Telephone Inquiries
Telephone inquiries should be directed to:
(512) 458-7578 for lab results
(512) 458-7598 for inquiries about guidelines for the submission,
collection, and handling of specimens.
We
examine specimens as carefully and rapidly as possible; however, we do not
sacrifice accuracy for speed. Please consider the following information
before making a telephone inquiry:
- Lab
reporting results are given only to the original submitter.
- Upon
receipt of the specimen at the Laboratory, most testing will be
completed in one to three days; however, newborn screening tests take 3-6
days.
- Confirmation
of findings in certain bacteriological examinations may necessitate a short
delay in reporting results.
- If
specimens must go to another reference center, the report will be delayed for
at least two weeks.
Of
course, emergency matters may be pursued any time.
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Reference Services
If
reference services are needed but are not provided in this laboratory system,
the Laboratory uses the services of the Centers for Disease Control
and Prevention (CDC) in Atlanta, Georgia or in Ft. Collins, Colorado. When a
particular test is available only from CDC, submitters should send the
specimen TDSHS requisition form, along with a patient history, to the Texas
Department of State Health Services for forwarding to the CDC.
Submission of Specimens
Please
exercise care when submitting specimens and requesting tests. Services are
offered only in keeping with departmental policies, licensure, and mission;
therefore, services may be withdrawn in case of misuse or improper specimen
submission. Submission of proper specimens under optimum conditions is very
important. Accurate tests seldom can be performed on poor specimens.
The Laboratory enforces the principles of Good Laboratory Practices.
The submitter is responsible for ensuring expiration dating on media. We will
monitor the interval between the collection and the receipt of time-sensitive
specimens (newborn screening, bacteriological water, gonorrhea).
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Guidelines for Specific Types of Specimens
Prenatal Triple Screen Collection and Packing Instructions
General Instructions:
-
Submit
a G-1C form for each patient with corresponding specimen tube.
-
Retain
a copy of the G-1C submission form for your records.
-
Clearly
label each specimen with the patient’s first and last name as written on the
G-1C specimen submission form. Pre-printed patient labels used for specimen identification MUST match
the patient’s name on the submission form.
- Specimens
must be triple-contained.
Special Requirements:
Required
Specimen Type: 2 mL of serum in blue top tube specific for
Triple Screen Testing.
Special Instructions:
- Specimen
must be collected from patients between 15.0 and 20.9 gestational weeks,
preferably 16-18 weeks. Serum specimen must be collected prior to amniocentesis.
- Allow samples to clot completely before centrifugation; remove serum
from clot within 2 hours of collection. Immediately transfer serum to special blue top tube provided by DSHS and
freeze (-20 degrees C or lower). Batching of specimens for shipment is
recommended.
- Specimens MUST be kept frozen until shipping is initiated. Ship specimens overnight on dry ice OR
with adequate ice packs so that specimens arrive at DSHS laboratory cold. Specimens received at room temperature will
be unsatisfactory for testing.
- Do NOT ship ANY prenatal
triple screen specimens on Fridays or prior to a Federally observed holiday
(for holiday delivery).
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Instructions for
Shipping Diagnostic Specimens:
To ensure proper packaging, please follow these instructions. See also the Triple Screen Packing Diagram below.
- Obtain enough dry ice to
keep the specimens frozen or enough ice packs to keep specimens cold for the
duration of the shipment.
- Place
the serum specimens in the blue top tube provided by DSHS laboratory, then
place them in a biohazard bag and seal. Place biohazard bag, containing the specimens, inside a canister
provided by DSHS and place up to 4 canisters in the bottom of the Styrofoam
box.
- Fill
the Styrofoam box with dry ice or ice packs. Ensure canisters are completely covered with dry ice or ice packs, and
secured.
- Place
the lid on the Styrofoam box. Make
sure the date and time is documented on the G-1C form when specimens are
removed from the freezer.
- Place
the completed G-1C form(s) in a plastic “zip lock” bag. Then place the plastic “zip lock” bag on top
of the closed Styrofoam box and seal the fiberboard box.
- Secure
the outer fiberboard box with packing tape.
- Ensure
that a diamond-shaped UN 3373 label is on exterior of the fiberboard box, when
shipping diagnostic specimens.
- Dry
ice is considered a “dangerous good”. If using dry ice:
- Use
less than 5 lbs of dry ice.
- Mark
the blank box and write “dry ice” in the Special Instructions
section of the air bill.
- Attach
a diamond-shaped dry ice label on the package with the number “9” and “UN1845”
on it. This label must include the
amount of dry ice used. Ensure that
this is legible and does not overlap any other label on the fiberboard box.
- Fill out Section 1 of the
air bill that is provided by DSHS and place it inside the sleeve and attach to
the top of the sealed fiberboard box.
CAUTION: MAKE SURE
THAT YOUR STYROFOAM BOX IS NOT AIRTIGHT, IF USING DRY ICE!
