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Hematology

Packaging & Transportation

The transportation of biological specimens, whether within the hospital via pneumatic tubes or externally via couriers and air mail, is a regulated activity with significant safety implications. Improper packaging can result in the leakage of infectious materials, posing a biohazard risk to couriers, postal workers, and the general public. Furthermore, poor transport conditions can degrade specimen integrity, rendering hematological testing inaccurate. The primary regulatory bodies governing this area are the Department of Transportation (DOT) for ground transport within the U.S. and the International Air Transport Association (IATA) for air transport. OSHA standards apply to the employees preparing the package

Regulatory Classification of Biological Substances

Before packing, the laboratory scientist must classify the material to determine the strictness of the packaging rules. Most hematology specimens fall under “Category B,” but understanding the distinction is vital for compliance

  • Category A (Infectious Substances): An infectious substance which is transported in a form that, when exposure to it occurs, is capable of causing permanent disability, life-threatening or fatal disease in otherwise healthy humans or animals
    • Identification: UN 2814: (affecting humans) or UN 2900 (affecting animals)
    • Examples: Cultures of Ebola, Bacillus anthracis, or highly pathogenic avian influenza. These are rarely shipped from a routine hematology lab without specialized training
  • Category B (Biological Substances): An infectious substance that does not meet the criteria for inclusion in Category A. This covers the vast majority of diagnostic specimens (patient blood, bone marrow, plasma) sent for testing
    • Identification: UN 3373
    • Labeling: The outer package must display the text “Biological Substance, Category B” next to the UN 3373 diamond mark
  • Exempt Human Specimens: Materials where there is a minimal likelihood that pathogens are present (e.g., blood for cholesterol screening from healthy volunteers). However, for safety, most clinical laboratories default to shipping diagnostic samples as Category B to ensure maximum protection

The Triple Packaging System

To meet the requirements of IATA Packing Instruction 650, Category B specimens must be packaged using the “Triple Packaging System.” This system is designed so that if the package is crushed or dropped, the infectious material remains contained. This consists of three distinct layers

Primary Receptacle

The primary receptacle is the container that holds the actual specimen (e.g., the EDTA tube, the Sodium Citrate tube, or a screw-cap vial for bone marrow)

  • Leakproof: The container must be water-tight. For screw caps, the cap may need to be taped or have a built-in washer to prevent loosening due to vibration or pressure changes
  • Absorbent Material: This is a critical safety component. The primary receptacle must be wrapped in enough absorbent material (cellulose wadding, paper towels, absorbent packets) to absorb the entire liquid content of the specimen in the event of breakage. If multiple fragile primary receptacles are placed in a single secondary packaging, they must be individually wrapped or separated to prevent contact

Secondary Packaging

The secondary packaging encloses the primary receptacle(s). Common examples include a sealed biohazard Ziploc bag or a plastic canister

  • Leakproof: Like the primary, this layer must be watertight
  • Protection: It serves as a containment barrier. If the primary tube breaks, the fluid is absorbed by the wadding, and the mess is contained within this secondary bag/canister. Documentation (requisitions) is typically placed outside this secondary barrier (often in a separate pouch of the bag) to prevent blood contamination of the paperwork

Outer Packaging

The outer packaging is the rigid shipping container (e.g., a fiberboard box or a rigid plastic cooler)

  • Strength: It must be capable of withstanding physical shocks, such as a drop from 1.2 meters (approx. 4 feet), without allowing the release of the specimen
  • Dimensions: At least one surface of the outer packaging must have a minimum dimension of 100 mm x 100 mm (4 inches x 4 inches) to allow adequate space for required labels and markings
  • Markings: The outer box must display the UN 3373 diamond, the proper shipping name (“Biological Substance, Category B”), and the name, address, and telephone number of both the shipper and the receiver

Shipping with Refrigerants (Dry Ice)

Hematology samples, specifically plasma for coagulation testing (e.g., Factor assays), are often shipped frozen. The use of Dry Ice (Solid Carbon Dioxide) introduces additional hazards and regulatory requirements

  • Class 9 Hazard: Dry ice is considered a “Miscellaneous Dangerous Good” (Class 9). It sublimes into Carbon Dioxide gas, which can displace oxygen in confined spaces (like aircraft holds or delivery vans), causing asphyxiation
  • Venting: The packaging must NOT be hermetically sealed (airtight). It must allow the release of CO2 gas to prevent pressure buildup that could cause the package to explode. Do not tape the entire seam of a Styrofoam cooler; allow gaps for gas escape
  • Placement: Dry ice is placed outside the secondary packaging but inside the outer packaging. The specimen must never be placed loose in the dry ice; it must be secured so that when the dry ice dissipates, the specimen does not roll around and break
  • Labeling: In addition to the UN 3373 label, the box must display:
    • The Class 9 Miscellaneous: hazard label (black and white vertical stripes)
    • UN 1845: (ID number for Dry Ice)
    • The Net Weight: of the dry ice (in kilograms). This allows the pilot to calculate the total CO2 load on the aircraft

Internal Transport (Pneumatic Tube Systems)

Inside the hospital, specimens are frequently moved via pneumatic tube systems (PTS). While efficient, these systems pose safety and quality risks specific to Hematology

  • Hemolysis Risk: The rapid acceleration and deceleration forces in a PTS can cause “in vitro” hemolysis. This creates a safety issue (need for redraw) and a quality issue (rejection of sample). High-potassium samples or lactate dehydrogenase (LDH) requests are most affected, but severe hemolysis also affects the CBC (lowering RBC count)
  • Leakage Protocols: Carriers (the “bullets”) used in the system must be padded with foam rubber inserts to immobilize the blood tubes. Samples must be placed in a sealed biohazard bag within the carrier to contain spills. If a specimen leaks inside the pneumatic tube network, the entire system must be shut down and decontaminated, causing massive hospital-wide delays
  • Prohibited Items: Irreplaceable specimens (such as cerebrospinal fluid or bone marrow aspirates) and specimens for tests highly sensitive to vibration (such as Platelet Function Analysis) generally should not be sent via PTS; they should be hand-delivered

Spill Procedures for Transport

If a package is received in a damaged condition or is leaking, specific safety protocols apply to protect the receiving personnel

  • Do Not Open: If a shipping box shows visible signs of leakage (wet spots, blood staining), do not open it in a routine processing area
  • Containment: Place the leaking package into a larger, leak-proof bin or biohazard bag within a biosafety cabinet if available
  • Notification: Notify the laboratory safety officer and the carrier/courier. Regulations often require reporting leakage of infectious materials to public health authorities or the DOT
  • Personal Protective Equipment (PPE): Anyone handling a damaged package must wear heavy-duty gloves, a fluid-resistant gown, and face protection to guard against splashes or aerosols from broken glass and pressurized containers