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Request form
All samples sent from outside Cambridge University Hospitals (CUH) must be accompanied by a HODS Request Form. For samples sent from within CUH, use the electronic order system on Epic.
Download HODS request form (PDF, 778 KB)(↗)
Last updated: 16 February 2024
Sample requirements
Different tests have different sample requirements. Check the specific test section for details.
RNA-based tests: Important information
For tests involving molecular detection of genetic translocations (such as BCR::ABL1, PML::RARA) or gene expression (for example, NPM1 quantitation for AML minimal residual disease detection):
Send samples to arrive at the laboratory before 3pm, Monday to Thursday
Late arrivals may lead to delayed results or affect result quality
Bone marrow aspirate sampling guidance
We have a suggested bone marrow aspirate sampling guide for use at Cambridge University Hospitals (CUH). This includes minimal residual disease (MRD) sample requirements.
This guide is for reference only. Other hospitals may have different sampling guidance.
Key points:
Collect separate samples for flow cytometry, molecular genetics and cytogenetics
This is especially important now that these laboratories are no longer part of HODS, to avoid delays in obtaining results
FISH testing preferably requires EDTA samples, not cytogenetics medium as commonly believed
Urgent and out-of-hours (OOH) samples
This guidance explains how to handle urgent samples and out-of-hours (OOH) deliveries for the Haematopathology and Oncology Diagnostic Service (HODS) at Cambridge University Hospitals NHS Foundation Trust.
Urgent samples
For all clinically urgent cases:
Notify the laboratory by telephone
Highlight urgency on the request form
Provide a contact number for the named consultant
We will prioritise these samples and phone results to the named consultant.
Out-of-hours samples
For samples that will arrive outside normal working hours:
Notify the laboratory during working hours (Monday to Friday, 7am to 5pm) whenever possible
Follow the courier instructions below if delivering samples
Urgent testing outside normal working hours
For morphology or immunophenotyping: contact the on-call HODS consultant via Cambridge University Hospital switchboard: 01223 245151
For non-trephine histopathology samples: follow your local Histopathology Department guidance.
CUH staff: Check the Histopathology section on CUH portal
For molecular and cytogenetic tests: there is currently no on-call service for these tests.
Bank Holidays and weekends
On bank holidays and weekends, we offer limited services for urgent cases:
East Genomic Laboratory Hub (GLH) provides a restricted cytogenetic service for very urgent cases
A molecular scientist may be available to help with urgent sample processing
For all urgent queries, contact the on-call HODS Consultant Haematologist (via Cambridge University Hospital switchboard: 01223 245151)
Important: Notifying the lab about out-of-hours samples
For samples arriving outside standard working hours, please notify the laboratory in advance during working hours (Monday to Friday, 7am to 5pm) whenever possible. This advance notice helps us prepare for your sample and ensure prompt processing.
Out-of-hours sample delivery (instructions for couriers)
These instructions are for couriers delivering samples to the Haematopathology and Oncology Diagnostic Service (HODS) outside normal working hours.
Location
HODS is on Level 3 in the Pathology Block.
Accessing HODS
The HODS entrance requires swipe card access.
If you need access, use the phone to the left of the HODS entrance door.
Call the Blood Transfusion Department on extension 596263.
Alternative entrance
If arriving via the Pathology entrance between 5pm and 7am:
Go to the main hospital entrance.
Ask reception staff to contact the Blood Transfusion Department for access.
Sample handover
A Blood Transfusion staff member will receive and sign for the samples.
Samples will be stored securely in the "HODS Out-of-Hours fridge".
Samples for external molecular MRD testing
When submitting AML and ALL samples for molecular MRD testing via HODS:
Mark the request form with "FOR MOLECULAR MRD" or tick the relevant box on the HODS request form
Provide at least 2 bone marrow aspirate samples in EDTA
Label the first collected sample with a "First Pull for MRD" sticker (contact lab for stickers)
Specify if a peripheral blood sample is also required for MRD testing
MRD tests requiring RNA extraction
Common tests include:
NPM1
BCR::ABL1 (p190)
PML::RARA
CBFB::MYH11
RUNX1::RUNX1T1
Important
MRD tests requiring RNA extraction are particularly time-sensitive.
Sample dispatch timing
For fastest processing:
Send samples Monday to Thursday
Samples should be received on the day of collection or by 1:30pm the following day
Samples received within these timeframes can usually be dispatched to external laboratories via the GLH without processing. This ensures the fastest possible turnaround times. Samples received outside these times will require processing by GLH before dispatch, which may delay results.
Alternative option
Samples can be sent directly from the local hospital to the specialist MRD laboratory to avoid potential delays in GLH processing.
Peripheral blood samples for genomic tests only
Although HODS screens all bone marrow samples, this is not necessary for many peripheral blood samples.
This is because:
A blood film has often been reviewed at the referring hospital
The diagnosis may already be established (e.g. CLL)
Only specific genomic tests may be required (e.g. MPN screening tests, TP53 mutations, CLL FISH)
HODS will screen peripheral blood if:
The request form asks for flow cytometry
The clinical information suggests an unknown diagnosis (e.g. "lymphocytosis ?cause")
If only cytogenetic or molecular tests are requested, HODS will assume that:
The referring clinician has assessed the clinical and laboratory information
Appropriate tests have been requested based on this assessment
Important notes
Myeloid NGS panel testing on peripheral blood is not generally recommended as a screening test for patients with unexplained cytopenias. This is because:
There is a risk of false negative results due to low "tumour burden" in peripheral blood
Most patients with positive results will need definitive diagnostic assessment with bone marrow examination
If a genomic test is performed by a specialist centre rather than East GLH (e.g. BCR::ABL1 TKD mutation testing by NGS or AML MRD on peripheral blood), the sample can be sent directly to the appropriate GLH by the hospital/clinician.
