QUALITY CONTROL
IN THE HISTOLOGY LABORATORY.
DRAFT COPY ONLY.
(Procedure 33).
http://www.netautopsy.org/axsop/axsop033.htm


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United States Government Work, uncopyrighted, public-domain, DRAFT COPY ONLY. This document does not necessarily represent the views or policies of any United States Government agency. This document is provided "as is", without warranty of any kind, express or implied, including but not limited to the warranties of merchantability, fitness for a particular purpose and non-infringement. In no event shall the authors be liable for any claim, damages or other liability, whether in an action of contract, tort or otherwise, arising from, out of, or in connection with the document or the use or other dealings made with the document.

See also: Quality improvement program: 34, 35, 87, 113, 137, 138.



PRINCIPLE OF THE TEST.
      Quality is assured in the Histology Laboratory with various monitors and maintenance, to provide optimal service.



SPECIMEN REQUIRED.
      All human tissue excised at surgery, outpatient clinics, and postmortems, fresh or in fixative, along with a filled-out Tissue Examination Form (U. S. Standard Form 515, USSF515).



REAGENTS, INSTRUMENTATION.
      VistA® computer system.



STEP-BY-STEP DESCRIPTION.

1. SPECIMEN IDENTIFICATION. The following surgical pathology specimens should not be accessioned. Instead, these specimens should be brought to the surgical pathology office. They are recorded in the Quality Control Log, and then returned to the requesting services.
1.1. Erroneous specimens such as cytology or microbiology specimens.
1.2. Specimens with inappropriately filled requisition forms.
1.3. Unlabeled or mislabeled specimens.


2. MAINTENANCE OF EQUIPMENT. All the equipment in the Laboratory should be maintained according to the maintenance schedule specified in the Histology Laboratory Procedure Manual.

3. INVENTORIES. Short supplies should be avoided by monthly inventory of the supplies.

4. SAFETY. All the procedures performed in the laboratory should comply with the safety precautions in the Histology Procedure Manual and the Safety Manual of the Laboratory Service.

5. TIMELINESS. The turnaround time of slide preparation is constantly monitored at the Surgical Pathology office. The turnaround time for preparation of glass slides should be less than those specified below: 



 5.1 Surgical specimens including bone marrows and cell blocks
     5.1.1. H and E..........................   1 days.
     5.1.2. Special stains and Decals........   2 days.



 5.2 Autopsies:
     5.2.1. H and E..........................  2 weeks.
     5.2.2. Special stains and decals........  1 week.


Requests for special studies, including special stains, deeper cuts, and extra sections should be recorded in the Special Study Log placed in the Histology Laboratory.

7. QUALITY OF SECTIONS AND STAINS. The quality of the sections and stains are evaluated daily by attending pathologists, at the daily Quality Assurance Conference. The records are filed in the surgical pathology office, and reviewed weekly. Any deficiencies are corrected promptly.

7. MAINTENANCE OF THE LABORATORY. The laboratory should be maintained clean, safe, and functional at all times.

8. STAINS AVAILABLE.
8.1. Hematoxylin and Eosin (H&E).
8.2. Acid Fast stain, including Fite.
8.3. Iron.
8.4. Brown and Brenn.
8.5. Verhoeff van Gieson.
8.6. Gomori methenamine silver (GMS).
8.7. Mucicarmine.
8.8. Masson Trichrome.
8.9. Periodic Acid Schiff (PAS), with or without digestion.
8.10. Colloidal Iron.
8.11. Reticulin.
8.12. Oil Red O.
8.13. Congo Red.
8.14 Immunoperoxidase stains (CD=cluster-of-differentiation):
8.14. Prostate spfc antigen/Prostate spcf acid phosphatase (PSA, PSAP).
8.15. S-100.
8.16. HMB-45.
8.17. UCHL-1 (CD45ro).
8.18. L-26. (CD20).
8.19. CEA.
8.20. Kappa.
8.21. Lambda.
8.22. Cytokeratin.




REFERENCES.

1. Rosai J.
Rosai and Ackerman's Surgical Pathology. Ninth Edition.
St Louis: C.V. Mosby. 2004;:.
ISBN: 0323013422, 3080 pages.

2. Mills SE, Carter D, Greenson JK, Oberman HA, Reuter VE, Stoler MH, eds.
Sternberg's Diagnostic Surgical Pathology. Fourth Edition.
New York: Lippincott Williams & Wilkins. 2004;:.
ISBN: 0781740517, 3089 pages.