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Consultant Haematopathologists
Dr Caoimhe Egan
Dr John Grant
Dr Lívia Rásó-Barnett
Dr Elizabeth Soilleux (Honorary)
Dr Joy Staniforth
About
HODS provide an integrated Haematopathology diagnostic service which covers histopathology, diagnostic cytology, immunohistochemistry and molecular pathology.
Specimen requirements
| Specimen | Fixed / Unfixed | Specimen requirements |
|---|---|---|
| Bone marrow trephine | Unfixed | Unfixed bone marrow trephine biopsies should be sent in formalin. Specimen should be immersed in six to ten times the volume of neutral buffered formalin (10%) in an appropriately sized container and the lid secured properly. The pot should be labelled with a formalin hazard label. |
| Fixed* | Fixed and stained sections with 10 unstained sections or Block(s) or Block(s) plus 20 consecutive serial sections (2–4 micrometres thin) with minimal trimming. Submitted as 3 H&E stained slides at level 1, 10 and 20 with the remaining 17 unstained slides for further IHC/retic | |
| Lymph node sample (core biopsy, excisional biopsy or aspirational cytology samples) for flow cytometry | Unfixed | Unfixed lymph node samples for flow cytometry can be sent FRESH Lymph node cores, where lymphoma is suspected: The sample should be sent FRESH in an appropriately sized and labelled container. Arrange in advance with Immunophenotyping (01223 586786) Please add 1ml of sterile saline to prevent dehydration (see specimen requirements in Immunophenotyping section) |
| Lymph node sample (core biopsy, excisional biopsy or cell block from aspiration cytology/EBUS-FNA) for histomorphology | Fixed | Submit single H&E stained slide from each block(s) plus block(s) or Single H&E stained slide from each block(s) plus 20 unstained slides from each block(s) Note: also attach the original request form (or a copy),as well as the local report and information about work-up performed and material retained in the referring hospital |
| Splenic biopsy | Fixed | Block(s) plus 20 consecutive serial sections (2–4 micrometres thick) with minimal trimming Submitted as 3 H&E stained slides at level 1, 10 and 20 with the remaining 17 unstained slides for further IHC/retic |
*For bone marrow trephine biopsy, local decalcification protocol to be followed. If local protocol is not in place, then the current protocol at department of Histopathology (Addenbrooke’s) can be followed: after fixation in 10% formalin (for 24 hours), bone marrow trephine biopsies undergo 24 hours EDTA decalcification (pH 6.5-7, at room temperature) before processing and sectioning.
Workflow of bone marrow trephine biopsies
Fresh bone marrow trephine biopsy samples should be sent to HODS (Level 3, Pathology Block) in purple HODS specimen bags alongside the liquid samples for morphology, flow cytometry, cytogenetic and molecular studies. They are booked in and linked via the specimen (SP) number in HODS.
After booking in, bone marrow trephines are transferred to the Department of Histopathology (LMB Cut-up room) for processing.
Fresh bone marrow trephine biopsy samples need to be fixed in six to ten times the volume of neutral buffered formalin (10%) in an appropriately-sized container for 24 hours. It is therefore of paramount importance that the referring clinical team clearly labels sampling time on the container.
Once 24 hours of fixation is complete, samples will be placed into EDTA (molecular decal solution) for 24 hours each evening Monday–Thursday and Friday–Saturday AM.
After 24 hours of decalcification is complete, specimens are processed overnight, then embedded and transferred back to the Immunohistochemistry Laboratory (Level 1, Pathology Block) the next morning for section cutting.
Once sections are cut, they are stained for HE in the Department of Histopathology (LMB – Main Laboratory) and transferred back to HODS for allocation to the Consultants in HODS.
Consultants request appropriate immunopanels and report cases once immunostained slides are available. For example, if a trephine sample is taken on a Tuesday before 3pm and reaches HODS by midday on Wednesday, HE stained slides should be available by Friday or Monday morning at the latest.
Potential factors delaying histopathology reports
Limited clinical information provided. Highlighting responsible clinician with email address and/or phone number is useful, but does not replace providing adequate clinical information upfront.
Limited sample size, for example EBUS-FNA samples or scanty material, as these need to be worked up in a stepwise fashion rather than with one diagnostic panel. A separate sample submitted for flow cytometry can greatly aid diagnostic yield.
Sample quality. Interpretation is more challenging in the presence of significant amounts of crush or cautery artefact and with small diameter tissue cores taken with higher gauge needles.