6.2 Special Specimen Types

6.2 Special Specimen Types

Quick Answer: Treat chain-of-custody (COC), legal alcohol, and forensic specimens as integrity-critical: preserve seals, labels, paperwork, and storage conditions, and never use them like ordinary leftovers. Newborn screening (NBS) cards need complete, evenly saturated circles, proper drying, no contamination, and correct ID. Always follow LIS special handling codes and referral packaging notes—if integrity fails, hold/escalate, do not “fix and ship.”

Domain I introduces how special collections are obtained. Domain II focuses on what the MLA does after those specimens arrive: receipt, processing support, acceptability, documentation, storage, and packaging for in-house or referral testing. Special specimen types fail more often from process breaks than from difficult venipuncture technique.

---

Chain-of-Custody Processing Integrity

Chain of custody documents who had control of a specimen at every step. It is used for workplace drug testing, legal toxicology, some employee health programs, and other legally sensitive work. For the MLA in processing:

Integrity goals

• Continuous identity linkage between patient/donor, collection form, seals, and containers
• Evidence that the specimen was not adulterated, substituted, or tampered with
• A written or electronic trail of transfers of custody
• Storage security appropriate to policy (limited access, temperature monitoring when required)

Processing do’s and don’ts

If a seal is broken, a signature is missing, a temperature strip failed (when used), or the donor ID does not match, the specimen may be rejected or placed on hold per the COC protocol. The MLA’s job is recognition and escalation—not improvisation.

---

Legal Alcohol Specimens

Legal blood alcohol (ethanol) collections are used for law enforcement or medicolegal purposes. Collection rules (site prep without alcohol swabs, specific tubes, witnesses) are established at draw time. Processing integrity continues afterward.

High-yield processing points

1. Container and additive must match the legal/protocol requirements (often a specific gray-top or designated legal kit—follow the kit and order, not habit).
2. Labeling and paperwork travel together; do not separate the tube from its legal form packet.
3. Seals and evidence tape, if applied, remain intact unless an authorized person opens them under documented procedure.
4. Storage follows policy (often refrigerated, secured) until testing or release to the designated laboratory/authority.
5. No casual clinical add-ons from a legal alcohol tube unless written policy and chain-of-custody rules explicitly allow a documented path—which many programs do not allow for non-protocol use.

Mixing a legal alcohol specimen into routine chemistry workflow without authorization can destroy its legal value even if the analytic number looks fine. When unsure, stop and escalate to a supervisor or the designated receiving protocol.

Common integrity failures

• Alcohol-containing prep used at collection (upstream failure discovered on paperwork review)
• Wrong tube type for the legal protocol
• Incomplete officer/collector/donor signatures when required
• Unsealed or resealed containers without documentation
• Lost chain documentation during courier handoff

Document observations factually in the LIS or COC log: what was received, what was missing, who was notified, and where the specimen was secured.

---

Forensic Holds

Forensic hold specimens are retained for potential legal, risk-management, or investigative use. They may include blood, urine, tissues, or other materials flagged by policy, provider order, or risk management.

MLA responsibilities

• Identify the hold flag or special comment in the LIS immediately on receipt or when notified.
• Use the designated secure storage location—not the routine short-term rack that is discarded on a normal schedule.
• Preserve original containers when policy requires; do not discard “empty” primaries that are under hold.
• Follow retention time rules; do not auto-discard under routine specimen retention tables without checking hold status.
• Restrict access and document retrievals.
• Coordinate with authorized personnel before release, destruction, or referral.

A forensic hold is not a suggestion. Pulling a hold specimen for convenience testing, discarding it during cleanup, or misplacing it can have serious legal and institutional consequences.

---

Newborn Screening Card Acceptability

Newborn screening (NBS) dried blood spot cards detect serious congenital conditions. The MLA may receive, inspect, dry, package, or prepare cards for the public health or referral laboratory. Analytic interpretation is not the MLA role; card quality is.

Acceptable card characteristics (typical criteria)

Why incomplete circles fail

Insufficient blood yields QNS punches for the screening laboratory. Partial saturation can cause false negatives or invalid assays. Recollection of a newborn is stressful for families and may delay diagnosis—so first-card quality matters.

