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Criteria for Specimen Acceptability/Rejection

Under the following conditions specimens may not be acceptable for testing purposes.

1. Incomplete requisitions.

Requisitions must accompany each specimen transported to the laboratory. At a


minimum the requisition must include:
a. Patient’s name or other unique identifier (i.e., disaster band).
b. Patient’s date of birth.
c. Name and address of the authorized person requesting the test. Authorized
individuals according to Medical Staff bylaws.
d. Test(s) to be performed.
e. TRANSFUSION SERVICE REQUISITIONS: Individual collecting sample
must sign, date and time the Transfusion Service test request form as
applicable to each campus.
f. MICROBIOLOGY REQUISITIONS: Antimicrobial therapy must be noted.
g. ANATOMIC (Histology and Cytology) REQUISITIONS: Collection site /
specimen type must be noted.

2. Inadequate Specimen Identification.

Specimen identification must include two unique identifiers and the following:
a. Patient’s name (first and last).
b. Patient’s date of birth.
c. Date and time of specimen collection.
d. Initials/mneumonics of individual collecting specimen.
e. Collection site/specimen type (throat, L eye, R finger, cervix, etc.).

An unlabeled, mislabeled, or mismatched specimen is unacceptable.

3. Transfusion Service Specimens: Prior to the performing of any Transfusion


Service testing, a technologist from the Transfusion Service will confirm that all
the identifying data on the blood specimen matches exactly with the data on the
Transfusion Service Test Request form. If any discrepancies are detected, a
new sample must be collected.

4. Inadequate volume of blood.

The amount of additive placed into a tube is intended for certain volume of blood.
If less than required is drawn, the excess amount of additive has the potential to
adversely affect the accuracy of test results.

Examples: Sodium citrate (blue top): coagulation testing


Heparin (green top): Blood gases

Inadequate specimen volume may require physician to prioritize testing to be


performed.
Refer to Pathology/Nursing manual for detailed information on testing
requirements.

5. Using the wrong collection method/device.

Additives can interfere with the analyte to be determined. Method-specific


specimen requirements must be followed when choosing collection tube.

Examples: Sodium fluoride (gray top) interferes with BUN.


Wrong order of draw during multiple specimen collection can invalidate
Results because of contamination by the additive. Draw additive tubes

6. Hemolysis

Hemolysis can result from a difficult venipuncture, improper handling of the


collected specimen or from a disease process. Certain tests will be inaccurate
when the specimen is “moderately” hemolyzed.

Example: Potassium (K)


LDH
LDH/CPK isoenzymes

7. Clotting

Clotting can be caused by inadequate mixing of samples placed in tubes or a


difficult venipuncture. Specimens submitted for specific testing that requires anti-
coagulated blood for analysis will not be accepted for testing. Small clots in
specimens adversely affect testing.

Examples: EDTA (purple): CBC’s


Sodium Citrate (blue): coagulation testing

8. Inappropriate patient preparation – Special Handling Required

Specific methodologies require detailed patient preparation for accurate test


results.

Examples: D-xylose
Glucose tolerance

When specific “special handling” is required, please contact the Laboratory to


coordinate.

Examples: Surgical specimens for specialized testing.

Refer to Pathology Services manual for specific instructions.


9. Improper Transportation

Specific testing methodology may require specific handling, such as keeping


warm or on ice, during transportation.

Examples: Cold agglutinins


Cryoglobulins
CH50

Refer to Pathology Services manual for detailed information on specific testing


requirements.

10. Leaky containers/contaminated specimens.

a. A specimen is unacceptable when the outside of the container is grossly


contaminated with specimen. LIDS MUST BE TIGHTENED SECURELY.
b. Specimens contaminated by another source (i.e., urine should not contain
stool) are not acceptable.
c. Specimens drawn above IV’s or from improperly cleared lines are
unacceptable.
d. Specimens not collected according to the Order of Draw (ex. EDTA
contamination).

11. Unacceptable Specimen Sources.

Specialized testing may require specific specimen requirements or eliminate


specific specimen sources.

Examples: Foley catheter tips are unacceptable for culture.


Serum specimen unacceptable for coagulation testing.
Samples collected from heparinized lines for coagulation testing.

Refer to Pathology Services manual for detailed information on specific testing


requirements. Contact the clinical section responsible for section specific
policies.

12. Specimen Stability

The stability of analytes and cellular components can deteriorate over time.
Stability criteria have been established which limit additional testing that can be
done on pre-existing samples. Refer to the Pathology Services Manual for
specific specimen stability requirements.

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