cost of supplies = Transport and Collection + Processing Cost of labor: estimated to be equal to the total QC IN HISTOPATHOLOGY cost of supplies Quality in control on fixation Total direct cost of test = Supplies + Labor ○ pH formalin solution should not drop Total test cost without profit = Total direct cost + below pH 6 (formation of formic acid can Overhead be prevented by the use of neutral ○ overhead: typically runs between 40 to buffered formalin) 50% of total cost; cost of running QC ○ between pH 5.6 and 6, or under pH 5.6, part of overheard DNA and RNA are poorly preserved and Total test cost with profit = total test cost + profit acid mucopolysaccharides are more ○ profit: determine by the institution and is soluble usually between 3% and 10% QC IN HISTOPATHOLOGY SERVICE SHORT CUTS FOR COST CUTS Quality in control on routine H & E staining Are good if quality is maintained ○ check pH of hematoxylin ○ rapid test mean faster turnaround time ○ when slides come out of the bluing Quality of slides and blocks agent (lithium carbonate or ammonia ○ reflects technique water), check the slide under the ○ depends on the quality of reagents microscope to make sure that Slides and blocks may be sent abroad for review hematoxylin has stain the nuclei, and or further testing the excess hematoxylin remove from Food for thought: if the specimen in question those structure—it should not stain were yours or your relatives, will you be satisfied to have it process and evaluated poorly MLS 301 Bachelor of Science in Medical Technology 1st Semester A.Y 2024-2025| Basanta, S.M. ○ after completion of H & E staining and Equipment uptime mounting, check slides microscopically ○ autotechnicon, microstainer, cryostat, for: embedding center, gross station 1. proper staining of nuclei and Errors corrected prior to releasing (% error) cytoplasm ○ pre-analytical: pre-procedural, specimen 2. bubbles, dirt, debris, or collection, ID precipitate on slide ○ technical phase 3. proper labeling ○ post analytical: typographical error 4. proper tissue orientation in embedding Quality in control on record ○ storage of records (histopath reports, slides, paraffin blocks) must be organized to facilitate retrieval Quality in control on the system ○ turn around time (TAT) factors involved 1. protector (“go back to specimen”) 2. quality of slide preparation 3. complexity of the case 4. secretarial component Use “in-time/date” stamp when tissue is received; time/date of the distribution report By sampling reports each month, TAT averages can be determined and compared with predetermined goals Efficient laboratories achieve TAT of 24 hours for simple cases 48-72 hours for complicated problems The secretarial component ○ the secretarial staff is responsible for the typing, filing and coding of surgical pathology data The product is continually monitored since the pathologist usually proofreads and correct the reports before signing them Each month, however, random samples of surgical pathology reports should be examined to determined quality and accuracy Process Control Procedures ○ a schedule and record for equipment maintenance and service ○ records of solution changes (note date of the container) ○ record of paraffin bath temperature; checked and noted daily ○ controls run on every special stain PERFORMANCE INDICATORS Waiting time Results processing: inpatient and outpatient Canceled procedures due to: ○ equipment breakdown, availability of supplies