Chapter 1 Discussion Questions and Answers

1.1 What information is included on the histopathology request form and why is it important for the clinician to complete the form accurately?

Patient details: name, date of birth, specimen type.
Hospital number or NHS number is really useful as there are certain names which can be very popular for patients. Also it is interesting to note that as fashions in names change there can be clusters of names around certain dates of birth. Patients called Claire are commonly born in the Mid 1970s. Certain areas have very common family names which can add to confusion.

1.2 Why are the majority of samples sent to the histopathology laboratory as ‘fixed’ specimens?

Most histological processes can be handled from fixed specimens. Fixing specimens allows tissues to be preserved and protected from autolysis and putrefaction which can impede and prevent morphological interpretation of tissues. Certain tissues for certain tests need to be sent fresh and thus muscle biopsies, renal biopsies and specimens for investigation of inflammatory skin conditions via immunofluorescence need to be sent fresh, on damp saline soaked gauze or in non-fixing transport media such as Michel’s transport media

1.3 Why was it necessary to introduce the Human Tissue Act in the UK in 2004?

The Human tissue act was a legal response to a pathology practice where patients organs were retained following macroscopic post-mortem examination. The retained tissues were following both Coroners and Hospital post-mortem examinations. The tissues were retained because it was considered that the tissue might be used later or be of clinical interest. This process lead to the accumulation of museum pot collections as well as other retained tissues. This practice of organ retention had remained unknown to the general public and caused much distress when this information came to light. The public viewed the retention of tissues as paternalistic and disrespectful and a massive public response was generated. Problems were particularly acute in the paediatric pathology environment where parents were very upset as to have not been asked about the organs of their deceased relatives. Also, many parents were not supported properly at the time of their child’s death and many were still grieving. The response in the UK and from the pathology professional bodies was one of contrition and also viewed as an opportunity to get their houses in order. Retained organs were returned to families for burial and also respectfully disposed of. Consent to post-mortem examination processes were much improved and liaison between the Coroner’s officers and families also improved.
The Human Tissue Act was introduced to place a legal framework around the use and retention of tissues to ensure that such incidents would never arise again. It also commissioned the human tissue authority as the regulatory bodfy to oversee the storage of tissues and regulation of post-mortem practices.