For an optimal result for the diagnostics and immunological research it is essential to follow the guidelines well when it is submitting material so that the integrity of the material can be guaranteed as optimally as possible. The physician is responsible for proper collection, identification, handling and packaging of the material and for completing the request form. We ask you to carefully handle this to prevent problems so that the application can proceed quickly and smoothly.

Request forms are available at the hospital’s main warehouse.  The Pathology department uses the following request forms.

Note: In failing to fill out the request form completely or in case of information discrepancies, the submitted material will be returned.

CITO Request forms

CITO request form should only be applied for if there are therapeutic consequences. The application form must be provided with the statement CITO / SPOED / RUSH! CITO requests are processed through the standard procedure, whereby a conclusion will be known within approximately 3 working days provided the material is present in the Pathology department before 14.00 hrs. The processing procedure for the result/ report also depends on the nature of the material and the degree of difficulty of the diagnosis.

Request forms for frozen section, preoperative diagnostics and elective surgery.

Frozen sections must be notified in advance by telephone to the pathologist in charge. Frozen sections are only indicated when it can give course to the preoperative:

• request for an extension of the disease process;
• request for a preoperative tissue identification;
• request for the representativeness of the sample.

These often involve applications with an urgent nature for the preoperative policy.Techniques that can be performed on frozen sections are: histochemical stains. For rapid diagnosis, the material (durant or peri-operational) or for the implementation of techniques should be fresh and not fixed or alcohol-impregnated tissue. When in doubt, discuss with the pathologist.

On the application form for histologically examination, the request for frozen section, must explicitly have the name of the doctor and the phone number. After the department receives the sample, the goal is to give results within 30 minutes by telephone to the applicant. It must therefore be taken into account that the waiting time can take longer when several frozen sections needs to be done.

Procedure for submitting a frozen section:

• written request from the clinician after consultation with the pathologist.
• the pathologist is notified by telephone when the tissue has left the operating room
• request form completely filled with indication, question and relevant clinical data along with the tissue delivered to the lab.
• state on the request form the telephone number where the requesting physician can be reached for the result, please also keep the device number free.

In case of details / emergency / changes:

• when a frozen section research is planned outside of working hours, this should be planned in agreement with the pathologist at least one day in advance.
• when due to circumstances, a planned frozen section is shifted to a later time /day the pathologist must be notified as soon as possible.
• if a planned frozen section research is canceled, the pathologist must be notified.

How to submit tissue:

• fresh
• small fresh biopsies between the saline-moistened gauze (prevents dehydration)
• not on compress or foam.
• with different fragments, clearly identify  the different anatomical localisations and numbering.

Contraindications:

• not visible or palpable lesions
• too small lesions leads to too much tissue loss
• calcified tissues
• adipose tissue cultured tissue

Request forms for revision / additional diagnostics / medical treatment abroad

Additional tests may be requested in writing to the pathologist (only by medical specialists and doctors). These additional tests are added provided there is an adequate supply of the right material and the storage temperature and retention period have not been exceeded. A pathologist can do this by telephone, followed by a written request form. A request form must be made for the material that has already been submitted in order to proceed with the additional tests. These request forms must be completely filled out  and signed by the requesting physician.

Request forms clinical autopsy

In case of autopsy, the request form must always have the signature of the requesting physician and if desired permission for body and/ or skull autopsy listed on the request form. Supplemented with relevant research data, for example X-ray MRI or CT examinations and other imaging. Please send medical records. The requesting physician has the obligation to inform the autopsy procedure to the relatives about the fact that the brain is involved and removal will not be returned.

In case of an autopsy:

• of a stillborn baby, one of the parents must sign the request form
• in case of an request form by the family, the spouse or parent (s) or children must sign.

Before the autopsy is performed, the following forms must be complete, signed and faxed to the office at 5873440 and then delivered to the pathologist.

