Specimen Handling,
Transport, and Processing
Chapter 16
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Learning Objectives
Lesson 16.1: Specimen Handling,
Transport, and Processing
(Slide 1 of 3)
1. Discuss what might happen to a sample that is not
properly handled and processed.
2. Describe four ways in which samples can be safely
transported to the laboratory.
3. Explain why tubes should be transported in an
upright position.
4. State the acceptable time between specimen
collection and separation of cells from plasma or
serum, and explain why this is necessary.
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Learning Objectives
Lesson 16.1: Specimen Handling,
Transport, and Processing
(Slide 2 of 3)
5. List two exceptions to time constraints, and state the
maximum time that each may be held.
6. List two tests for which the samples must be kept warm,
and explain how to do this.
7. Describe how to handle samples that must be chilled.
8. List at least three analytes that are light sensitive, and
explain how to protect them.
9. Describe the safety equipment that must be used when
processing samples.
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Learning Objectives
Lesson 16.1: Specimen Handling,
Transport, and Processing
(Slide 3 of 3)
10. Explain why samples must be allowed to clot fully
before processing, and state the average time for
complete clotting to occur in a red-topped tube and
when clot activators are used.
11. Explain the principle and proper operation of a
centrifuge.
12. Describe the proper procedure for removing a stopper.
13. List at least five reasons for specimen rejection.
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Proper Handling of Specimens
Critical to ensure accuracy of test results obtained
from them
Analytes may change in composition and
concentration over time and with temperature
changes or exposure to light
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General Guidelines for
Specimen Transport
(Slide 1 of 3)
Tubes with additives should be inverted gently
and completely 5 to 10 times immediately after
being drawn
Thorough mixing allows the additives to be evenly
distributed throughout the sample
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General Guidelines for
Specimen Transport
(Slide 2 of 3)
An efficient and safe way to transport
samples is in a leak-resistant bag with
zip closure
Specimen bags are marked with a
biohazard symbol and have a separate
front pouch for requisitions to prevent
contamination of the requisition should
the specimen leak
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General Guidelines for
Specimen Transport
(Slide 3 of 3)
Tubes should remain upright during transport
This accomplishes several purposes:
It promotes complete clot formation when there is no
additive present
It prevents sample contamination due to prolonged
contact with the stopper
It reduces the likelihood of aerosol formation during
uncapping, as there is no residual blood clinging to the
stopper
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Time Constraints
(Slide 1 of 2)
The quality of test results depends heavily on the
time between when the sample is drawn and when it
is analyzed: The longer the interval, the more likely
the results will be inaccurate
Ongoing glycolysis (metabolic sugar breakdown
within cells) within the specimen is a primary cause
of inaccurate test results
As a general rule, an uncentrifuged blood sample
should be delivered to the laboratory within 45
minutes of being drawn
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Time Constraints
(Slide 2 of 2)
A few sample types can wait longer before
processing without loss of viability
Because fluoride inhibits glycolysis, glucose
samples collected in gray-topped tubes can be held
for 24 hours at room temperature and for 48 hours
at 2º to 8º C
Blood smears made from such samples must be
done within 1 hour of collection because
ethylenediaminetetraacetic acid (EDTA) will
eventually distort cell morphology
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Temperature Considerations: Keeping
Specimens Warm
Specimens that must be maintained at 37º C
during transport and handling include cold
agglutinins, cryoglobulins, and cryofibrinogen
The tubes for these specimens should be warmed
using a heel-warmer packet before collection, and
the sample should be transported wrapped in a
heel-warmer packet as well
Specimens for cold agglutinin testing and
cryofibrinogen must also be kept warm
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Temperature Considerations: Keeping
Specimens at Room Temperature
Some specimens must be kept at room
temperature
If the specimen is being delivered outside the
facility by courier, it may be placed in an insulated
container to protect it from extreme heat or cold
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Temperature Considerations: Keeping
Specimens Cool
Chilling a specimen slows metabolic processes
and keeps analytes stable during transport and
handling
Samples that need to be chilled include pyruvate
and lactic acid
To chill a sample, place it in a slurry of chipped
or shaved ice and water
This promotes complete contact between the
sample and the ice bath
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Temperature Considerations: Keeping
Specimens Frozen
