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Paediatric Laboratory Medicine Histopathology Welcome to the home page of the department of Paediatric Histopathology. Histopathology is the study of the disease process within cells, tissues and organs. The department comprises laboratories, mortuary and bereavement suites. Mission Statement Our aim is to provide high quality and timely regional histopathology service including paediatric surgical and autopsy, fetal & perinatal services and to contribute to the HM Coroner’s service. Location The department is located in its own building behind the Estates Department on the Springfield Park side of the site. The other pathology disciplines are found on the ‘A’ corridor of the main building Specimen Reception Histopathology samples are to be brought by hand to the histopathology department. Samples must be presented with a specimen request form. Specimen request forms are generated on Meditech. The sample requires a minimum amount of information on the pot and the form. The specimen pot must contain the patient name, unit number, date of birth and specimen site. For further information about each type of specimen please use the “Repertoire” link Reports Finalised reports are posted onto the Meditech patient index. Consultants and healthcare professionals can access the reports from any linked terminal within the trust. Paper copies are sent to the appropriate clinician. Turnaround times he department of Paediatric Histopathology monitors turnaround times. Most surgical samples are reported within 5 working days. Post-mortems are reported within 6-8 weeks. Some cases because of complexity or technical reasons may require more time. URGENT CASES: Provisional report on urgent cases is made available in 24 hrs if the specimen is received in the laboratory before 3 PM. Please discuss the case with the pathologist before requesting for urgent results. Workload The workload is approximately 2,500 patient surgical requests and 240 post mortems together generate approximately 11,000 tissue blocks. Do not forget to mention the contact details of the person to whom the report need to be communicated.
The department is open as follows:
There is an out of hour’s consultant advice service. The pathologist may be contacted via switchboard. All surgical specimens
Routine surgical specimens
Frozen section
Fresh tissue (Tumours)
Rectal biopsy for assessment of Hirschsprung’s Disease
Renal biopsies
Muscle biopsies
Skin samples for fibroblast culture (cytogenetics) only:
Fluid samples for Cytology
Transmission Electron Microscopy (TEM)
The Histopathology laboratory does not provide an out of hours service (opening hours: 9.00am – 5.30pm)
Hospital post mortems
The purpose, of hospital post mortems is:
Coroner’s post mortems A Coroner’s post mortem is required when the cause of death is unknown or unnatural. This includes cases where
Reporting a death to the Coroner does not automatically mean that a post mortem will be performed if in doubt it is best to speak to Coroner or his officer. A Consultant Pathologist is also available to offer advice. If you are unsure whether to discuss the death with the Coroner then please contact the pathologist. Home Office post mortems Home Office post mortems are also known as forensic post mortems. Home office post mortems are carried out at the instruction of the police. Home office post mortems are undertaken when the cause of death is unknown and foul play is suspected. Access to the Mortuary & Accompanying Parents and Relatives for Visiting Background The Mortuary Technician is responsible for keeping all necessary and appropriate records relating to bodies in the Mortuary (now on Meditech) and also for the supervision of the body store. When the Mortuary Technician goes off duty, or leaves the hospital site for any reason, he will ensure that Patient Services and the Bereavement Co-ordinator have details of all the bodies in the Mortuary and all the necessary information concerning the release of those bodies. The Mortuary Technician is available Monday to Thursday 8.30am - 5pm and Friday 8.30am - 4.30pm. The Mortuary Technician will inform Patient Services of any communication with the funeral directors, about collecting or bringing bodies into the store, so that the necessary information is always available out of hours. Transferring a child to the Mortuary In working hours, a member of staff should telephone the Mortuary Technician on Out of hours, telephone Patient Services on Extension 2730 or Bleep 306 to arrange access to the mortuary. They will check that no families are visiting and arrange for someone to meet you and let you into the mortuary. Babies can be wrapped in a blanket, placed in a Moses basket and carried over to the Mortuary. Older children should be transferred in the Mortuary trolley. Telephone the Charge Hand Porter and arrange for the trolley to be picked up from the mortuary and brought to the ward/department. The porter will help lift the child, if required. Arrangements should be made to minimise distress to other children and families on the ward when the child is transferred. When a child is taken home If the child's body is taken home or directly to the funeral directors, always ring the Mortuary Technician, or out of hours, Patient Services. They need to know that the child has left the hospital and who has taken the child (family or funeral directors). It is important that funeral directors are not allowed into the ward / department to remove the body. To limit distress to other patients and families, the porters will collect the child and arrange for them to be handed over to the funeral directors at a suitable location on the hospital site. This should be arranged with the Mortuary Technician or Patient Services. Procedures for Funeral Directors Funeral Directors coming personally to the hospital should be directed to the Mrtuary. If the Mortuary Technician is not available, the notice on the Mortuary door will advise the funeral directors to contact the switchboard. Switchboard staff will then contact the Mortuary Technician. Telephone enquiries from the funeral directors will normally be dealt with by the Mortuary Technician. Releasing the Body If the Mortuary Technician is not on site, he will be contacted by switchboard or Patient Services. The Mortuary Technician, or Patient Services will then give instructions to the Charge Hand Porter and funeral director. Advice from Pathologists A Pathologist can normally be contacted between 9am-5.30pm via the Histology Office (x3656). Out of hours a Consultant Pathologist can be contacted via Switchboard. Access to the Mortuary for Visiting Parents will usually request to see their child via the ward or department. Wherever possible, arrange a time for the family to visit, allowing adequate time for preparation of the viewing room and the child. Ward or departmental staff concerned should always make arrangements with the Mortuary Technician (x2219 or bleep 163) or when he is unavailable, with Patient Services (x2730 or bleep 306) who