Collecting a Coppe Laboratories Sample The Coppe Laboratories Sample Kit contains: Test Request Form (TRF) Heparin tube Absorbent sheet Biohazard bag Foil pouch Label for blood tube Box Seal Instructions Following the individual specimen instructions is an appendix with additional information about minimum specimen, alternate samples, and reasons for rejection. Please note: Contact Coppe Laboratories at 262-574-0701 if archival plasma samples need to be tested. Table of Contents Collecting a blood sample 1 Collecting and sending a serum 2 Collecting and sending a bone marrow sample 3 Collecting and sending a cord blood sample 3 Collecting and sending a cerebrospinal fluid sample 4 Collecting and sending a hair follicle sample 5 Collecting and sending a tissue (slide) sample for IHC 6 Testing appendix 7 9 Reasons for sample rejection 10 Contact Us 10
Whole Blood (or whole blood for plasma sample) Specimen Type: Whole blood (or whole blood to be processed for plasma) (Plasma tests ordered require heparin whole blood sample which will be processed by Coppe Laboratories. Please call for information about acceptability of other collected plasma samples.) 1. Fill in the Test Request Form completely. Be sure to include date and time of specimen collection, physician information and signature, and test ordered. Attach payment information. Incomplete or inaccurate information may cause delays in testing and reporting of results. 2. Draw blood in a heparin tube and gently invert blood tube 8 10 times. 3. Label the blood tube with patient name, date of birth and date and time of draw. 4. Place blood tube into biohazard bag with absorbent pad and seal. 5. Place the biohazard-labeled bag into the foil pouch and seal. 6. Place the foil pouch and the test request form into the pre-labeled Coppe Laboratories box and seal with enclosed Box Seal. 7. Send the pre-labeled box via FedEx, priority overnight shipping. Place test kit box directly into any FedEx drop box or Call FedEx at 1-800-463-3339 for pickup. 1
Serum Specimen Type: Serum Fill in the Test Request Form completely. Be sure to include date and time of specimen collection, physician information and signature. Attach payment information. Incomplete or inaccurate information may cause delays in testing and reporting of results. 1. Draw 6 10 ml of blood and gently invert blood tube 8 10 times. 2. Label the SST tube with patient name, date of birth and date and time of draw. 3. Allow blood to clot at room, upright, for 30 60 minutes 4. Place tube in centrifuge for 15 30 minutes. 5. Place blood tube into biohazard bag with absorbent pad and seal. 6. Place the biohazard-labeled bag into the foil pouch and seal. 7. Place the foil pouch and the test request form into the prelabeled Coppe Laboratories box and seal with enclosed Box Seal. 8. Send the pre-labeled box via FedEx, priority overnight shipping. Place test kit box directly into any FedEx drop box or Call FedEx at 1-800-463-3339 for pickup. 2
Bone Marrow/Cord Blood Specimen Type: Bone Marrow or Cord Blood Fill in the Test Request Form completely. Be sure to include date and time of specimen collection, physician information and signature, and test ordered. Attach payment information. Incomplete or inaccurate information may cause delays in testing and reporting of results. 1. Place 2 ml of bone marrow aspirate (or cord blood) in a pediatric (3mL) heparin or ACD tube and gently invert blood tube 8 10 times. 2. Label the tube with patient name, date of birth and date and time of draw. 3. Place blood tube into biohazard bag with absorbent pad and seal. 4. Place the biohazard-labeled bag into the foil pouch and seal. 5. Place the foil pouch and the test request form into the pre-labeled Coppe Laboratories box and seal with enclosed Box Seal. 6. Send the pre-labeled box via FedEx, priority overnight shipping. a. Place test kit box directly into any FedEx drop box or b. Call FedEx at 1-800-463-3339 for pickup. 3
Cerebrospinal Fluid (CSF) Specimen Type: CSF Since CSF samples will be sent refrigerated, please freeze gel ice packs for 4 hours prior to shipping. Fill in the Test Request Form completely. Be sure to include date and time of specimen collection, physician information and signature, and test ordered. Attach payment information. Incomplete or inaccurate information may cause delays in testing and reporting of results. 1. Place CSF into a sterile, leak-proof plastic tube. 2. Label the CSF specimen with patient name, date of birth and date and time of draw. 3. Place tube into the biohazard bag and seal. 4. Place the frozen gel pack into the foil pouch. 5. Place the biohazard-labeled bag into the foil pouch and seal. 6. Place the foil pouch and the test request form into the pre-labeled Coppe Laboratories box and seal. 7. Send the pre-labeled box via FedEx, priority overnight shipping. a. Call FedEx at 1-800-463-3339 for pickup or b. Place test kit box directly into any FedEx drop box. Note: If a sample cannot be immediately shipped, it can be stored for 3 days refrigerated or 1 year frozen. Must be shipped with dry ice if frozen or ice packets if stored refrigerated. 4
