specimen submission guidelines - mhrp submission... · assay with geenius hiv 1/ 2 supplemental...

SPECIMEN SUBMISSION GUIDELINES HIV Diagnostics and Reference Laboratory HIV Diagnostics and Reference Laboratory

US Military HIV Research Program, Walter Reed Army Institute of Research 9100 Brookville Road, BLDG 508, Silver Spring, MD 20910

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Walter Reed Army Institute of Research

DEPARTMENT OF LABORATORY DIAGNOSTICS AND MONITORING

SPECIMEN SUBMISSION GUIDELINES

Version: June 2017



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TABLE OF CONTENTS

1.0 GENERAL INFORMATION .............................................................................................................................. 3

1.1 LABORATORY SERVICES ........................................................................................................................... 3 1.2 TEST MENU .................................................................................................................................................... 3 1.3 LABORATORY HOURS AND ADDRESS ................................................................................................... 4 1.4 POINTS OF CONTACT .................................................................................................................................. 4

2.0 SPECIMEN COLLECTION, PROCESSING AND HANDLING ...................................................................... 5 2.1 PATIENT PREPARATION ............................................................................................................................. 5 2.2 ORDER OF DRAW ......................................................................................................................................... 5 2.3 REQUIREMENTS (IF NOT SPECIFIED IN INDIVIDUAL TEST) ............................................................. 5 2.4 LABELING OF SPECIMENS ......................................................................................................................... 6 2.5 SPECIMEN TEST REQUEST FORMS .......................................................................................................... 7 2.6 SPECIMEN REJECTIONS .............................................................................................................................. 7 2.7 PACKAGING AND SHIPMENT OF SPECIMEN ......................................................................................... 8 2.8 SPECIMEN STORAGE ................................................................................................................................... 9

3.0 REPORTING OF RESULTS ............................................................................................................................... 9 4.0 FOLLOW-UP PROCEDURES FOR POSITIVE RESULTS .............................................................................. 9 5.0 SUPPORTING DOCUMENTS ......................................................................................................................... 10

SUMMARY OF CHANGES

• June 2017

o New HDRL web page is: http://www.hivresearch.org/hiv-diagnostics-and-reference-laboratory

o Changed HIV Algorithm and the HDRL Test Menu to replace Multispot HIV 1/ 2 assay with Geenius HIV 1/ 2 Supplemental Assay because the vendor of Multispot kits stopped production of the kits.

o Effective 12/1/2016, Geenius HIV 1/ 2 Supplemental Assay replaced Bio-Rad Multispot HIV 1/ 2 assay in the new US Army HIV Algorithm at the HIV Diagnostics and Reference Laboratory (HDRL). Sites will not see any change in the ordering process. On the “Result Report”, the Multispot HIV 1/ 2 result was replaced with the Geenius HIV 1/ 2 results.

o Effective 6/22/2017, SOP revised and reformatted. Significant changes included in the revision are: updated mission, inclusion of order of specimen draw instruction, addition of Test Specifications, reformatting and addition of Test Request forms to the SOP, molecular testing was broken out into three Test Request Forms based upon qualitative, quantitative and send out testing procedures, and addition of HIV test algorithms to the SOP.

Reference a complete list of the Summary of Changes on the HDRL website at: http://www.hivresearch.org/hiv-diagnostics-and-reference-laboratory



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HDRL Mission: The HIV Diagnostics and Reference Laboratory (HDRL), as part of the Department of Laboratory Diagnostics and Monitoring (DLDM), is dedicated to defining and executing state-of-art infectious pathogen diagnostics and monitoring in support of the Department of Defense and Department of Army personnel and their beneficiaries. HDRL assures the highest quality test results within the shortest feasible turnaround time.

