The document provides comprehensive guidelines on the collection and handling of laboratory specimens, emphasizing the importance of proper procedures to ensure specimen integrity and accurate test results. Key points include pre-analytical errors, specimen labeling requirements, and the correct order of draw for blood samples, alongside specific instructions for various types of specimen collection such as urine and stool. It highlights that missteps in collection, handling, and transportation can lead to erroneous results and adversely affect patient care.

1. LABORATORY SPECIMEN
COLLECTION AND HANDLING
BY PURITY MUSYOKI
MEDICAL LABORATORY OFFICER

2. EXAMPLES OF LAB. SPECIMEN
 Blood
 Urine
 Stool
 sputum
 Csf (cerebrospinal fluid)
 Tissues Biopsies and fine needle aspirates
 Swabs (high vaginal swabs, urethral swabs, pus swabs)
 Semen
 Bone marrow
 Other body fluids like sweat, saliva and oral fluids, amniotic fluid,
synovial fluid, peritoneal fluid, pleural fluid, and pericardial fluid etc.

3. PURPOSE
 Laboratory testing provides information about a
patient's health to assist Physicians in diagnostic
and therapeutic decisions.
 Specimen Integrity is dependent on accurate pre-
analytical processes which include patient
preparation, specimen collection, handling, and
transportation.
 Improper collection and handling of samples can
give erroneous results and compromise the care
of the patient.

4. Errors in specimen handling
 Pre analytical errors –before analysis i.e. during
specimen collection
 Analytical errors-during analysis
 Post analytical errors – after analysis i.e. during
reporting of results

5. Pre analytical factors
 There are multiple Pre-Analytical factors associated
with the handling and processing of laboratory
specimens that can lead to test result inaccuracy.
 Strict adherence to all phases of proper collection and
processing is essential for accurate test results.
Specimen Collection:
a. Improper Patient Identification
b. Incorrect Order of Draw
c. Incorrect Tube Selection
d. Traumatic draws leading to hemolysis
e. Inadequate mixing or insufficient sample

6. Specimen collection
 Patient results are only as good as the specimen
collected.
 The integrity of the sample must be preserved
and requirements for collection and handling
must be followed.
 It is critical that adequate volumes are collected
on each patient and the patient preparation is
adhered to follow test requirements such as
fasting.

7. Collection process
 Following proper phlebotomy techniques will assist in
preventing inaccurate test results:
a. Tourniquet left on <1 minute to prevent hemolysis.
b. All tubes collected must be collected in the correct
Order of Draw and inverted gently to ensure proper
mixing of additive or anticoagulant.
c. All collection tubes must be filled with the required
volume (no short samples). Fill lines are indicated by
the black and white notches on the side of the label.
d. Do not use expired tubes. Expiration dates can be
found on each paper label on the tube.

8. NOTE
 Incorrect Order of Draw will
introduce contamination with
anticoagulants and often produce
inaccurate results.
 An example would be increased
Potassium if the Lavender tube is
drawn prior to collection of Gold and
reduced calcium levels.

9. Specimen labelling
 All specimens must contain two specimen
identifiers:
a. Patient’s first and last name
b. Patient’s Date of Birth/age
c. Unique Identifying number to assist with
identification such as Social Security number
Note:
Hospital policy requires Patient’s first and last
name and Date of birth.

10. Order of draw of blood
 Blood culture tubes
 Sodium citrate tubes (e.g., blue-stopper)
 Serum tubes with or without clot activator, with
or without gel separator (e.g., red-, gold-,
speckled-stopper)
 Heparin tubes with or without gel (e.g., green-
stopper)
 EDTA tubes (e.g., lavender-stopper)
 Glycolytic inhibitor tubes (e.g., gray-stopper)

12. Mix by inversion

13. NOTE
 Carefully tighten specimen container lids to avoid leakage
and/or potential contamination of specimens.
 Mix by inverting specimen with additive immediately after
collection
 Avoid hemolysis: red blood cells broken down and
components spilled into serum. For routine collections, use a
21- to 22-gauge needle. (On occasion, however, it may be
necessary to use a 23-gauge needle for patients from elderly
and pediatric populations with small or difficult veins. Avoid
pushing blood through the needle (23 G needle.)
 Fill the tube completely, thereby avoiding a dilution factor
excessive for total specimen volume. The tubes have indicated
marks for where the blood should fill up to.