By following these instructions when shipping
diagnostic specimens, your responsibility should be fulfilled.
Shipping Instructions:
Check elsewhere in this section for specific test instructions and information about
tube types.
For
blue top specimen tubes and questions about shipping of triple screen
specimens, call (800) 687-4363 or (512) 458-7138.
For
shipping containers, call (512) 458-7661.
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Flow Chart for Collection and Shipping of Triple Screen Specimens:
Collect whole blood from
patients for triple screen testing who are between 15.0-20.9 weeks of
gestational age |
|
Centrifuge specimen and
separate serum from RBC within 2 hours. |
|
Place 2 ml of serum in 3 ml
blue top tube provided by DSHS Laboratory. |
|
Place specimen/s in
biohazard bags and place in canisters.
Multiple specimens may be contained inside the
canisters.
FREEZE canister(s) containing specimens IMMEDIATELY. |
|
After specimens are frozen: |
|
Batch specimens and ship once or twice a week.
Do not ship on Fridays or the day before Federal holidays. |
|
Place up to 4 canisters with
frozen specimens in the bottom of the Styrofoam box. |
|
Place and secure ice packs
or place dry ice on top of canisters |
|
Close the Styrofoam box |
|
Place the Styrofoam box
inside the fiberboard box. |
|
Before sealing the
fiberboard box, record Time and Date on each G1-C form for each specimen
removed from the freezer. |
|
Place requisition forms on
top of the Styrofoam box,
but inside fiberboard box. Seal fiberboard box. |
|
Place an air bill provided
by the Prenatal Testing Laboratory inside the shipping sleeve and attach to top
of the sealed fiberboard box and ship specimens overnight. |
Serological Testing
The DSHS Laboratory does not provide blood collection tubes, except for those who are under contract or are eligible under the Texas Health Steps (THSteps) Program; therefore, physicians should have a supply of vacuum tubes for the collection of blood specimens for serological testing.
They may either be serum tubes,
silicon coated (red-top tubes), or Serum Separator tubes with clot activator
and gel for serum separation (red gray or “tiger” top tubes). Assays will
require at least 5mls of whole blood in a tube. General specimens handling
requirements are listed below, however, they differ with each assay, so please
refer to the test requested in the Lab Tests for
Diseases/Agents section of this manual.
Serum samples that are to be tested fresh may be stored for
up to two hours at 2-8°C in the presence of clots.
Serum may be separated from the clot by centrifugation and transferred to a
sterile tube with a screw-cap (make sure that the seal is tight to prevent
leakage). Serum separated from the clot may be stored at 2-8°C
up to 48 hours. After 48 hours, or for shipping, the serum must be frozen at
-20°C
and sent on dry ice. Temperature level during entire shipment should be no
warmer than –20°C.
Pack specimens in compliance with government regulations covering the
transportation of etiologic agents. To prevent hemolysis in the specimens,
avoid bacterial contamination, the presence of water or chemicals in syringes
or tubes, or rough treatment. Avoid extremely high temperatures, such as may
occur in mail vans and drop boxes in the summer and never freeze whole blood.
How to collect serum sample using serum separator tubes with clot activator:
- Gently invert tube 5 times to mix clot activator with blood.
- Allow blood to clot for a minimum of 30 minutes in a vertical position. Observe a dense clot.
- Centrifuge at full speed (between 1100 and 1300g) for 10 minutes for swing-head unit or 15 minutes for fixed angle units. Barrier will form, separating serum specimen from clot.
- Transport spun tube to the laboratory.
A single result is significant in a few serological tests,
such as immune status testing. In many cases, single results will be more
misleading than helpful. Therefore, the Laboratory’s policy requires paired
specimens, that is two blood specimens collected from two to three weeks apart
for most diseases. Collecting the first specimens as soon as possible after the
onset of the disease is essential. Single specimens will be accepted for
syphilis and HIV serology, immune status testing (i.e. rubella in pregnant
women), and IgM antibody tests. Single specimens may also be submitted for systemic mycoses when a chronic infection is underway.
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Sputum
When
submitting sputum, be certain that it is from the deeper portion of the
lungs. Often saliva only is submitted, and this is usually unsatisfactory.
The Laboratory in Austin provides reference and primary culturing
work in mycobacteriology and mycology.
Fecal
specimens for bacteriological culturing
Fecal specimens for bacteriological culturing will be accepted only under special circumstances
and with prior approval (512-458-7318). When approved, these specimens must
be submitted in Cary-Blair transport medium. Instruction sheet and
medium available upon request. Call (512) 458-7661.
Fecal specimens for intestinal parasites
The
examination of fecal specimens for intestinal
parasites is still viewed as a reference service and will be
offered to any public health clinic, but prior arrangement is required for
all other specimens (512-458-7318). The specimens must not be sent in the
bacteriological preservative. The specimen should be divided into two
portions, one being placed into a vial of 10% Formalin, the second being
placed into a vial of PVA (polyvinyl alcohol). The Laboratory
provides kits to qualified providers. Call (512) 458-7661.
