PART THREE
Special Techniques in Cytology
Table 31.6 Preparation of Cell Blocks—Cont'd
Thomas Jefferson University Hospital cytology
laboratory cell block and Shandon megawell preparations
for fine-needle aspirates
Time
University of Rochester
cytopathology laboratory
standard cell block procedure
Time
20
Allow the slide to air dry under the safety hood.
20-30 min
21
Place slide in 95% ethanol.
10 min
22
Stain the slide using the laboratory approved
nongynecologic cytologic staining procedure.
23
Cover slip the slide.
separate stain lines. The fo llo w in g separate staining order is pre-
scribed fo r nongynecologic specimens: u rin a ry tract specimens,
endoscopic specimens, negative b o d y cavity fluids, and then
p ositive b o d y fluid s o r washings (E. Lucas, personal c o m m u n i-
cation, 2007).
Johns H o p kin s considers b od y cavity fluid s at h ig h risk fo r
c o n ta m in a tio n and stains th em ind ivid u a lly. T he stains are fil-
tered th rou g h the separatory fu n n e l system. Xylene is filtered
th ro u g h a M illip o re filte r to ensure no m a lig n a n t cells are le ft
b e h in d to contam inate a no the r case.
Infection Control
Exposure to b loo d b orn e pathogens (h u m a n im m un od e ficien cy
virus, hep atitis B virus, tuberculosis) m ay result fro m the
in itia l h a n d lin g o f cell samples, fro m the preparation o f b o th
gynecologic and nongynecologic cell samples, fro m a lack o f
special h a n d lin g in disposing o f the specim en, and fro m n o t
d econtam inating the workspace used in the p reparation o f the
cell sample. B ody flu id s — inc lu d in g pleural, p eritoneal, pericar-
dial, synovial, and resp iratory tract specimens; cerebrospinal,
salivary, and vaginal secretions; and p o te n tia lly any b o d y flu id
v is ib ly contam inated w ith b lo o d — require special hand ling .
Each and every specim en sho uld be hand led as th ou g h it were
infectious. O ne m ay n o t learn o f the infectious nature o f the
specim en u n til cytologic preparations have been com pleted.
A lab o rato ry p lan fo r occupational exposure to b loo d b orn e
pathogens and a chem ical hygiene plan are required by the
O ccupational Safety and H e alth A d m in is tra tio n .3 Em ployees at
risk o f exposure to hep atitis B virus m ust be offered vaccination
w ith in 10 days o f assignm ent. A n em ployee w h o chooses n o t to
be vaccinated m ust sign a waiver.
A tra in in g program m ust be in place fo r all new employees
and p e rio d ic ally renewed fo r a ll employees th ro u g h o u t th e ir
e m p loym en t in the cytop atholog y laboratory. Em ployees are
classified according to th e ir p o ten tial risk o f exposure. H o w -
ever, there are always instances w h en employees at lo w ris k m ay
u n in te n tio n a lly place them selves at greater risk. V igilance on the
part o f each sta ff m em b er is essential in order to m a in ta in a safe
w orkplace fo r all.
C reating a delineated workspace th a t requires w orkers to
w ear protective eq uip m e nt m ay be h elp ful. Protective equip-
m e n t such as gloves, masks, and disposable gowns are to be
used b y those preparing cell samples.
C olor-coded disposal waste containers m ay also help re m in d
w orkers o f the difference between biohazardous waste m ate-
ria l and o th e r waste m aterial and m ay prevent housekeeping
personnel fro m being contam inated. Biohazardous m aterials
m ust be sealed in containers b y la b o ra to ry personnel.
Laboratory p o licy sho uld state standards such as "speci-
m ens w ith needles attached are n o t accepted b y the lab o rato ry."
This ru le alone w ill protect all th e ind ivid u als w h o hand le the
specimen.
O ne o f the m ost d iffic u lt tasks is to m a in ta in the coopera-
tio n o f each la b o ra to ry w o rke r to com p ly w ith the protective
procedures on a d a ily basis. Som e w orkers in e vita b ly believe
them selves to be im p ervious to infectious hazards, and they
m ay be responsible fo r c on tam ina tin g the w orkplace and th e ir
coworkers.
Other Factors Related to Cytopreparation
T im e fo r cytopreparation is u su ally lim ite d , and decisions related
to preparatory techniques m ay relate to the d a ily w o rklo a d and
available staff. M ost lab oratories provide results w ith in a 24-h
period. The v o lu m e o f emergency requests also influences the
selected preparatory m ethod s in a given setting.
Laboratories in w h ic h the cytotechnologist does n o t prepare
the cell sam ple m ay best be served b y the design o f a strict p ro -
tocol in w h ic h all possib ilities are covered and various sam ple
preparations can be processed at one tim e.
The h u m a n factor also plays a ro le in the preparatory lab ora-
tory. Procedures change over tim e. V ariations o r m od ifica tio n s
o f the w ritte n procedures m ay be m ade b y those preparing
cell samples. It is advisable to observe o r m o n ito r cell prepa-
ra tio n p erform ed b y d iffe re n t sta ff m em bers on a regular basis
to com pare the w ritte n procedures w ith w h a t is actually being
done. Som e m od ifica tio n s m ay save tim e and be eq uivalent to
the w ritte n procedure; others m ay not. In any event, the w rit-
ten procedure sho uld reflect w h a t is actually carried o u t b y each
sta ff m em ber.
Concluding Remarks
As technolog y changes and advances in cell preparation take
place in the cytop atholog y laboratory, so to o does the m anner
in w h ic h specimens are processed and evaluated. A specim en
m ust be carefully prepared, w e ll fixed, and stained in its jo u r-
ney to the microscope. Today, a u to m a tio n in various fo rm s has
m ade an im p act on the w o rk flo w and increased efficiency in the
cytop atholog y laboratory. A utom ate d im aging devices, staining,
and cover-slipping instrum ents have altered preparatory ro u -
tines in m an y laboratories.
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