Hair Folliclle Specimen Type: Hair Follicle Fill in the Test Request Form completely. Be sure to include date and time of specimen collection, physician information and signature, and test ordered. Attach payment information. Incomplete or inaccurate information may cause delays in testing and reporting of results. 1. Explain to the patient that you will need to remove 2 3 hairs from their head. Hair taken from combs or brushes is not an acceptable specimen. 2. Using a tweezer or forceps, grasp the hair near the scalp and pull quickly. 3. Check root to ensure hair follicle is attached (see picture below). Lack of follicle on the hair shaft will cause the sample to be rejected. 4. Repeat steps 2-3 twice. 5. Place hair in small zip lock bag. 6. Label the zip lock specimen bag with the patient first name, last name, date of birth, and specimen removal date. 7. Place zip lock bag in biohazard bag and seal. 8. Place biohazard bag into padded foil bag and seal. 9. Place foil bag and completed test request form in Coppe Laboratories box and seal. 10. Send the pre-labeled box via FedEx. a. Place test kit box directly into any FedEx drop box or b. Call FedEx at 1-800-463-3339 for pickup. 5
Slides for Immunohistochemistry Specimen Type: Unstained slides for Immunohistochemistry (4 micron, FFPE slides) Fill in the Test Request Form completely. Be sure to include date and time of specimen collection, physician information and signature, and test ordered. Attach payment information. Incomplete or inaccurate information may cause delays in testing and reporting of results. 1. Label slides with patient first name, last name, and date of birth. 2. Package 6 unstained slides in a slide mailer, transporter or slide holder. 3. Place slides into the biohazard-labeled bag. 4. Place the biohazard-labeled bag into the foil pouch and seal. 5. Place the foil pouch and the test request form into the pre-labeled Coppe Laboratories box and seal. 6. Include a copy of the pathology report in the box. 7. Send the pre-labeled box via FedEx. a. Place test kit box directly into any FedEx drop box or b. Call FedEx at 1-800-463-3339 for pickup. 6
Appendix Cell-Free and Cellular Samples Real-Time DNA PCR on Cell-Free Samples: Quantitative Detection in Plasma for HHV-6A, HHV-6B, HHV-7 and CMV Qualitative Detection in CSF for HHV-6A, HHV-6B, HHV-7, CMV, EBV Test numbers: 1104, 1105, 1205, 1304, 1305, 1404, 1405 Specimen requirements are as follows: Specimen Volume Minimum Vol. Whole Blood to be processed to plasma CSF 6 10 ml collected in heparin tube. ACD also acceptable 2 ml cryotube Specimen Volume Minimum Vol. Whole Blood Bone Marrow 6 10 ml collected in heparin or ACD tube 2 ml collected in pediatric heparin ro ACD tube Storage/collection to test initiation 3 ml Less than 48 hours from collection to arrival in lab, room 0.5 ml Refrigerated 3 days or frozen up to 1 year Storage/collection to test initiation 3 ml Less than 48 hours from collection to arrival in lab, room 1 ml Shipping Room Dry ice or ice packs Quantitative, Real-Time DNA PCR (qpcr) on Cellular Samples: Whole Blood, Bone Marrow and Cord Blood for HHV-6A, HHV- 6B HHV-7, CMV, EBV Test numbers: 1106, 1206, 1306, 1406 Specimen requirements are as follows: Cord Blood 2 ml collected in pediatric heparin or ACD tube 1 ml Shipping Room 7
Appendix Cellular Samples mrna, cihhv-6 Screening Reverse Transcription PCR on Cellular Samples for mrna: Whole Blood, Bone Marrow and Cord Blood for HHV-6A, HHV-6B and CMV Test numbers: 1110, 1303 Specimen Requirements are as follows: Specimen Volume Minimum Vol. Whole Blood Bone Marrow Cord Blood 6 10 ml collected in heparin or ACD tube 2 ml collected in pediatric heparin or ACD tube cihhv-6 Screening Panel: Includes Quantitative, Real-Time DNA PCR (qpcr) on Whole Blood, Reverse Transcription PCR for mrna and Real-Time DNA PCR on Hair Follicle Test number: 1012 Specimen requirements: Specimen Volume Minimum Vol. Whole Blood AND Hair Follicle 6 10 ml collected in heparin or ACD tube 3 4 hairs with follicle Storage/ collection to test initiation 3 ml Less than 48 hours from collection to arrival in lab, 1 ml room Storage /collection to test initiation 3 ml Less than 48 hours from collection to arrival in lab, room At least Room 1 follicle, 1 week 8 Shipping Room temperatur e Shipping Room
Appendix Lyme Tests/ Babesia Tests Lyme Tests: Antibodies to Borrelia Test numbers: 3001, 3002, 3003 Specimen Requirements are as follows: Specimen Volume Min. Vol. Whole Blood to be processed to plasma 6 10 ml collected in heparin tube (EDTA also acceptable) Babesia Tests: qpcr, IFA, panel Test numbers: 3004, 3005, 3006 Specimen Requirements are as follows: Specimen Volume Min. Vol. Whole Blood to be processed to plasma by Coppe Laboratories 6 10 ml collected in heparin tube (EDTA also acceptable) Storage/ collection to test initiation 3 ml Room less than 72 hours Storage/ collection to test initiation 3 ml Room less than 72 hours Shipping Room Shipping Room
12/16/2015 Specimen Collection and Preparation Laboratory test results are dependent on the quality of the specimen submitted. It is important that all specimens and request forms be properly labeled in the presence of the patient. Specimens should be labeled with patient name and date of birth, the collection date and time. If there is any doubt or question regarding the type of specimen that should be collected, it is imperative that Coppe Laboratories be contacted to clarify the order and specimen requirements. Causes for rejection of sample: Specimens submitted in an improper tube or container Specimens not accompanied by a requisition or incomplete requisition Unlabeled specimens Leaking containers Insufficient quantity of specimen Improper storage Failure to receive samples prior to expiration Box not sealed or seal broken Please contact Coppe Laboratories with any questions: W229N1870 Westwood Drive Waukesha, WI 53186 phone 262.574.0701 fax 262.574.0703 info@coppelabs.com www. coppelabs.com 10