14. Criteria of sample rejection in the lab
 Incorrect sample types received:
 Basic incorrect blood tube/other sample.
 Samples without the appropriate preservative (e.g.
acidified urine samples).
 Samples that are received ambient, when a frozen
sample is required.
 Samples that are received unprotected from light, when
they are required to be covered at the point of
venipuncture.
 Samples in incorrect containers (e.g. cervical cytology
must be a Thin Prep vial; urine cytology must be in a
uricyte container). Gene xpert samples also

15. Cont.…
 Insufficient sample received.
 No sample received.
 Labelling or form issues (mislabeled/unlabelled/no
forms/no clinical information).
 Clotted/haemolysed/lipaemic (turbid)/icteric
samples( high bilirubin content).
 Sample is broken or has leaked in transit.
 Stability time has been exceeded. Stability time is test-
dependent, and also refers to tests that can only be
carried out on certain days of the week.

16. Department -specific
 Sample Reception will not accept samples packaged with needles of
any kind.
 Hematology cannot accept frozen whole blood for testing.
 Coagulation cannot accept over or under filled samples for testing.
 Coagulation cannot accept previously frozen samples that have
thawed in transit.
 Biochemistry cannot accept previously frozen samples that have
thawed in transit.
 Biochemistry cannot accept samples that display antibody
interference.
 Biochemistry cannot accept samples that have had separation
delays/un-centrifuged samples that have been stored in the fridge.
 Biochemistry cannot accept Para protein resulting in viscous samples.
 Biochemistry cannot accept CSF protein that is blood stained.

17. Cont.…
 Immunology cannot accept TBQ kits that:
 Do not contain all of the appropriate tubes.
 Are incubated for more than the specified 16 hours.
 Have passed the incubation time period.
 Are over- or under-filled.
 Microbiology cannot accept samples in non-sterile containers or in formalin.
 Referrals cannot accept samples without three points of identification
 Referrals cannot accept samples that are not labelled by hand for blood group
testing.
 Molecular Pathology cannot accept samples for Hemophilia testing without
informed consent.
 Cervical Cytology cannot accept over or under filled samples for testing.
 Cervical Cytology cannot accept samples received within three months of the
previous test in order to allow epithelial cells to regenerate.
 Urine cytology cannot accept delayed samples unless they have been
refrigerated.

18. Note
 Samples deemed to be PRECIOUS (e.g. CSF, fluid,
tissue, bone marrow and pediatric samples) will
not be discarded by the laboratory. – they are
delicate samples
 Results will include a comment relating to the
condition of the sample (e.g. sample unlabeled).

19. Urine Specimen Collection
Clean Catch Urine Collection (for Urinalysis and Culture)
 Supplies (sterile urine cup, clean catch wipes, plastic bag
for transport if necessary) .
Please follow these instructions:
 Clean genital area with the wipes. FEMALES: Clean from
front to back; MALES: Clean urethral opening area.
 Allow first urine flow to go into the commode.
 Catch the "mid-stream" of the urine in the sterile container.
 Replace lid firmly on the container.
 Label specimen with name, date and time of collection.
 Place the specimen in the transport bag.

20. cont.…
 Transport the specimen to the lab as soon as
possible. If delay is necessary, specimen may be
kept in your refrigerator up to 24 hours
 Provide patients with instructions for 24-hour
urine collection(s).
 Provide sufficient quantity of specimen to meet
the minimum fill line on preservative transport
container.
 Avoid contamination from stool /rectum
contents.

21. Stool specimen collection
 Collect the stool in a dry, clean, leak proof container. Make sure no
urine, water, soil or other material gets in the container.
 Fresh stool should be examined, processed, or preserved
immediately. An exception is specimens kept under refrigeration
when preservatives are not available; these specimens are suitable
for antigen testing only.
 Preserve the specimen as soon as possible with 10% formalin and
PVA (polyvinyl-alcohol), using suitable containers. Add one volume
of the stool specimen to three volumes of the preservative.
 Ensure that the specimen is mixed well with the preservative.
Formed stool needs to be well broken up.
 Ensure that the specimen containers are sealed well. Reinforce with
parafilm or other suitable material. Insert the container in a plastic
bag.

22. This image demonstrates the distribution of protozoa in relation to
stool consistency and should be taken into consideration when
specimens are received

23. THANK YOU
GOOD DAY