1.0 GENERAL INFORMATION

1.1 LABORATORY SERVICES The HIV Diagnostics and Reference Laboratory (HDRL), Department of Laboratory Diagnostics and Monitoring (DLDM), U.S. Military HIV Research Program (USMHRP), at the Walter Reed Army Institute of Research (WRAIR), is a Department of Defense – Clinical Laboratory Improvement Program (DOD-CLIP) and College of American Pathologists (CAP) accredited Reference Laboratory that offers testing to Department of Defense (DoD) Laboratories.

HDRL began its mission in 1986 as the HIV Diagnostics Laboratory, when Congress authorized creation of the USMHRP to protect U.S. troops and serve the global community by reducing the risk of HIV-1 infection.

HDRL conducts standard retroviral serology and HIV clinical (viral load) monitoring testing for both clinical care and in support of the USMHRP research protocols. HDRL provides HIV screening of all U.S. Military Entrance Processing Command (USMEPCOM) applicants, confirmatory HIV testing for the Air Force and Navy and additional confirmatory Hepatitis B testing for Navy recruits. The Laboratory also provides HIV-1 resistance genotyping services to all DoD HIV infected force members. HDRL is responsible for technical oversight for all Army retroviral diagnostics performed by independent government contractors.

NOTE: Only the U.S. Army European Command (USAREUR) and U.S. Army Central Command (CENTCOM) are authorized to use WRAIR/HDRL to meet HIV Surveillance (Force Screen) requirements. Non-USAREUR facilities must use Service-directed test facilities (contract laboratory); special requests for assistance must be coordinated with HDRL.

1.2 TEST MENU

Type Tests Available Test Specs Serology

o HIV Combo Ag/Ab EIA o HIV-1 Western Blot (WB) Supplemental o Geenius HIV 1/2 Supplemental o Hepatitis B Surface Antigen (HBsAg) Confirmatory Assay

Appendix A1 Appendix A2 Appendix A3 Appendix A4

Molecular

o HIV-1 Viral Load (COBAS AmpliPrep/ COBAS TaqMan) o HCV Viral Load (COBAS AmpliPrep/ COBAS TaqMan) o HIV-1 RNA Qualitative Assay (APTIMA) o HCV RNA Qualitative Assay (APTIMA) o HIV-1 Resistance Genotype o HIV-1 Integrase Genotype o HIV-1 Phenotype (sent out to Monogram Biosciences) o HIV-1 Trofile (sent out to Monogram Biosciences) o HIV-1 DNA PCR, HIV-2 DNA PCR

Appendix A5 Appendix A6 Appendix A7 Appendix A8 Appendix A9 Appendix A10 Appendix A11 Appendix A12 Appendix A13

https://www.hivresearch.org/sites/default/files/HIV%20Combo%20Ag%20Ab%20EIA%20Test%20Specification_0.pdf

https://www.hivresearch.org/sites/default/files/HIV-1%20Western%20Blot%20%28WB%29%20Supplemental%20Test%20Specification_1.pdf

https://www.hivresearch.org/sites/default/files/Geenius%20HIV%201%202%20Supplemental%20Test%20Specification_0.pdf

https://www.hivresearch.org/sites/default/files/Hepatitis%20B%20Surface%20Antigen%20%28HBsAg%29%20Confirmatory%20Assay%20Test%20Specification_0.pdf

https://www.hivresearch.org/sites/default/files/HIV-1%20Viral%20Load%20%28COBAS%20AmpliPrep%20COBAS%20TaqMan%29%20Test%20Specification_0.pdf

https://www.hivresearch.org/sites/default/files/HCV%20Viral%20Load%20%28COBAS%20AmpliPrep%20COBAS%20TaqMan%29%20Test%20Specification_0.pdf

https://www.hivresearch.org/sites/default/files/HIV-1%20RNA%20Qualitative%20Assay%20%28APTIMA%29%20Test%20Specification_0.pdf

https://www.hivresearch.org/sites/default/files/HCV%20RNA%20Qualitative%20Assay%20%28APTIMA%29%20Test%20Specification_0.pdf

https://www.hivresearch.org/sites/default/files/HIV-1%20Resistance%20Genotype%20Test%20Specification_0.pdf

