Week Three at Shadyside Tissue Bank

[Written in the third week of January]

Well, there are only a few more days until our first test of the year, so I have been mostly focusing on studying for that. There are still many things that I’d like to talk about in regards to the tissue bank however.

I haven’t touched on any of the hands-on work at the tissue bank yet. I think that it would be easiest to divide the specimens that we work on between ‘patient non-consented’, ‘patient consented’ and 'special protocols'.


Non-consented Specimens
As mentioned in an earlier post, even if a patient has not given their consent to use their excess tissue for research, if the tissue has become de-identified/anonymized, then it can still be used. For these specimens, first, the PA grosses the specimen in the pathology laboratory. While they are grossing, if they can see obvious tumor and don’t need to submit all of the tissue to the pathologist for diagnosis, then they can give some of the excess tissue to the tissue bank technicians fresh from the bench. As soon as the tissue is put into the hands of the tissue bank, the tissue is assigned an anonymous number and all of the original patient information is put into a database that only the tissue bank workers can access. (Only ‘honest brokers’ can view this information and that is why all people working in the tissue bank are certified honest brokers.) So now, the tissue can only be identified by a number. The tissue is placed into a large freezer in pieces that are no heavier than 0.50 grams (or as close to 0.50 grams as possible). This means that if a large piece of tissue is given to the tissue bank techs, then they will need to cut the tissue.

There are a few other things about banking that I left out, but the above describes the basic process for most tissues.


Consented Specimens
When a patient consents to let their excess tissue be used for research, in addition to the normal excess tissue being donated, a blood sample is also taken. Researchers use this blood to mainly look at RNA or DNA. The blood is put into a centrifuge and separated into its component parts. Blood that is collected into normal tubes is separated into an upper layer of serum and a lower layer of red blood cells. Blood that is collected in tubes containing an anti-coagulant are separated into an upper layer of plasma, a middle layer of white blood cells and a lower layer of red blood cells. The middle layer of white blood cells contain the RNA and DNA that is of most interest to researchers.

Each of the blood components is put into a number of different small plastic vials and placed into a freezer.

Special Protocols
Another task of the tissue bank is keeping track of all of the various researchers and their research projects. There may be more than a dozen different projects going on at any one time and some of these projects require that fresh tissue be handled in a special way. Each researcher creates a protocol to follow for tissue that is for their particular study, which means that the tissue bank technicians need to keep track of and remember how to handle each different specimen. For example, (the following is just a protocol I thought up) some special study may require bladder tissue and the bladder needs to be prepared in a special way by the pathologist assistant or the tissue needs to be put in a special medium rather than frozen. In addition to blood, the tissue bank technician may also receive urine to be frozen. Not all tissue may be usable either. Some researchers are only looking for tissue with a certain kind of tumor or the tumor has to be a certain size or it has to show invasion through the serosa or any number of other conditions must be met. It’s a daunting task keeping everything straight and can get hairy when things get busy in the lab. And on top of all of that the tissue needs to be processed as fast as possible to prevent degradation, especially of RNA.

Because of the time-sensitive nature of many of these protocols, often the surgeon in the OR will call the tissue bank directly and request that they come and pick up the specimen by hand. The tissue bank has been my first experience in going to an OR and I found it to be interesting. We are only in-and-out of the operating room but there is a slight rush of adrenaline because you are racing against the clock to get the tissue/blood back to the laboratory as soon as possible.