will check the visiting status of the child, in case of any restrictions on visiting, and will ensure that two families do not arrange to visit at the same time. A trained member of nursing staff should normally accompany parents or relatives who go to the Mortuary to see their child. If visiting is permitted, but with restrictions on access (eg through the glass only) it will be necessary for the Mortuary Technician, or Patient Services to supervise throughout the visit. Two members of staff should normally be present in the Mortuary when accompanying parents & families. In hours, this will normally include the Mortuary Technician. Out of hours, this will normally include Patient Services. If, for any reason, a second member of staff is not present throughout the visit, arrangements should be made with Security to provide back-up during this time. Preparing yourself to accompany relatives It is important that you are familiar with the layout of the mortuary in advance of accompanying a family to the mortuary. If you haven't been over, please contact the Mortuary Technician to arrange a visit. If you have not been directly involved with the death, find out as much information as you can about the child before you meet the family. Preparing the child for visiting The Mortuary Technician, or Patient Services (out of hours) will normally prepare a child for visiting, or help you to do so. They will check that there are suitable clothes for the child. It may be necessary to obtain items from the ward before taking the family across to the mortuary. If the child has had a post-mortem, care will have been taken to dress the "wounds" sensitively, particularly if the head is involved. There is a Moses basket and linen for babies. Accompanying parents & families It is important that the accompanying nurse checks that the body is properly laid out in the visiting room before admitting parents or families to the Mortuary. Make sure that the room is warm enough and that lights are switched on - use the dimmer switches. Once everything is ready, bring the relatives to the front door of the Mortuary. Out of hours, make sure that someone is there to welcome you. Patient Services will normally meet you there. Offer the family a drink or offer them the facilities to make one. Stay with parents until they appear able to cope, but be aware that they may not wish to hold their child. Ask if they would like to be alone. If so, go into the waiting area and tell them where you are. Parents need space and time to do whatever they wish - to say goodbye or just hold their child for the last time. Be discreet but available. Try to avoid interruptions such as using the phone. If you have to use the phone, make sure the door between the viewing room and the back is locked. Appointment times should be limited to one hour time slots, wherever possible, so that relatives rooms can be available to other families. Respect the parents' religious beliefs. The hospital chaplains will come in and talk to parents or just sit with them if required, or they can arrange to contact an appropriate religious leader for families of other faiths. Parents will sometimes ask questions you cannot answer. Be truthful and tell them you can try to find out for them. The hospital social workers (or family's own social worker if they have one) will be able to advise the family about registering the child's death, making funeral arrangements etc. The funeral directors can also give the family information about what they need to do next. Really, all we can do is to be there and listen. Words are not always necessary or appropriate... just listen. It is often less frightening for the parents if we continue to talk to the child and refer to them by name. When the parents are ready to go, walk with them to the front door and wait for a short time. Some parents may come back so it is best to leave the child "ready" for a while. After Visiting Before you leave, make sure that the waiting area and visiting room are tidy. If stocks of tea, coffee, tissues, gloves, aprons etc are running low, make sure that the Mortuary Technician or Patient Services are aware of this, so that they can be re-stocked. If you are the last to leave, make sure all the doors are locked and the lights are off. Go out by the back door and make sure that someone is there to lock up before you leave (normally Patient Services). There are three Consultants in Paediatric/Perinatal Pathology: Dr George Kokai (ext. 2275) Dr Srinivas Rao Annavarapu - Specialty Registrar (SpR) in Paediatric Pathology The Technical Staff complement of the Department is: Laboratory. The Lead BMS can be contacted on ext. 3615 The laboratory staff can be contacted on ext.3505 or 2177 Mortuary. Contact number ext. 2219 The secretarial staff comprises: Office Team Leader – Linda Simpson Contact number ext. 3656 or 2081 1. Surgical-pathological routine diagnostic work 2. Autopsy service 3. Other professional activities contribution to: 4. Education 5. Publications and international attendance 6.Staff Development
Muscle biopsies should be booked in advance with the laboratory. Please call x3505. Please indicate the following information
Time of procedure. Please ensure samples reach the lab by 4pm. It takes over an hours to prepare the samples. This histology laboratory closes at 5.30pm Differential diagnosis – this will affect how we divide the sample A clinical letter should be sent to the lab the clinical letter should be a summary of the clinical history. Copies of the letter should be sent to all interested parties including Dr. Helliwell at RLUH. If you wish to discuss the case with Dr. Helliwell his Telephone number is 706 4492. Requests for muscle biopsy examination should be made on Meditech. If the laboratory has sufficient notification of the receipt of muscle biopsy samples, then we can order card ice for sample dispatch and reduce any delays. Muscle biopsies should measure at least 1 x 1 x 0.5 cm. Samples should be received in the laboratory fresh on saline soaked gauze. Do not place the samples in formalin or allow them to dry out. Once the biopsy is removed it should be transferred to the laboratory quickly. The muscle biopsy samples are routinely divided thus:
Depending on the size of the sample the following samples are prepared
Muscle biopsies for routine histochemistry are sent to the Royal Liverpool University Hospital for analysis in the Histopathology Department by Dr. Helliwell. Samples for analysis are sent to arrive at the referral centres no later than Thursday. This may mean a delay over the weekend. The website for the RLUH Histology department is http://www.rlbuht.nhs.uk/jps/pafram.htm There are a number of specialist referral centres to which muscle samples are sent. Some centres have specific request forms which may be downloaded below. Request forms for specialist centres must be completed before samples are dispatched. The specialist areas are
Further reading Pamela Ashton, George Kokai, Sarah Eykelenboom & Rajeev Shukla |
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