https://www.hivresearch.org/sites/default/files/HIV-1%20Integrase%20Genotype%20Test%20Specification_0.pdf

https://www.hivresearch.org/sites/default/files/HIV-1%20Phenotype%20%28sent%20out%20to%20Monogram%20Biosciences%29%20Test%20Specification_0.pdf

https://www.hivresearch.org/sites/default/files/HIV-1%20Trofile%20%28sent%20out%20to%20Monogram%20Biosciences%29%20Test%20Specification_0.pdf

https://www.hivresearch.org/sites/default/files/HIV-1%20DNA%20PCR%2C%20HIV-2%20DNA%20PCR%20Test%20Specification_0.pdf



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1.3 LABORATORY HOURS AND ADDRESS Open Monday through Saturday from 0800 to 1830 EST for testing. Client Services available Monday through Friday from 0700 to 1600 EST at the number listed below. Closed Sundays and holidays.

SPECIMEN SUBMISSION SHIPPING ADDRESS LABORATORY MAILING ADDRESS:

HIV Diagnostics and Reference Laboratory

Department of Laboratory Diagnostics and Monitoring

US HIV Military Research Program, Walter Reed Army Institute of Research 9100 Brookville Road, BLDG 508, Silver Spring, MD 20910

Phone: (301) 319-3123

Fax: (301) 319-3502

Web Site

US Military HIV Research Program – http://www.hivresearch.org

HIV Diagnostics and Reference Laboratory – http://www.hivresearch.org/hiv-diagnostics-and-reference-laboratory

Reference the HDRL web page: – http://www.hivresearch.org/hiv-diagnostics-and-reference-laboratory for the latest Specimen Submission Guidelines, Test Descriptions, Testing Algorithms, Test Request and Point of Contact (POC) forms, and Accreditation Certificates (CAP and Clinical Laboratory Improvement Program [CLIP]).

1.4 POINTS OF CONTACT Director, US Military HIV Research Program

COL Nelson Michael, MD, PhD

Chief, Department of Laboratory Diagnostics and Monitoring Laboratory Director, HIV Diagnostics and Reference Laboratory

Sheila A. Peel, MSPH, PhD, Commercial (301) 319-3511

Assistant Chief, Department of Laboratory Diagnostics and Monitoring CDR Jennifer Malia, MS, DrPH, Commercial (301) 319-3511

Laboratory Manager, HIV Diagnostics and Reference Laboratory LTC John Nuckols, Commercial (301) 319-3173

Assistant Laboratory Manager, HIV Diagnostics and Reference Laboratory CPT Malinda Davis, Commercial (301) 319-3177

Serology Technical Supervisor, HIV Diagnostics and Reference Laboratory Jason Ouellette, Commercial (301) 319-3076

Molecular Technical Supervisor, HIV Diagnostics and Reference Laboratory Joanna Freeman, Commercial (301) 319-7159



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2.0 SPECIMEN COLLECTION, PROCESSING AND HANDLING

2.1 PATIENT PREPARATION Verify patient identification and tests requested before blood draw and follow local approved standard operating procedures.

2.2 ORDER OF DRAW When multiple specimens are required, follow the proper order of draw (CLSI H3-A6, Section 8.10).

Order Tube(Type Tube(Stopper(Color( Mix(by(Inverting

1 Blood&Culture,SPS Yellow&& 8,10&Times

2 ACD* Yellow 8,10&Times

3 Citrate Light&Blue 3,4&Times

4 BD(Vacutainer®(SSTTM(Gel(Separator(* Orange&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&or&Red/Black 5&Times

5 Serum((Plastic(Only)* Red 5&Times

6 Heparin Green 8,10&Times

7 BD Vacutainer® PST Gel Separator with Heparin Light&Green&&&&&&&&&&&&&&&&&&&&&&or&Light&Green/Black 8,10&Times

8 EDTA*(and(PPT* Lavender&&&&&&&&&&&&&&&&&&&&&&&&&&&White 8,10&Times

9 Flouride&(Glucose) Grey 8,10&Times * Signifies collection tubes used for tests identified in this manual

2.3 REQUIREMENTS

NOTE: REFERENCE APPENDIX A: SPECIMEN SUBMISSION GUIDELINES FOR TEST SPECIFICATIONS AND INDIVIDUAL TEST DESCRIPTIONS. SUBMISSION OF THE APPROPRIATE VOLUME AND TYPE OF SPECIMEN IS REQUIRED OR TEST(S) MAY BE REJECTED.