Some specimens must be kept frozen, because
some analytes are stable only in extreme cold
Require storage at temperature ranging from -20º
C down to -70º C before testing
Clotting factors and complement factors
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Protecting Specimens from Light
Exposure to light can break down light-sensitive
analytes
Bilirubin is the most common light-sensitive
analyte; others include vitamin B12, carotene,
folate, and urine porphyrin
To prevent light exposure, samples are collected in
amber-colored microtubes, wrapped in aluminum
foil, or an amber/brown biohazard bag, and placed
inside a brown envelope or heavy paper bag
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Protecting Specimens from Light
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Transporting Specimens
to the Laboratory
(Slide 1 of 2)
In many institutions, samples are hand-carried by
the phlebotomist or another member of the
laboratory team
Samples may be dropped off at designated areas
within the hospital for transportation and delivery
by the laboratory staff
Minimum information should include the patient’s
name, hospital number and room number, specimen
type, date and time of delivery to the drop-off area,
and name of the person depositing it
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Transporting Specimens
to the Laboratory
(Slide 2 of 2)
Some institutions use a pneumatic tube system, in
which samples are carried in sealed plastic carriers
that travel within a network of tubes
Shock-absorbing foam inserts are placed in
carriers to reduce the shaking and agitation of the
sample during transport
Special containers are used to protect the sample
and prevent contamination of other material
during transport
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Pneumatic Tube System
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Safety
The Occupational Safety and Health
Administration (OSHA) requires personal
protective equipment (PPE) to be worn during
sample processing
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Central Processing
(Slide 1 of 2)
Specimens entering the laboratory are usually first
handled by central processing, an area devoted to
accessioning and sorting samples as they arrive
The date and time of arrival are recorded, often
with a time- and date-stamping machine
Each sample is marked with an accession number,
a unique identifying number used for cataloging
the sample in the laboratory
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Central Processing
(Slide 2 of 2)
Central processing is also usually responsible for
centrifuging samples, to separate plasma or serum
from cellular elements, and for preparing aliquots,
which are small portions of the specimen
transferred into separate containers for distribution
to a variety of laboratory departments
Before centrifuging, the stopper should remain on
the sample to prevent its contamination or
alteration
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Clotting
Serum specimens must be completely clotted
before centrifugation
Complete clotting may take 30 to 45 minutes at
room temperature
Samples with clot activators (including serum
separator tubes) clot within 30 minutes
If thrombin is used, complete clotting may occur
within 5 minutes
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Centrifuging
A centrifuge spins the sample at a very high speed,
separating components based on density
Cellular elements, which are denser, move to the
bottom; the less dense plasma or serum is pushed
to the top
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Blood after spun
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Removing a Stopper
The major risk of stopper removal is formation of
an aerosol, a microscopic mist of blood that forms
from droplets inside the tube
Aerosols are especially likely if the tube or rim
has been contaminated by blood during collection
or transport
Many automated instruments allow for testing
without stopper removal
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Preparing Aliquots
All tubes into which aliquots are placed should be
labeled before filling and then capped before
delivery to the appropriate department
Aliquots are not poured off because this may
cause splashing and aerosol formation
Instead, an aliquot is removed with any one of
several types of disposable pipetting systems
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Transport and Processing
of Nonblood Specimens
Microbiology samples must be transported to the
laboratory immediately to increase the likelihood
of recovering pathogenic organisms
Most specimens are collected in transport media
and do not require additional processing after
collection
Most samples are plated immediately on culture
media; often the phlebotomist is trained to
perform this task
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Specimen Rejection
Improper or inadequate identification
Hemolysis
Incorrect tube for the test ordered
Tubes used past their expiration date
Inadequate ratio of blood to additive
Insufficient volume for testing
Drawing a specimen at the wrong time
Contaminated specimen
Improper handling
Bringing a sample to the laboratory outside the
appropriate time frame
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Questions?
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