6 Specimen Handling Practice Cases

A test-specific decision sequence

Specimen quality depends on the entire path from collection to testing. Always follow the laboratory’s written procedure for the specific test: acceptable specimen types, required identifiers, transport conditions, centrifugation settings, storage limits, and rejection criteria can vary. A specimen unsuitable for one test may still be usable for another.

For each specimen, work through these checks:

1. Identity: Do the required identifiers on the specimen match the requisition or electronic order, and is the label attached to the container?

2. Suitability: Are the specimen type, container, additive, and volume appropriate for the test?

3. Transport: Did the specimen arrive within the required time and temperature range, in an intact, properly contained package?

4. Processing: Must the specimen clot, be centrifuged, be separated or aliquoted, or be protected from light? Are the equipment and settings correct for the procedure?

5. Storage: If testing is delayed, what temperature, duration, and other conditions does the test require?

6. Disposition: Should the specimen be accepted, held for clarification, or rejected under written policy?

Document nonconformities and communicate promptly. Never guess a patient’s identity or silently alter a specimen label. Consistent handling and written rejection criteria help protect result quality.

Identity and labeling

Required identifiers on the specimen must match the requisition or electronic order. If a tube reads “Jordan Lee” while the requisition reads “Jordon Lee,” and the dates of birth also differ, do not choose which identity is correct or relabel the tube by inference. Quarantine or reject it according to laboratory policy, contact the authorized collector or requester, record the discrepancy, and request recollection when required. A mismatch can make it impossible to assign the result reliably to a patient.

An unlabeled specimen requires the laboratory’s written policy to be followed. Do not label it from memory or treat verbal identification as an automatic substitute for required identification. If policy permits an exception for an irreplaceable specimen, obtain the required authorization, document the circumstances, and communicate the limitations. Unlabeled specimens are a common reason for rejection, and exceptional handling must be controlled and documented.

Specimen suitability and package integrity

Check whether the specimen type, container, additive, and volume meet the requirements of the specific test. A specimen in the wrong container or below the stated minimum volume may be unsuitable; reject it and request recollection when required by policy, document the reason, and notify the requester. Do not transfer it into another container unless the procedure specifically permits that transfer.

A package that has leaked presents a safety and specimen-integrity problem, even if the identifiers match. Follow the laboratory’s spill and rejection procedures; do not process a contaminated or compromised container as though it were intact. Notify the submitting site and request recollection if needed. Transport packaging should contain leaks and protect both specimens and personnel.

Transport, delays, and uncertainty

Compare transport history with the requirements for each ordered test. For a delayed blood tube with multiple tests, check each test’s stability, specimen type, and separation requirements. Do not apply one universal time limit or assume a specimen is acceptable because it looks normal. If suitability cannot be established, contact the requester and follow laboratory policy for holding, testing with a limitation, or recollection.

If a time-sensitive specimen arrives without a temperature record, check the test’s transport limits and any available evidence, such as a temperature log or validated transport process. Document uncertainty and escalate it under laboratory policy rather than assuming the specimen remained suitable. Prompt transport and appropriate storage help preserve specimen integrity.

Processing and centrifugation

Follow the tube manufacturer’s instructions and the laboratory’s validated procedure for clotting and centrifugation. Do not assume that spinning a serum tube immediately after collection is equivalent to spinning it after the required clotting time. Check the resulting specimen for fibrin or other problems and apply the test-specific acceptance rules.

Centrifugation conditions depend on factors such as the tube, additive, temperature, and applied force; one setting should not be treated as universal. Before starting a run, balance the rotor according to the equipment instructions and laboratory procedure, using suitable counterbalancing tubes or materials when needed. Confirm the specified rotor, settings, and run parameters. If a run has already occurred under improper conditions, assess the specimen and equipment under the applicable procedure before using the specimen.

Storage and final disposition

Storage requirements depend on the specimen and test. Do not presume refrigeration is acceptable for every specimen or test. Compare the actual storage history with the test-specific requirements, document any deviation, and ask the technical supervisor or responsible laboratory professional to determine whether testing is valid or recollection is needed.

When a specimen may be unsuitable or its handling history is uncertain, do not improvise. Accept, hold for clarification, or reject it according to written policy. Document problems, communicate promptly, and request recollection when needed. If an exception may be justified, use the laboratory’s authorized process and document it rather than inferring identity or suitability.

• Nonconformity