Vitreous humour samples
Vitreous humour samples present unique challenges for haemato-oncological testing due to:
Small sample volumes
Often paucicellular nature
Frequently non-diagnostic results
Important considerations
Send the most appropriate sample for the most critical testing modality/modalities
Consider the clinical differential diagnosis when selecting tests
Suspected primary intra-ocular lymphoma
If primary intra-ocular lymphoma is suspected:
Discuss possible HODS testing with the flow cytometry team before sampling
Contact the flow cytometry team on [insert contact number/email]
Services not provided by HODS
HODS does not handle:
Conventional cytomorphological interpretation ("cytology")
Microbiological/virological assessment
Cytokine testing
For these services, contact your local providers to arrange appropriate sample submission.
Specimen labelling
Proper labelling is crucial for accurate sample processing. Please follow these guidelines:
Sample tubes and pots
Label with at least 3 identifiers:
Patient's full name (surname and forename)
2 additional identifiers (e.g. date of birth, hospital number, NHS number)
Slides
Label with:
Patient's full name (surname and forename)
Date of collection
One additional identifier
Additional labelling requirements
Provide date and time of sample collection on the request form.
For non-Epic orders, include on the request form:
Referring centre details
Relevant clinical information
Referring clinician's name and contact details
Distinguish different samples by labelling pots/tubes (e.g. BM for bone marrow, PB for peripheral blood, 'first pull').
Important notes
Addressograph labels may be used on specimen tubes or pots, but not on slides.
Insufficient or incorrect information may result in:
• Sample being returned to sender
• Delays in sample processing
Packaging samples
Samples sent by Royal Mail or courier must comply with packaging instruction P650 for UN3373 biological substance, category B (Diagnostic specimens).
Packaging requirements
Use good quality packaging that can withstand shocks (95 kPA pressure) and normal handling during transport
Ensure packaging prevents loss of contents due to vibration, temperature, humidity, or pressure changes
Use three components: primary receptacle, secondary packaging, and outer packaging
Packaging instructions
Place absorbent material between the primary receptacle(s) and secondary packaging
Put the primary receptacle and absorbent material into a single leak-proof bag
Include the request form in the pouch of the leak-proof bag
Labelling
Label the package "BIOLOGICAL SUBSTANCE, CATEGORY B"
Place "UN3373" inside a diamond-shaped mark (minimum 50mm x 50mm)
Ensure the diamond line is at least 2mm wide
Use letters and numbers at least 6mm high for "UN3373" and "BIOLOGICAL SUBSTANCE, CATEGORY B"
Place "BIOLOGICAL SUBSTANCE, CATEGORY B" adjacent to the diamond mark
Important notes
For transport within Addenbrooke's Hospital, dangerous goods markings are not required
HODS treats all samples as potentially high risk
Use UN3373 Biological Substance, Category B labelling for all samples, even if not known or suspected to be infectious
HODS expected turnaround times
The Haematopathology and Oncology Diagnostic Service (HODS) aims to provide timely results for various tests. The table below outlines our target turnaround times for key services:
| Test | Turnaround Time | Target |
|---|---|---|
| Bone marrow aspirate morphology | 3 working days | 80% |
| Immunophenotyping | 3 working days | 80% |
| CD34 enumeration | 2 hours | 80% |
| Lymph node histology | 5 working days | 80% |
| Bone marrow trephine histology | 6 working days | 80% |
| Clinically urgent aspirate (suspected acute leukaemia or Burkitt lymphoma) | Verbal communication within 6 hours | 90% |
| Integrated report | 6 weeks | 90% |
For further information about the cytogenetic and molecular tests provided by the East GLH, please refer to their website: www.eastgenomics.nhs.uk
Clinical details
Providing appropriate clinical details is essential for rapid and effective diagnosis. This information helps us tailor our diagnostic approach to each patient's specific needs.
Key information to include:
Relevant medical history
Current symptoms
Suspected diagnosis
Any ongoing treatments or clinical trials
Important information
If additional relevant information becomes available after sample submission, email this to a member of the HODS reporting team.
For patients where comprehensive prognostic testing may not be appropriate (e.g. due to age or performance status), please clearly state this in the clinical details.
Inform us if the patient is being monitored on a clinical trial to avoid duplicate testing.
Sample testing frequency depends on the specific clinical scenario. Our reports will indicate if a sample is technically inadequate for diagnostic interpretation, which may require repeat testing.
Consent prior to testing
Many samples investigated for haematological malignancies undergo genomic tests, including cytogenetics and next-generation sequencing (NGS) panels.
These tests aim to:
Identify abnormalities that explain the clinical presentation
Provide clinically useful information
In rare cases, these tests may reveal unexpected potential germline findings that could have clinical significance for the patient and/or family members.
Important information
Patients should be counselled before genetic testing
At least verbal consent should be obtained
Explain the possible results, including implications of identifying a germline mutation
Further actions
In some cases, additional testing or discussion with other clinical teams may be recommended. For more information on consent for genetic testing in haematological malignancies, see Killick et al, British Journal of Haematology 2021;194(2):282-293.
Second opinions
You can request second opinions on selected cases from outside the contracted HODS region.
To do this:
Contact a HODS consultant by email for approval before sending the case
Include a copy of the consultant's email approval with the case
Send the original report with the case
Important information
We may return cases received without prior approval to the submitting centre.