WHOLE BLOOD Collect whole blood according to instructions provided for the individual test referenced in Appendix A. Thoroughly mix blood tubes containing additives by gently inverting the tube as noted in order of draw above, and by referencing specific test specifications.

Maintain the specimen at room temperature before shipping to HDRL unless instructed otherwise by Test Specification requirements. Never freeze whole blood unless instructed to do so in accordance with a test’s specimen collection and handling requirements (Appendix A). Do not place whole blood specimens in direct contact with ice/cool packs.

PLASMA Plasma contains fibrinogen and other clotting factors when separated from the red blood cells. Evacuated tubes used to collect plasma specimens contain anticoagulants and, frequently, a preservative. The additive in each tube is specified on the label and tube stoppers are color-coded according to the additive present.



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Consult the Test Specification requirements to determine the correct additive/tube to use. If specimen is transferred to a secondary tube, indicate the specimen type (plasma) on the plastic screw-cap vial for transport and on the corresponding test request form.

SERUM

HDRL recommends the use of serum separator collection tubes (SSTs) for most serological analyses. When using a serum separator tube, invert the tube gently five times. Further inversion may cause alterations in specimen integrity. DO NOT centrifuge immediately after drawing blood. Allow the blood to clot in an upright position for at least 30 minutes, but not longer than 2 hours before centrifugation. If specimen is transferred to a secondary tube, indicate that the specimen is serum on the plastic screw-cap vial for transport and on the corresponding test request form.

CENTRIFUGATION Instructions for centrifugation of specimen collection tubes: 1) Draw 5 mL of whole blood for each 2 mL of serum or plasma required in an

appropriate collection tube in appropriate order (section 2.2 Order of Draw). 2) If serum is required, allow the specimen to clot for at least 30 minutes, but no

longer than 2 hours, in an upright position prior to centrifugation. 3) For serum, centrifuge within 2 hours of collection per manufacturer guidelines

unless otherwise specified for the individual test.* 4) For plasma, centrifuge within 4 hours of collection per manufacturer guidelines

unless otherwise specified for the individual test.* 5) Pipette the serum or plasma into a clean plastic screw-cap vial and attach the

label. Do not transfer red cells to the vial.

*All non-gel blood collection tubes (including those that contain heparin, EDTA and non-gel serum tubes) can be centrifuged at ≤1300 RCF for 10 minutes. The BD Vacutainer® SST™ and PST™ gel tubes should be spun at room temperature at a speed of 1000 to 1300 RCF for 10 minutes in a swing bucket centrifuge and 15 minutes in a fixed-angle centrifuge. Information for conversions of RCF to RPM follows:

g Force (RCF) = (rpm)2 × 1.118 × 10-5 × r

RPM = √[RCF/(r × 1.118)] × 1 × 105

2.4 LABELING OF SPECIMENS Verify identification once again post draw and before labeling the tubes.

Each submitted specimen must be labeled legibly with the following information to prevent test delay:

o Patient name o Unique DOD number o Social Security number (SSN) and family member prefix (FMP) (Required for inquiry of patient

results/status in legacy LIMS) o Date of birth and/or barcode written exactly as it appears on the test request form o Date of collection/draw date o Specimen type (e.g., serum, plasma, whole blood, etc.)

Failure to include required information on the specimen label may result in rejection of the specimen (section 2.6 Specimen Rejections).



