Ways to Handle an “Unacceptable” Specimen

There may be several ways to resolve the problems associated with an unacceptable specimen.

Type of Specimen	Examples	Simple Solution
easily replaced	blood, urine	Recollect.
replaced with some difficulty	CSF, needle biopsy of large mass	Recollect if critical..
irreplaceable but significant pathology not suspected	tissue such as skin tag or hernia sac	Discuss with physician and notify patient..
irreplaceable and significant pathology suspected	tissue such as complete excision of tumor	None.
irreplaceable and identity of source in question	unlabeled specimen	Recollect if possible. Identity testing if irreplaceable.

Type of Testing	Examples	Simple Solution
absolutely must be done on a reliable specimen	compatibility for blood products	Must recollect.
not be significantly affected by specimen problem	chemical analysis not affected by interference	Perform test and note problem with specimen.
an alternative methodology available to get an answer	culture not possible but pathogen detection by PCR available	Use alternative method.
testing can be done but results potentially misleading	major interference with analytical method	Must recollect if possible.

Issues:

(1) The laboratory should adhere to its policies for rejecting an unacceptable specimen.

(2) Approval by the physician and documentation of what was done may not protect against a lawsuit.

(3) Inclusion of the patient in the discussion may be necessary and must be documented.

(4) It is often better not to perform a test than to perform the test and get a misleading result.

(5) Legal counsel may be necessary.

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