Fecal
specimens for viral isolation
Fecal specimens for viral isolation must not be chemically preserved. Instead,
fresh, unpreserved stools must be submitted. Any viral isolation specimen
should be maintained at refrigerator temperatures (4-8° C) between the time
of collection and the time of receipt in the laboratory. If the expected time
between collection and receipt in the laboratory will be greater than 72
hours, freeze specimens after collection and ship on dry ice.
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Rabies specimens
The TDSHS Laboratory recommends shipping rabies specimens by bus. Guidelines for
shipping rabies specimens are as follows:
- Specimens
must be shipped in a sealed, sturdy double container; a Styrofoam container
inside a cardboard box works well.
- Place completed Rabies Submission Form (G-9) in a separate plastic bag to
keep the form dry.
- Enclose
sufficient absorbent material to keep all moisture within the container.
- Specimens
should not be frozen because freezing delays and frequently compromises the
examination.
- Use
sufficient cold packs, to maintain a cool environment,
even with a delay of one full day. Wet ice is not recommended. If ice must be
used, double bag to prevent leakage. Zip-lock bags are recommended.
State law requires telephone
notification to this Laboratory
before shipment of rabies specimens:
1-800-252-8163
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Specimen management for infrequently encountered organisms
|
Organism
(disease) |
Specimen of choice |
Transport issues |
Comments |
Bartonella
sp (cat scratch fever) |
Blood, tissue, lymph node
aspirate |
1 wk at 4°C; indefinitely at
-70°C |
May see organisms in or on
erythrocytes with Giemsa stain. Use
Warthin Starry silver stain for tissue. SPS is toxic |
Borrelia
burgdorferi (Lyme disease) |
Skin biopsy at lesion periphery,
blood, CSF |
Keep tissue moist and sterile;
hand carry to laboratory if possible |
Consider PCR in addition to
culture. Culture yield is low. Warthin-Starry silver stain tissue. AO and Giemsa for blood and CSF |
Borrelia
sp. (relapsing fever) |
Blood smear (blood) |
Hand carry to laboratory if
possible |
Use direct wet mount in saline
for dark-field microscopy. Stain with
Wright's or Giemsa stain. Blood
culture is unreliable. |
Brucella
sp.b |
Blood bone marrow |
Transport at room temperature;
pediatric lysis-centrifugation tube is helpful |
Routine blood culture bottles
are useful if held 30 days. Blind
subculture may be necessary. Joint
fluid culture in arthritis. Notify laboratory
if Brucella suspected |
Klebisella
granulomatis (granuloma inguinale; donovanosis) |
Tissue, subsurface scrapings |
Transport at room temperature |
Mostly a tropical disease. Stain with Wright's or Giemsa stain.
Epithelium alone is adequate. Organism cannot be cultured. |
Coxiella
(Q fever), b Rickettsia
(spotted fevers; typhus) |
Serum, blood, tissue |
Blood and tissue are frozen at
-70°C |
Refer isolation to reference
laboratory. Serologic diagnosis is
preferred. |
Organism
(disease) |
Specimen of choice |
Transport issues |
Comments |
Ehrlichia
sp. |
Blood smear, skin biopsy, blood
(with heparin or EDTA anticoagulant), CSF, serum |
Material for culture sent on ice;
keep tissue moist and sterile; hold at 4 to 20°C until tested or a t -70°C for shipment; transport on ice or
frozen for PCR test |
Serologic
diagnosis preferred. Fix smear in
methanol. Tissue stained with FA or
Gimenez stain. Refer isolate to
reference laboratory. CSF for direct
examination and PCR. |
Francisella
sp. (tularemia)b |
Lymph node aspirate, scrapings,
lesion biopsy, blood, sputum |
Rapid transport to laboratory or
freeze; ship on dry ice |
Send to reference
laboratory. Serologic testing
helpful. Gram stain of tissue is not
productive. IFA available. Culture effective 10% of the time. |
Leptospira
sp. |
Serum, blood (citrate containing
anticoagulants should not be used), CSF (1st wk), urine (after 1st wk) |
Blood <1 h; urine, <1 h or
dilute 1:10 in 1% bovine serum albumin and store at 4-20°C or neutralize with
sodium bicarbonate |
Serologic testing most
helpful. Acidic urine is
detrimental. Dark-field microscopy
and direct FA available. Warthin-Starry silver stain for tissue. |
Streptobacillus
sp. (rat bite fever; Haverhill fever) |
Blood, aspirates of joint fluid |
High-volume bottle preferred |
Do not refrigerate. Requires blood, serum, or ascitic fluid
for growth. SPS is inhibitory. AO staining is helpful. |
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