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2.5 SPECIMEN TEST REQUEST FORMS Complete the appropriate HDRL Test Request Form (Appendix B) for each specimen:

Serology Clinical Test Request Form

- Suspicion of acute HIV infection: order the Acute HIV Algorithm on the Serology Clinical Test Request Form. A 4th generation HIV Ag/Ab Combo test (with a shorter diagnostic window period) will be performed along with an HIV RNA Qualitative Test to assist with diagnosis of acute or primary HIV infection.

HIV Verification Algorithm Test Request Forms (NOTE: CONUS and OCONUS forms are different)

Molecular Aptima/Qualitative Test Request Form

- Aptima HCV RNA Qualitative Assay is offered on the Molecular Test menu as a confirmatory test for the repeat reactive HCV EIA result. A quantitative HCV RNA test is available, if required, to assist with diagnosis and management of HCV infection.

Molecular Viral Load (Quantitative)/Drug Resistance Test Request Form

Molecular Send Out Test Request Form

Vaccine Induced Sero-Reactivity Test Form

- For Vaccine Induced Sero-Reactivity (VISR) individuals in whom Sero-Reactivity is suspected due to participation in a HIV vaccine trial, a complete HIV algorithm will be performed inclusive of DNA PCR (Additional testing may be performed if needed).

Hepatitis B Surface Antigen Test Request Form

All forms can be found on the HDRL website at:

http://www.hivresearch.org/hiv-diagnostics-and-reference-laboratory

NOTE: Enclose the appropriate Test Request Form(s) with patient specimen (s) in the shipment. Multiple tests may be requested, but each requested test requires a dedicated specimen.

Ensure that the specimens are shipped using federal, state, and international regulations as appropriate. See Section 5.0 or HDRL website http://www.hivresearch.org/hiv-diagnostics-and-reference-laboratory

VERBAL TEST REQUESTS WILL ONLY BE ACCEPTED WHEN AN ADDITIONAL REQUEST IS ADDED POST-SUBMISSION ONLY IF FOLLOWED BY THE APPROPRIATE TEST REQUEST FORM WITHIN FIVE (5) BUSINESS DAYS.

NOTE: Do not send e-mails containing PHI to HDRL e-mail accounts that do no end in @mail.mil. When sending an e-mail that is inclusive of PHI, ensure that e-mail is transmitted encrypted.

NOTE: HDRL follows test algorithms (Section 5.0). We may modify your request in order to run an initial screening test and then reflex, if needed, for the test you requested.

2.6 SPECIMEN REJECTIONS HDRL reserves the right to reject and discard specimens that:

(1) Do not meet the specimen collection and storage requirements specified on the appropriate Test Request Form(s)

(2) Contain the following errors:



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A. Test Request Form errors include, but are not limited to: o Illegible information o Missing draw date o Missing family member prefix (FMP) o Missing/incomplete Social Security Number (SSN) o Missing/incomplete date of birth o Missing name of requesting physician and/or site

B. Specimen errors include, but are not limited to: o Provided specimen quantity not sufficient (QNS) o Duplicate specimen (same assay requested for same person within one 7-day period), unless

authorized by the Laboratory Director o Illegible label o Incomplete information on label (at least two identifiers required per regulation) o Leaking/Cracked specimen tube o Incorrect specimen type o Specimens collected in expired collection tubes o Hemolyzed, contaminated, lipemic, or coagulated specimen o Package not in compliance with applicable federal and state shipping standards (such

shipments will be rejected) o Specimens not shipped at specified shipping temperature

C. Mismatch errors between Test Request Form and specimen to include, but not limited to: o Discrepancy between specimen label and Test Request Form o Incorrect type of specimen for test requested o Missing specimen or Test Request Form

The submitting laboratory will be notified of any rejected specimen either by e-mail or telephone call.

2.7 PACKAGING AND SHIPMENT OF SPECIMEN

DO NOT SEND SPECIMENS TO HDRL DURING COURIER OBSERVED HOLIDAYS, FOR ARRIVAL ON SUNDAYS OR FOR ARRIVAL ON FEDERAL HOLIDAYS.