Improper drying and contamination

• Wet packaging promotes bacterial growth, serum separation artifacts, and invalid results.
• Stacking wet cards transfers blood between specimens—identity and integrity disaster.
• Contaminants (including alcohol from skin prep not fully dried at collection) can alter results or invalidate the card.

If a card fails acceptability, follow program rules: do not punch or ship a clearly unacceptable card as if it were fine. Initiate recollection pathways and document the defect (incomplete circles, wet, contaminated, mislabeled, etc.).

---

Special Handling Codes in the LIS

Modern LIS workflows attach special handling codes (or flags, comments, transport instructions) to orders and specimens. Examples of what codes may drive:

• Temperature: ambient, refrigerated, frozen, body-temperature transport
• Light protection: amber bag or foil for light-sensitive analytes
• Time sensitivity: deliver immediately, on ice, or within X minutes
• Department routing: blood bank, microbiology, molecular, cytology
• Referral / send-out laboratory destination
• COC / legal / forensic processing pathway
• Aliquot requirements and minimum volumes
• Centrifuge / do-not-spin instructions

MLA habits that prevent errors

1. Read handling codes before parking a specimen in the default rack.
2. Do not override a frozen-send-out code by leaving the sample at room temperature “until the end of the batch.”
3. When codes conflict (e.g., two tests with incompatible temperatures on one tube), escalate—do not invent a compromise that invalidates both.
4. If a code is missing but the test is known to be special (legal alcohol, NBS, CSF, stones, etc.), consult the test directory/SOP rather than treating it as routine.
5. Document exceptions when a code cannot be met (courier delay, equipment failure) and notify per policy.

Special handling codes exist because analytic validity depends on pre-analytic control. Ignoring them is a processing error even if the tube looks “fine.”

---

Packaging Notes for Referral Testing

Referral (send-out) testing multiplies risk: longer transport, more handoffs, and external accessioning. Packaging is part of specimen integrity.

Packaging checklist

Notes the MLA should act on

Processing notes and rejection comments from referral labs often cite:

• Leaking primary tubes
• Unlabeled or mismatched aliquots
• Missing collection date/time
• Wrong temperature on arrival
• QNS after transport
• Hemolyzed samples that should have been caught before shipping
• Incomplete NBS cards
• Missing COC seals or signatures

Before sealing a send-out, fix what you can: relabel only under policy, replace a leaking tube with an authorized aliquot, add ice, attach the form, or cancel/recollect. Shipping a known defective package shifts the error downstream and delays care further.

For Category A/B infectious shipping details, later Domain II content on external packaging applies; here the key is that special specimen type + referral multiplies documentation and integrity requirements.

---

Integrated Scenarios

Scenario 1 — COC urine
A sealed workplace drug screen arrives with a completed custody form. One seal edge is lifted and wet. Do not open and aliquot for convenience. Document seal integrity failure, secure the specimen, and notify the supervisor/authorized receiver per COC SOP.

Scenario 2 — Legal alcohol residual
A nurse asks to “just add a CMP” to a legal alcohol gray-top still under evidence protocol. Unless policy expressly permits a documented dual-use path (uncommon), refuse the casual add-on and route through proper clinical recollection or authorized protocol.

Scenario 3 — NBS card
Three of five circles are half-filled with white centers; the card is still damp in a plastic bag. Unacceptable. Do not ship as satisfactory. Follow recollection and documentation procedures.

Scenario 4 — LIS code ignored
A light-protected vitamin send-out sits on an open bench under bright lights for hours because it “looked like a regular gold top.” Integrity may already be compromised—escalate rather than shipping as routine.

---

Link to Practice and Adjacent Skills

/practice/ascp-mlaPractice questions with detailed explanations

---

Key Takeaways

• COC / legal / forensic: seals, paperwork, secure storage, and documented custody beat speed.
• Legal alcohol specimens are not ordinary chemistry leftovers.
• NBS cards: full circles, dry, clean, identified—or recollect.
• LIS special handling codes are processing instructions, not optional comments.
• Referral packaging must protect identity, temperature, and leak integrity before the courier leaves.