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Request form
All samples sent from outside CUH must be accompanied by a HODS request form. Samples sent from inside CUH must be accompanied by an electronic order on Epic.
Sample requirements
Sample requirements are listed under the relevant sections. Samples for RNA-based tests, where molecular detection of genetic translocations is required (e.g. BCR-ABL1, PML-RARA), or gene expression (e.g. NPM1 quantitation for AML minimal residual disease detection) should preferably arrive in the lab before 3pm Monday to Thursday. Samples received later than this risk either delayed results, poorer quality results or both.
Read our suggested bone marrow aspirate sampling guidance (including MRD sample requirements) currently in use in CUH. This is for reference only, as hospitals will have their own sampling guidance. However, the need for separate samples for flow cytometry, molecular genetics and cytogenetics is of increased importance now that these laboratories are no longer part of HODS, to avoid delays in obtaining results. It is also a common misconception that FISH requires collection in cytogenetics medium, whereas EDTA is preferable.
Urgent & Out-of-hours (OOH) samples
For all clinically urgent cases, it is essential to notify the laboratory by telephone and clearly mark this on the request form. Such samples will be prioritised, and the results will be communicated directly to the Consultant named on the form. Please ensure to include a contact number to facilitate prompt communication.
All samples arriving after standard working hours should be notified to the laboratory where possible within working hours (07:00 – 17:00)
Out-of-Hours Sample Delivery (Instructions for Couriers)
Couriers delivering samples to HODS should note the following instructions for Out-of-Hours (OOH) deliveries. HODS is located on Level 3 in the Pathology Block.
Accessing HODS:
The entrance to HODS is via swipe card access only.
If access is needed, please use the phone located to the left of the HODS entrance door to contact the Blood Transfusion Department at extension x596263.
Alternative Entrance:
If arriving via the Pathology entrance outside of standard hours, please note that it is swipe card restricted from 17:00 to 07:00.
Proceed to the main entrance and request the reception staff to contact the Blood Transfusion Department for access.
Sample Handover:
A member of the Blood Transfusion staff will receive and sign for the samples.
The samples will be securely placed in the “HODS Out-of-Hours fridge”.
Morphology or Immunophenotyping Samples
If urgent morphology or immunophenotyping is needed outside of working hours, please contact the on-call HODS consultant via Cambridge University Hospital switchboard on (01223) 245151.
Histopathology Samples
For out-of-hours histopathology samples (non-trephine) please refer to guidance from your local Histopathology Department regarding sample submission. For CUH users this can be found on the Histopathology section of the CUH portal (http://connect2/article/1376/Histopathology).
A limited cytogenetic service is provided on Bank Holidays by East GLH for very urgent cases and may be available at weekends on discussion; please contact the HODS on-call Consultant Haematologist if required.
Molecular or Cytogenetic Samples
There is currently no on-call molecular or cytogenetic service.
Samples for external molecular MRD testing
All AML and ALL samples for molecular MRD testing that are received via HODS must state “ FOR MOLECULAR MRD” on the request form, or tick the relevant box on the HODS request form (appendix 1). At least two bone marrow EDTA samples should be supplied and the first should be labelled with a “1st pull for MRD” sticker; please contact the laboratory to obtain more stickers. If peripheral blood is required to be sent for MRD in addition to bone marrow, this must also be stated on the request form.
MRD tests that require RNA extraction include (but are not limited to) NPM1, BCR::ABL1 (p190), PML::RARA, CBFB::MYH11 and RUNX1::RUNX1T1. These can usually be dispatched to external laboratories via the GLH without processing if they are received on Monday-Thursday, either on the same day as collection or if the collection date was the day prior and the sample is received before 1.30pm. Samples not received in this timeframe will require processing in the GLH prior to external dispatch and overall turnaround times will be delayed. An alternative is for the samples to be sent directly from the local hospital to the specialist MRD laboratory.
Peripheral blood samples for genomic tests only
Although HODS screens all bone marrow samples, this is not necessary for many peripheral blood samples because a blood film has been reviewed in the referring hospital, the diagnosis may already be established (e.g. CLL) and only genomic tests are required (e.g. MPN screening tests, TP53 mutations, CLL FISH). HODS will screen peripheral blood if the request form asks for flow cytometry or the clinical information implies the diagnosis is unknown e.g. “lymphocytosis ?cause”. If only cytogenetic or molecular tests are requested, HODS will infer that the referring clinician has made an assessment of the clinical and laboratory information and has requested appropriate tests. Please note that myeloid NGS panel testing on peripheral blood is not generally recommended as a screening test for patients with unexplained cytopenias, since there is a risk of false negative results (due to low "tumour burden" in peripheral blood) and most patients with positive results will need definitive diagnostic assessment with bone marrow examination.
