Get Started
Thank you for choosing Rabkin Dermatopathology Laboratory! We’re committed to providing you with the fastest and most efficient service possible. To help ensure a smooth experience, we’ve created this guide to walk you through key procedures that may be helpful to you. Whether you’re a referring physician or a patient, our instructions will make it easy to get started and get the answers you need.
Fixative Safety
Regular specimen containers (15 ml or 20 ml) are filled with 10% neutral buffered formalin, while large specimen containers (60 ml) contain 10% formalin with added alcohols, which improve the fixation of large and/or fatty specimens. It’s important to note that both formalin and alcohols are potentially hazardous substances.
In compliance with OSHA regulations, any laboratory providing formalin-containing fixatives must also supply information on the potential health effects of these substances and how to manage spills or exposure. We include the relevant MSDS sheets in our ‘Getting Started Packet.’ For additional copies, please contact us.
By following our recommended packing and shipping instructions, significant formalin exposure should not occur.
Specimen Collection
Lab Supplies and Specimen Handling
Rabkin Dermatopathology provides referring physicians with all necessary lab supplies at no charge. These supplies include three types of specimen containers based on the specimen size, none of which require refrigeration. Specimens should be placed in the appropriate formalin container as soon as possible after removal. For tissue intended for direct immunofluorescence (IF) studies, use only IF medium (Michel’s medium) containers. Note: When requesting direct immunofluorescence studies, the specimen should never come into contact with formalin.
Steps for Sending a Specimen
1. Labeling: Complete a specimen bottle label for each specimen and affix it to the container. Use ball-point pens to fill out labels and requisition slips, as felt-tip markers can become illegible if there is leakage. Waterproof ink pens are available upon request.
2. Requisition Forms: Use our 3-part carbonless requisition slips. Complete one form for each patient and tear off the back (pink) sheet for your records. Place the specimen container(s) for each patient into a biohazard bag, and fold the requisition form along with any additional paperwork, placing it in the pocket of the biohazard bag.
3. Packaging: Place all individual patient biohazard bags containing specimens and requisition slips into a larger plastic transport bag (or FedEx large clinical pak bag). Squeeze out excess air and seal the bag.
Courier and Shipping Services
Rabkin Dermatopathology offers courier services or FedEx pick-ups to transport specimens from your office to our lab. Contact us at (412) 786-3054 or (412) 968-9266 to arrange for these services.
When using FedEx, we provide personalized, pre-paid mailing labels (called “Billable Stamps”) attached to the FedEx boxes. Your office will not be billed for shipping, as Rabkin Lab covers all expenses.
Be sure to tear off the left-hand side of the Billable Stamp label as your receipt before handing the package to the FedEx driver.
For additional supplies, please submit a Supply Request Form found under the “Supplies” tab on our website.
Final Steps for Shipping
1. Place the sealed FedEx large clinical pak into the pre-addressed FedEx mailing box.
2. Ensure the FedEx Billable Stamp label is attached to the box.
3. Call our lab at (412) 786-3054 or (412) 968-9266 to schedule a FedEx pick-up as soon as possible.
Patient Reports and Additional Services
Patient reports can be delivered based on your practice’s preferences:
• Mailed or faxed directly to your office
• Via Electronic Medical Records (EMR) interface
• Duplicate slides can be sent upon request for all cases.
Questions & answers on Formalin and IF fixative (Michelʼs medium)
What fixative (which type of specimen container) should I use?
All specimens should be placed in the appropriate fixative as soon as possible after surgery. • For most skin biopsies, regular size containers (15 or 20 ml of 10 % formalin) are best. • Excisions and other large or fatty specimens should be placed in large containers (60 ml of 10 % Formalin) which contain a specially prepared mixture of alcohols and formalin. • Tissue for direct immunofluorescence studies should be placed in IF transport medium (Michel’s medium), which we supply in clearly labeled bottles.
How should fixatives be stored? Do fixatives require refrigeration before or after the specimen is added?
All fixatives including Michel’s IF transport medium should be stored at room temperature. Our fixatives should not be refrigerated before or after the specimen is added.
What is the shelf life of fixatives before use?
10 % Formalin evaporates very slowly. Our prefilled bottles have a recommended shelf life of about 18 months. Michel’s is a simple, stable salt solution. Water in the medium evaporates over time, reducing the volume of fluid and changing the concentration of the components. We date our IF specimen containers and recommend replacement after one year. If all you have is overage fixative, it is probably OK to use it, but call and have us send you new fixative at your earliest convenience.
Can specimens stay in fixative for a few days before being shipped to the laboratory?
It does not hurt regular or IF specimens to stay in fixative for a few days, for example over a weekend.
If we are out of IF fixative, can we use formalin instead?
No! If you are out of IF fixative, do not under any circumstances put the specimen in formalin – it will destroy IF reactivity. You can try putting the specimen in saline or in a piece of gauze wrapped in sterile water or saline and sending it with a note to transfer it into IF medium as soon as it is received. This sometimes works, but unfortunately there is no guarantee that reactivity will be preserved.
What if I have a very large specimen, too large to fit in a large formalin container?
You can put the specimen in a urine cup, Tupperware container, etc. and fill the container with ideally 10 % Formalin from the large containers or less optimally formalin from smaller containers. The ratio of fixative volume to specimen volume should be at least 3:1. Be sure that the container does not leak, and that it is sealed in a leak-proof plastic bag. Very large specimens such as wide excisions are best handled by gross dissection and processing within a few hours of surgery, which usually can only be done by hospital laboratories. Formalin does not penetrate large intact specimens fast enough to give good fixation.
What fixative do I use for specimens that require lymphocyte marker studies?
Many studies can be performed on specimens fixed in formalin and processed routinely. Some lymphocyte markers and molecular studies such as gene rearrangement studies require fresh or frozen tissue. These specimens are best obtained at medical centers where the specimen can be instantly frozen and directly transported to the relevant laboratory in frozen form. At the current time, it is generally not practical to perform these studies on specimens obtained at physician’s offices.
Why must immunofluorescence specimens be sent in biohazard bags?
OSHA bloodborne pathogens regulations introduced under CLIA ’88 (CFR 1910) require that laboratory employees must be warned when material represents a known or potential hazard. Formalin kills pathogens, so formalin fixed specimens do not require a biohazard label. However, Michel’s transport medium (used for direct IF specimens) is a simple salt solution which does not kill many pathogens. Therefore, blood and tissue specimens sent for IF studies must be labeled as potential biohazards.
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