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Guidance on request forms, sample requirements, packaging, specialist samples and turnaround times.
All samples sent from outside Cambridge University Hospitals (CUH) must be accompanied by a HODS Request Form. For samples sent from within CUH, use the electronic order system on Epic.
Download HODS request form (PDF, 778 KB)(↗)
Last updated: 16 February 2024
Different tests have different sample requirements. Check the specific test section for details.
For tests involving molecular detection of genetic translocations (such as BCR::ABL1, PML::RARA) or gene expression (for example, NPM1 quantitation for AML minimal residual disease detection):
Send samples to arrive at the laboratory before 3pm, Monday to Thursday
Late arrivals may lead to delayed results or affect result quality
We have a suggested bone marrow aspirate sampling guide for use at Cambridge University Hospitals (CUH). This includes minimal residual disease (MRD) sample requirements.
This guide is for reference only. Other hospitals may have different sampling guidance.
Key points:
Collect separate samples for flow cytometry, molecular genetics and cytogenetics
This is especially important now that these laboratories are no longer part of HODS, to avoid delays in obtaining results
FISH testing preferably requires EDTA samples, not cytogenetics medium as commonly believed
This guidance explains how to handle urgent samples and out-of-hours (OOH) deliveries for the Haematopathology and Oncology Diagnostic Service (HODS) at Cambridge University Hospitals NHS Foundation Trust.
For all clinically urgent cases:
Notify the laboratory by telephone
Highlight urgency on the request form
Provide a contact number for the named consultant
We will prioritise these samples and phone results to the named consultant.
For samples that will arrive outside normal working hours:
Notify the laboratory during working hours (Monday to Friday, 7am to 5pm) whenever possible
Follow the courier instructions below if delivering samples
For morphology or immunophenotyping: contact the on-call HODS consultant via Cambridge University Hospital switchboard: 01223 245151
For non-trephine histopathology samples: follow your local Histopathology Department guidance.
CUH staff: Check the Histopathology section on CUH portal
For molecular and cytogenetic tests: there is currently no on-call service for these tests.
On bank holidays and weekends, we offer limited services for urgent cases:
East Genomic Laboratory Hub (GLH) provides a restricted cytogenetic service for very urgent cases
A molecular scientist may be available to help with urgent sample processing
For all urgent queries, contact the on-call HODS Consultant Haematologist (via Cambridge University Hospital switchboard: 01223 245151)
Important: Notifying the lab about out-of-hours samples
For samples arriving outside standard working hours, please notify the laboratory in advance during working hours (Monday to Friday, 7am to 5pm) whenever possible. This advance notice helps us prepare for your sample and ensure prompt processing.
These instructions are for couriers delivering samples to the Haematopathology and Oncology Diagnostic Service (HODS) outside normal working hours.
HODS is on Level 3 in the Pathology Block.
The HODS entrance requires swipe card access.
If you need access, use the phone to the left of the HODS entrance door.
Call the Blood Transfusion Department on extension 596263.
If arriving via the Pathology entrance between 5pm and 7am:
Go to the main hospital entrance.
Ask reception staff to contact the Blood Transfusion Department for access.
A Blood Transfusion staff member will receive and sign for the samples.
Samples will be stored securely in the "HODS Out-of-Hours fridge".
Samples sent by Royal Mail or courier must comply with Packaging Instruction P650 for UN3373 Biological Substance, Category B (diagnostic specimens).
Packaging must be of good quality and strong enough to withstand shocks, including 95 kPa pressure, and normal conditions encountered during transport, handling, loading, unloading and transfer between vehicles, containers or storage areas. Packaging must be constructed and sealed to prevent loss of contents caused by vibration or by changes in temperature, humidity or pressure.
Packaging must consist of three layers:
Primary receptacle (sample tube, pot or container)
Secondary packaging
Outer packaging
Place sufficient absorbent material between the primary receptacle(s) and the secondary packaging to absorb any leakage or spillage.
Place the primary receptacle(s) and absorbent material together inside a single leak-proof bag.
Place the request form in the document pouch of the leak-proof bag.
The outer package must be clearly labelled:
BIOLOGICAL SUBSTANCE, CATEGORY B
UN3373 displayed within a diamond-shaped mark
The diamond mark must:
be at least 50 mm x 50 mm
have a line width of at least 2 mm
Letters and numbers used for UN3373 and BIOLOGICAL SUBSTANCE, CATEGORY B should be at least 6 mm high.
The wording BIOLOGICAL SUBSTANCE, CATEGORY B should be placed adjacent to the diamond mark.
For transport within Addenbrooke’s Hospital / the Trust, dangerous goods markings are not required, as transport regulations do not apply to internal movement within the site.
Important note
UN3373 Biological Substance, Category B formally applies to known or suspected infectious specimens. HODS treats all samples as potentially high risk. For this reason, use of UN3373 Biological Substance, Category B labelling is advised for all samples.
Addressed purple outer packaging bags are available for regional users on request from the HODS specimen reception team.
Telephone: 01223 217132
Email: add-tr.HODS@nhs.net
Proper labelling is crucial for accurate sample processing. Please follow these guidelines:
Label with at least 3 identifiers:
Patient's full name (surname and forename)
2 additional identifiers (e.g. date of birth, hospital number, NHS number)
Label with:
Patient's full name (surname and forename)
Date of collection
One additional identifier
Provide date and time of sample collection on the request form.
For non-Epic orders, include on the request form:
Referring centre details
Relevant clinical information
Referring clinician's name and contact details
Distinguish different samples by labelling pots/tubes (e.g. BM for bone marrow, PB for peripheral blood, 'first pull').