• death certificates
• autopsy request
• consent form and copy identification survivor (s)
• medical records of the deceased

After the autopsy, the funeral director will be called by one of the autopsy employees to come collect the remains.

Medical autopsy

Indication of a natural death or if the body is released by The Public Ministry then it also falls under medical autopsy. These autopsies are performed by the clinical pathologist.

In short:

• The indication for whether or not an autopsy is performed is always made by the pathologist, naturally in close consultation with the requesting physician.
• The indication will always be strictly medical.
• For autopsies a written consent is required of the patient or in case of death of his relatives .
• Requesting physician must complete the declaration of natural death.
• The physician must send a completed request form from the autopsy with the deceased to the mortuary of the Dr. Horacio Oduber Hospital.
• Specific consent must be requested and given for the performance of a skull autopsy.
• The autopsy is performed the next working day after receiving the forms. This will be reported in short by telephone and in writing will be in the form of a preliminary report.
• Completion of the autopsy can take about 6 weeks in total. In case of brain autopsy will be considerably longer about 10 weeks.
•  During the autopsy, small pieces of tissue are stored for further microscopic examination.
• In case of brain autopsy, brains are completely removed, therefore relatives need to be informed.

Forensic autopsy

Forensic autopsy for the purpose of justice are not performed by clinical pathologists of the FSLMA. However, the facilities are made available for the forensic pathologists. Click here to view our PA autopsy flowchart.

Additional research

Additional inquiries can be requested in writing on material that has already been submitted. Materials are stored at the laboratory for a limited period of 3 months, if possible.The storage period of the coupes and blocks is 30 years in accordance with the NVVP guidelines.

Responsibilities

The requesting applicant is responsible for sending  the material according to the described procedure.The employees of the Pathology department are responsible for receiving and processing according to protocol. In short: only until the material has a PA number the responsibility are among the employees of the Pathology department. Till then the requesting applicant is responsible.

Submitting the material

All patient materials for research must be in a sterile, leak-proof and clean container accompanied with a fully completed requesting form. On the container as well as on the requesting form has to have a pasted label with the data of the patient. The storage medium in which the material is located should  be clearly stated on the container. If this is not stated, it is assumed that the material is provided in 10% buffered formalin phosphate (fixative). The patient material should be delivered in sufficient formalin phosphate. This is typically the case of large pots 10 times the size of the material, in biopsies a 4-times the size of the material. Materials from outpatients can be handed in at different FSLMA locations. 

All materials have to be submitted at the laboratory before 15:00. In case this is not possible:

• Biopsies should be stored in formalin phosphate at room temperature or in the refrigerator.
• In case of emergency/ CITO please contact the pathologist on duty at 527 4000.

Click here to know exactly how to submit the material( in dutch alphabetical order). Please read carefully before submitting materials.

Results are available for inspection by an authorized physician in Cerner.

• Can only be obtained by fax during working hours at 527 4910 or 527 4911.
• Authorized representatives can use a letter of authorization and a valid ID of themselves and the relevant person in order to get a result at the secretariat.
• Physicians / medical specialists / (co-) practitioners can retrieve the results of that patient or receive by fax.
• Medical assistants can only retrieve results by telephone from patients of the  physician for which they work. Autopsy reports can only be requested by physicians.

ATTENTION for the results of a study there is no direct contact with patients whose material is being examined. The pathologist carries out research at the request of a specialist, a physician or doctor from another institution. The results of the research will be passed on to the treating physician. The therapist is informed about the diagnosis and the further course of events. Patients remain the owner of the collected material and are entitled to the research material and rest material (if present) to request. In order to retrieve the researched material the laboratory has an extraction form to be signed by the patient.

The regular working hours are from Monday to Friday from 7 am to 4 pm, we are closed during the weekends and  on holidays.

The pathologist on duty has an on-call service and can work outside regular working hours via 527 4000.

For the complete Pathology Lab guideline in Dutch click →Laboratoriumgids 2020