Australian Clinical Guidelines for Radiological Emergencies - September 2012

Appendix A: Biodosimetry Sample Collection Instructions

Page last updated: 07 December 2012

Instructions

Dicentric assay

As partial body exposure is more likely in accidental exposures, peripheral blood should not be collected in the initial 24 hours following the accident, to ensure irradiated and non-irradiated blood have mixed and reached equilibrium. However, the sample must be collected before the lymphocyte count is diminished or transfusions have occurred.

For overseas shipment:

Collect 8-10 mL of peripheral blood into each of 4 to 5 vacutainer lithium-heparin tubes. The additional tubes are collected in case of breakage or leakage during transport. Clean any blood from the top of the tube with an alcohol wipe. Ensure complete mixing in the sample tubes by gently inverting the tubes several times. Label with patient’s name, hospital ID, date of birth, date and time of blood collection. Transfer at room temperature immediately. Do not freeze.

Label the package URGENT DIAGNOSTIC SAMPLES. FRAGILE. BIOHAZARD. DO NOT FREEZE. DO NOT X-RAY. Include a film badge or thermo-luminescent dosimeter in the package. Ship immediately.

For international transit, specimens may be sent by air cargo. The laboratory should be advised of the flight number and airway bill number to enable the specimen to be traced through cargo handling and customs. It is often convenient to use a courier service that provides a “door-to-door” service.

For air transport, the International Air Transport Association (IATA) stipulates packaging for blood samples that conforms to regulations for transporting dangerous goods class 6.2, infectious substances. The plastic or glass lithium heparin tubes should be placed in a secondary rigid, crush-proof, watertight container. This container should also contain cushioning and sufficient absorbent material to absorb the entire contents. This secondary package should be placed in rigid outer packaging appropriately labelled. The outer packaging should be of thermal insulation material such as polystyrene. If cooling packs are used, these should be placed in the outer packaging, not the secondary package. The label should include the name and contact details of the responsible person and have a Regulation Class 6.2 Hazard Label.

For shipment within Australia:

Prior to shipment notify DNA Damage Diagnostics laboratory, CSIRO Human Nutrition (contact Prof. Michael Fenech, tel 03 8303 8880)

The requirements for both the dicentric and CBMN assays are as follows: 8 mL of blood collected in lithium heparin tubes, stored at 10-20oC, and delivered within 24 hours of collection. In the case of children, babies and neonates, the CBMN assay can be performed on finger-stick or heel-prick blood.

Deliver to the CSIRO laboratory at the following address: CSIRO Human Nutrition, Gate 13 Kintore Avenue, Adelaide SA 5000. The delivery should be marked “Attention Prof. Michael Fenech and/or Dr. Philip Thomas”.

The samples should be kept in an appropriate box to ensure that temperature is maintained between 10-20oC during storage and transit. The IATA packaging requirements for blood samples are applicable for all air transport, including domestic.

Nail clippings

Information to be collected from the donor:
  • identity details, including age, gender and occupation
  • estimation of time elapsed since exposure
  • estimation of donor position relative to the source
  • donor activities since irradiation (hand washing, shower, manual activities, sweating activities – type, frequency, time)
Collection of nail clippings
  • donors should not wash their hands
  • collect nail clippings as large as possible, with the minimum of cuts
  • collect separately the clippings from each limb (4 collections from each donor)
  • do not wash or clean the clippings
  • store in a dry, sealed container at the lowest possible temperature
  • note the time of collection, and the temperature
  • note variations of temperature during storage and transportation