Important notes
Addressograph labels may be used on specimen tubes or pots, but not on slides.
Insufficient or incorrect information may result in:
• Sample being returned to sender
• Delays in sample processing
Appropriate clinical details are essential for rapid and effective diagnosis.
Relevant clinical history
Current symptoms or presentation
Suspected diagnosis
Current treatment
Whether the patient is being monitored on a clinical trial
If 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 example because of age or performance status), please state this in the clinical details.
If the patient is being monitored on a clinical trial, please state this to avoid duplicate testing.
Additional note
Sample testing frequency depends on the specific clinical scenario.
Reports will indicate if a sample is technically inadequate for diagnostic interpretation and repeat testing may be required.
Many samples investigated for suspected haematological malignancy will undergo further genomic testing, including cytogenetics and/or next-generation sequencing (NGS) panels.
These tests aim to:
identify abnormalities relevant to the patient that may explain the clinical presentation
provide further clinically useful information
In a small minority of cases, testing may also identify unexpected potential germline findings that 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 are counselled before genetic testing.
At least verbal consent should be obtained.
This should include discussion of possible results, including the implications of identifying a germline mutation.
Further actions
In some cases, additional testing or discussion with other clinical teams may be recommended.
For further information on consent for genetic testing in haematological malignancies, see Killick et al. British Journal of Haematology. 2021;194(2):282–293.
For AML and ALL samples sent for molecular MRD testing via HODS:
Mark the request form "FOR MOLECULAR MRD" or tick the relevant box on the HODS request form
Send at least 2 bone marrow aspirate samples in EDTA
Label the first collected sample with a "1st Pull for MRD" sticker (contact the laboratory for further stickers)
If peripheral blood is also required for MRD testing, state this on the request form
Common examples include:
NPM1
BCR::ABL1 (p190)
PML::RARA
CBFB::MYH11
RUNX1::RUNX1T1
MRD tests requiring RNA extraction are particularly time-sensitive.
These samples can usually be dispatched to external laboratories via the GLH without processing if they are received:
Monday to Thursday, on the day of collection, or
before 1.30 pm on the day after collection
Samples received outside this timeframe will usually require GLH processing before onward dispatch, and overall turnaround times may be delayed.
An alternative is for samples to be sent directly from the local hospital to the specialist MRD laboratory. Please indicate on the request form if this has been arranged, to avoid confusion.
Although HODS screens all bone marrow samples, screening is not necessary for many peripheral blood samples.
This is usually because:
a blood film has already been reviewed at the referring hospital
the diagnosis is already established (for example CLL)
only specific genomic tests are required (for example MPN screening, TP53 mutation testing, CLL FISH)
HODS will screen peripheral blood samples if:
flow cytometry is requested
the clinical details suggest the diagnosis is not yet established (for example lymphocytosis ?cause)
If only cytogenetic or molecular tests are requested, HODS will assume the referring clinician has reviewed the clinical and laboratory information and requested appropriate investigations.
Myeloid NGS panel testing on peripheral blood is not generally recommended as a screening test for unexplained cytopenias.
This is because:
false negative results may occur due to low tumour burden in peripheral blood
patients with positive results will usually still require definitive bone marrow assessment
If a genomic test is undertaken by a specialist centre rather than East GLH (for example BCR::ABL1 TKD mutation testing by NGS or AML MRD on peripheral blood), the sample may be sent directly to the appropriate GLH by the requesting hospital or clinician.
Where both flow cytometry and genomic testing are requested on a peripheral blood sample, please send at least 2 EDTA peripheral blood samples to help streamline processing on arrival.
These samples can be challenging because of:
small sample volumes
often paucicellular nature
haemato-oncological tests frequently being non-diagnostic
It is important that the most appropriate sample is sent for the most important testing modality or modalities, taking account of the clinical differential diagnosis.
If primary intra-ocular lymphoma is suspected:
possible HODS testing must be discussed with the flow cytometry team before sampling
please contact the flow cytometry team in advance for advice
HODS does not provide:
conventional cytomorphological interpretation (“cytology”)
microbiological or virological assessment
cytokine testing
Please discuss these with local providers so that appropriate samples can be sent.
The Haematopathology and Oncology Diagnostic Service (HODS) aims to provide timely reporting across its diagnostic services. The table below outlines target turnaround times for key investigations.
| Test | Turnaround Time | Target |
|---|---|---|
| Bone marrow aspirate morphology | 3 working days | 80% |
| Immunophenotyping | 3 working days* | 80% |
| CD34 enumeration | 2 hours | 80% |
| Lymph node histology | 5 working days | 80% |
| Bone marrow trephine histology | 6 working days | 80% |
| Clinically urgent aspirate (suspected acute leukaemia or Burkitt lymphoma)** | Verbal communication within 6 hours | 90% |
| Integrated report (new presentation) | 6 weeks | 80% |
| Integrated report (follow-up case) | 6 weeks | 90% |
*5 working days for acute leukaemia flow cytometry follow-up cases (flow cytometry MRD).
**Cases must be notified to the laboratory by telephone in advance of sample receipt.
Information on recent turnaround times is provided at regional user group meetings. More detailed performance information is available on request from the clinical or operational lead.
For further information on cytogenetic and molecular tests provided by East GLH, please refer to the East Genomics website: www.eastgenomics.nhs.uk
Second opinions on selected cases from outside the contracted HODS region may be arranged with prior approval from a HODS consultant.
A HODS consultant must be contacted by email in advance
Include a copy of the authorising email with the case
Include the original report with the case
Important information
Cases received for second opinion without prior approval may be returned to the submitting centre.