Sites submitting specimens must comply with all applicable federal and state regulations concerning shipment for diagnostic specimens. The minimum requirements for packaging and shipping are:

A. Wrap all vials individually to avoid contact B. Surround individually wrapped specimens with enough absorbent material to contain spillage C. Package specimen in a watertight primary and secondary container. Additional information can be

found on the HDRL website at: http://www.hivresearch.org/hiv-diagnostics-and-reference-laboratory D. Place request forms within the container but separate from the tubes E. Label container and ship specimens according to applicable guidelines for diagnostic specimens F. Mail to shipping address listed in section 1.3 Laboratory Hours and Address G. Fax/E-mail a FedEx/UPS tracking and/or invoice number to ensure all shipments sent to HDRL

are received, IAW CAP GEN.40530 (REQUIRED OF SUBMITTING LABORATORY).



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NOTE: All personnel handling specimens for transport MUST be trained in safe handling practices and in decontamination procedures in case of spillage.

NOTE: If you would like your shipping boxes returned to your site, enclose a pre-paid FedEx/UPS shipping label or address slip with FedEx/UPS billing information and material to cover hazardous warning markings.

2.8 SPECIMEN STORAGE Immediate Shipping: To avoid hemolysis, separate serum from cells within 2 hours of draw and separate plasma within 4 hours of draw for EDTA or 2 hours of draw for PPT (refer to section 2.3 Requirements). Ship specimen to HDRL in an appropriate specimen shipping container adhering to specimen temperature requirements listed on the Test Request Form(s) (Appendix A).

Delayed Shipping: Separate serum or plasma from cells within specified time (2 hour for serum, 4 hours for EDTA plasma, 2 hours for PPT plasma) and freeze. Ship specimen frozen on dry ice in an insulated shipping container to HDRL. Use 2+ lbs. of dry ice per day of transport for frozen specimens. Specimens must arrive frozen. Plan/coordinate for the additional dry ice for any delays that may occur during shipment. NOTE: HDRL recommends using an additional 6 lbs. of dry ice in the event the package is delayed in transit to HDRL.

3.0 REPORTING OF RESULTS HDRL will test all specimens submitted that adhere to specified Specimen Submission Guideline Test Specifications in an expeditious manner and in accordance with specified turnaround times.

HDRL generates hardcopy or electronic reports and transmits them via secured fax or encrypted e-mail to a designated Point of Contact (POC) for each submitting facility. On a limited basis, HDRL enters results directly in CHCS for specimens received through LIO. Result reports are also sent via secure file transfer to the Service-directed test facilities for the Army and Navy and directly to USMEPCOM. Due to the sensitive nature of our reports, only the designated POC (or alternate) can receive reports from HDRL. The facility POC is the sole manager of distribution of HDRL reports within that institution. To designate a POC for results reporting, complete a Point of Contact Form – Results Reporting (Appendix C). To designate a healthcare provider POC for notification and follow-up of positive patient test results, complete a Point of Contact Form – Notification and Follow-up (Appendix C). Fax these forms to HDRL at 301-319-3502. New sites MUST submit these forms before shipping specimens to HDRL for the first time. Use the same forms for updates/changes to these POCs. HDRL cannot/will not change or create POCs without these forms.

4.0 FOLLOW-UP PROCEDURES FOR POSITIVE RESULTS

Complete follow-up procedures are outlined in HDRL Standard Operating Procedure GEN 002. HDRL/WRAIR complies with AR 600-110 Army HIV Surveillance Program closely adhering to the following key points:

• Initial (first-time) HIV positive result for Active Duty Service members require the submission of

a second specimen for independent verification of infection status. HDRL will coordinate with the site POC for shipment of a collection kit to the site as described below:

§ CONUS Active Duty Service members:



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o An HIV Verification Request Kit and Form (CONUS sites only) will be shipped to

your site o The site must complete the accompanying Test Request Form and return the kit with

specimens to HDRL according to the instructions provided

§ All other Active Duty Service members (OCONUS) and other Service Components: o Complete the HIV Verification Algorithm Test Request Form (Sites other than

CONUS) found on the HDRL website o Ship the specimen to the address provided on the form

• If the original specimen and verification specimen are discordant, a third independent verification

specimen will be required.