Please note that if a genomic test is performed by a specialist centre rather than East GLH (e.g. BCR::ABL1 TKD mutation testing by NGS or AML MRD on peripheral blood), the sample can be sent directly to the appropriate GLH by the hospital/clinician.
Specimen labelling
Sample tubes and pots must be labelled with at least three points of identification, e.g. patient name (surname and forename) and two additional identifiers, such as date of birth, hospital number or NHS number.
Slides must be labelled with the patient name (surname and forename), date of collection and one additional identifier.
Addressograph labels may be used to label specimen tubes or pots, but not slides.
The date and time of sample collection should be provided on the request form.
If not an internal Epic order, then the request form should include details of the referring centre, relevant clinical information, the referring clinician’s name and contact details.
Different samples must be distinguished by labelling the pots/tubes, e.g. BM (bone marrow) or PB, (peripheral blood), and ‘first pull’.
Insufficient or incorrect information on a specimen container(s) or request form can result in the sample being returned to the sender and delays in sample processing.
Packaging samples
Samples sent by Royal Mail or courier must comply with packaging instruction P650 for UN3373 biological substance, category B (Diagnostic specimens).
Packaging shall be of good quality, strong enough to withstand shocks (95 kPA pressure) and loadings normally encountered during carriage, including transhipment between vehicles or containers and between vehicles or containers and warehouse as any removal from a pallet or over pack for subsequent manual or mechanical handling. Packaging shall be constructed and closed to prevent any loss if contents that might be caused under normal conditions of carriage by vibration or by changes in temperature, humidity or pressure.
Packaging shall consist of three components:
Primary receptacle
Secondary packaging
Outer packaging
There should be sufficient absorbent material placed between the primary receptacle(s) and secondary packaging to absorb any spillage.
The primary receptacle and absorbent material must be placed into a single leak-proof bag with the request form in the pouch.
The package should be clearly labelled “BIOLOGICAL SUBSTANCE, CATEGORY B” and “UN3733” must be placed inside a diamond-shaped mark which has a minimum dimensions of 50 mm x 50 mm; the width of the line forming the diamond shall be at least 2 mm and the letters and numbers of UN3733 shall be at least 6 mm high. “BIOLOGICAL SUBSTANCE, CATEGORY B” shall also be at least 6 mm high and marked adjacent to the diamond-shaped mark.
For transportation around the Trust (Addenbrooke’s hospital) they will not need any dangerous goods markings as the transport regulations do not apply.
Please note: UN3373 Biological Substance, Category B only applies to KNOWN or SUSPECTED infectious specimens. HODS treats all samples as potentially high-risk therefore it is advised to use UN3373 Biological Substance, Category B.
HODS expected turnaround times
| Test | Target turnaround time |
|---|---|
| Urgent cases (suspected acute leukaemia or Burkitt lymphoma) | Verbal communication within 6 hours |
| Routine bone marrow aspirate morphology | 2.5 working days |
| Routine immunophenotyping | 3 working days |
| Routine bone marrow trephine histology | 6 working days |
| Routine lymph node histology | 5 working days |
For further information about the cytogenetic and molecular tests provided by the East GLH, please refer to their website: www.eastgenomics.nhs.uk
Clinical details
Appropriate clinical details are essential to facilitating rapid and effective diagnosis. If any additional relevant information becomes available after sample submission, please email this to a member of the HODS reporting team.
If comprehensive testing to provide prognostic information is not appropriate for a patient due to age or performance status, please provide this information in the clinical details and these standard diagnostic pathways will be adjusted accordingly. If patients are being monitored on a clinical trial, please also provide this information to avoid duplicate testing and hence unnecessary expense to the NHS.
Consent prior to testing
Many samples investigated for a haematological malignancy will undergo further genomic tests including cytogenetics and/or next-generation sequencing (NGS) panels. The aim of these tests is to look for abnormalities relevant to this patient that explain the clinical presentation or provide further clinically useful information. These tests may also in a small minority of cases demonstrate unexpected potential germline findings which could have clinical significance for the patient and/or family members. In some cases additional testing or discussion with other clinical teams may be recommended.
It is recommended that patients undergoing investigation for a possible haematological malignancy should be counselled and at least verbal consent taken prior to genetic testing, to explain the possible results including the implications of identifying a germline mutation (Killick et al, Br J Haematol 2021;194(2):282- 293).
Second opinions
Second opinions on selected cases from outside the contracted HODS region may be arranged with the prior approval of a HODS consultant. The consultant must be contacted by email in advance and a copy of the authorising email response should be enclosed with the case, together with the original report. Cases for second opinion which are received without prior approval may be returned to the submitting centre.