• Per AR 600-110, each site is required to have an appointed HIV Program Manager. This individual will serve as the POC for follow-up test coordination with HDRL.

• The identified Primary or Secondary POC will be notified by the HDRL or Army Public Health

Command in accordance with HDRL SOP GEN 002.

5.0 SUPPORTING DOCUMENTS Appendix A: Specimen Submission Guidelines (tests description and specification) Appendix B: Test Request Forms Appendix C: Point of Contact Forms Appendix D: HIV Testing Algorithm Appendix E: HIV Acute Infection Algorithm NOTE: All documents (including CAP and DOD-CLIP certificates and Historical Changes to HDRL testing operations) are available online at: http://www.hivresearch.org/hiv-diagnostics-and-reference-laboratory



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Appendix A: Specimen Submission Guidelines (Tests description and specification)



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Appendix A1



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Appendix A2



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Appendix A3



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Appendix A4



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Appendix A5



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Appendix A6



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Appendix A7



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Appendix A8



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Appendix A9



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Appendix A10



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Appendix A11



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Appendix A12



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Appendix A13



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Appendix B: Test Request Forms



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Appendix B1



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Appendix B2



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Appendix B3 – CONUS

!

Form # TR VA Version May 2014

HIV DIAGNOSTICS AND REFERENCE LABORATORY 13 Taft Ct. � Suite 100 � Rockville, MD 20850

HIV Verification Algorithm Test Request Form TESTS SPECIMEN REQUIREMENT DRAW TUBE

HIV Algorithm 4 ml plasma (Cold Pack) PPT

SHIP FROZEN PLASMA IF SAMPLE WILL NOT BE RECEIVED AT HDRL WITHIN 72 HOURS.

PATIENT IDENTIFICATION CONTACT INFORMATION

Patient Stamp must include: Full Name*, FMP*/SSN*, DOB* Specimen Draw Date / Time*: ________________________

Ship Date: ________________ Sample Storage (circle): Frozen / Refrig / Ambient Sample Shipping (circle): Dry Ice / Cold Pack

POC* _____________________________________________

Physician Name* ____________________________________

Clinic / Center* ____________________________________

Center Address* ____________________________________

____________________________________

____________________________________

____________________________________

Telephone Number ______________________

Fax Number ______________________

(Commercial # only; please include area/country code)

Alternate POC Name ________________________________

Alternate POC Phone ________________________________

*Required

PROCESSING LAB (For internal use only) BARCODE DATE RECEIVED QUANTITY & TYPE RECEIVED/INITIALS

TUBES DRAWN SPECIMEN REQUIREMENT INSTRUCTIONS

□□□ 4 PPT s

Aliquot!PPL!into!NINE!(9)!cryovials!

8 2, 1.0 mL each 8 2, 0.5 mL each 8 1, 2mL 8 2, 1.20 mL each 8 1, 2 mL 8 2, remaining volume

Freeze!at!880°C!or!lower!

Forward!one!vial!of!plasma!at!1!ml!to!HDRL!for!confirmatory!

testing

□□□ 2 CPTs

Collect!Cell!Pellets!and!store!into!SEVEN!(7)!cryovials!

8 2, 5 million cells each 8 5, 1 million cells each

Freeze!at!880°C!or!lower!



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Appendix B4



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Appendix B5



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Appendix B6



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Appendix B7



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Appendix B8



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Appendix C: Point of Contact Forms



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Appendix C1



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Appendix C2



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Appendix D: HIV Testing Algorithm



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Appendix E: HIV Acute Infection Algorithm

specimen submission guidelines - mhrp submission... · assay with geenius hiv 1/ 2 supplemental...

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